Date of Award

Spring 2020

Degree Name

Bachelor of Arts

Department

Psychology; College of Arts & Sciences

First Advisor

Dr. Clabaugh

Abstract

There has been much debate surrounding the over- or under- diagnoses of attention deficit hyperactivity disorder (ADHD). One reason for this debate is that ADHD is a commonly misdiagnosed disorder. This leads to negative consequences for those who have been misdiagnosed and receive stimulant medication management. Misdiagnosis of ADHD is likely due to the interaction of four main factors. First, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has a lower validity for ADHD diagnosis than previous editions. Second, primary care physicians (PCPs) are responsible for the vast majority of ADHD diagnoses but have a statistically low accuracy for correctly diagnosing the disorder. Additionally, screening and assessment tools have only fair to dismal probabilities of correctly identifying those who have a diagnosis. Finally, an individual’s socioeconomic status, as well as confounding disorders such as trauma or mood disorders, increase the risk of incorrect diagnosis. Stimulant medication management is one of the most common treatments for ADHD but creates negative consequences for someone inaccurately diagnosed with the disorder. These consequences include increased impulsivity, greater likelihood of partaking in illicit substances, and greater likelihood of tobacco use. Suggestions for how the treatment framework should be reorganized to decrease this likelihood of stimulant medication management in misdiagnosed populations is discussed. Recommendations for how to better support primary care physicians in their diagnosis of ADHD are also discussed.

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ADHD: Not Overdiagnosed, Misdiagnosed

There has been much debate surrounding the over- or under- diagnoses of attention deficit hyperactivity disorder (ADHD). One reason for this debate is that ADHD is a commonly misdiagnosed disorder. This leads to negative consequences for those who have been misdiagnosed and receive stimulant medication management. Misdiagnosis of ADHD is likely due to the interaction of four main factors. First, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has a lower validity for ADHD diagnosis than previous editions. Second, primary care physicians (PCPs) are responsible for the vast majority of ADHD diagnoses but have a statistically low accuracy for correctly diagnosing the disorder. Additionally, screening and assessment tools have only fair to dismal probabilities of correctly identifying those who have a diagnosis. Finally, an individual’s socioeconomic status, as well as confounding disorders such as trauma or mood disorders, increase the risk of incorrect diagnosis. Stimulant medication management is one of the most common treatments for ADHD but creates negative consequences for someone inaccurately diagnosed with the disorder. These consequences include increased impulsivity, greater likelihood of partaking in illicit substances, and greater likelihood of tobacco use. Suggestions for how the treatment framework should be reorganized to decrease this likelihood of stimulant medication management in misdiagnosed populations is discussed. Recommendations for how to better support primary care physicians in their diagnosis of ADHD are also discussed.