This paper discusses the over-diagnosis of behavioral and conduct disorders like ADHD. Diagnostic criteria for these disorders are outlined in the DSM-V. There has been concern that ADHD is over-diagnosed, driven by increased prescription of stimulant medications for children. However, rates of diagnosis and medication use vary significantly between regions. Over-diagnosis can lead to potential short-term side effects from medications as well as long-term risks if symptoms are not properly assessed and treated. Comprehensive evaluations are needed to provide effective care and address concerns about over-diagnosis.

1. Running head: OVER-DIAGNOSIS 1
(3-3) Short Paper: Over-Diagnosis
Alexandra Perkins
Southern New Hampshire University

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Behavioral and conduct disorders are diagnosed via DSM-V criteria. If an educator or
parent expresses concern regarding the development of a child, concerned adults should bring
these developmental delays to the attention of the child’s physician. Children will undergo
preliminary assessments to determine if their maladaptive behaviors meet the criteria for
behavioral and conduct disorders. Updated criteria for DSM-V still includes the same 18 primary
symptoms for ADHD that were used in DSM-IV. Criteria continues to be “divided into two major
symptom domains: inattention and hyperactivity/impulsivity. And, like in the DSM-IV, at least
six symptoms in one domain are required for an ADHD diagnosis” (Grohol, 2013).
Updates to the current DSM sought to revisit criteria for diagnosis previously found in the
DSM-IV chapter that included diagnosis made in infancy, childhood, or adolescence. Instead,
diagnostic criteria for behavioral and conduct disorders were relocated to chapters addressing
disorders of a similar nature. ADHD diagnostic criteria can now be found in the
neurodevelopmental disorders chapter of the current DSM, reflective of this disorder’s
correlation with brain development (American Psychiatric Association, 2013). Children
diagnosed with behavioral and conduct disorders must meet the criteria outlined in DSM-V.
Specific to ADHD criteria, the onset criteria states “several inattentive or hyperactive-impulsive
symptoms were present prior to age 12” (Grohol, 2013). Therefore, a child’s behavior that is not
reflective of the criteria outlined in DSM-V will not be eligible for a diagnosis.
The purpose of diagnostic criteria is to effectively recognize and treat specific
maladaptive symptoms of the affected individual. Often this criterion also offers a classification
of severity that is paramount when professionals are determining the course of treatment. As
diagnostic criteria continue to be reviewed and updated DSM criteria is published, changes in
methods of diagnosis will also be affected.

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There are a multitude of factors that contribute to the over-diagnosis of conduct and
behavioral disorders. Currently, concerns raised by professionals, media outlets and the public
about the overdiagnosis of ADHD in youth are salient. Media coverage emphasizes the
“assumption that ADHD is over diagnosed and that stimulant drugs are overused and
overprescribed in children and adolescents with and without ADHD” (Connor, 2011).
This assumption was provoked by an increase of the prescription of stimulants for children.
Following the expanded coverage of psychotropic medications in 1990, and the FDA
Modernization Act passed in 1997, there were dramatic increases in the number of stimulants
being prescribed to children (Connor, 2011); “As a result, the prescribing of stimulants for
children with ADHD increased 4-fold between 1987 and 1996, with a further increase of 9.5%
between 2000 and 2005. Currently, slightly more than 4% of children and adolescents in the
United States use ADHD medications” (Connor, 2011). This rapid increase drove concerns of
over-diagnosis in both professionals, educators, and parents.
Media coverage further amplified these concerns, potentially contributing to both
overdiagnosis and under-diagnosis of pediatric disorders. Parents began to express anxieties
about their children not reaching milestones and concluded that there was an issue with their
child, and other parents began to ignore these symptoms due to the belief that ADHD was being
over diagnosed (Connor, 2011). However, this increase (while evidence does suggest significant
overdiagnosis of children with ADHD) was also caused by increased awareness of the disorder
and newly accessible treatment methods.
There are both long- and short-term implications of over-diagnosis on children. Stimulant
over prescription is an especially salient concern for parents and physicians. The short-term
implications of over prescription can include increased vulnerability to side effects such as

4. OVER-DIAGNOSIS 4
decreased appetite and sleep disturbances (National Institute on Mental Health, 2012). These
short-term consequences can result in further developmental implications in the future, especially
in younger children. Less frequently, children may also develop tics or flat affect, both
symptoms of other psychiatric disorders. These side effects not only impar the executive function
of these children, but incite further complications related to misdiagnosis.
Long-term consequences of over-prescription of ADHD stimulants includes slower
growth rates in preschool children, cardiovascular problems, and psychotic symptoms. Children
who have been prescribed medication should be closely monitored to avoid overlooking these
consequences. Perhaps the most severe side effect of taking unnecessary stimulants are psychotic
symptoms. Children may begin to express hearing voices, hallucinating or experiencing manic
impulses (NIMH, 2012). For some children, these psychotic symptoms manifest through suicidal
ideation and ignoring either form of psychosis can result in severe bodily harm or death.
Children taking stimulant medication without an ADHD diagnosis are especially susceptible to
experiencing side effects.
However, the overdiagnosis of behavioral disorder and over prescription of medication
are complex and vary by geographic location, age, and gender. Research has found that some
regions of the U.S. overprescribe while under prescribing in others (Connor, 2011). According to
research conducted by the CDC, communities in North Carolina “found that 7.3% of children
were receiving stimulants but only 3.4% of children met an unequivocal diagnosis of ADHD,
which suggests that pockets of overprescribing do exist” (Connor, 2011).
One major concern for long-term consequences of stimulant over prescription would be
abuse. Concerns of substance abuse are valid; “abuse rates rise in persons with ADHD comorbid
with substance use disorders and/or other disruptive behavior diagnoses, such as oppositional

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defiant disorder and conduct disorder” (Connor, 2011). Addiction leads to use of other
substances and maladaptive behavior, a serious concern for weary educators and parents.
However, the clinical efficacy of stimulant medication outweighs risks of abuse liability.
Without stimulant medication, children with ADHD and a need for psychotropics will continue
to experience impairment.
Controversy surrounding overdiagnosis continues to be a subject of interest due to
physician over prescribing, severe side effects, stimulant abuse and diversion, and continuing
unease regarding the legitimacy of the ADHD diagnosis. Comprehensive assessments are
necessary to provide effective treatment and evidence-based stimulant prescription. This change
will hopefully reassure parents and educators that treatment is consistent and with due expertise.

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References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.). Arlington, VA: American Psychiatric Publishing.
Connor, D. F. (2011). Problems of overdiagnosis and overprescribing in ADHD. Psychiatric
Times (28)8, 1-4. https://www.psychiatrictimes.com/adhd/problems-overdiagnosis-and-
overprescribing-adhd
Grohol, J. (2013). DSM-5 Changes: Attention Deficit Hyperactivity Disorder (ADHD). Psych
Central. https://pro.psychcentral.com/dsm-5-changes-attention-deficit-hyperactivity-
disorder-adhd/
National Institute on Mental Health. (2012). Attention Deficit Hyperactivity Disorder. U.S.
Department of Health and Human Services.
https://web.archive.org/web/20151014021850/http://www.nimh.nih.gov/health/publicatio
ns/attention-deficit-hyperactivity-disorder/ADHD_Booklet_CL508_144426.pdf