Over-Diagnosis

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Psychology

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Feb 20, 2024

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Over-Diagnosis Krista Wehr Southern New Hampshire University PSY 314: Disorders of Child/Adolescence

Over-Diagnosis How are behavioral and conduct disorders diagnosed? There are many different types of behavioral and conduct disorders , the two most common ones are oppositional defiant disorder (ODD) and conduct disorder attention-deficit/hyperactivity disorder (ADHD), mood disorder and intermittent explosive disorder. Conduct disorder is a childhoods most common psychiatric problem which has than increased in adolescence. The primary diagnostic of conduct disorder includes aggression, theft, vandalism, violations of rules and/or lying, behaviors like being angry or losing their temper, arguing with adults, refusing to comply with adult’s rules or requests, being resentful or spiteful . The disorder is usually diagnosed by a child psychologist, or a licensed mental health professional and their behavior must occur for a six-month period and will make their diagnosis by completing a clinical interview with the child and their parents or caregivers reporting a detailed history of the child’s behavior will be discussed, school records will also be obtained and reviewed if any court/child welfare records, and if there are any past treatment records. “They may also observe the child’s behavior and perform psychological tests before making a diagnosis” (Nationwide Childrens, n.d.). What factors potentially contribute to the over-diagnosis of these types of disorders? There are many factors which could lead to the over-diagnosis of certain types of disorders within children and adolescents, with the growing awareness and acceptance of these types of mental health disorders. When a child receives an incorrect diagnosis in the past, it may be correctly diagnosed which contributes to the rising rate of diagnosis going up. Changes also in

the diagnose criteria would also contribute for the diagnosis increasing the idea of over-diagnosis also, misdiagnosing also plays a factor in over-diagnosing as well. “ Factors that influence diagnosis can be assigned to two steps of the diagnostic process. First, information concerning the behavior and feelings of a patient needs to be assessed. Different to mental disorders in adults, mental disorders in children are established using a multi-informant approach. Thus, not only the child but also the parents and other important caregivers (e.g., teachers) are asked for a description of the child's behavior. Second, the diagnostician must decide whether the gathered information points to a diagnosis. The process of information gathering is prone to mistakes due to factors concerning the informant. The diagnostic decision-making process can be influenced by multiple factors, for instance by the characteristics of the diagnostician, the diagnostic criteria or the health care system in question” ( Merten, Cwick, Margraf, Schneider, 2017 ). What long- and short-term implications does over-diagnosis have on a child? T he child could experience negative physical and psychosocial effects, and their family also can experience psychosocial effects as well as a big financial burden that some may not be able to afford. By underdiagnosed and undertreatment of children and adolescents who would largely benefit from the treatment principles of ‘right care’ . Over-diagnosis can have a significant amount of long- and short-term implications on the child's physical and mental health, their social interactions with others, their education. It's crucial that our healthcare professionals exercise caution when diagnosing children to avoid any harm. As many errors can and could be made while diagnosis: underdiagnosis, misdiagnosis, and overdiagnosis. “While underdiagnosis (missing something that is present) and misdiagnosis (making the wrong diagnosis) are clear errors, overdiagnosis is different” (Moyer, MD, 2018). “First do no harm. We will need to

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educate ourselves and our colleagues about the potential for harm from overdiagnosis and learn how to balance the potential benefit of a diagnosis against the risk of overdiagnosis” (Moyer, 2018). References: Nationwide Childrens. (n.d.). Conduct disorders. Symptoms, Causes, Diagnosis and Treatment. Retrieved 2021, from Conduct Disorders: Symptoms, Causes, Diagnosis and Treatment | Nationwide Children's Hospital (nationwidechildrens.org) Overdiagnosis of mental disorders in children and adolescents (in developed countries). Written by Merten, E.C., Cwik, J.C., Margraf, J. et al. (2017). Overdiagnosis of mental disorders in children and adolescents (in developed countries) | Child and Adolescent Psychiatry and Mental Health | Full Text (biomedcentral.com) Problems of Overdiagnosis and Overprescribing in ADHD. Written by: Daniel F. Connor, MD. 2011. Problems of Overdiagnosis and Overprescribing in ADHD (psychiatrictimes.com) First do no harm: overdiagnosis in Pediatrics Virginia A. Moyer, MD, MPH. 2018;116(6):426- 429 / 426. v116n6a14e.pdf (sap.org.ar)

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