Evan Accatino, Applied Sciences, Winter 2022
Figure: Adjectives such as these (scattered, disorganized, forgetful, etc.) are often used to describe individuals who have been diagnosed with attention-deficit/hyperactivity disorder.
Image Source: Wikimedia Commons
The effects of severe early childhood adversity are being increasingly mislabeled as attention-deficit/hyperactivity disorder (ADHD) by medical professionals. Though the number of children misdiagnosed with ADHD annually remains unclear, a 2010 study from the Michigan State University estimated the figure to be in excess of one million (Elder, 2010). According to Dr. Nicole Brown, a pediatrician at Johns Hopkins University, children hailing from neighborhoods that experienced chronic stressors and frequent acts of violence were more likely to receive an ADHD diagnosis than children from more regulated backgrounds. Those who experienced high levels of family substance abuse, violence, or divorce face this risk as well. And, children who endured four or more adverse life events (abuse, sexual assault, abandonment, etc.) in early childhood are three times more likely to be prescribed ADHD medication (Brown et al., 2014).
In classroom, social, and home environments, teachers describe these children as inattentive or disruptive and parents find them difficult to care for. Thus, because they present with behaviors that are classic symptoms of ADHD – hyperactivity, impulsivity, and an inability to focus – the children are often labeled with the disorder without a second thought. However, if medical professionals probed parents and children for information regarding life-altering, traumatic events prior to concluding that an ADHD diagnosis is warranted, cases of misdiagnosis would be greatly reduced. Inquiring first about what happened to a child allows for a diagnosis based on how specific obstacles in an individual’s life impact their behavior. Yet, pressure placed upon physicians to be “brief and billable” in their patient interactions limits the discourse that a provider can have (Brown et al., 2017).
Say, for instance, that a child often seems combative and inattentive towards a male teacher who wears the same cologne as the child’s father. If this child was physically abused by his father, he has come to associate the smell of the cologne with the threat of impending violence. Because more primitive parts of the brain respond to external stimuli before the cortex (the “thinking” part of the brain), the child will experience a heightened level of stress in response to the stimuli of the cologne, regardless of contextual differences. However, to a physician with little time to gather information about a patient’s life history, this child’s disruptive behavior, though caused by adversity faced in early childhood, may be easily mislabeled as ADHD (Winfrey, 2022).
Additionally, treating a traumatized child with ADHD-reducing therapies and medications may be causing more harm than good. Some clinicians worry that stimulant medications, which increase amounts of neurotransmitters in the brain associated with attention and focus, negatively affect children with trauma-rooted PTSD. These children may already feel agitated and hyper-focused. And, while behavioral therapies for ADHD emphasize organization and time management, they are inadequate to address problems occurring secondary to psychological turmoil (Winfrey, 2022).
Ultimately, a broader education for clinicians is needed in this area in order to ensure that physicians have the tools necessary to make well-informed diagnoses. A 1994 edition of the Diagnostic and Statistical Manual of Mental Disorders (which contains descriptions, symptoms, and other criteria for diagnosing mental disorders) warned of the importance of distinguishing between ADHD symptoms and similar presentations in children from “disorganized or chaotic environments,” (Frances, 1994) but no such recommendation exists in current editions. In order to cultivate a more well-informed community of clinicians, warnings such as this one must be presented and followed to the highest degree.
References
Brown, N. M., Brown, S. N., Briggs, R. D., Germán, M., Belamarich, P. F., & Oyeku, S. O. (2017). Associations between adverse childhood experiences and ADHD diagnosis and severity. Academic Pediatrics, 17(4), 349–355. https://doi.org/10.1016/j.acap.2016.08.013
Elder, T. (2010, August 17). Nearly 1 million children potentially misdiagnosed with ADHD. MSUToday. Retrieved January 11, 2022, from https://msutoday.msu.edu/news/2010/nearly-1-million-children-potentially-misdiagnosed-with-adhd
Frances, A. (1994). Diagnostic and statistical manual of mental disorders: Dsm-Iv. American Psychiatric Association.
Winfrey, O & Perry, B. (2022). What happened to you?: Conversations on trauma, resilience, and healing. “How We Were Loved.” BLUEBIRD.