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Prescription Drug Abuse in Adults with Misdiagnosed ADHD

Prescription Drug Abuse in Adults with Misdiagnosed ADHDAttention Deficit Hyperactivity Disorder (ADHD) is a commonly diagnosed but somewhat controversial condition. The U.S. Centers for Disease Control  (CDC) notes that it is one of the most common neurobehavioral disorders of childhood. Because there is no one definitive test for ADHD, it is possible for the condition to be misdiagnosed.

The Diagnosis and Prevalence of ADHD

WebMD notes that there are three primary categories of ADHD symptoms. These are inattention, hyperactivity and impulsivity, which may show themselves in a variety of ways. To be diagnosed with ADHD, children should consistently display some or all of the problematic behavior in at least two settings for at least six months.

The CDC’s National Center on Birth Defects and Developmental Disabilities conducted an epidemiologic study of ADHD. Teachers in two locations screened children who were then interviewed. The interviewers used the ADHD case definition to identify children who met the criteria. About nine percent of children in one geographical area and 11 percent of those in the other were identified as suffering from ADHD. One significant study finding was that a majority of children taking medication for ADHD were not found to meet the case definition. Of those taking medication, 39.5 percent in one location and 28.3 percent in the other met the criteria. The authors note that the findings may reflect both children who were properly diagnosed and treated and those who never met the criteria and who were inappropriately medicated.

Conditions that May Mimic ADHD

There are a number of other conditions and normal childhood behaviors that can mimic ADHD and lead to misdiagnosis including the following:

  • Younger age than classmates –  A 2010 Science Daily article reported on a study finding that the youngest kindergarteners were 60 percent more likely to receive an ADHD diagnosis than the oldest ones. The pattern held throughout the years with the youngest fifth and eight graders being more than twice as likely to be prescribed stimulant medication. The study author speculated that about 20 percent of children with an ADHD diagnosis have likely been misdiagnosed.
  • Giftedness – A report published by the ERIC Institute of Education Sciences notes that gifted children can be misdiagnosed with various disorders including ADHD. The author states that gifted children are often very intense and that this intensity can be misunderstood. In addition boredom at school can lead to behaviors that may mimic other conditions.
  • A mental health disorder – A number of mental health disorders may share symptoms with ADHD. Individuals who have been abused, for example, can suffer from post-traumatic stress disorder which may involve difficulty concentrating. Obsessive-compulsive disorder may also look like ADHD when people are so distracted by their obsessions and compulsions that it affects their ability to concentrate on other things.
  • A physical condition – Impaired hearing may look like inattention. Hypoglycemia may cause hyperactivity and difficulty concentrating.
  • Learning disorders – Children who have trouble learning may disengage from a task in school and become inattentive because they do not understand the concepts.
  • Sleep problems – A 2012 article in U.S. News and World Report  related a study which analyzed more than 11,000 children over a six year span. The children who exhibited sleep-disordered breathing were 50 to 90 percent more likely to develop behaviors that resembled ADHD. The article notes that sleep deprivation can damage brain neurons perhaps due to decreased oxygen and increased carbon dioxide.

The Cause and Treatment of ADHD

The cause of ADHD is not fully understood, but brain abnormalities may be involved. The National Institute of Mental Health notes that in youth with the condition, brain maturation is delayed, on average, by about 3 years.  The delay affects brain regions associated with thinking, planning and paying attention. There is also an abnormal growth pattern in a structure involved in communication between the two halves of the brain.

The medications most frequently used to treat ADHD are stimulants like Adderall (dextroamphetamine) and Ritalin (methylphenidate). As with the causes of the disease, how stimulants work to combat the symptoms of ADHD is also not fully understood. The drugs increase neurotransmitters, like dopamine and norepinephrine, which may play a role in their beneficial effects.

Unfortunately the drugs are not without dangers. Side effects of Adderall and related stimulants may include cardiovascular problems, an increased risk of stroke or seizures and psychological disturbances like paranoia or psychosis. The drugs also have addiction potential. Because dopamine is part of the brain’s reward pathway, any activity that raises levels is something that human beings learn to repeat. Furthermore when levels of neurotransmitters rise beyond normal levels, the body tends to react by lowering the amount it produces itself or by making receptor cells less sensitive. This leads to tolerance and drug dependence.

It is possible for people to develop addiction to ADHD medication. It is also possible for people with undiagnosed ADHD to self-treat with other prescription or illicit drugs. In an article on ADHD and Substance Abuse, WebMD notes that children with ADHD may be more likely than others to abuse substances in adulthood. They note, however, that one study indicates that those who are treated with medications early in life may have a lower potential for later substance abuse. Although stimulants are the most commonly prescribed drugs for ADHD, three non-stimulants without addiction potential have been approved by the FDA for treating the condition. There are also non-drug treatments that have been used successfully.

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