What To Know About Misdiagnosing ADHD In Children

By: Sarah Fader

Updated October 20, 2021

Medically Reviewed By: Prudence Hatchett, LPC, NCC, BC-TMH

Today, Attention Deficit Disorder (ADHD) has become a common diagnosis of children and adolescents. Roughly 7% of American children between the ages of 7 and 13 diagnosed with ADHD. This phenomenon has been on the rise since the early 1990s when the first drug was discovered for helping parents and teachers control the behaviors of children with what was considered extreme hyperactivity and difficulty concentrating. Individuals with Attention Deficit Disorder (ADD) do not automatically meet the diagnostic criteria for ADHD.

According to studies, many children and teens are misdiagnosed with the H-factor, when they do not meet that criteria. According to the diagnostic criteria from the DSM-5, children and teens must exhibit not only a deficit in the area of attention, but also must display symptoms of impulsivity, hyperkinetic activity, and blurt out thoughts.

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The qualifiers most doctors seem to miss, or gloss over, are the words persistent and increasing when it comes to the diagnostic criteria. Some researchers are concerned that evaluators are placing too much stock in self-reports of children and teens, or what teachers have to say. Without following the DSM-5 criteria, these children and teens are labeled with ADHD, and this can be stigmatizing for them, as well as their families.

Why So Many Get It Wrong

Children are typically quite active, and some may seem hyperactive. However, hyperactivity coming from a teacher's or a parent's point of view may be subjective. Children are expected to sit for extended periods of the day in school. For a child who likes to play, this may seem unreasonable. Depending upon how structured the home is, this may be the only time the child is expected to sit still. Children are typically more active than most adults. They often play, they run around, and they show a variety of interests and curiosities in the world around them. If a child is bored or has been kept inactive for long periods, he or she may feel they are bursting from the seams with energy. Before parents and teachers label a child as ADHD and seek a supporting diagnosis they may want to ask themselves a series of questions:

  1. What am I doing to engage this child mentally?
  2. In what ways and how do I provide physical activity opportunities for this child?
  3. Do I allow enough socialization for this child?
  4. Do I engage this child in discussions; group or individual?

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Some teachers may seem to forget at times that differentiating classroom instruction and activities do not always apply to children with learning disabilities or exceptionalities. Different children have different personalities and learning styles and education may not work as one-size fits all, as well as a home life for a child. If a parent has five children, no two of them will be the same. If one child, the oldest of two, is quiet, with a calm demeanor, never giving a moment of trouble, when the younger sibling comes along and is talkative and sometimes mischievous, their parents cannot expect the same strategies used with one child for getting homework done, or a bath is taken to work the same for both.

Where is the bar set for teachers and parents before they decide they may need to seek mental health support for a child? The difficult part is often, once one teacher has labeled a child with ADD or ADHD, it often sticks and sets the tone for other teachers to anticipate these behaviors.

When It is Right

ADHD may also be a very legitimate concern for some children and adolescents. It is a disorder, and what that means is that there is a persistent pattern of behavior or symptoms that may interfere with the child's or adolescent’s ability to function in their daily life. However, there is nowhere in the criteria that state the child or teen's behavior interferes with the parents or the teacher's ability to function.

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The Dangerous Side of Flip

Alternatively, there are the children who are never identified. Their thoughts and behaviors become uncomfortable for them, so by the time they reach adolescence they have learned to self-medicate either with alcohol or other substances. These adolescents may have just opened the door to substance use, and that has the potential to become a dangerous path or continuous cycle.

There is yet another side of the coin when it comes to children and adolescents who show signs and symptoms that may signify ADHD, and that may not be hyperactivity, but hyper-intelligence. That is perhaps one of the more difficult parts of medicating a child. Medicating a child who is gifted is may be like breaking the wrist of a child who has a great pitching arm. The characteristics of the gifted child are often confused with that of the ADHD.

Characteristic Hyperactivity Poor Attention Span Exaggerated Expressions Talkative Bossy/Assertive Creative/Big Ideas
Gifted x x x x x x
ADHD x x x x x x

The difference is that when a gifted child is placed with others who are also gifted, or above average intelligence, difficult behaviors that may mask themselves as symptoms of ADHD will often diminish.

Frequently parents who are feeling frustrated or helpless with a child's behavior may be willing to accept the opinion of a teacher, school psychologist, or special education evaluator in search of answers, and that opinion may not always be accurate.

The Duality of Being Mislabeled

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There are also children with dual exceptionalities; they are gifted and have ADHD, yet do not fit neatly under either label. As a recent study has suggested, it may be discomforting to realize that someone is so multifaceted that they cannot easily fit inside a box, or assigned a label. Often, it is simply easier to label a child as ADHD and place the child for treatments. than simply see that child as being eccentric, which is often a characteristic of giftedness. Such students carry this label with them through high school; as once diagnosed, the situation is rarely revisited. High school students often have lived with the stigma associated with special education since elementary school.

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Alternative Treatments

Before labeling a child as ADHD, it is important for parents, teachers, and practitioners to recognize that a child is more than a diagnosis. It takes time, sometimes even months of testing, trying different strategies, and working closely with the child by all involved parties before a diagnosis should be rendered. Most importantly, the time and steps should be taken before prescribing medications.

While the treatment that is emphasized for treating ADHD is a pharmacological one, there are nonpharmacological approaches that are also being studied and practiced. Although medications are an effective treatment for ADHD and work quickly, the long-term side effects are not well known. Medication also doesn’t necessarily address issues children have managing academic performance or personal relationships. If you feel your child or adolescent may be living with ADHD or has recently been diagnosed, there are many effective treatments you can try before resorting to prescribing medications.

Behavioral Intervention

The American Academy of Pediatricians' 2011 treatment guidelines recommends behavioral strategies as the first line of treatment for ADHD in young children, and says the key to success is early and consistent intervention. These types of intervention treatments fall into three main categories: parent programs, teacher programs, and therapeutic recreational programs.

The parent program focuses on parents or caregivers rewarding children for good behavior instead of always commenting on the behaviors they deem bad or poor. This ensures children are getting attention for being good instead of always focusing on the negative.

Teacher programs focus on giving teachers behavioral strategies to use in the classroom. These often include simple step-by-step instructions and to announce consequences ahead of time for not paying attention or following instructions. Contingency management is also used in teacher programs where children may receive daily report cards outlining goals within the classroom. Children will receive rewards when they've met their goals.

Therapeutic recreational programs involve regular interactions between children with ADHD. In these programs, children learn traditional activities or  sports, along with behavioral interventions, social skills, contingency management strategies, and team skills.

Lifestyle Changes

Lifestyle changes may be a powerful treatment for children or adolescents with ADHD, as well as caregivers or those involved. Research shows that daily physical activity may help those with ADHD ignore distractions, focus on tasks, and have better academic performance. Studies also show that adequate sleep is crucial for children living with ADHD symptoms, and behaviors improved among children who got more sleep. Unlike adults who become fatigued and slow down with lack of sleep, children with ADHD often become hyperactive. 

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Parents should be empowered by school counselors, teachers, and pediatrictians to advocate for their children. Providing literature, seminars, and webcast information, strategies and the latest educational resources, as well as medical research, can benefit parents.

Until a proper diagnosis has been given and a decision made as to whether medication is the appropriate course of treatment, parents may consider other forms of treatment such as behavioral therapies and interventions. If you feel your child may have ADHD, a therapist may be able to help. BetterHelp is an online therapy platform that can provide you and your family with support and advice to get your child on the right track. They can offer different strategies that will best suit yours and your child’s needs. Reach out to speak to someone today.

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