Attention-deficit/hyperactivity disorder is defined by psychologytoday.com to be “A neurobehavioral disorder characterized by a combination of inattentiveness, distractibility, hyperactivity, and impulsive behavior, that appears early in life.”  The website goes on to classify children with ADHD to “Have difficulty sitting still, paying attention in class, do not do well at school, even when they have normal or above-normal intelligence, and engage in a broad array of disruptive behaviors and experience peer rejection.” “ADHD is the most extensively studied pediatric mental health disorder, yet controversy and public debate over the diagnosis and medication treatment of the disorder continue to exist.” (Connor 2011) In the world that we live in, at this day in age, with so much going on at all times, it is hard to argue that having some sort of attention problem, though the degree might differ from person to person, is abnormal.  “More than 1 in 10 (11% or 6.4 million) US school-aged children had received an ADHD diagnosis by a health care provider by 2011, as reported by parents” (Visser 2014). Of those 6.4 million children that had been diagnosed, it was later proven that “Approximately 1.1 million children received an inappropriate diagnosis and over 800,000 received stimulant medication” (Frances 2016).  “ADHD is being over-diagnosed today… and medication for ADHD is over-prescribed” (Association for Youth 2012), “Over-diagnosis in psychiatry occurs where patients are identified with a mental disorder when they do not have significant impairment and would not be expected to benefit from treatment.” (Paris 2015) The problem at hand is neither the excessive amount of diagnoses, nor the over prescription of “study-aiding” drugs, but the approaches not only parents take towards treating their children, but also teachers, doctors, and peers.  “We should let kids outgrow immaturity the old fashioned way by getting older, not treat it with a pill… Preventing over diagnosis requires multiple approaches, including improving access to behavioral treatments, adapting billing systems to reduce tendencies to diagnose questionable cases, and improving access to comprehensive evaluations” (Frances 2016).  “Children can be helped in a balanced way, without having to resort to drugs, and many have done just that” (Association for Youth 2012)

“The number of children on medication for ADHD has “soared” from 600,000 in 1990 to 3.5 million” (Shwarz 2013).  Alan Schwarz later referred to the severe rise in the numbers has been referred to as a “national disaster of dangerous proportions.”  Though there is no specific way for doctors to differentiate who has ADHD from who wants to have ADHD, Allen Frances but highlights that there should be some way to measure the average diagnostic rate and how to differentiate the average child from that.  Diagnosing ADHD and prescribing medication may not be the best way to start treatment; however, due to pressure to conduct rapid assessments, limited access to appropriate care and billing systems requiring a diagnosis, providers might feel that making a diagnosis is the only reasonable option.” (Power 2013).  That concern, thought about by many, leads to the related concern that many are missing the “real” signs a child with ADHD acquires, which has nothing to do with solely being “hyper” or “inattentive.”  Thomas Power mentions that many are confusing children that are “lazy, bad, inattentive, or overactive” as those with ADHD, but in reality, what child isn’t inattentive or overactive?  “Although toddlers and preschoolers, on occasion, may show characteristics of ADHD, some of these behaviors may be normal for their age or developmental stage. These behaviors must be exhibited to an abnormal degree to warrant identification as ADHD. Even with older children, other factors can produce behaviors resembling ADHD.”  (Home 2003) Professionals diagnosing ADHD struggle determining whether or not a child does actually have ADHD, and instead of handing over prescriptions, these medical professionals should challenge the parents to be more attentive and accommodating.  “It seemed too much of a coincidence that in the same school district where many children played five hours of video games a day, which is certainly not unique to any geographic region in the United States or the world, that there would be, what was described by one school psychologist, an “epidemic” of cases of ADHD.” (Association for Youth 2012) Behavioral analyzations that determine whether children need to be put on medication, in my opinion should be conducted over an extended period of time, after different approaches like cognitive therapy, or neurostimulation are attempted.  “Although medication was considered an effective treatment by the parents of 85% of the children given the medication, efficacy was unrelated to the accuracy of diagnosis.”  (Wolraich 1990)

Parents are recommended to treat ADHD in a multimodal manner, “Multimodal treatment often includes interventions such as medical treatment, educational interventions, behavior modification programs and psychological treatment.” (Bailey 2003), in hopes that the collaboration of the treatment results in an improvement in the child’s suspected disorder, before resulting to just medication. There should be multiple components that contribute to the diagnosis of a single individual, straying from just their attention problems, or their misbehavior.  “The diagnosis of adult ADHD should be made cautiously, making use of multiple sources of information, including self-report, clinical interviews, collateral information, childhood documentation, and neuropsychological testing.” (Paris 2015) “A highly successful treatment for children who are inattentive and/or disruptive (regardless of whether they have ADHD) is behavioral parent training; cognitive-behavioral therapy strategies have been shown to be highly promising.” (Power 2013) In 1999, Julie Magno Zito, conducted a study with the objective of describing the temporal patterns of office visits for attention-deficit/hyperactivity disorder and stimulant treatment among American children between the ages of 5 and 14.  The study consisted of collecting information based on surveys, in the setting of physician offices, with a systematically sampled group of office-based physicians as the participants.  “ADHD doesn’t have to put a child’s life on indefinite hold, and it doesn’t necessitate a prescription.” (Association for Youth 2012) The results of the study concluded that “Youth visits for ADHD as a percentage of total physician visits had a 90% increase, from 1.9% in 1989 to 3.6% in 1996. Stimulant therapy within ADHD youth visits rose from 62.6% in 1989 to 76.6% in 1996.” (Zito 1999) Those results directly proving that a hefty statistic of patients that walked into the doctor’s office, more likely in a psychiatrist office, walked out of the office with a prescription.  “Complex medication therapy was more likely to be prescribed by psychiatrists and less likely to be related to visits with health maintenance organization reimbursement.” (Zito 1999) In a Ted Talk given by Stephen Tonti, titles “ADHD As A Difference In Cognition, Not a Disorder,” Tonti opens up with his own personal life story, bringing up his struggles after being diagnosed with ADHD, and then provides the solution much of my argument can support “We have to teach kids to teach themselves, and our society has to embrace cognitive diversity.” (Tonti 2013)

College campuses may be one of the most competitive places someone can be, and for some reason, people seek medical aid thinking that it’s going to help them in the long run, but once their dealers run out, they’re left thinking that they “need” these drugs that they don’t even need in the first place.  A study conducted by a group of doctors at Duke University, including David L. Rabiner, Rick H. Hoyle, H. Scott Swartzwelder, and E. Jane Costello posed the question “Are students treating themselves for their attention problems?” Studying the motives of nonmedical ADHD medication use by college students.  The objective being to find out exactly why college students take a medication that they are not prescribed, through a survey conducted with an audience of more than 3,400 students.  “In a nationally representative sample of students attending 119 four-year-colleges and universities, the past year prevalence of nonmedical use of prescription stimulants ranged from 0% to 25%, and approximately 10% of colleges has a prevalence of 10% of higher” (McCabe 2005).  The results of the study showed the motivation for students varied from wanting to concentrate better while studying, wanting to feel less restless while studying, wanting to feel better, wanting to get high, and wanting to lose weight, among other factors.  The abuse of ADHD medication, especially when it is nonmedical ADHD medication, has proven to be uniquely associated with the abuse of other prescription medications, and would likely lead the user to a substance abuse problem.  “The final analyses planned examined the association between ADHD symptoms and three different substance use outcomes during the prior 6 months: nonmedical ADHD medication use, nonmedical use of other prescription medications, and other substance use.” (Rabiner 2008) “If proper attention is paid to age-appropriate symptoms of ADHD, and careful longitudinal data are obtained from patients presenting with ADHD or substance use disorders, proper treatment can be given to patients with these comorbid disorders.” (Levin 2006)

With the prominence of over diagnoses, many of those who actually struggle with Attention-deficit/hyperactivity disorder are doubted, one of those people being myself.  I find it hard to believe that the diagnosis of ADHD can go in two completely different directions; there are doctors who hand out prescriptions, and then there are doctors that don’t believe those who are struggling, and refuse to address their attention problems.  There is a plethora of misconceptions and myths that come along with ADHD, including, but not limited to it being a “made-up” disorder, or something for sympathy or advantages in school, being only a childhood disorder, being caused by actions of the parents, and it being more common in boys than girls.  Aside from the doubt of having ADHD, many look at those with the disorder as lesser, or those with a crippling disability.  “To have ADHD is, often, to be judged incapable. It seems easy for those around us to consider us lazy or inattentive.” (Babcock 2013) In many cases parents have reported getting their children’s report cards just to see comments like “Your child is not working up to his or her potential and would benefit greatly from paying more attention.” or the misunderstanding that “Our children are perceived to be actively not paying attention, when in reality it is quite passive.” (Babcock 2013).  Another misconception being that ADHD is not a real disorder, and that it is an excuse to get extra time and sympathy.  There is scientifically proof, that ADHD impairs the development of the brain, falsifying the accusations of it not being a real disorder. “Structural imaging studies, particularly those with longitudinal designs, suggest that brain maturation is delayed by a few years in ADHD.” (Vaidya 2012).  “Twin studies of children with ADHD show that the family environments of the children contribute very little to their individual differences in ADHD symptoms” (Barkley 2015).  There is little to no proof or evidence showing that there is a correlation between parenting styles and the severity of a child’s attention disorder, though, as stated before, the way parents address their child’s disorder is a completely different scenario.  Adults that are further along in life are also candidates for being diagnosed with ADHD, “This disorder has been diagnosed routinely among children for decades, but frequent identification in adults, particularly in those who were never treated as children, is more recent.” (Paris 2015) Though many figure out they have the disorder early on, in some cases, many just assume they just simply have a harder time paying attention, and there is no scientific reason or solution for it. “ADHD affects people differently at different ages.” (Home 2003)

One of the biggest factors that determines whether or not ADHD is, in fact, over diagnosed is the broad list of symptoms, and how much wider that list is getting.  The criteria set forth the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) are used as the standardized clinical definition to determine the presence of ADHD, but there is constantly a new edition of the list being released, broadening the symptoms, causing for so many more people to be “diagnosed” with ADHD.  “The DSM-5 criteria for adult ADHD are so broad that they fail to distinguish between illness and normal variation.” (Paris 2015) When it comes to other disorders like bipolar disorder or depression, there are lists of criterion that doctors are advised to use to allow them to directly diagnose the problem at hand, and address the severity of the disorder, but there is no specific list of ADHD, confirming how broad these “symptoms” can be.  “We were not able to find any articles on how clinicians use criteria to make this diagnosis. The absence of gold standard measures for diagnosis is a general problem for psychiatry. In the absence of biomarkers, we are limited to assessing signs and symptoms. Moreover, the use of DSM algorithms tends not to be systematic, as shown when clinical diagnoses of major depression or screening methods for bipolar disorder are compared with the results of semi-structured interviews that closely follow the manual. No such studies have been carried out for ADHD, either in children or adults.” (Paris 2015) With no direct list of what to look for, that leaves diagnoses up to the doctors, which is likely a very large contribution to the rises in prescriptions that are written, the amount of people that seem to think they have ADHD, because they are being told so, just because there is no direct list for them to follow. 

In conclusion, there are so many other ways to address a child’s inability to pay attention in school, or their inability to follow directions, rather than to just hand over a prescription that could have detrimental effects on their health.  Many professionals mistake those symptoms for ADHD, “Many symptoms commonly mistaken as ADHD show only subtle differences from normal features of acceptable young adult behaviour.” (Paris 2015) Data shows the direct correlations between the numbers of prescriptions handed out, being directly correlated with pharmaceutical companies wanting to push certain products.  “Our results point to areas where additional research should be conducted, particularly for better understanding the reasons that provider characteristics are associated with diagnostic prevalence and medication use.” (Fulton 2015) Along with that data, there has been studies conducted by the National Center for Health Statistics, stating “Of the ADHD youth visits, an estimated 77.0% (95% CI, 70.6%-83.4%) had 1 or more psychotherapeutic medications recorded for the visit.” (Zito 1999)  The main point I would like to leave the reader of this essay with is that the problem is not people with ADHD, but the people that are led to think they have ADHD, be poor judgement on behalf of the physicians that misdiagnose them, those who seem to think that they “need” medication, for so many of the wrong reasons, “Students without prescriptions use ADHD medication primarily to enhance academic performance and may do so to ameliorate attention problems that they experience as undermining their academic success.” (Rabiner 2008) and, finally, the parents of children who just aren’t exactly calm and quiet, as almost no child is, that thinks the first and final option is a prescription. 
