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Experts Worry Broaden Definition of ADHD Will Lead to Over-Diagnosis

Update Date: Apr 14, 2013 04:00 AM EDT
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Experts believe several changes will broaden the definition and diagnosis of attention-deficit/hyperactivity disorder, or ADHD, when new psychiatry "bible" is released in May.

Experts have controversial opinions whether the shifts in thinking about this neurodevelopmental disorder will be a good thing.

Dr. James Norcross, a child and adolescent psychiatrist at the University of Texas Southwestern Medical Center at Dallas, outlined the major changes that should be coming in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders(DSM-5), which is published by the American Psychiatric Association.

"One is the latest age that someone can have the onset of symptoms," Norcross explained. "In the current version, it's seven years. That will be changed to 12 years in the DSM-5, which may make things easier for adults and adolescents, because they'll be able to better recall some of the challenges that may have occurred."

Norcross also expects the criteria to change for those over 17. Instead people will only have to meet 5 criteria instead of the current six criteria in order to be diagnosed to ADHD, according to Health Day.

"This could increase the number of adults [who] are diagnosed because the criteria were largely developed for children, and they're not necessarily things we see in adults," he explained. For example, one of the criteria for hyperactivity has been squirming in your seat.

The last significant expected change is that ADHD will be grouped neurodevelopmental disorders as opposed to conduct disorder and oppositional defiant disorder.

"They're trying to group disorders by similar pathology, and this is a better description of ADHD. More and more, it's being shown to be a biological process," Norcross explained.

Norcross largely viewed the changes as positive, saying that they might remove some of the stigma that's been attached to an ADHD diagnosis. But he notes that diagnosis in adults needs to be done very carefully.  

However, another expert worries the changes could lead to overdiagnosis of the disorder, which would also mean a subsequent jump in the prescribing of stimulants to treat the disorder.

"In trying never to miss a case, they may mislabel millions of people with a disorder they don't have. Everyone has problems with distractibility, but when ADHD is real, it starts early, it's intense and it's unmistakable," said Dr. Allen Frances, chair of the task force for the DSM-4 and former chair of psychiatry at Duke University School of Medicine in Durham, N.C. The fourth edition of the DSM has been in force since 1994.

"We're already overdiagnosing ADHD. Almost 20 percent of teen boys get the diagnosis of ADHD, and about 10 percent of boys are on stimulant drugs. We don't need to make it easier to diagnose ADHD," Frances said.

Frances' largest concern is that more children and adults will be put on stimulant medications, such as Adderall, Ritalin, Concerta and Vyvanse.

"In the short-term, performance is improved, which makes it highly desirable. In the long-run, there's a risk of addiction. Would you think it's OK for people to take steroids to improve their tennis game? It's pill-pushing," Frances said.

"If we decide as a society that the use of stimulants is good, it shouldn't be done through a fake medical diagnosis. Making it a medical diagnosis is what's wrong here," Frances explained. "I'm not against these drugs being legal, but I'm against the backdoor medical diagnosis."

Another concern Frances pointed to is that people who have other psychiatric disorders may be wrongly classified as having ADHD.

"Every single psychiatric disorder has distractability as part of it. If you misdiagnose someone with bipolar disorder as having ADHD and put them on stimulants, you'll throw them into mania," he cautioned.

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