Why Tests That Screen Kids For ADHD Can Be Misleading

by Abby Norman

Attention Deficit Hyperactivity Disorder, known as ADHD, is a fairly frequently heard diagnosis among kids these days. But unlike many disorders that show up in early childhood, the first to make the diagnosis to a parent is not often a child's doctor: rather, it's usually their teachers. Often, behavioral problems or learning disabilities present themselves in the context of school activities, and while teachers might be the first to suspect a child is struggling, they can't make a definitive diagnosis. Even still, some believe that the tests that screen kids for ADHD can be misleading, and here's why.

A child with ADHD may have any number of the most commonly reported symptoms: they might fidget or squirm, have trouble sitting still, be generally forgetful or prone to losing things, have a hard time organizing their things, struggle to listen and follow through when given instructions, be extremely talkative or interrupt others — the list goes on. The symptoms of ADHD in young children may not appear the same in older children and adults. The symptoms can also be different depending on the child's sex: female children with ADHD often go under- or undiagnosed because the symptoms present differently.

ADHD is generally believed by medical science to be a neurobehavioral disorder, meaning that there's something about how a person's brain is wired that makes them have this particular array of symptoms. Several studies have lead scientists to believe that ADHD is primarily related to dopamine receptors, and that may be why the first line of treatment is stimulant drugs like Ritalin and Adderall, which act on these receptors. People who exhibit the classic symptoms of ADHD have lower circulating dopamine in their brains. When given stimulants like Adderall, their dopamine levels increase and their symptoms decrease.

Or at least that's what should happen — when it doesn't, many wonder if they or their child actually has ADHD at all. And what does it mean if they don't?

How Are Kids Tested For ADHD?

Symptoms typical of ADHD generally present in childhood, though depending on their severity, they may not be expressed until a child is older — even an adult. If the symptoms are disruptive enough that they do warrant a trip to the pediatrician for assessment, however, there's a standard set of criteria a doctor reviews to decide if the child has ADHD.

The official diagnostic criteria for ADHD in children, as listed in the DSM-5, states that the child must have had symptoms prior to the age of 12, that they must have persisted for at least six months, that they must be "inconsistent with developmental level," "negatively impact social and educational activities," and present in "more than two settings" — like at home, at school, and when playing with friends. The DSM-5 also states that other disorders, like schizophrenia, have to be ruled out.

There are three distinct presentations of ADHD, too: the "hyperactive" version, the "inattentive" version and a combination of the two. ADHD, in any form, can also be mild, moderate or severe in intensity, which is important when a doctor is trying to assess what treatment options are best suited to a particular child.

Basically, review of this criteria by a licensed professional — such as a child psychologist, social worker, or family doctor — is how a diagnosis of ADHD is made. It may be that a child's teacher mentioned to their parents that they seem to have trouble focusing, or that they don't sit still during class – and parents might be tempted to try to diagnose their child themselves, using readily available online quizzes or "tests" — which, while based on this criteria, don't replace a visit to a professional.

Standardized tests that are given to children in school to measure things like reading comprehension, intelligence, and personality may also wrongly attribute personality quirks to ADHD or even nonexistent learning disabilities, according to the Child Mind Institute. The rate of misdiagnosis may be as high as 20 percent. For this reason, many believe that a child's behavior and academic performance should not be evaluated on test results alone, as many students may do very well on in-classroom work, homework and assignments but struggle with the demands of tests.

Frequency Of Diagnosis

Even if a child is evaluated by a licensed professional, some believe that the disorder is routinely over-diagnosed — especially in the United States. The rates of ADHD in the UK, by way of comparison, are just half what they are in the U.S. Many believe that this is not because there are more children living with the condition, but, rather, because professionals are too quick to diagnose it.

If cases are actually increasing, though, it could be an important clue for researchers who are still trying to figure out exactly why people have ADHD. Some theorize that it's a combination of brain chemistry and environmental triggers, plus stuff like parenting techniques and early childhood experiences.

Things That Look Like ADHD, But Aren't

But this brings up an important caveat: in some cases, childhood trauma may be mistaken for ADHD. Children who have been exposed to violence and trauma often exhibit similar symptoms in the classroom and may be mislabeled as having ADHD when, in reality, they are having fairly normal reactions to the trauma they've experienced and are beginning to process. Stress responses in children who live in violent environments are measurably "in overdrive," and these children tend to be hyper-vigilant and can sometimes appear to be "daydreaming" — what psychologists call "dissociating," according to The National Childhood Traumatic Stress Network.

Normal childhood illnesses like a middle ear infection can cause symptoms that are similar to those seen in ADHD, according to the National Resource Center on ADHD, though these symptoms usually resolve when the child recovers from the bug. Other more serious conditions, like seizure disorders, can also cause ADHD-like symptoms. Sometimes it's even as simple as something like poor vision: a child who needs glasses may appear inattentive or do poorly on their classwork. In other cases, a child who has a learning disability such as dyslexia may be mislabeled as having ADHD, or, a child who is reading above their grade level may be bored and therefore may not pay attention in class and may even act out.

Some also worry that ADHD is pathologizing normal childhood behaviors. Toddlers can often have a hard time listening, find it difficult to focus on the task at hand when they'd rather be playing, be talkative or, alternatively, very shy. But it's important to keep in mind that brain studies have proven that, when a child really does have ADHD, there are changes in their brains that signify something beyond normal childhood development. And if a child does have ADHD? Finding a treatment that works for them can make all the difference.