A team of American pediatric physicians has published an article in the journal Pediatrics examining the many ways in which medical overdiagnosis may be harming children. “Overdiagnosis is defined as the identification of an abnormality where detection will not benefit the patient,” they write. They specifically discuss ADHD as one of many problematic and questionable diagnoses.
“Unlike misdiagnosis, the finding is accurate; the condition detected may be precisely the condition that was meant to be detected,” they write. “The notion that an accurate diagnosis could be anything but beneficial runs counter to the conventional wisdom that the more that is known about a patient, the better. Unfortunately, not only do overdiagnosed patients fail to benefit from their diagnosis, they may also be harmed.”
The authors lament that the phenomenon of overdiagnosis has been little studied in children, but examine numerous areas of concern from food allergies and gastroesophageal reflux to hypercholesterolemia and tonsillectomy, and discuss harms such as physical effects of tests and unnecessary treatments, psychological effects of anxiety and stigma, and financial strain on families.
They also explore some of the reasons for overdiagnosis, such as industry influences. “The 2012 attention-deficit/hyperactivity disorder (ADHD) guideline panel included 9 members, 5 of whom had industry ties to manufacturers of widely used medications for ADHD. Based on this committee’s recommendations, the definition of ADHD was broadened to include children 4 to 18 years old (previously 6–12 years old). Although it is unclear how many new diagnoses of ADHD this expansion created, diagnostic creep has resulted in the prescription of stimulants to 10,000 toddlers aged 2 and 3 years old.”
“Substantial proportions of children may not benefit from commonly pursued pediatric diagnoses,” they conclude. “In some cases, overdiagnosis is necessary to ensure larger gains for the children who do benefit from the diagnosis. However, for many diagnostic tests, the ratio of benefit to harm resulting from the diagnosis is incompletely understood.”
(Abstract) (Full text) Overdiagnosis: How Our Compulsion for Diagnosis May Be Harming Children (Coon, Eric R. et al. Pediatrics. Published online October 6, 2014. doi: 10.1542/peds.2014-1778)