Researchers in Germany find that mental health practitioners tend to diagnose ADHD using their intuition and unclear rules of thumb, not recognized diagnostic criteria.

PROBLEM: The rates of ADHD diagnosis in the developed world have become almost inflationary, increasing annually by an average of three percent from 1997 to 2006 and 5.5 percent from 2003 to 2007 in the U.S. But how accurate are these diagnoses?

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METHODOLOGY: Researchers led by University of Basel's Katrin Bruchmueller surveyed 1,000 child and adolescent psychotherapists and psychiatrists across Germany, 473 of whom participated in the study. They received one of four case vignettes, and were asked to give a diagnosis and a recommendation for therapy. In three out of the four cases, the described symptoms and circumstances did not fulfill ADHD diagnostic criteria. The gender of the child was included as a variable as well, resulting in eight cases.

RESULTS: Many mental health practitioners seem to proceed heuristically and base their decisions on unclear rules of thumb. The respondents more readily diagnosed ADHD when the case involved a male patient and presented prototypical symptoms, such as impulsiveness, motoric restlessness, and lack of concentration. They were, for instance, twice more likely to conclude ADHD with the boy version of the vignettes than with the girl vignettes. Interestingly, even the therapist's gender played a role in the diagnostic as male doctors diagnosed ADHD more frequently than their female counterparts.

CONCLUSION: ADHD is over-diagnosed because doctors rely too much on their intuition and not on defined, established diagnostic criteria.

SOURCE: The full study, "Is ADHD Diagnosed in Accord With Diagnostic Criteria? Overdiagnosis and Influence of Client Gender on Diagnosis," is published in the Journal of Consulting and Clinical Psychology.