3.2 Discussion. DSM and ADHD Diagnoses for Children
Getting Started
There’s perhaps no better way to explore the relationship between diagnosis and practice than to look at an actual condition. Attention deficit hyperactivity disorder (ADHD) is one of the most frequently diagnosed conditions in children in the United States. It is also given a detailed explanation in the DSM-5. ADHD was re-categorized from a “disruptive behavior disorder” in the DSM-4 to a “neurodevelopmental disorder” in the DSM-5. With that re-categorization also came a change in the language of the diagnostic criteria.
In the DSM-4, there needed to be “clear evidence of clinically significant impairment in social, academic, or occupational functioning” to justify the diagnosis. In the DSM-5, that language has been changed to “clear evidence that the symptoms interfere with or reduce the quality of social, academic, or occupational functioning.” In other words, the DSM-5 greatly broadens the range of behaviors that could be considered appropriate for a diagnosis of ADHD. It moves the needle from behaviors that show “clinically significant impairment” to behaviors that simply “interfere with or reduce the quality” of life.
Let’s look at a case study to explore this further. Jimmy is a 12-year-old sixth-grader who gets along well with his peers but underperforms in school. He is frequently called out by his teachers for not paying attention in class and fidgeting in his seat. He is a very creative kid who loves to draw and paint but has difficulty with reading and comprehension. If you put him in front of an interesting movie, he can sustain his attention for prolonged periods but has difficulty focusing on conversations that last more than a few minutes. According to his parents, he shows these same symptoms at home. After consulting with Jimmy’s teachers, Jimmy’s parents decide to take him to their pediatrician for a consultation. They describe his symptoms to the doctor, and the doctor agrees that Jimmy shows signs of ADHD. He prescribes Ritalin (a common stimulant used to treat ADHD) and sets a follow-up appointment to measure progress. Do Jimmy’s behaviors represent “clinically significant impairment” or behaviors that “interfere with or reduce his quality” of life?
This case study illustrates the way many children end up with the diagnosis of ADHD. The DSM-5 gives very broad latitude for more children to be considered for this diagnosis. And the usual treatment is medication. A growing number of people believe that ADHD is simply a medical term attached to children who show what they would call “typical” behavior. Would the diagnosis be different if we learned that Jimmy’s parents are in the middle of a divorce and that Jimmy doesn’t have anyone at home who consistently helps him with his homework?
Diagnoses among children in the United States have more than doubled between 2005 and 2014, according to a recent 2017 study by BMC Pediatrics. Are there more diagnosed cases of ADHD because the diagnostic criteria have been broadened, or is there something going on culturally that has led to a significant spike in ADHD symptoms over the past decade? That’s what you will be discussing with your classmates in this forum.
Upon successful completion of the course material, you will be able to:
· Discuss the rise in ADHD diagnoses and the efficacy of conventional medication treatment.
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Resources
· Textbook: Modern Psychopathologies: A Comprehensive Christian Appraisal
· Article: Prescription Stimulants
· Article: Challenges in Defining the Rates of ADHD Diagnosis and Treatment: Trends over the Last Decade
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Background Information
Read Chapter 7 from the textbook and the two articles, “Prescription Stimulants” and “Challenges in Defining the Rates of ADHD Diagnosis and Treatment: Trends over the Last Decade,” in that order. Feel free to do additional research in preparation for the discussion if you would like to learn more about how stimulants (like Ritalin) work in a counterintuitive way to help calm those who are experiencing attention-related difficulties.
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Instructions
1. Read Chapter 7, “Problems in Childhood and Adolescence,” in your textbook.
2. Read the following articles in the order presented:
a. Prescription Stimulants
b. Challenges in Defining the Rates of ADHD Diagnosis and Treatment: Trends over the Last Decade
3. Navigate to the Discussion page and respond to the following prompts:
a. What factors do you think might be contributing to the dramatic rise in ADHD diagnoses among children and adolescents?
b. What do you know about Jimmy’s current behaviors? What do you know about his family? His medical history? His past functioning?
c. If you were conducting a thorough assessment of Jimmy and his family what other areas of functioning would you address? Consider the questions within these areas:
i. Medical Conditions / Recent Injuries
ii. Medications
iii. Family Functioning
iv. Parenting
v. Peers and New Friends
vi. Past Behaviors
vii. Grades
viii. Motivating Factors
ix. Response to Discipline
x. Sleeping and Eating Habits
xi. Allergies
4. Your initial post:
a. Should be between 400 to 500 words.
b. Is due by the end of the fourth day of the workshop.
5. Read and respond to at least two of your classmates’ postings, as well as instructor follow-up questions directed to you, by the end of the workshop.
6. Your postings should also:
a. Be well developed by providing clear answers with evidence of critical thinking.
b. Add greater depth to the discussion by introducing new ideas.
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