Katrin Bruchmüller1, Jürgen Margraf, Silvia Schneider. 1. Department of Clinical Psychology and Psychiatry, University of Basel, Missionsstrasse 60-64, Basel, Switzerland. katrin.bruchmueller@unibas.ch
Abstract
OBJECTIVE: Unresolved questions exist concerning diagnosis of ADHD. First, some studies suggest a potential overdiagnosis. Second, compared with the male-female ratio in the general population (3:1), many more boys receive ADHD treatment compared with girls (6-9:1). We hypothesized that this occurs because therapists do not adhere to Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) and International Classification of Diseases (10th rev.; ICD-10) criteria. Instead, we hypothesized that, in accordance with the representativeness heuristic, therapists might diagnose attention-deficit/hyperactivity disorder (ADHD) if a patient resembles their concept of a prototypical ADHD child, leading therapists to overlook certain exclusion criteria. This may result in overdiagnosis. Furthermore, as ADHD is more frequent in males, a boy might be seen as a more prototypical ADHD child and might therefore receive an ADHD diagnosis more readily than a girl would. METHOD: We sent a case vignette to 1,000 child psychologists, psychiatrists, and social workers and asked them to give a diagnosis. Four versions of the vignette existed: Vignette 1 (ADHD) fulfilled all DSM-IV/ICD-10 criteria of ADHD. Vignettes 2-4 (non-ADHD) included several ADHD symptoms but stated other ADHD criteria were nonfulfilled. Therefore, an ADHD diagnosis could not be given. Furthermore, boy and girl versions of each vignette were created. RESULTS: In Vignettes 2-4 (non-ADHD), 16.7% of therapists diagnosed ADHD. In the boy version of these vignettes, therapists diagnosed ADHD around 2 times more than they did with the girl vignettes. CONCLUSIONS: Therapists do not adhere strictly to diagnostic manuals. Our study suggests that overdiagnosis of ADHD occurs in clinical routine and that the patient's gender influences diagnosis considerably. Thorough diagnostic training might help therapists to avoid these biases. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
OBJECTIVE: Unresolved questions exist concerning diagnosis of ADHD. First, some studies suggest a potential overdiagnosis. Second, compared with the male-female ratio in the general population (3:1), many more boys receive ADHD treatment compared with girls (6-9:1). We hypothesized that this occurs because therapists do not adhere to Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) and International Classification of Diseases (10th rev.; ICD-10) criteria. Instead, we hypothesized that, in accordance with the representativeness heuristic, therapists might diagnose attention-deficit/hyperactivity disorder (ADHD) if a patient resembles their concept of a prototypical ADHDchild, leading therapists to overlook certain exclusion criteria. This may result in overdiagnosis. Furthermore, as ADHD is more frequent in males, a boy might be seen as a more prototypical ADHDchild and might therefore receive an ADHD diagnosis more readily than a girl would. METHOD: We sent a case vignette to 1,000 child psychologists, psychiatrists, and social workers and asked them to give a diagnosis. Four versions of the vignette existed: Vignette 1 (ADHD) fulfilled all DSM-IV/ICD-10 criteria of ADHD. Vignettes 2-4 (non-ADHD) included several ADHD symptoms but stated other ADHD criteria were nonfulfilled. Therefore, an ADHD diagnosis could not be given. Furthermore, boy and girl versions of each vignette were created. RESULTS: In Vignettes 2-4 (non-ADHD), 16.7% of therapists diagnosed ADHD. In the boy version of these vignettes, therapists diagnosed ADHD around 2 times more than they did with the girl vignettes. CONCLUSIONS: Therapists do not adhere strictly to diagnostic manuals. Our study suggests that overdiagnosis of ADHD occurs in clinical routine and that the patient's gender influences diagnosis considerably. Thorough diagnostic training might help therapists to avoid these biases. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
Authors: Christiane Diefenbach; Martina F Schmidt; Jochem König; Michael S Urschitz; Michael Huss Journal: Eur Child Adolesc Psychiatry Date: 2021-06-05 Impact factor: 4.785
Authors: Madeline M Robertson; Sarah Furlong; Bradley Voytek; Thomas Donoghue; Charlotte A Boettiger; Margaret A Sheridan Journal: J Neurophysiol Date: 2019-10-16 Impact factor: 2.714
Authors: Stephen V Faraone; Jeffrey H Newcorn; Kevin M Antshel; Lenard Adler; Kurt Roots; Monika Heller Journal: J Child Adolesc Psychopharmacol Date: 2016-04-22 Impact factor: 2.576
Authors: Matthew R G Brown; Gagan S Sidhu; Russell Greiner; Nasimeh Asgarian; Meysam Bastani; Peter H Silverstone; Andrew J Greenshaw; Serdar M Dursun Journal: Front Syst Neurosci Date: 2012-09-28