The Selling of Attention Deficit Disorder

A few years back, the New York Times ran an article on the front page entitled the “The Selling of Attention Deficit Disorder.” As a clinical psychologist/educator, the conclusions did not come as a surprise.

The data pointing out the correlations between direct to consumer advertising and the increase in medication use and the diagnosis of ADHD seem to place the blame on advertising and big pharma’s influence. Case closed, big pharma and their advertising dollars are to blame…right?

I disagree. Psychologists, psychiatrists, and other mental health professionals are the gatekeepers of the diagnosis, and we have to shoulder much of the blame in this “epidemic.” Do not make any mistake; I believe ADHD is a real diagnosis with real-life consequences which impacts one’s functioning.

But, the massive increase in the diagnosis and use of medication is a direct result of mental health professional’s shoddy diagnostic practices….Period. Sure, I could blame advertising but we as mental health professions have an ethical obligation to look past advertising and take a balanced view of the research and take our time in making a diagnosis.

One particularly disturbing part of the article highlighted an advertisement that had a client speaking with his doctor and diagnosis being given out in about ten minutes. Let me be perfectly clear, the diagnosis of ADHD should never be made in 10 minutes. If someone tells you it can be, get a second opinion.

The diagnosis is made by a comprehensive clinical interview and history, gathering information from caregivers, review of any and all records from school, work, etc., and the use of some well researched and validated rating scales. Such an evaluation may take 2-3 hours. I once had a professor tell me the differential diagnosis for ADHD is normal behavior. I guess he knows about the best practices in education.

What she was telling us is that as clinicians we need to determine if the symptoms are causing a clinically significant impact on the client’s functioning, and not necessarily jump to ADHD as the cause. There’s so much nonsense and misinformation out there and you cannot just state that ADHD is playing a role like that. Too many times, clinicians are overlooking factors such as sleep, family discord, anxiety, or even developmentally appropriate behavior and mistakenly arriving at the diagnosis of ADHD.

The real problem is not the advertising industry and not big pharma. We have no one to blame but ourselves. We must realize that there are no short cuts for a thorough and comprehensive evaluation. Psychologists, psychiatrists, and physicians should not be getting our information on ADHD or drugs used to treat the condition from drug representatives with a fraction of our education and training. Harmony has also to do with education and we must take ownership to ensure that accurate diagnoses are being made.

Learning Center, Brain Training, or Psychologist?

It is hard to drive through a city or town nowadays without finding at least one “Big Box” academic learning center or brain training facility that provides tutoring and some type of evaluation services to foster critical thinking skills for their students. These types of centers are very popular nowadays and are also very convenient for many busy parents. For most students who need some extra help in a particular academic area, these types of learning centers can be very useful and help them on the road to success.

However, some students continue to struggle academically or are very slow to make progress despite their efforts. Home education is also not always the answer but while many of the Big Box learning centers and brain training facilities do provide an academic or cognitive evaluation, these tools are typically a brief screening instrument given by a teacher who is not trained or qualified to diagnose learning disabilities, ADHD, or emotional/behavioral issues that impact learning.

A thorough assessment by a highly qualified professional is essential because there are many other types of social/emotional/cognitive difficulties that can look like or cause learning problems in children, adolescents, and even adults. These type of tutoring or brain training centers often leave out the other factors that impact learning in their assessments which means that the tutoring or brain training may not be targeting the correct area or may not be the best type of service to help a particular student. Testing, testing, and more testing cannot be the answer as well.

At many Centers for Counseling and Personal Growth, there are doctoral-level psychologists who have extensive training and expertise in the diagnosis of learning and academic issues as well as social/emotional problems. A comprehensive educational or psychological evaluation can identify if a learning disability is causing the difficulty, but can also detect any other social, emotional, or cognitive factors that are impacting the student’s learning process. Weak education is a common issue in America and a proper diagnosis is absolutely essential so that the correct academic interventions can be chosen to help the student reach their potential.