We are immersed in a dynamic of overdiagnosis of ADHD, as has happened in the USA. UU. and Canada in the last decade, and there is a scientific and ethical need to avoid this overdiagnosis.
This is what two professionals of the Pediatric Service at the Marqués de Valdecilla University Hospital affirm, in a work entitled 'Is there an overdiagnosis of attention deficit hyperactivity disorder (ADHD)?' The objective of the article, published in Evidence in Pediatrics, is analyze the possible causes of a current overdiagnosis of ADHD in our environment and know how it can be avoided.
It seems that ADHD is the most frequent neurobehavioral infantojuvenil pathology. The high prevalence (in some studies up to 17%) should be taken into account, but the authors indicate that in case of neurodevelopmental pathologies, morbid prevalence figures above five percent should be interpreted very carefully.
Overdiagnosis is diagnosing a "disease" that will never cause potentially serious symptoms or the death of the patient. This is an important problem, since it makes people "sick" without the need to be and leads to treatments that can only cause harm, by not providing any benefit to their health. It is not an innocuous process, because it causes numerous problems both for the patient who suffers it, and for the added costs that they imply for the healthcare system
The impact of diagnosis on the life of patients
The symptoms of attention deficit hyperactivity disorder (ADHD) have a great impact on the development of the individual and interfere with their social, emotional and cognitive functioning, causing significant morbidity and dysfunction not only in the child, but also in the group of schoolmates and in his family.
We talk about a disorder that affects an increasing number of children and adults. If these progressively increasing, almost "epidemic" figures are critically analyzed, it is easy for the question to arise: is there such a disorder or is it an "invention" that creates many economic benefits when treating and medicating healthy people? Today it is almost impossible to prove that ADHD is not a disease, given the neuropsychological and neurobiological advances in the study of this disorder. And on the other hand, it is still impossible to prove with certainty that it is, since it still lacks a specific diagnostic test and uses only clinical assessment instruments.
The growing dimension of the problem is such that the United Nations Organization (UN), through the United Nations Children's Fund (UNICEF) and the World Health Organization (WHO) they have called attention to detect the increase, barely justified by clinical criteria.
It is these organizations that recommend children and young people's mental health professionals, who, in addition to putting more interest in making a correct and strict diagnosis of ADHD, medication treatment is established only after the attempt of others of a psychopedagogical and behavioral nature.
The causes of ADHD
When analyzing the 'explosive' increase in diagnosed cases, the concurrence of factors is raised: greater knowledge, early detection, effective diagnosis, better coordination.
But are there other reasons that justify the increase? We must ask ourselves (as in other neurodevelopmental disorders) Is there any relationship with 'epidemic' factors such as food additives, heavy metals, recurrent infectious processes.
Maybe (just maybe) could also have something to do the psychosocial changes of our technological society intoxicated by an excess of information. No cause-effect relationship has been established between lifestyles and TDH, but our current society may intervene in a greater dysfunctional disorder.
The consumer society and the shift towards a materialistic mentality present few opportunities to favor and train sustained attention, culture of effort, reward delay, the use of reflexive strategies and the development of effective mental self-control.
Setting limits and Organized behavior models represent an important educational effort and it requires time investment by parents, an element that is increasingly scarce in industrialized countries and which is also influenced by the change of family models (uniparental families, divorced parents, etc.).
The diagnosis of ADHD has limits
And after analyzing a series of data, the authors of the article have seen that It is not as “easy” as it was thought to diagnose ADHD. In a multicentre study conducted between Belgian and English paidopsychiatrists, neurosurgeons and pediatricians, all clinicians agreed to describe this diagnostic process as complicated and closely linked to the need for adequate consultation time and sufficient prior clinical experience.
With all the instruments available to those responsible for pediatric and mental health services for children, it is important to note that the inclusion criteria must be known, but also the exclusion criteria, given that the differential diagnosis of a possible ADHD is broad and heterogeneous, with multiple neurological, pediatric and psychosocial causes.
The diagnosis it must always be carried out rigorously by a multidisciplinary team. In addition, the clinical and contextual data of the individual patient will always be integrated (including the characteristics of the developmental stage that we consider).
'With this, we may be able to avoid inappropriate diagnoses and pharmacological treatments and banish the policy of creating an unjustified alarmism with our professional information, both within the general population and in the educational community and among the medical class'.
I think it is a very complete and interesting work that provides data that at least I did not know, for all those who are interested in expanding the information, you can consult the original article.
