Researchers Issue Warning: Potential Errors in Diagnosing ADHD in Children Highlighted
The first time that Attention Deficit Hyperactivity Disorder (ADHD) appeared documented was in a Dutch medical text dated 1753, according to a publication in March this year, in the Journal of Attention Disorders . Since then, the disorder has gained greater notoriety, being increasingly studied, which has led to a significant increase in the number of diagnoses. According to data from the Brazilian Attention Deficit Association (ABDA), around 2 million people suffer from the disorder in Brazil. The increase in the disorder has raised a number of questions about the possible reasons behind the growth. Some people even began to question the existence of the condition or its trivialization.
Anaísa Leal Barbosa Abrahão, PhD in Psychology from the Faculty of Philosophy, Sciences and Letters of Ribeirão Preto (FFCLRP) at USP, explains that ADHD is a neurodevelopmental disorder, characterized by harmful levels of inattention, disorganization, hyperactivity and impulsivity, which affects different areas of life. The specialist emphasizes that its onset is generally in childhood, but can persist into adulthood.
But, according to the expert, there is still no definitive consensus on the origin of ADHD. “Some studies suggest that both environmental and genetic factors can contribute to the development of the disorder,” she explains.
There are several environmental factors, which may include prematurity, intrauterine exposure to substances such as tobacco, alcohol and drugs, low birth weight, maternal psychological problems during pregnancy, perinatal complications and brain injuries.
She, however, highlights that ADHD does not have a specific biological marker and, although certain genes may be correlated, they are not considered determinants in themselves.
Three types of ADHD
Neurologist Alicia Coraspe, from the Hospital das Clínicas of the Faculty of Medicine of Ribeirão Preto (HC-FMRP) at USP, talks about the three types of ADHD that exist: hyperactive/impulsive, inattentive and mixed/combined.
“In the case of people with hyperactive/impulsive ADHD, individuals tend to be restless, talk a lot and constantly interrupt. People with inattentive ADHD make mistakes due to lack of attention and have difficulty organizing tasks and activities”, explains the specialist. The mixed/combined type, as the name suggests, mixes symptoms of inattention with hyperactivity and impulsivity.
According to the neurologist, in childhood, the disorder usually presents in combination, with characteristics of hyperactivity and inattention. But, in adulthood, the most predominant type is inattention.
“Understanding the symptoms of ADHD and their variations across different age groups is essential for an accurate and less stigmatized diagnosis”, he emphasizes.
Alicia also warns that the diagnosis of Attention Deficit Hyperactivity Disorder in childhood requires a trained eye to distinguish age-typical behaviors from those characteristic of the disorder.
“Lifestyle changes, such as the increased use of screens and shorter digital content, along with the hectic routine of parents, who have less time for their children, have led more families to doctors’ offices questioning the possibility of this diagnosis” , he states. However, according to Alicia, the diagnosis of ADHD is often not confirmed, suggesting a possible overvaluation of behavioral symptoms that may be normal for the age group or reflections of the modern environment.
“The difficulty of diagnosis in adulthood lies in obtaining reports of the patient’s behavior in childhood and the need to distinguish ADHD from other disorders such as anxiety, depression, bipolarity, thyroid dysfunction and vitamin deficiencies, which are more prevalent in this range. age”, he comments.
Anaísa is also concerned about the trivialization of the ADHD diagnosis and warns against false positives. “ We carried out research at USP in 2022 and, when evaluating 43 children with a medical diagnosis of Attention Deficit Hyperactivity Disorder , only three met the criteria for ADHD when subjected to specific scales.”
Anaísa’s research also indicated widespread use of methylphenidate, one of the main medications used to treat ADHD. “Of the 43 participants, the majority were using this medication, without showing significant improvements in the main symptoms of the disorder or in the behavioral problems reported by family members and teachers.”
She therefore suggests a more comprehensive approach to treating the disorder, including psychosocial interventions, rather than relying exclusively on pharmacological treatment. The neurologist agrees that the treatment of ADHD must involve much more than psychostimulant medications. “A good night’s sleep, good habits, schedules and a well-structured routine are actually what change a patient’s life.”
The experts are not alone: the Federal Council of Psychology, together with other bodies and countries, is promoting the No to the Medicalization of Life campaign, which discusses the dangers associated with the excessive medicalization of children and adolescents. The initiative is also concerned with identifying children with ADHD, which can result in stigma and unfair blame on people for their difficulties.