Overdiagnosis, Misdiagnosis, or just Misunderstanding?
CARL HENEGHAN, TOM JEFFERSON
The UK Health Secretary, Wes Streeting, has just ordered a review into mental health and ADHD diagnoses. He says it will look at whether there is evidence of overdiagnosis and identify gaps in support.
NHS figures show rates of common adult mental health conditions have increased from 17.6% in 2007 to 22.6% in 2023/4. The proportion of adults screening positive for ADHD has risen from 8.2% in 2007 to 13.9% in 2023/4 – roughly 1 in 7 adults now has a diagnosis.
Back in March, we asked if there was an ‘overdiagnosis’ of mental health problems.
Back then, we were concerned that Wes didn’t really know what he was on about: overdiagnosis is not a false-positive result where someone is incorrectly labelled with ADH when they aren’t. It’s also not misdiagnosis, which is a wrong diagnosis and might see someone labelled with ADHD when they have another condition that is missed.
To meet the criteria for overdiagnosis, the abnormality would need to meet an agreed-upon criterion for ADHD, but the condition would not cause any symptoms or problems. As we pointed out, understanding how overdiagnosis contributes to a complex and confusing condition is essential to changing what happens next.
However, the term “overdiagnosis” wasn’t mainstream a decade or so ago, and it doesn’t get much recognition in the published literature.
So, watch out for the ensuing expert review that does little to move the dial forward.
Overdiagnosis is primarily caused by two factors: overdetection and overdefinition of disease. Although the forms of overdiagnosis vary, the consequences remain the same: diagnoses that ultimately inflict more harm than benefit.
Mental health is complex. It is intertwined with social deprivation, employment, and various societal ills. Misunderstandings about what constitutes overdiagnosis in ADHD will only hinder progress toward a solution.
Carl’s introduction to Overdiagnosis at PODC 25
This post was written by two old geezers who do not follow fads.
This article (Overdiagnosis and ADHD) was created and published by Trust the Evidence and is republished here under “Fair Use”
See Related Article Below
Wes Streeting’s Inquiry Into ADHD and Autism Over-Diagnosis is Overdue
MARY GILLEECE
Hats off to Wes Streeting for attempting to address the obvious and sustained over-diagnosis of conditions such as autism and ADHD. The Times reports that:
Some 4.4 million working-age people claim disability or incapacity benefit, a rise of 1.2 million since 2019. Record numbers of young people are dropping out of the workforce and Streeting has warned previously that “overdiagnosis” mean too many people are “written off”. … Nearly one in four adults has a common mental health condition such as depression or anxiety, the NHS says. Some 8.9 million people in England are on antidepressants, up from 6.9 million a decade ago. Streeting has said this is “cause for concern”.
Professor Peter Fonagy, a Clinical Psychologist at University College London specialising in child mental health, is leading the review that will examine what is causing the rising demand for diagnoses.
As one who attempts to teach children who refuse to go to school, generally on account of one or more of these conditions, I am personally delighted that the Health Secretary is turning his gaze to an issue that I find is fraught with misunderstanding and overmedicalisation. Fonagy has said he is seeking evidence from “people with lived experience, and from clinicians working at the frontline of mental health, autism and ADHD services”. So here is my “lived experience” of working with such over-diagnosed but genuinely miserable children. My answer to the question “what is causing the over-diagnosis of autism, ADHD and other developmental difficulties?” is: a deadly concatenation of over-extended mental health diagnoses and genuine societal sadness, chiefly:
1. The NHS’s reliance on the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). This diagnostic handbook is chiefly responsible for expanding the diagnostic criteria for a number of conditions from a narrow understanding to a ‘spectrum’ of disorder.
2. A co-ordinated promotion of mental health conditions by celebrities and industry. Will Professor Fonagy please find out if TikTok videos about pill popping and celebrities revealing ADHD diagnoses for instance, are funded by, or affiliated to, the pharmaceutical industry. How many of these mental health conditions are being confected and exacerbated by an unscrupulous backdoor global marketing campaign?
3. Negligent care from GPs and psychiatrists who diagnose and medicalise rather than address root causes. A 40-minute CAHMs appointment is deemed sufficient in many cases to establish whether a miserable teenager has autism, OCD, ADHD or similar. Melatonin is routinely prescribed by GPs rather than strategies given to stop sleepless teenagers using phones in bed, stimulants to ADHD children with no discussion about exercising or sleeping properly, and anti-depressants issued if children parrot lines learned on TikTok about suicide ideation.
4. Too much technology for children. Babies watching phones in pushchairs, toddlers being seated in cafes in front of an iPad, teenagers hooked on Minecraft and Fortnite, constant use of phones by children of all ages, EdTech in schools – all of it must stop.
5. Family breakdown. 51% of children are now born outside of marriage or civil partnership and nearly three million children are growing up in households without a father. Family separation causes deep misery to children. There is real emotional desolation being experienced by vast numbers of children, but this does not mean that they are suffering a neurological issue.
6. Parental incapacity. Many parents of over-diagnosed children are also addicted to tech and have limited capacity or ability to properly parent their children. By outsourcing parenting to a digital babysitter, parents have initially appreciated the ‘quiet’ but this backfires spectacularly at a later date. A massive public health campaign is required to make overuse of tech within the home – by all family members – as socially unacceptable as smoking next to a baby’s cot.
7. Demoralising new-builds. Those fortunate children who are able to escape the digital prison – and their own mental health issues – do so because they discover they can walk to a local shop or park or into town to work or socialise. This is known as ‘agentic living’ or ‘living with agency’. The current design of new-build housing estates makes it difficult for children to walk anywhere pleasant – a 45-minute walk through the housing estate and across a dual carriageway might take the child to a retail park if they are lucky. If the parent does not have the ability or finances to drive, and public transport is scarce, the child becomes stuck in a bedroom. Bicycles are stolen or deemed by tech-addicted parents to be too dangerous.
8. Lack of Youth Clubs. Paedophiles and drug dealers put paid to youth clubs, which once provided a third space away from home and school for children to congregate and have fun together. Youth clubs (paedo and drug-dealer free) must be revived and made appealing.
9. Existential despair. Though working with children in the lowest income bracket in the country, my ‘lived experience’ suggests it is not material poverty that causes mental health issues but a poverty of belonging and purpose. A listlessness has descended on generations of families whereby life is genuinely joyless and without meaning. Wes Streeting ought to delegate this aspect of things to the new Archbishop of Canterbury, Bear Grylls, or whoever steps up as the country’s next spiritual leader. There is more to this than mere low serotonin.
10. A shameful skills deficit at British schools. A child educated in the British state education system will leave school without having been taught how to make nutritious meals, how to do basic DIY, how to plant and grow vegetables, how to do basic plumbing or electrical work, how to maintain a car, how to sew on a button, how to build a fence, and so on. By focusing on academic and creative rather than physically practical skills, the education system has entirely ignored children – largely boys – who are good at building, making and repairing things. No wonder they feel hopeless.
Good luck Professor Fonagy and team!
Mary Gilleece is an education support worker and her name is a pseudonym.
This article (Wes Streeting’s Inquiry Into ADHD and Autism Over-Diagnosis is Overdue) was created and published by The Daily Sceptic and is republished here under “Fair Use” with attribution to the author Mary Gilleece
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