ADHD Diagnostic Criteria May Be Expanded
Affecting an estimated 8 million American adults, the diagnosis and treatment of Attention Deficit Hyperactive Disorder (ADHD) is as prevalent as it is controversial. Responding to the heightened public awareness of the disorder, the American Psychiatric Association (APA) has announced new diagnosis criteria for ADHD, which could lead to a marked increase in diagnosis and treatment rates amongst adults. The proposed changes will require patients over the age of 18 to exhibit fewer symptoms in order to receive a diagnosis and expand the window for the age of first onset from seven to 12 years of age.
According to the Center for Disease Control (CDC), about 4 percent of American adults suffer from ADHD. The symptoms include impulsiveness, an inability to concentrate and physical hyperactivity. The disorder is usually identified in school-aged children and is often treated with stimulants such as Ritalin, Adderall or Vyvanse.
The rate of ADHD diagnosis has steadily climbed about 3 percent a year over the last decade, according to a study undertaken by the CDC. The climbing ADHD diagnosis rates, especially amongst school-aged children, has led to concern about over-diagnosis and the misuse and abuse of medication. As there is no conclusive test for the disorder, diagnosis relies upon observational reports made by parents, teachers and doctors.
“The best practice in diagnosis ADHD is a psychological evaluation … and also achievement testing,” Dr. Jeanette Corredor, a psychologist and the assistant program director of the Counseling and Wellness Center (CWC), said. “That’s a very comprehensive way to do a diagnosis and rule out other things related to learning challenges and other mental health difficulties.”
About 60 percent of children diagnosed with ADHD will continue to experience symptoms into adulthood. Although boys are three times more likely than girls to be diagnosed with ADHD during childhood, the frequency of the disorder amongst adults is almost evenly split between males and females. However, as the current diagnosis criteria were outlined to correspond to those symptoms that usually manifest during childhood, an estimated one-fourth of adults who have ADHD have yet to be diagnosed.
“It’s unfortunate because, here they are in their second or third year of college, and they have been struggling and no one really identified why,” Corredor said.
Corredor hopes that the new criteria will make it easier for doctors to identify adult patients who could benefit from treatment.
“Many experts have argued that there should be more specific wording for adults to distinguish the symptoms for children versus adults,” Corredor said, “As it reads now, such symptoms as fidgeting or difficulties sitting are fine for children, [but] still do not translate well for adults.
“The overall thing that students struggle with is their executive functioning,” Corredor added. “That entails their organization, planning, and just being on top of things.”
Corredor hopes that the changes made by the APA to the forthcoming edition of the Diagnostic and Statistical Manual (DSM), a diagnostic manual for psychiatrists published by the APA, will make the diagnostic criteria for ADHD more attuned to the symptoms experienced by adults.
While fidgeting and hyperactivity are often seen in children with ADHD, adults often struggle with different symptoms associated with the disorder, such as the inability to concentrate, forgetfulness and difficulties with planning.
“It’s more about the planning, the challenges organizing,” Corredor said. “If a student has difficulty with that, you’re going to struggle academically.”
Fourth-year Kyle Larson was diagnosed with ADHD at the age of seven and has found that his academic performance and personal relationships have been improved by the use of medication.
“I took a break from the medication in high-school,” Larson said. “I said it wasn’t helping me, even though it was. I ended up being expelled from two schools.”
As well as potentially affecting academic outcomes and personal relationships, ADHD also impacts workplace productivity. A 2011 Harvard study found that productivity losses associated with ADHD total nearly $70 billion per year.
Adults with ADHD not only see their academic performance impacted by the disorder but may experience difficulties with personal relationships.
“Just because of their difficulty with remembering things, sometimes people will feel like they are not being cared for but, really, it is just their difficulty with keeping track of events,” Corredor said.
Larson now adheres to his treatment plan and is a dedicated and enthusiastic student who enjoys challenging himself academically.
“While I was off the [ADHD] medication I was very impulsive and anti-authoritative, just very disorganized and hyper,” Larson said.
Although Larson believes that adult ADHD is often under-diagnosed, he worries that the prevalent use of ADHD medications could potentially have a negative impact on those diagnosed with the disorder.
“People can do what they want to do, but there are negative effects on people with ADHD when people who haven’t been diagnosed use those drugs,” Larson said, “People who don’t really know ADHD just see it as a study drug. They just think that we should just try harder.”
“Unfortunately, nationally on college campuses, it is a drug that is being abused because of the academic pressures,” Corredor said “I think often students consider that, well, if this is a drug that other people use, then I can use it as well. What they may not know is that there is a risk of seizure or other things. They are putting themselves at risk.”
Unfortunately, the ubiquity of ADHD diagnoses and the medications used to treat it can increase, rather than reduce, stigma against those with the disorder.
“It’s almost normalized now,” Corredor said. “But at the same time for those individuals who may not be as informed as to what ADHD is and how it can affect someone’s life, they may believe that someone with that diagnosis is faking it.”
Thesis-student Nikolas Santamaria, who was diagnosed with ADHD at the age of five, believes that concerns about over-diagnosis are overblown. Santamaria, whose thesis explores the clinical history of ADHD, said that the abuse of ADHD medications and instances of misdiagnosis are not as rampant as some observers fear.
“Everyone I know who takes these drugs either benefit from them or need them,” Santamaria said. “I think that there are a lot of reasons why the diagnosis rates keep going up … but, personally, I haven’t experienced people being over diagnosed.”
Santamaria said that, although he experiences side effects such as insomnia and loss of appetite, meeting his academic demands would be exceedingly difficult without medication.
“It’s hard to say now if I would have been better off having never taken them,” Santamaria said, “There is a long withdrawal period when there is long term use of these medications. The withdrawal can exacerbate symptoms. I’ve gone several months without taking them, but I still have a lot of problems and right now it’s impractical to not take them.”
Like many who were diagnosed with ADHD in childhood, both Larson and Santamaria have continued to experience symptoms into adulthood. About 60 percent of children diagnosed with ADHD will continue to experience symptoms into adulthood.
“Right now stopping [ADHD medication] would be impractical,” Larson said. “But after I graduate I would like to try some alternative methods for treating my symptoms.”
Although the extent of the changes made to the ADHD diagnosis criteria will not be known until the release of the newest edition of the DSM later this year, Corredor believes that making the diagnostic criteria more relevant to manifestation of the disorder in adults will be beneficial for patients and doctors.
For now, Corredor hopes that those students who find themselves struggling with the symptoms of ADHD will utilize the diagnostic, academic and counseling resources available to them through CWC.