On the heels of a report in the U.S. that found ADHD diagnoses among children has risen by 66 percent since 2000, a new study out of Germany suggests that the disorder is over-diagnosed, especially in young boys.
The findings, which were published in the Journal of Consulting and Clinical Psychology, seem to show that many practitioners rely on their own rules of thumb instead of the recognized criteria for the disorder.
Germany, like the United States, has seen a massive rise in attention deficit hyperactivity disorder diagnoses in recent years. From 1989 to 2001, the number of diagnoses in German clinical practices rose by 381 percent.
Researchers from Ruhr-Universität Bochum and the University of Basel presented more than 450 child psychotherapists and psychiatrists in Germany with a patient case for evaluation. Four different cases existed, but in three of them, the patient's symptoms and circumstances didn't meet all the requirements for an ADHD diagnosis.
"We found that 20 % of children who did not fulfill the DSM (Diagnostic and Statistical Manual of Mental Disorders) diagnoses criteria received an incorrect ADHD diagnosis," Dr. Silvia Schneider, one of the researchers, wrote in an email to The Huffington Post.
In one sample case, the therapists evaluated, the patient showed symptoms of ADHD only in school, and those symptoms began after the age of 9. According to the guidelines for diagnosis, a child is supposed to show symptoms in more than one setting (also at home, for example) and before the age of 7. Still, 20 percent of the therapists went ahead with an ADHD diagnosis anyway.
Another case featured a child who met all the criteria for generalized anxiety disorder, but 14 percent of the therapists diagnosed ADHD instead. On top of that -- all else equal -- cases featuring boys were twice as likely to result in an ADHD diagnosis than those featuring girls.
The findings are likely to add to the ongoing debate over whether ADHD is over-diagnosed -- especially since Schneider said the new research may not even fully reflect the extent of the issue.
"We think that the study is underestimating the false-positive rate since all experts based their diagnosis on the same case vignette, in real clinical life there is much more "noise" in the way how experts get information from the patients leading to more misdiagnoses," she said.
The study also revealed that male therapists were more likely than female therapists to make an ADHD diagnosis. However, researchers called the phenomenon "unexpected" and said further study would be required to explain it.