Amber Collins

Professor Hunter

English

10 February 2019

Annotated Bibliography

My research paper will attempt to answer the question as to why are so much of our

youth being diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). Is this truly a

mental disorder or normal behavior being misdiagnosed? In this research paper, I hope to find

out what are the contributing factors? Is there an epidemic that parents, teachers, and friends

should be educated about and made aware? Is something happening in our social environment to

create an evolutionary change in our genetic make-up?

Michael J. Manos, PhD; Kimberly Giuliano, MD; and Eric Geyer, BA, ADHD: Overdiagnosed

and Overtreated, or Misdiagnosed and Mistreated?”,

https://consultqd.clevelandclinic.org/adhd-overdiagnosed-and-overtreated-or-

misdiagnosed-and-mistreated/, 5 February 2018.

This article mainly focuses on the treatment of ADHD and the systematic procedures of

what is being done and what isn’t in determining treatment. A small portion of this article

contributes very interesting data towards the topic of over diagnosing and the increase of the

diagnosis across the country. This is important information and can be one of many answers to

the question as to why we have seen this increase and be a key contributing factor. The data

provided has sparked conversation and debates with some believing that ADHD is either over

diagnosed or underdiagnosed, but most agree that it is misdiagnosed. With 42% increase in
diagnoses from 2003 to 2011 across the US and diagnostic guidelines not being strictly applied,

this has contributed to misdiagnosis. “For example, in a study of 50 pediatric practices, only half

of clinicians said they followed diagnostic guidelines to determine symptom criteria from at least

2 sources and across 2 settings, yet nearly all (93%) reported immediately prescribing

medications for treatment.” (Epstein JN, Kelleher KJ, Baum R, et al. Variability in ADHD care

in community-based pediatrics. Pediatrics 2014; 134:1136–1143)

The purpose of this article is to discuss why is an increase of cases of diagnosis in

ADHD. The author is a psychologist and the head of the Center for Pediatric Behavioral Health,

Pediatric Institute at Cleveland Clinic. This article helps explain different perspectives of the

increase in ADHD. I intend to use this article as the main influential factors why there is an

increase in the disorder ADHD. This article is recently published with current up to date

information.

Rabiner, David PhD., “New Diagnostic Criteria for ADHD: Subtle but Important Changes”,

Help For ADD. June 2013, http://www.helpforadd.com/2013/june.htm.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a universal

handbook, published by the American Psychiatric Association, which lists classifications,

symptoms, and diagnostic criteria for all mental disorders used by and for clinicians and

psychiatrics to diagnose. Changes have been made in the DSM-5 (2013) compared to the DSM-

IV (1994) due to clinical experiences, real-world practice and the correlation found between

developmental brain activity and ADHD. To reflect the discover, this disorder has been moved in

the manual to the chapter, “Neurodevelopmental Disorder”. I think one important overall change

in the DSM-5 is the fact that they have made the criteria much more lenient by requiring that the

symptoms don’t have to impair the individual’s functioning but interfere. In the previous DSM-
IV, it was difficult to diagnose an adult with ADHD because the patient had to meet the criteria

before the age of 7. The new DSM-5 removes this requirement along with the understanding that

as a patient gets older the individual has learned to manage the symptoms and there is less

criteria that needs to be met, like the criteria of that of a teen.

The DSM does not provide specifications on the methods that clinicians should use to go

about determining if patients meet those criteria. The American Academy of Pediatrics provide

suggested evaluation guidelines, but diagnosis is solely based on clinical judgement and the

information and methods that the clinicians choose to use and obtain. These changes and the

requirement to associate the diagnosis with 1 of 3 severity classifications, I can’t see how the rate

of diagnosis will only increase.

This information was published to explain the DSM and the differences with between the

old version and the latest. This is important information, because this too effects the number of

cases being diagnosed. The article is written by David Rabiner Ph.D who is a Psychologist and a

research professor at Duke University. The article was written in 2013 when the new DSM-5 was

released and updated. I intend to use this article to help explain the timeline and logistics of how

an ADHD diagnosis is derived and the impact that these changes will have on the amount of

confirmed cases.

Livingstone, Luisa T., et al. “Does the Environment Have an Enduring Effect on ADHD? A

Longitudinal Study of Monozygotic Twin Differences in Children.” Journal Of Abnormal

Child Psychology, vol. 44, no. 8, Nov. 2016, pp. 1487–1501.

https://www.researchgate.net/publication/298910787_Does_the_Environment_Have_an_
 Enduring_Effect_on_ADHD_A_Longitudinal_Study_of_Monozygotic_Twin_Difference

s_in_Children.

A study amongst monozygotic twin differences was published to expose whether

environmental factors made any differences in the subjects. Since MZ twins inheritable have the

same genes, a study with these types of subjects can be used to expose any environmental

influences. This article references many of these types of studies and conclude that ADHD is

genetic with “70-90% of the variance between twins to be hereditary factors and 10-30% due to

unique environmental factors.” The authors of this article went further and published a new study

to elaborate on these unique environmental factors. Do these unique environmental factors have

long or short-term effects? The study was performed over a 4-year period of which in conclusion

the researchers felt like a study needs to be done for a longer period in order to see more of a

trajectory. These unique environmental factors include child stroke, lead exposure, and traumatic

brain injury. Low birth weight and streptococcal infection have been associated as possible

factors. There are some psychosocial factors that are thought to influence the severity of ADHD,

although not a direct factor; such as maternal depression, lower household income, and a less-

stimulating and supportive home environment. Research has shown that these specific

environmental factors have a transient or short-term effect.

This article focuses on the fact that what is not hereditary or genetic influences of the

ADHD mental disorder, must be environmental influences by default. This is important and

allows us to focus on the amount of environmental influences that exist. This is important

because this answers my research question directly as to what are the contributing factors that

have caused an increase in ADHD with our youth? This publication and study is for academia

purposes and written by a registered clinical psychologist, Luisa Livingstone.

Gnaulati, Enrico. Back to Normal : Why Ordinary Childhood Behavior Is Mistaken for ADHD,

Bipolar Disorder, and Autism Spectrum Disorder. Boston : Beacon Press, [2013], 2013.

EBSCOhost, sinclair.ohionet.org: Adobe Digital Edition,

https://www.worldcat.org/title/back-to-normal-why-ordinary-childhood-behavior-is-

mistaken-for-adhd-bipolar-disorder-and-autism-spectrum-disorder/oclc/858874155.

How many of the symptoms are associated with everyday normal childhood behaviors?

The diagnostic process is a subjective interpretation and judgement that could cause doctors and

therapists to throw false positives. Just like the puppy dog scenario. Don’t all children have the

core symptoms of ADHD; distractibility, forgetfulness, problems with follow-through, not

listening, talking excessively, fidgetiness, and difficulty waiting one’s turn. “Sometimes a child’s

troubles simply mean that he or she is slow to mature in an area and will do just fine with some

combination of adjustments to his or her daily environments, targeted parenting interventions,

and garden-variety talk and play therapy. I like to think in terms of normal human variation,

development glitches, and wellness.” (Pg.6)

The book talks about how we have evolutionary personality traits such as anxiety,

aggressiveness, and action-geared that would allow us to adapt to “hunter-gatherer times,” but

are not acceptable in today’s types of classrooms. (Pg.9) The author goes on to speak about how

the ADHD symptoms often mimic normal childhood narcissism. One example, a child’s

forgetfulness could be nothing more than “under-practicing and underpreparing because he or

she is overconfident.” (pg. 9)

This book is written by Enrico Gnaulati, a clinical psychologist, for parents and teachers

of our youth. I intend to use this book as a reference to explain that all too often there are
professionals out there that are quick to label a child that has ADHD when in fact, they may be

just acting normal. He talks about the judgement that professionals must use and there is nothing

out there for a protocol on diagnosis this disorder in the DSM. Again, this is supporting my

stance that the reason we are seeing an increase in the amount of cases of ADHD, is become of

the new society norm and physicians and psychologists are too quick to label our kids with this

disorder. This book was wrote in 2013, the same time that the revised DSM-5 came out with

revised criteria and guidelines for the ADHD disorder.

Smith, Kathleen PhD., “Causes of ADHD.” PSYCOM, 14 February 2018,

https://www.psycom.net/adhd-causes.

This article discusses the myths and origins behind what causes ADHD. The genetic and

hereditary component is the strongest indicator that leads to one having ADHD with only

environmental factors aiding in the severity and trajectory of the disorder. There were once

theories that the sugars in food increased or the hormones that affect your balance increase your

risk of developing ADHD. These theories and those alike such as poor parenting, a non-

supportive family environment, lack of discipline, too much television, video games, and internet

all have been disproven to cause ADHD. The author of this article is Kathleen Smith, PhD., a

licensed professional counselor and psychologist and mental health writer. This article is for the

average person interested in reading about mental health. It is organized very well and addresses

myths and false origins. I intend to use this source to support the theories that ADHD is not

caused by environmental things such as sugar and parenting.

Saul, Richard Dr., “Exclusive: Is ADHD a Medical Myth?” CBS Television Distribution,

uploaded by The Doctors, 17 February 2014,

https://www.thedoctorstv.com/videos/exclusive-is-adhd-a-medical-myth.

In this interview, Dr. Richard Saul talks about his book that in my opinion is

inappropriately titled. He claims that the ADHD disorder doesn’t exist, however, he does say that

the symptoms are present in some children, a lot less than the present day 1:10 ratio. Those

children where the symptoms are present and need to be treated with stimulants, should be

referred to as having a neurochemical impulsive distractible disorder, not ADHD. He feels that

the ADHD diagnosis is overly diagnosed, and these symptoms are present in over 20 other

diseases and disorders. I chose to include this video and interview of Dr. Richard Saul as an

opposing viewpoint and stance on whether ADHD is truly a mental disorder. I had asked, Is

ADHH a true mental disorder or normal behavior as one of my research questions. Dr. Saul is a

psychiatrist, neurologist, author and a renowned expert in the field of behavioral neurology.

Zagorski, Nick., “Could a Video Game Help Kids with ADHD”, Psychiatry Online, 5 April

2018, https://doi.org/10.1080/17482798.2015.1088872.

Technology is not a factor that leads to ADHD. Studies, current research and preliminary

findings are proving that technology and gaming could protentional become a part of treatment

for ADHD. While it is a debate whether technology could or should be considered an addiction

in the DSM, most children that are found to be “addictive” to social media or gaming have

underlying mental disorders. These disorders consist of ADHD, anxiety, and depression.

Researchers at Akili Interactive Labs are trying to get FDA approval of this new idea of a digital

gaming “drug” to treat and stimulate patients that suffer from ADHD. Although more extensive
case studies are in the works, they have seen indicators that their tablet-based video games have

proven to “stimulate visual and motor networks in the brain in a very specific way.” (Zagorski)

I chose this article to include as a source because often the common person might think

that technology might cause ADHD or that it could heighten symptoms of ADHD. This also

answers my question as to what the contributing factors are increasing ADHD. Screen time has

been increasing over the years and this correlates with the number of cases of ADHD. I felt this

was necessary to bring this topic up to explain the correlation. Nick Zagorski PhD. is a senior

staff writer for Psychiatry Online and a Doctor of Philosophy- Biochemistry and Molecular

Biology. This article has an intended audience for parents, teachers, and anyone that has any

business in technology. This article was recently written in 2018 and case studies are still on-

going.

Powell, L., Parker, J. & Harpin, V. Eur Child Adolescent Psychiatry (2018) 27: 1391. https://doi-

org.sinclair.ohionet.org/10.1007/s00787-017-1092-x.

Is an article collaborating all the studies and levels of evidence that currently exist to

support the theory that technology can impact in a positive or negative way the outcome of those

that suffer from ADHD. This article provides a lot of case studies that I would consider outdated

and as I suggested early, more extensive studies are in the works and need to be taken into

consideration. This article was worth noting and mentioning because it too also speaks about

technology and the influence that it may have on those that have been diagnosed with mental

disorders such as ADHD. This supports the ideas that technology may worsen the symptoms of

ADHD. The case studies are old, and it may have correlation with the type of gaming or social
media which I think is important to take notice so that the two articles can be compared, and

conclusions can be made.