May 13, 2021

MYTHS ABOUT THE DIAGNOSIS OF ADHD

Myth: The ADHD diagnosis is very much "in the eye of the beholder."
This is one of many ways in which the ADHD diagnosis has been ridiculed in the popular media. The idea here is that because we cannot diagnose ADHD with an objective brain scan or a blood test, the diagnosis is "subjective" and subject to the whim and fancy of the doctor making the diagnosis.

Fact:  The ADHD diagnosis is reliable and valid.
The usefulness of a diagnosis does not depend on whether it came from a blood test, a brain test, or from talking to a patient. A test is useful if it is reliable, which means that two doctors can agree on who does and does not have the disorder, and if it is valid, which means that the diagnosis predicts something important to the doctor and patient, such as whether the patient will respond to a specific treatment. Many research studies show that doctors usually agree about who does and does not have ADHD. This is because we have very strict rules that one must use to make a diagnosis. Much work over many decades has also shown ADHD to be a valid diagnosis. For details see: Faraone, S. V. (2005). The scientific foundation for understanding attention-deficit/hyperactivity disorder as a valid psychiatric disorder. Eur Child Adolesc Psychiatry, 14, 1-10. The short story is that the diagnosis of ADHD is very useful for predicting what treatments will be effective and what types of problems ADHD patients are likely to experience in the future.

Myth: ADHD is not a medical disorder.  It's just the extreme of normal childhood energy
Mental health professionals use the term "disorder" to describe ADHD, but others argue that what we view as a disorder named ADHD is simply the extreme of normal childhood energy. After all, most healthy children run around and don't always listen to their parents. Doesn't the ADHD child or adult simply have a higher dose of normal behavior?

Fact: Doctors have good reasons to describe ADHD as a disorder
The idea that the extreme of normal behavior cannot be a disorder is naïve. Consider hypertension(high blood pressure). Everyone has blood pressure, but when blood pressure exceeds a certain value, doctors get worried because people with high values are at risk for serious problems, such as heart attacks. Consider depression. Everyone gets sad from time to time, but people who are diagnosed with depression cannot function in normal activities and, in the extreme, are at risk of killing themselves. ADHD is not much different from hypertension or depression. Many people will show some signs of ADHD at some times, but not all have a "disorder." We call ADHD a disorder not only because the patient has many symptoms, but also because that patient is impaired, which means that they cannot carry out normal life activities. For example, the ADHD child cannot attend to homework or the ADHD adult cannot hold a job, despite adequate levels of intelligence. Like hypertension, untreated ADHD can lead to serious problems such as failing in school, accidents, or an inability to maintain friendships. These problems are so severe that the center for Disease Control described ADHD as  "serious public health problem."

Myth: The ADHD diagnosis was developed to justify the use of drugs to subdue the behaviors of children.
This is one of the more bizarre myths about ADHD. The theory here is that to sell more drugs, pharmaceutical companies invented the diagnosis of ADHD to describe normal children who were causing some problems in the past.

Fact: ADHD was discovered by doctors long before ADHD medications were discovered.
People who believe this myth do not know the history of ADHD. In 1798, long before there were any drugs for ADHD, Alexander Crichton, a Scottish doctor, described a "disease of attention," which we would not call ADHD.ADHD symptoms were described by a German doctor, Heinrich Hoffman, in1845 and by a British doctor, George Still, in 1902. Each of these doctors found that inattentive and overactive behaviors could lead to a problem that should be of concern to doctors. If they had had medications to treat ADHD, they probably would have prescribed them to their patients. But a medication for ADHD was not discovered until 1937 and even then, it was discovered by accident. Dr. Charles Bradley from Providence, Rhode Island had been doing brain scanning studies of troubled children in a hospital school. The scans left the children with headaches that Dr. Bradley thought would be relieved by an amphetamine drug. When he gave this drug to the children after the scan, it did not help their headaches. However, the next day, their teachers reported that the children were attending and behaving much better in the classroom. Dr. Bradley had accidentally discovered that amphetamine was very helpful in reducing ADHD symptoms, and amphetamine drugs are commonly used to treat ADHD today. So, as you can see, the diagnosis of ADHD was not "invented" by anyone; it was discovered by doctors long before drugs for ADHD were known.

Myth: Brain scans or computerized tests of brain function can diagnose ADHD.
Someday, this myth may become fact, but for now, and shortly it is a solid myth. You may think this is strange. After all, we know that ADHD is a brain disorder and that neuroimaging studies have documented structural and functional abnormalities in the brains of patients with ADHD. If ADHD is a biological disorder, why don’t we have a biological test for the diagnosis?

Fact:  No brain test has been shown to accurately diagnose ADHD.
ADHD is a biologically based disorder, but there are many biological changes and each of these is so small that they are not useful as diagnostic tests. We also think that there are several biological pathways to ADHD. That means that not all ADHD patients will show the same underlying biological problems. So for now, the only officially approved method of diagnosing ADHD is by asking patients and/or their parents about ADHD symptoms as described in the American Psychological Association's Diagnostic and Statistical Manual

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Swedish nationwide population study identifies top predictors of ADHD diagnoses among preschoolers

Most preschool-aged children diagnosed with ADHD also exhibit comorbid mental or developmental conditions. Long-term studies following these children into adulthood have demonstrated that higher severity of ADHD symptoms in early childhood is associated with a more persistent course of ADHD. 

The Study: 

Sweden has a single-payer national health insurance system that covers virtually all residents, facilitating nationwide population studies. An international study team (US, Brazil, Sweden) searched national registers for predictors of ADHD diagnoses among all 631,695 surviving and non-emigrating preschoolers born from 2001 through 2007.  

Preschool ADHD was defined by diagnosis or prescription of ADHD medications issued to toddlers aged three through five years old.  

Predictors were conditions diagnosed prior to the ADHD diagnosis. 

A total of 1,686 (2.7%) preschoolers were diagnosed with ADHD, with the mean age at diagnosis being 4.6 years. 

The Numbers:

Adjusting for sex and birth year, the team reported the following predictors, in order of magnitude: 

  • Previous diagnosis of autism spectrum disorder increased subsequent likelihood of ADHD diagnosis twentyfold. 
  • Previous diagnosis of intellectual disability increased subsequent likelihood of ADHD diagnosis fifteenfold. 
  • Previous diagnosis of speech/language developmental disorders and learning disorders, as well as motor and tic disorders, increased subsequent likelihood of ADHD diagnosis thirteen-fold. 
  • Previous diagnosis of sleep disorders increased subsequent likelihood of ADHD diagnosis fivefold. 
  • Previous diagnosis of feeding and eating disorders increased subsequent likelihood of ADHD diagnosis almost fourfold. 
  • Previous diagnosis of gastroesophageal reflux disease (GERD) increased subsequent likelihood of ADHD diagnosis 3.5-fold. 
  • Previous diagnosis of asthma increased subsequent likelihood of ADHD diagnosis 2.4-fold. 
  • Previous diagnosis of allergic rhinitis increased subsequent likelihood of ADHD diagnosis by 70%. 
  • Previous diagnosis of atopic dermatitis or unintentional injuries increased subsequent likelihood of ADHD diagnosis by 50%. 

The Conclusion: 

This large population study underscores that many conditions present in early childhood can help predict an ADHD diagnosis in preschoolers. Recognizing these risk factors early may aid in identifying and addressing ADHD sooner, hopefully improving outcomes for children as they grow

July 2, 2025

Northern Finnish Population Study Finds ADHD Slashes Higher Education Attainment, Comorbidity of ADHD + ODD much worse

Background:

Although ADHD typically begins in childhood, its symptoms frequently continue into adulthood, and it is widely acknowledged as having a lifelong prevalence for most persons with ADHD. 

ADHD symptoms are linked to poor academic performance, mainly due to cognitive issues like compromised working memory. These symptoms lead to long-term negative academic outcomes and difficulty in achieving higher educational degrees. 

Oppositional Defiant Disorder (ODD) often co-occurs with ADHD. In community samples, it appears in about 50–60% of those with ADHD. ODD symptoms include an angry or irritable mood, vindictiveness toward others, and argumentative or defiant behavior that lasts more than 6 months and significantly disrupts daily life.  

Since ODD tends to co-occur with ADHD, research on pure ODD groups without ADHD is limited, especially in community samples. This longitudinal study aimed to examine the impact of ADHD and ODD symptoms in adolescence on academic performance at age 16 and educational attainment by age 32. 

Study:

Finland, like other Nordic countries, has a single-payer health insurance system that includes virtually all residents. A Finnish research team used the Northern Finnish Birth Cohort to include all 9,432 children born from July 1, 1985, through June 30, 1986, and followed since then. 

ADHD symptoms were measured at age 16 using the Strengths and Weaknesses of ADHD symptoms and Normal-behaviors (SWAN) scale. 

Symptoms of ODD were screened using a 7-point rating scale similar to the SWAN scale, based on eight DSM-IV-TR criteria: “Control temper”, “Avoid arguing with adults”, “Follow adult requests or rules”, “Avoid deliberately annoying others”, “Assume responsibility for mistakes or misbehaviour”, “Ignore annoyances from others”, “Control anger and resentment”, and “Control spitefulness and vindictiveness.” 

Higher education attainments were determined at age 32. 

Results:

After adjusting for the educational attainments of the parents of the subjects, family type, and psychiatric disorders other than ADHD or ODD, males with ADHD symptoms at age 16 had a quarter, and females a little over a third, of the higher education attainments of peers without ADHD symptoms at age 32.  

With the same adjustments, males with ODD symptoms alone had two-thirds, and females 80%, of the higher education attainments of peers without ODD, but neither outcome was statistically significant. 

However, all participants with combined ADHD and ODD symptoms at age 16 had roughly one-fifth of the higher education attainments of peers without such symptoms upon reaching age 32. 

Interpretation: 

The team concluded, “The findings that emerged from this large longitudinal birth cohort study showed that the co-occurrence of ODD and ADHD symptoms in adolescence predicted the greatest deficits of all in educational attainment in adulthood.” 

This study highlights the significant, long-lasting impact that co-occurring ADHD and ODD symptoms can have on educational outcomes well into adulthood. It underscores the importance of addressing both disorders together during adolescence to help improve future academic success.

July 1, 2025

U.S. Nationwide Study Finds Down Syndrome Associated with 70% Greater Odds of ADHD

The Background:

Down syndrome (DS) is a genetic disorder resulting from an extra copy of chromosome 21. It is associated with intellectual disability. 

Three to five thousand children are born with Down syndrome each year. They have higher risks for conditions like hypothyroidism, sleep apnea, epilepsy, sensory issues, infections, and autoimmune diseases. Research on ADHD in patients with Down syndrome has been inconclusive. 

The Study:

The National Health Interview Survey (NHIS) is a household survey conducted by the National Center for Health Statistics at the CDC. 

Due to the low prevalence of Down syndrome, a Chinese research team used NHIS records from 1997 to 2018 to analyze data from 214,300 children aged 3 to 17, to obtain a sufficiently large and nationally representative sample to investigate any potential association with ADHD. 

DS and ADHD were identified by asking, “Has a doctor or health professional ever diagnosed your child with Down syndrome, Attention Deficit Hyperactivity Disorder (ADHD), or Attention Deficit Disorder (ADD)?” 

After adjusting for age, sex, and race/ethnicity, plus family highest education level, family income-to-poverty ratio, and geographic region, children and adolescents with Down syndrome had 70% greater odds of also having ADHD than children and adolescents without Down syndrome. There were no significant differences between males and females. 

The Take-Away:

The team concluded, “in a nationwide population-based study of U.S. children, we found that a Down syndrome diagnosis was associated with a higher prevalence of ASD and ADHD. Our findings highlight the necessity of conducting early and routine screenings for ASD and ADHD in children with Down syndrome within clinical settings to improve the effectiveness of interventions.” 

June 27, 2025