Thought Leadership: Effective Diagnosis of Kids with ADHD
By Judy Jankowski, Ed.D., CBA Head of School
If it feels to you like more and more kids are being diagnosed with attention deficit hyperactivity disorder (ADHD) these days, you’re right. A recent National study found that between 2016 and 2022, the number of school-aged children diagnosed with ADHD grew to 7.1 million – an increase of a million more children diagnosed over the six-year period. The authors reviewed data collected through the National Center for Health Statistics to identify reasons for the increase, and they point to two main causes.
The study explains the increase, in part, as being due to the growing number of girls getting diagnosed. In the past, boys were diagnosed at rates two and a half times greater than girls. But while ADHD in boys is often clearly visible in their hyperactivity and impulsivity, the inattentive type of ADHD more often seen in girls is less obvious and harder to diagnose. Now the levels of diagnosis in girls and boys are beginning to even out.
The other cause of increasing diagnosis found in the data is the advent of COVID. Overall, the mental health of children suffered as a result of the stressors presented by the pandemic. Combine that with the fact that 78% of children in the study who were diagnosed with ADHD had one or more co-occurring diagnoses (learning differences, anxiety, autism spectrum disorder) and it gets increasingly difficult to parse out the individual pieces. The truth is that diagnosis is a complicated undertaking and ADHD is a neurodevelopmental disorder with a lot of subtle nuances.
Unfortunately, the authors did not present data on how this legion of newly-diagnosed children had been diagnosed in the first place – what was the process? In my years of experience educating exceptional learners, too often a diagnosis of ADHD is made by a pediatrician after only a brief conversation with the parent. Sometimes, a behavioral checklist completed by parents and teachers is included in the exercise before a diagnosis is rendered. While an experienced pediatrician is a good start, the most accurate diagnosis requires a trained psychologist or neurologist. The psychologist can observe the child both during an office visit and in a natural environment like home or school. In addition, the administration of a Test of Continuous Performance, a software program that exposes the child to a rapid succession of continuously changing stimuli they must respond to, provides objective data to inform the diagnosis.
While taking these additional steps requires more time, effort and expense, the improved accuracy of the process is undeniable and has important implications that inform better treatment. It also has direct implications for behavior management, both at home and at school. One must wonder, how many fewer (or more) children would receive the ADHD diagnosis with a standardized protocol for the work. We owe it to these kids to find out.