What percent of ADHD cases are misdiagnosed?

ADHD: The Misdiagnosis Hiding a Larger Problem in Children

ADHD is one of the most common diagnoses in children. Recently there has been a significant uptick in the number of children diagnosed per year. While some attribute this to hasty diagnosis, or issues in parenting, there may be a more significant problem at hand: trauma.

The ADHD diagnosis requires symptoms of both inattention and hyperactivity. These symptoms, crucial for an ADHD diagnosis, could be misinterpreted. Post Traumatic Stress Disorder and responses to trauma often include hypervigilance, jumpiness and dissociation. When placed in a school setting, it is easy to mistake dissociation and hyperarousal as inattention and hyperactivity. Children, often referred to psychologists by educational professionals, could easily be misdiagnosed with ADHD despite actually having underlying trauma.

The stimulants often provided for ADHD could worsen the PTSD symptoms. Stimulants, which help to focus an inattentive brain may create more hypervigilance, jumpiness and dissociation in a child with underlying PTSD. This would cause children to perform worse in school and the home setting, possibly leading to more abuse. This cycle exemplifies the importance of a proper diagnosis.

Dr. Nicole Brown at Duke university studied the connection between Adverse Childhood Experiences (ACE’s) and ADHD diagnoses. She studied over 65,00 children between the ages of 6 and 17 years of age. Their parents were questioned about ADHD diagnosis, severity and medication. They were also questioned about potential ACE’s that their child faced. Sixteen percent of the children diagnosed with ADHD had faced at least four ACE’s as opposed to the six percent diagnosis in children who faced no ACE’s.

ACE’s can include things such as poverty, death of a parent or guardian, divorce, domestic violence, violence in the community, substance abuse, incarceration, discrimination or familial mental illness. Depending on severity and personal response, most, if not all, ACE’s could qualify as trauma. Therefore, it is safe to say that many of the children experiencing ADHD, could potentially be suffering from PTSD from the trauma they are facing at home.

The study by Dr. Brown and her team at Duke University illustrate an important consideration in diagnosis. When there is potential for a child to be considered for ADHD, greater care should be taken. Psychologists and doctors should investigate their home life looking carefully for potential trauma. This will help identify children who are victims of abuse or allow for additional support for those in poverty or with unstable home lives.

New research showing the potential for misdiagnosis of ADHD will help psychologists, particularly in a school setting, intervene sooner in cases of children with difficult home lives. Often children facing multiple ACE’s and trauma can be overlooked and find themselves on pathways to develop mental illness and criminal behavior. By recognizing potential ADHD symptomology as part of possible trauma, we make it easier to spot dangerous behaviors before they spiral.

Hopefully, by calling attention to a highly diagnosed psychological issue, we can help to properly diagnose young children who may be dealing with Post Traumatic Stress Disorder rather than ADHD.

Szalavitz, M. (2007). Trauma in Disguise. Scientific American Mind, 18(4), 12-12. Retrieved from http://www.jstor.org.ezproxy.bu.edu/stable/24939673

American Academy of Pediatrics. (2014, May 6). Study finds ADHD and trauma often go hand in hand. ScienceDaily. Retrieved December 6, 2017 from www.sciencedaily.com/releases/2014/05/140506074719.htm

ADHD: The Misdiagnosis Hiding a Larger Problem in Children

By amilner

Posted 5 years ago on Monday, December 11th, 2017 in CJ 725

Merck Manuals Survey Reveals 70% of Americans Think ADHD is Over-Diagnosed in Today’s Culture

KENILWORTH, N.J. , Sept. 3, 2019 /PRNewswire/ — More than half of Americans (52%) say they personally know someone who has been diagnosed with attention-deficit/hyperactivity disorder (ADHD), according to a recent survey from the Merck Manuals. Yet perceptions surrounding diagnosis continue to make ADHD a controversial topic around the U.S.

While a slight majority of Americans have a personal connection to ADHD, seven in 10 Americans overall (70%) somewhat or strongly agree that ADHD is over-diagnosed in today’s culture. Moreover, 30% of Americans believe that prescription medication is the only way to manage ADHD in children. These beliefs about ADHD and its symptoms can create a lot of uncertainty for parents wondering if their child should be tested for ADHD and what a diagnosis might mean for their future.

The survey of more than 2,000 U.S. adults was conducted online by The Harris Poll on behalf of the Merck Manuals in July 2019 . Other key findings include:

Nearly half (46%) of Americans believe that children grow out of ADHD as they get older. Those who don’t personally know someone diagnosed with ADHD are more likely than those who do know someone to have believed this (50% vs. 43%).
52% of parents of children under 18 think children grow out of ADHD as they get older, while only 44% of those who are not parents of children under 18 feel the same.
More than three-quarters (78%) of Americans think ADHD is more common today than it was 20 years ago.
A slight majority of Americans (58%) believe increased use of technology (e.g., video games, mobile devices) has led to greater occurrences of ADHD in children. This figure rises to 65% among those ages 45-54 and dips slightly to 55% among those ages 18-35.

ADHD is a brain disorder that develops at or shortly after birth, but symptoms typically aren’t apparent until age four or five and often not until children are in elementary or middle school. In a recent editorial on MerckManuals.com, Dr. Catherine M. Soprano, MD, a renowned physician specializing in pediatrics, explains that despite 30% of Americans believing prescription medication is the only way to treat ADHD, the reality is much more complex. Medications are just part of an effective treatment plan and are not necessary in every case. Behavioral therapy that aims to help both the child and parents manage the condition is often the first treatment strategy. Parents’ first step should always be to talk to a physician about their child’s needs.

«Some parents may resist ADHD testing or diagnosis for their children,» Dr. Soprano said. «They don’t want the stigma or hope the child will grow out of it. But if a child’s behavior is impacting their success or happiness, it’s always better to talk to a pediatrician early on to explore all of the options available to them.»

The Merck Manuals survey also revealed some other attitudes and perceptions about treating ADHD and managing the condition.

86% of Americans believe that children with ADHD can benefit from having a more structured environment
59% of Americans think ADHD is difficult to diagnose
78% think the symptoms of ADHD are often similar to those of mood disorders and anxiety disorders

«While each individual child requires different treatment plans, there are several broad behavior-based techniques that should be considered,» Dr. Soprano said. «Those techniques include making environmental changes, setting reachable goals, and keeping behavioral responses consistent. In the classroom, an individualized education plan (IEP) is a valuable tool for success in children with ADHD.»

About The Merck Manuals and MSD Manuals

First published in 1899 as a small reference book for physicians and pharmacists, The Merck Manual grew in size and scope to become one of the world’s most widely used comprehensive medical resources for professionals and consumers. As The Manual evolved, it continually expanded the reach and depth of its offerings to reflect the mission of providing the best medical information to a wide cross-section of users, including medical professionals and students, veterinarians and veterinary students, and consumers. In 2015, The Manuals kicked off Global Medical Knowledge 2020, a program to make the best current medical information accessible by up to three billion professionals and patients around the world by 2020. For access to thousands of medical topics with images, videos and a constantly expanding set of resources, visit MerckManuals.com or MSDManuals.com and connect with us on social media:
For Consumers in the U.S. and its territories: Twitter and Facebook
For Professionals in the U.S. and its territories: Twitter and Facebook

Survey Methodology

This survey was conducted online within the United States by The Harris Poll on behalf of Braithwaite from July 18-22, 2019 among 2,021 U.S. adults ages 18 and older. This online survey is not based on a probability sample and therefore no estimate of theoretical sampling error can be calculated. For complete survey methodology, including weighting variables and subgroup sample sizes, please contact Joe McIntyre at joe@gobraithwaite.com.

About Merck

For more than a century, Merck, a leading global biopharmaceutical company known as MSD outside of the United States and Canada , has been inventing for life, bringing forward medicines and vaccines for many of the world’s most challenging diseases. Through our prescription medicines, vaccines, biologic therapies and animal health products, we work with customers and operate in more than 140 countries to deliver innovative health solutions. We also demonstrate our commitment to increasing access to health care through far-reaching policies, programs and partnerships. Today, Merck continues to be at the forefront of research to advance the prevention and treatment of diseases that threaten people and communities around the world — including cancer, cardio-metabolic diseases, emerging animal diseases, Alzheimer’s disease and infectious diseases including HIV and Ebola. For more information, visit www.merck.com and connect with us on Twitter, Facebook, Instagram, YouTube and LinkedIn.

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Joe McIntyre
Braithwaite Communications
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Does ADHD Go Away?

Keath Low, MA, is a therapist and clinical scientist with the Carolina Institute for Developmental Disabilities at the University of North Carolina. She specializes in treatment of ADD/ADHD.

Updated on June 09, 2022
Medically reviewed

Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more.

Aron Janssen, MD is board certified in child, adolescent, and adult psychiatry and is the vice chair of child and adolescent psychiatry Northwestern University.

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ADHD does not go away, usually. It was once thought that children would grow out of ADHD as they developed and matured. We now know that ADHD symptoms can continue into adolescence and beyond—throughout a person’s life. While some kids may seem to outgrow the disorder (or no longer have symptoms that result in impairment), in most cases kids with ADHD grow up to be adults with ADHD.

According to a longitudinal study, 60% of kids with ADHD still have symptoms as adults.

Though ADHD is chronic in nature, symptoms may present in differing ways as a person moves through life stages. These symptoms may even diminish as that person grows older—for example, hyperactivity and fidgetiness may decrease with age.

As well, teens and adults whose ADHD has been addressed over the years will have a range of resources and strategies to turn to when ADHD symptoms become problematic.

Watch Now: Strategies for Living Well With ADHD

ADHD Persists Into Adulthood

Research suggests that while symptoms may change as people grow older, people who have ADHD in childhood are often still affected by the condition in adulthood. However, estimates vary as to how many people still have persistent symptoms and impairment in adulthood.

In one study that followed children diagnosed with ADHD into adulthood, researchers found that:

29% of people diagnosed in childhood had ADHD symptoms as adults.
81% of those with adult ADHD also had at least one other psychiatric condition.
Common co-occurring disorders seen in adulthood included substance use disorders, anxiety, and depression.

Of all the children participating in the study, only 37.5% were free of symptoms or negative outcomes in adulthood. The results also indicated that the participants had higher rates of incarceration and suicide as adults.

Another study published in The Journal of Child Psychology and Psychiatry found that 60% of kids with ADHD still had symptoms as adults, and 41% had symptoms that created impairment.

Research conducted by the National Human Genome Research Project found that ADHD does not go away for between 20% and 30% of people with the condition. While the study found that the condition persists for many, it also showed that around half of adults experience fewer or less severe symptoms in adulthood.

When Does ADHD Peak?

One older study found that ADHD symptoms are often worse in kids aged 6 to 8 and gradually decline around age 11. Symptoms of hyperactivity and impulsivity were more likely to decline with age, while symptoms of inattention were likely to persist.

Diagnosed at a Later Age

Many people with ADHD may not be diagnosed until their teenage or adult years. This is particularly true of those with predominately inattentive symptoms, which are less disruptive and overt as compared to impulsive/hyperactive symptoms.

Girls and women, in particular, are more likely to experience the inattentive type of ADHD. This often means that they are diagnosed later in life. Research suggests that because these symptoms are less noticeable, girls develop coping strategies to help hide their symptoms.

Though children may be able to successfully manage symptoms, the teenage and adult years bring on increased demands for sustained attention, planning, organization, and self-management that can make coping with ADHD more and more difficult.

People who are diagnosed as teens or adults may find a sense of relief in the diagnosis, which explains a wide range of lifelong challenges.

It can be particularly helpful to learn that there are both medical treatments and strategies that can make a positive difference. In addition, having a diagnosis can open the door to helpful conversations with parents, friends, and partners.

Teens With ADHD

Teens with untreated ADHD have few tools and resources for managing their symptoms. As a result, they are more likely than their typical peers to have difficulty juggling multiple classes and extracurricular activities.

Like other teens, teens with ADHD are separating from family and becoming more independent—but with fewer internal restraints, teens with ADHD are more likely to get involved in risky behavior. All these challenges can lead to injury and/or lowered self-esteem.

Teens with untreated ADHD are more likely to experience a higher incidence of driving accidents, underachievement in school/work, relationship problems, and even substance abuse.

Adults With ADHD

Researchers have also found that structural differences in the brain persist into adulthood, even in cases where people previously diagnosed with ADHD no longer met the diagnostic criteria for the condition.

Such findings suggest that while ADHD symptoms may become less apparent as someone grows older, they may still experience a variety of neurological differences that can influence behavior in a variety of ways.

Symptoms in adulthood can be more varied and present in more subtle ways—some examples include:

Disorganization
Impulsive decision-making
Internal restlessness
Wandering attention
Procrastination

Though symptoms may be less visible, they can be just as impairing. For example, adults with ADHD may have difficulty managing work tasks or respond impulsively in situations requiring self-restraint and tact. This can lead to more frequent job changes or unemployment. They may also have a difficult time maintaining long-term friendships and romantic relationships.

Does ADHD Get Worse With Age?

Symptoms may affect adults differently, but they typically do not grow worse with age. Adults also generally have more coping skills and resources to manage their symptoms as they age.

A Word From Verywell

While symptoms of ADHD often change with age and may become less severe in adulthood, the condition does not necessarily go away. While researchers are still learning more about why ADHD persists for many people, the evidence does suggest that getting a diagnosis and treatment as early as possible can improve outcomes.

Whether you were diagnosed in childhood or recently learned that you have adult ADHD, talking to your doctor and getting appropriate treatment can help you manage your symptoms and improve your ability to function in your daily life.

11 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Barbaresi WJ, Colligan RC, Weaver AL, Voigt RG, Killian JM, Katusic SK. Mortality, ADHD, and psychosocial adversity in adults with childhood ADHD: a prospective study. Pediatrics. 2013;131(4):637-644. doi:10.1542/peds.2012-2354
Sibley MH, Swanson JM, Arnold LE, et al. Defining ADHD symptom persistence in adulthood: optimizing sensitivity and specificity. J Child Psychol Psychiatr. 2017;58(6):655-662. doi:10.1111/jcpp.12620
InformedHealth.org. Attention deficit hyperactivity disorder (ADHD): Overview. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG).
Sudre G, Szekely E, Sharp W, Kasparek S, Shaw P. Multimodal mapping of the brain’s functional connectivity and the adult outcome of attention deficit hyperactivity disorder. Proc Natl Acad Sci USA. 2017;114(44):11787-11792. doi:10.1073/pnas.1705229114
Biederman J, Mick E, Faraone SV. Age-dependent decline of symptoms of attention deficit hyperactivity disorder: impact of remission definition and symptom type. Am J Psychiatry. 2000;157(5):816-8. doi:10.1176/appi.ajp.157.5.816
Banaschewski T, Becker K, Döpfner M, Holtmann M, Rösler M, Romanos M. Attention-deficit/hyperactivity disorder: a current overview. Dtsch Arztebl Int. 2017;114(9):149-159. doi:10.3238/arztebl.2017.0149
Quinn PO, Madhoo M. A review of attention-deficit/hyperactivity disorder in women and girls: uncovering this hidden diagnosis. Prim Care Companion CNS Disord. 2014;16(3):PCC.13r01596. doi:10.4088/PCC.13r01596
Wilens TE, Spencer TJ. Understanding attention-deficit/hyperactivity disorder from childhood to adulthood. Postgrad Med. 2010;122(5):97-109. doi:10.3810/pgm.2010.09.2206
Roman-Urrestarazu, A., Lindholm, P., Moilanen, I. et al.Brain structural deficits and working memory fMRI dysfunction in young adults who were diagnosed with ADHD in adolescence. Eur Child Adolesc Psychiatry 25, 529–538 (2016). doi:10.1007/s00787-015-0755-8
Geffen J, Forster K. Treatment of adult ADHD: a clinical perspective. Ther Adv Psychopharmacol. 2018;8(1):25-32. doi:10.1177/2045125317734977
U.S. Food and Drug Administration. Dealing with ADHD: What you need to know.

By Keath Low
Keath Low, MA, is a therapist and clinical scientist with the Carolina Institute for Developmental Disabilities at the University of North Carolina. She specializes in treatment of ADD/ADHD.