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The unfortunate consequences of misdiagnosing ADHD

Robin Wulffson MD's picture
attention deficit-hyperactivity disorder, ADHD, wrong diagnosis, misdiagnosis

Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders; symptoms include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity. Any diagnosis of a neurologic abnormality can be devastating to the parents as well as the affected child. However, according to a new study, ADHD is not uncommonly misdiagnosed. Those diagnosed with ADHD are categorized as special needs children and often placed on medication to treat the condition. As a result, children with ADHD receive beneficial therapy and support; however, a child misdiagnosed with ADHD can be harmed.

Canadian researchers published their findings on March 5 in the Canadian Medical Association Journal. They evaluated the frequency of ADHD diagnoses related to immaturity. The annual cutoff date of birth for school enrollment in British Columbia is December 31. As a result, children born in December are typically the youngest in their grade. The researchers’ goal was to determine the influence of relative age within a grade on the diagnosis and pharmacologic (drug) treatment of ADHD in children.

A research team led by Richard Morrow, MA conducted a study comprised of 937,943 children in British Columbia who were between 6 and 12 years of age at any time between December 1, 1997 and November 30, 2008. They calculated the absolute and relative risk of receiving a diagnosis of ADHD and of receiving a prescription for a medication used to treat ADHD (i.e., methylphenidate, dextroamphetamine, mixed amphetamine salts or atomoxetine) for children born in December compared with children born in January.

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The researchers found that boys who were born in December were 30% more likely to receive a diagnosis of ADHD than boys born in January. Girls born in December were 70% more likely to receive a diagnosis of ADHD than girls born in January. Furthermore, boys were 41% more likely and girls 77% more likely to be given a prescription for a medication to treat ADHD if they were born in December than if they were born in January.

The authors concluded that their results indicate a relative-age effect in the diagnosis and treatment of ADHD in children aged 6 to 12 years in British Columbia. They noted that their findings raise concerns regarding the potential harms of overdiagnosis and overprescribing. Specifically, these harms include adverse effects on sleep, appetite and growth; in addition, a misdiagnosis increases the risk of a cardiovascular event from the medication. Misdiagnosis of ADHD may be a larger problem in the United States than Canada. The researchers noted that the prevalence of ADHD and the use of ADHD treatment medications are higher in the United States than in other developed countries, including Canada.

Take Home Message:
This study illustrates the potential harm of a misdiagnosis. If your child has been diagnosed with a diagnosis (or you know of a child who has been diagnosed), it would be prudent to determine if the child is younger than most of his or her classmates. If so, this fact should be brought to the attention of a healthcare professional. The longer the duration of treatment, the greater is the potential for irreparable harm.

Reference: Canadian Medical Association Journal

See Also: ADHD research exploding in recent months