Is ADHD overdiagnosed?

Are ADHD, autism and other neurodevelopmental disorders overdiagnosed? Is it all in our heads? Is self-diagnosis legit? Isabelle and David take some common stigmas and misperceptions to task and explore how labels and identities can help or hurt, how policing stigma when you're not a member of the group being stigmatized (or asking us what we need), and the huge weight our world puts on external, visible behaviors rather than internal pain, frustrations, and strengths.-----Isabelle references a podcast episode she listened to recently, Armchair Expert with guest Suzanne O’Sullivan on overdiagnosis. She brings up the idea of psychosomatic illness, and the example this epilepsy expert uses is that there are a certain percentage of cases of epilepsy that appear very different on brain scans, that appear to be psychologically caused (or psychosomatic). This is one of those confusing, stigmatized concepts—Isabelle would originally think that this means “made up.” But NO. What it means is that people are still experiencing the symptoms, are still suffering from symptoms of seizures, sometimes way worse than those who on EEGs, etc. appear to have ‘epilepsy.’ It is the opposite of ‘in your head,’ it is very real. The same goes for the placebo effect, which is that when they do studies on medications or treatments, they have people do something neutral or take a sugar pill or a pill with no active ingredients. A percentage of people in every case will see symptom improvement or a positive effect. This does not mean it’s made up, it means the mind is powerful and just because we don’t know how something works doesn’t mean it doesn’t bring relief. And the same goes with nocebo, or the way things can have an adverse or ill effect, too. But now David and Isabelle get to the other idea this author has, about how ADHD and autism and other diagnoses are being ‘over diagnosed,’ because, as the author states, autism used to mean something different than it does now, because now people later in life who are high masking are being diagnosed with it—and the cutoff points for diagnoses are being too muddled, and isn’t it (as the author puts it), “awful that kids will be labelled with these self-fulfilling prophecies” that will create limiting beliefs for them, isn’t it causing harm, can’t we meet kids needs without these labels? And more so, the cut off point should be “disablement.” But wait a minute, isn’t that pre-diabetes? But isn’t it like the biggest predictor of heroin use is milk consumption…because everyone who takes heroin used to drink milk. David wants to come at this. David wants more inclusive education, he doesn’t want smaller and smaller classrooms, and what to have a very diverse set of people in the room. A diverse group of people learning at once. To answer why do we need to label them? Because every person has different needs, we need labels to tailor education to each person. The more standardized it becomes the more it becomes marginalized. Stay in your lane, let people within the culture manage the stigma around the culture. “Can you just include someone from these communities?” A bunch of people talking about us and deciding what’s harming us without talking to us. Isabelle refers back to psychopharmacology and psychopathology class—you gotta learn a ton about diagnostic criteria and learn how to categorize the experiences of people your seeing. Isabelle’s professor was a neuropsychologist and was very into accurate language. You can look at diagnoses from a couple of different angles—why do we diagnosis? We need to have a standardized understanding of a group of experiences, so when we talk about it we all say “this is the part that we mean.” There needs to be some kind of shared consensus around what ADHD means. Cut off points could be true for insurance purposes, political, and financial, and for research and understanding, and it also is not all encompassing—but if you accurately sync a person up to a diagnosis, it gives them an understanding of a person that helps them. Everyone isn’t self-diagnosing. It’s the people who resonate with the experiences of those who are AuDHD or autistic or an ADHDer. David names that he loves the podcast (as does Isabelle, she’s a big archerry) and that the people on this podcast are falling into something society does, not necessarily leading society there, which is validating external manifestations of pain rather than internal frustration. David leans on the work of Marcus Soutra, with the idea that perhaps instead of thinking of things as diagnoses, it's more of an identification. We’re accurately identifying people.  Isabelle further details that they mention that mental health diagnoses go up when mental health awareness is spread. To which she wonders—what about how psychoeducation and awareness allow for people to be more vulnerable and feel safe disclosing what's really going on, internally? The example that ‘doesn’t everyone have a little ADHD’ is—-wrong. Nope, Not everyone. But maybe those who have untreated ADHD do? And with the example of Bill Gates identifying as autistic, and the author naming that she doesn’t see him as having struggles or disability, again, a very external definition—they have no clue about what he has gone through or what it is like to go through life not fully understanding yourself without such an identity. Autism and ADHD is not necessarily a learning difference Armchair Expert episode Isabelle is referencingSuzanne O'Sullivan's book, The Age of DiagnosisUSEFUL DEFINITIONSPsychosomatic - a word that literally means "mind" and "body" -- where stress or worry make a symptom or condition develop, get worse, or show up in the first place. While common usage means we often think this is saying "it's all in your head,"or that it's not real---it's saying the opposite: it's saying that the mind has such a powerful effect that it can cause real physical pain and suffering and that illnesses and all kinds of conditions can have many different causes. This does not mean what you're experiencing is not real, it means we now understand that stressors and emotions and our minds can connect to a number of health conditions. See here for more (Source: Cleveland Clinic).Placebo effect - the way a sugar pill or random remedy (used in clinical research trials for a medication, let's say, or a 'fake surgery' in surgical trials, where nothing is implanted or changed) produces symptom relief and improvement as if it were a real pill or real surgically-altering procedure. This means that the person experiences actual change, again, that is not explained by the treatment or pill being studied. We don't fully understand why this is, but we know it's there, and it likely has something to do with a person's expectations of whether something could help them. It has a big impact on research and neuroscience in general. See here for more (Source: NIH 2023)Nocebo effect - opposite from placebo, where a person's negative expectations play out when given a sugar pill or 'sham' surgery and their symptoms get worse even thought they did not receive any medicine or treatment that would give them side effects. See here for more (Source: NIH 2012). -----cover art by: Sol Vázqueztechnical support by: Bobby Richards