The Myth of Overdiagnosis

Women and minorities are going dangerous undiagnosed, so why is there so much concern about overdiagnosis?

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The medical community and society as a whole have become increasingly aware of the prevalence of mental illness and neurodiversity. While there is some support for increased diagnosis, there is a misconception that more diagnoses are proof that these neurological differences are modern inventions. Some argue that people are using typical childhood behavior that may be disruptive to justify medicating a child in place of teaching proper conduct.

While the perception that more people are getting diagnosed is correct, the reasoning behind why diagnosis rates are increasing is wrong. According to the World Health Organization, diagnosis rates of mental health conditions have risen by 13 percent in recent years. There has been an estimated 800 percent increase in diagnosis rates of autism in the last 20 years and two million more parent reports of an attention deficit hyperactivity disorder (ADHD) diagnosis in 2011 than in 2003. It appears that many people feel overwhelmed by the number of children and adults with neurological differences, and they wrongfully respond with skepticism. According to a 2005 survey by psychologists Jill Norvilitis of the University at Buffalo, SUNY, and Ping Fang of Capital Normal University in Beijing, 82 percent of U.S. teachers believe ADHD to be overdiagnosed, and even popular television doctor “Dr. Phil” weighed in, saying that ADHD is “so overdiagnosed.” A simple Google search will reveal just how much overdiagnosis is a part of the popular discussion, as news outlets ranging from USA Today to The Guardian are joining in the conversation.

Before continuing to discuss these topics, it’s important to understand the terminology that will be used. The term “neurodiverse” refers to when a person’s brain chemistry causes it to function differently from a “neurotypical” person’s brain. The term was coined just over two decades ago and is preferable because it acknowledges that the neurodiverse simply have brains that work differently. Conditions that fall under the umbrella of neurodiversity include autism, ADHD, and dyslexia. Mental illnesses, on the other hand, are widely considered an impairment to functioning and include anxiety, depression, and bipolar disorder. So, while both neurodiversity and mental illnesses affect how one engages with the world, they do so in very distinct ways.

Theories of overdiagnosis ignore that while some groups may be overdiagnosed, others have been too long ignored. Take ADHD for example: young children are 34 percent more likely to be diagnosed with ADHD than children in upper grades, and one in five high school boys is diagnosed with ADHD compared to one in eleven high school girls. As of five years ago, autism diagnosis rates in white children were 19 percent higher than in black children, and another study found that wealthier children were significantly more likely to get an autism diagnosis than middle or lower-class children. These disparities in diagnosis rates suggest that gender, race, and socioeconomic status greatly impact a person’s ability to receive a diagnosis. Clearly, this is a multifaceted issue, and the theory of overdiagnosis ignores the complex history of these disorders and neurological differences.

The field of psychology has long been dominated by research on white, upper middle-class males. For example, in the 1940s, Hans Aspergers published a groundbreaking study on autism, or what used to be called “Aspergers.” His study solely looked at young, white boys, as did many studies which followed. Though increasing numbers of doctors and psychologists recognized the disability, they often disagreed on the cause. In 1967, psychologist Bruno Bettelheim falsely posited the notion that a lack of love from one’s mother was the ultimate cause. Even 20 years after discovering that the cause of autism was genetic, the belief that vaccination caused autism still gained traction in the early 2000s, and many still believe it today.

Therefore, several issues can be identified in diagnosing women and minorities. Firstly, the criteria to diagnose conditions like autism was based on the symptoms of young white men. This presents a challenge in diagnosing women and people of color who may exhibit “non-traditional” symptoms. If not paired with up-to-date, knowledgeable doctors and psychiatrists, a diagnosis may be deemed unnecessary, even when the person’s life is deeply affected by a disability. Second, the popularization of alternate reasons for neurodiversity other than genetics has led to people blaming families and thus discourages people from seeking treatment or answers.

This may be a side effect of media that has popularized certain ideas about neurodiversity and mental illness. Many movies and television shows that address mental differences and issues, unsurprisingly, do so through white men. Not only do shows and movies like Big Bang Theory, What’s Eating Gilbert Grape?, and Forrest Gump solely deal with white, male, neurodivergent characters, they do so in ways that are not always accurate. Therefore, some people may be doubtful about the increasing numbers of women and people of color being diagnosed. Not only do they look different from neurodiverse people on TV, but they also probably don’t act like them either. Contrary to the belief that diagnosis rates are absurdly, or even impossibly, high, they may be reaching the levels they should because our society is recognizing neurodiversity and mental illness in previously unidentified groups.

Luckily, the gap in the diagnosis rate of underrepresented populations is closing. Between 2018 and 2020, the diagnosis rate of four-year-old girls increased more than it did in same-aged boys, and a study published just a few months ago found that 2.9 percent of black eight-year-olds were diagnosed with autism compared to 2.4 percent of white eight-year-olds. These changes are helping minorities and women to get diagnosed despite the massive social and economic barriers to support. 

Nonetheless, we must continue to support minorities and women in their search for answers and treatment. An estimated 45 percent of Americans with a clinical-level mental issue do not seek treatment or support. These numbers are unacceptable, especially given the massive importance of early diagnosis. Too many people are being overlooked and ignored when it comes to mental health, and this is causing them to experience greater suffering from treatable issues. 

Ultimately, the biggest barrier to people knowing how and when to seek help is knowledge. Sadly, the communities with the least information on mental illness and neurodiversity are often the ones that can least afford to deal with the consequences of an undiagnosed disorder. Therefore, it should be considered a core responsibility of our schools to educate students on mental health and neurodiversity. By giving students the tools to handle mental differences and disorders, we not only help the individual but also entire communities. Parents who never had access to this information will learn it through their children, and when these students have children, they may be better equipped to help their children overcome the challenges they may face.

Our greatest challenge is not overdiagnosis but underdiagnosis, which can and is affecting the courses of entire lives.