Wednesday, October 04, 2017

Why Are Diagnoses of ADHD, ASD, BD…Increasing So Much? (Revised)

“We Have Seen the Enemy and He is Us” 

This seems like an obvious "truth", yet I haven’t seen anything published that says this.  It seems plainly obvious…

Clearly, diagnoses of ADHD, ASD, Bipolar, etc. have been increasing dramatically.  But so has knowledge about these disorders.  Also, we humans have a well documented inclination to minimize, under-estimate and to project the blame/cause for our personal problems!  One particular pattern within this inclination is for us to develop “Cognitive Biases.”    

Three particular Cognitive Biases are the most-likely-suspects for much of the excessive, over-the-top claims of ADHD, ASD, etc. being "Over-Diagnosed."  
Availability Cascade” - repeat it often enough and long enough and more people will accept it as "true.".

Bandwagon Effect” - "group-think" or "herd behavior."

Confirmation Bias” -  tendency to search for, interpret, focus on and remember information in a way that confirms one's preconceptions.

My Opinions  -  These Diagnoses are Increasing So Much Because:
1)  Prevalence of most MH problems have been grossly underestimated;
2)  Knowledge about identification/diagnosis has increased dramatically;
3)  The public are more aware and, thus are reporting more to physicians;
4)  The seriousness of these problems and the degree to which they interfere with daily-life is often down-played by some clinicians and journalists; 
5)  These problems are serious; engender much personal desperation; thus, spur people to seek help as it becomes increasingly available. 

Most of us clinicians, including me, try very hard to do our “due diligence” with differential-diagnosis and using multiple, different assessment/diagnostic tools to arrive at a “preponderance of evidence” to support any diagnosis.  

I take great offense and exception to the notion that the current, officially accepted method of diagnosing these disorders is “overly-subjective.”  This simply is NOT true.  Even some of the so-called “medically objective” diagnostic methods can result in false positive and negative outcomes.  Plus, some individuals are so adept at hiding their symptoms that ONLY a “clinical interview” can ferret them out.

Last but not least, not all of us medical and mental health clinicians are the same.  Some of us are very conscientious and follow accepted guidelines for diagnosis and treatment.  Doing this avoids almost all problems that get so much negative press, e.g., misdiagnosis, under-diagnosis of co-occurring conditions, ineffective treatment and bad reactions to medication.  Just a few years ago the American Pediatric Association did a study which found that over 90% of primary care physicians did NOT follow accepted guidelines for diagnosis and treatment of these disorders.  Now what do you think comes out of that inappropriate practice?

So, let’s stop trying to find the “bogey-man” everywhere else and look inside ourselves?    

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