ADHD diagnoses rates are rising 5 percent per year, and one third of new cases involve children under age six. Are these startling numbers due to doctor diligence or sloppiness? A new report sheds light. (Photo: Getty Images)
Are we over-diagnosing ADHD? That question has been on the lips of parents and medical experts for years, as statistics show cases of ADHD have been consistently rising for more than a decade.
However, according to a new report from the CDC, clinicians are actually getting more methodical in their approach to diagnosing the condition in children, using best practices set by the American Academy of Pediatrics, referring the youngest kids to specialists and getting opinions on child behavior from non-family members.
Data from this report was taken from the 2014 National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome. This study followed up on the 2011-2012 National Survey of Children’s Health, polling around 3,000 parents about the methods and tactics involved when their children were diagnosed with ADHD.
Study lead author Susanna N. Visser, Dr.P.H., an epidemiologist at the National Center on Birth Defects and Developmental Disabilities says the CDC has had a program tracking ADHD since 2002.
5% Rise in ADHD Diagnoses Per Year
“What we’ve been seeing is a 5 percent rise in diagnoses per year, and a 7 percent rise in medicated diagnoses,” she tells Yahoo Health. “So we conducted interviews to see who was diagnosing these kids, and what tools they were using. The goal of the study was to figure out whether the American Academy of Pediatrics’best-practice guidelines were being followed.”
As it turns out, most clinicians are paying close attention to the process. Consistent with recommendations, behavior rating scales were used in diagnosing nine out of 10 children. In more than 80 percent of cases, there was input on the child’s behavior from someone outside the family, like a teacher, during the diagnostic process. Additionally, the youngest children are being seen by specialists.
One Third of Children Diagnosed Before Age 6
“We found that, of the children diagnosed, one third were diagnosed before age six,”says Visser. “This is important, because children that young are a special group, and diagnosis is very complicated. Preschoolers have symptoms that are often very similar to what’s developmentally-appropriate. We need to be very careful when diagnosing young kids.”
Visser says that, for the first time, the question of “Who is diagnosing these kids?”was posed. While half of children are being diagnosed by primary-care physicians, primarily pediatricians, the same cannot be said of the youngest group.
“Disproportionately, we found that children ages zero to five were being diagnosed by psychiatrists, which is great, because this group really needs a specialist to look into their symptoms,”says Visser.
Child psychiatrist Francisco X. Castellanos, MD, a professor in the Department of Child and Adolescent Psychiatry at NYU Langone’s Child Study Center, says the results of this report are reassuring, as concerns abound about ADHD abound.
“While there’s never an A+ report card, because healthcare is always variable, this report does show evidence of greater care and greater expertise at younger ages,” Castellanos tells Yahoo Health. “This is especially striking given there is a shortage of child psychiatrists.”
How Do You Diagnose Young Children Under Age Six?
Just like Visser, Castellanos says it’s tough. “It’s tougher for young children to regulate their mental behaviors and attention span,” he says. “That’s why it takes years of study to diagnose: you have to calibrate each case against the typical child, having a sense of what is normal for a four-year-old, which is much different than what’s normal for a nine-year-old.”
Once diagnosed, treatment is usually a comprehensive process that first involves behavioral therapies including goal-setting, rewards and consequences and education for parents.
“Often, parents think they’ve done something wrong, that they’re child is misbehaving because of their parenting, which, in turn, that burden can make them less effective,” Castellanos says. “We know that’s not what’s going on, and it’s tough. As children have difficulty regulating their behaviors, parents need to become aware of where boundaries need to be placed at specific ages.”
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