May 31, 2017, By Rahil R. Jummani, MD, Emily Hirsch, and Glenn S. Hirsch, MD.
Comment by Douglas Berger, Psychiatrist in Tokyo, Japan
This is a good article, though with some fuzzy parts:
1. The authors go to great lengths to describe the difference in DSM-5 and ICD-10 diagnostic criteria for ADHD that differ in significant ways on at least 4 important comparison items, then later say that the “Best practices in diagnosing ADHD are well-established”, and that “rating scales lack specificity leading to a high false positive rate…”
What they mean to say, and should say, is that, “because psychiatric disorders are not fully proven by diagnostic criteria or rating scales, clinical suspicion along with response to interventions (usually medication) will help close-in on the likelihood of a specific diagnosis, although a diagnosis in psychiatry is never fully provable because there are no absolute objective physical markers (=biologic findings) that are specific for a diagnosis in an individual patient”.
2. ADHD is both over- and under- diagnosed, depending on the set of people you look at. The authors title “Are We Overdiagnosing and Overtreating ADHD?”, is somewhat unfair to the cohort of persons who are underdiagnosed: