Psychiatric Overdiagnosis: The Price of Prosperity and abundance?

Recommendable! Food for thought! This subject has been debated for several decades in Western countries.

Is the modern world and/or too much leisure time behind the increased diagnosis of mental health issues around the world?

Or do we have too many doctors specialized on mental health always trying to make a living by diagnosing new occurrences and having more patients?

Are we unable to properly distinguish rather harmless from severe cases of mental health issues in too many cases?

Caveat: Behind the Great Firewall of China, I am unable to access this article.

Psychiatric Overdiagnosis: The Price of Prosperity? "Abundance, loose criteria, and perverse healthcare incentives turned normal struggles into a diagnosable epidemic"

No evidence ADHD is being over-diagnosed in the UK, say experts. Really!

What is ADHD anyway? Is this not a broad spectrum disorder that allows almost any kid to be diagnosed as such?

How much of normal children's behavior is diagnosed as ADHD? I bet, too much!

When is an underdiagnosis an overdiagnosis?

The more patients, the better for the business of doctors!

"In a paper, published today in the British Journal of Psychiatry, a group of experts say there is no robust evidence that ADHD is over-diagnosed in the UK. They refute the view that ‘nowadays everyone has ADHD’, which is gaining traction in public discourse and has been amplified by some leading politicians, as demand rises for NHS assessments and services. ...

“While many more people with ADHD are being recognised and treated, we are failing to support many more. Overdiagnosis is not a problem, but misdiagnosis may be as people are driven into the private sector by long waits; and sadly, missed diagnoses remain common.” ..."

From the abstract:

"When thoroughly assessed, the prevalence of attention-deficit hyperactivity disorder (ADHD) in children/adolescents is estimated at 5%.

There is no evidence that ADHD is over-diagnosed in the UK. Indeed, available data point to under-diagnosis, even though rigorous updated post-COVID-19 pandemic data are not available.

Some cases may be misdiagnosed due to low-quality assessment, poor adherence to national guidance or inappropriate differential diagnosis. Beyond the controversy around over- or under-diagnosis and over-medicalisation of ordinary behaviours or emotions, the main issue is that UK clinical services cannot adequately support individuals with ADHD who need help. There is a risk that the narrative claiming ‘ADHD is over-diagnosed’ could be used to deny people with properly-diagnosed ADHD the care they deserve."

No evidence ADHD is being over-diagnosed, say experts | University of Cambridge "Experts are warning that far from being over-diagnosed, people with ADHD are waiting too long for assessment, support and treatment."

ADHD (over) diagnosis: fiction, fashion and failure (open access)

Are We Overdiagnosing Mental Illness? Here's what Doctors Say with Palki Sharma

Very recommendable! Palki says e.g. don't confuse momentary emotions with mental illness.

I have also for decades argued that mental illness is most likely overdiagnosed in Western countries.

It is good business for the medical profession! Individuals with diagnosed mental illness get more attention and treatment, excuses are easier and other benefits.

Autism rates rose again in the United States. Really!

Medical overdiagnosis seems to be prevalent when it comes to Autism Spectrum Disorder (ASD)! Just the fuzzy term ASD strongly suggests wide diagnostic latitude for doctors! Too wide for my taste! Reminiscent of "gender dysphoria".

Serious doubts are in order! From a physician's perspective there are no healthy individuals! Ulterior motives like more government funding, more jobs for the medical profession etc.?

This rise of Autism, ADHD and the like in children seems to have become a very popular narrative of alarmism and hysteria. It's good for the business of the medical profession! This narrative puts extra stress on parents to worry about their children! This would be reckless and irresponsible!

I also have a strong suspicion that ASD is perhaps a more transient and temporary condition in children than a permanent conditions like a phase of development. 

I blogged here yesterday about what seems to be a junk study of high prevalence of ASD and ADHD among Australian children.

"Autism is more common than ever before, a new report suggests.

As of 2022, about 1 in 31 children in the United States were diagnosed with autism by the time they were 8 years old, researchers reported online April 15 in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report. Previous studies had put the number at 1 in 36 in 2020 and 1 in 150 in 2000."

From the abstract:

"Problem/Condition: Autism spectrum disorder (ASD).

Period Covered: 2022.

Description of System:

The Autism and Developmental Disabilities Monitoring Network is an active surveillance program that estimates prevalence and characteristics of ASD and monitors timing of ASD identification among children aged 4 and 8 years.

In 2022, a total of 16 sites (located in Arizona, Arkansas, California, Georgia, Indiana, Maryland, Minnesota, Missouri, New Jersey, Pennsylvania, Puerto Rico, Tennessee, Texas [two sites: Austin and Laredo], Utah, and Wisconsin) conducted surveillance for ASD among children aged 4 and 8 years and suspected ASD among children aged 4 years. Surveillance included children who lived in the surveillance area at any time during 2022.

Children were classified as having ASD if they ever received

1) an ASD diagnostic statement in a comprehensive developmental evaluation,

2) autism special education eligibility, or

3) an ASD International Classification of Diseases, Ninth Revision (ICD-9) code in the 299 range or International Classification of Diseases, Tenth Revision (ICD-10) code of F84.0, F84.3, F84.5, F84.8, or F84.9.

Children aged 4 years were classified as having suspected ASD if they did not meet the case definition for ASD but had an evaluator’s suspicion of ASD documented in a comprehensive developmental evaluation.

Results:

Among children aged 8 years in 2022, ASD prevalence was 32.2 per 1,000 children (one in 31) across the 16 sites, ranging from 9.7 in Texas (Laredo) to 53.1 in California. The overall observed prevalence estimate was similar to estimates calculated using Bayesian hierarchical and random effects models. ASD was 3.4 times as prevalent among boys (49.2) than girls (14.3).

Overall, ASD prevalence was lower among non-Hispanic White (White) children (27.7) than among Asian or Pacific Islander (A/PI) (38.2), American Indian or Alaska Native (AI/AN) (37.5), non-Hispanic Black or African American (Black) (36.6), Hispanic or Latino (Hispanic) (33.0), and multiracial children (31.9). No association was observed between ASD prevalence and neighborhood median household income (MHI) at 11 sites; higher ASD prevalence was associated with lower neighborhood MHI at five sites.

Record abstraction was completed for 15 of the 16 sites for 8,613 children aged 8 years who met the ASD case definition. Of these 8,613 children, 68.4% had a documented diagnostic statement of ASD, 67.3% had a documented autism special education eligibility, and 68.9% had a documented ASD ICD-9 or ICD-10 code.

All three elements of the ASD case definition were present for 34.6% of children aged 8 years with ASD.

Among 5,292 (61.4% of 8,613) children aged 8 years with ASD with information on cognitive ability, 39.6% were classified as having an intellectual disability. Intellectual disability was present among 52.8% of Black, 50.0% of AI/AN, 43.9% of A/PI, 38.8% of Hispanic, 32.7% of White, and 31.2% of multiracial children with ASD.

The median age of earliest known ASD diagnosis was 47 months and ranged from 36 months in California to 69.5 months in Texas (Laredo).

Cumulative incidence of ASD diagnosis or eligibility by age 48 months was higher among children born in 2018 (aged 4 years in 2022) than children born in 2014 (aged 8 years in 2022) at 13 of the 15 sites that were able to abstract records. Overall cumulative incidence of ASD diagnosis or eligibility by age 48 months was 1.7 times as high among those born in 2018 compared with those born in 2014 and ranged from 1.4 times as high in Arizona and Georgia to 3.1 times as high in Puerto Rico. Among children aged 4 years, for every 10 children meeting the case definition of ASD, one child met the definition of suspected ASD.

Children with ASD who were born in 2018 had more evaluations and identification during ages 0–4 years than children with ASD who were born in 2014 during the 0–4 years age window, with an interruption in the pattern in early 2020 coinciding with onset of the COVID-19 pandemic.

Overall, 66.5% of children aged 8 years with ASD had a documented autism test. Use of autism tests varied widely across sites: 24.7% (New Jersey) to 93.5% (Puerto Rico) of children aged 8 years with ASD had a documented autism test in their records.

The most common tests documented for children aged 8 years were the Autism Diagnostic Observation Schedule, Autism Spectrum Rating Scales, Childhood Autism Rating Scale, Gilliam Autism Rating Scale, and Social Responsiveness Scale.

Interpretation:

Prevalence of ASD among children aged 8 years was higher in 2022 than previous years. ASD prevalence was higher among A/PI, Black, and Hispanic children aged 8 years than White children aged 8 years, continuing a pattern first observed in 2020. A/PI, Black, and Hispanic children aged 8 years with ASD were also more likely than White or multiracial children with ASD to have a co-occurring intellectual disability. Identification by age 48 months was higher among children born in 2018 compared with children born in 2014, suggesting increased early identification consistent with historical patterns.

Public Health Action:

Increased identification of autism, particularly among very young children and previously underidentified groups, underscores the increased demand and ongoing need for enhanced planning to provide equitable diagnostic, treatment, and support services for all children with ASD. The substantial variability in ASD identification across sites suggests opportunities to identify and implement successful strategies and practices in communities to ensure all children with ASD reach their potential."

Autism rates rose again. Experts explain why "A new report offers a better reflection of autism rates and an opportunity to help families in need"

Prevalence and Early Identification of Autism Spectrum Disorder Among Children Aged 4 and 8 Years — Autism and Developmental Disabilities Monitoring Network, 16 Sites, United States, 2022 (open access)

45.6% of Australia's teens have at least one chronic disease, ADHD or autism. Really!

This obviously reeks of overdiagnosis! Plus, the study only included just over 5,000 adolescents and it is based only on self-reporting! Junk science?

How were the 5,000 plus adolescents selected? To cite from the study: "Participants were adolescents taking part in the ‘Health4Life’ health behaviour change cluster randomised controlled trial (RCT) among 71 schools across three Australian states (New South Wales, Queensland and Western Australia).21,22 All adolescents aged 11-13 years, who were fluent in English, attending participating schools and had parental consent were eligible to participate." There is a strong suspicion of selection bias!

The reporting about the study and the study itself seem to check all the usual narrative checkboxes like sugar-sweetened beverages, ultra-processed food and so on.

Caveat: I did not read the study.

"A first-of-its-kind study has found that almost half, 45.6%, of Australian teenagers are living with one or more chronic diseases, including diabetes or asthma, or a developmental condition like ADHD. The study has linked these diseases and conditions to factors such as an unhealthy diet and poor mental health. ...

Overall, a staggering 45.6% of adolescents reported having at least one of the 10 chronic diseases or developmental conditions the researchers examined. The most prevalent diseases were hay fever (23.2%) and asthma (15.1%); type 2 diabetes was the least prevalent (1.0%). Of the developmental conditions, ADHD was the most prevalent at 9.4%. ..."

From the abstract:

"Objective

Amongst Australian youth, there is currently a lack of understanding of the prevalence of noncommunicable diseases and developmental conditions and links with modifiable lifestyle behaviours, mental health and other socio-demographics. This paper aims to address this gap.

Methods

Australian adolescents (N = 5014, Mage=14.7, SD=0.80) completed a self-report survey assessing noncommunicable diseases/developmental conditions, sex, socio-economic status (SES), lifestyle behaviours and mental health. Multivariable logistic regressions were used to estimate the associations between these variables. The moderating effects of sex and SES were investigated by including interaction terms in each regression model.

Results

45.6% adolescents reported ≥1 noncommunicable disease/developmental condition. Being female, consuming more sugar-sweetened beverages, ultra-processed foods, or alcohol, participating in more screen time, having depression, anxiety or psychological distress were each associated with higher rates of having at least one disease/condition (p<0.01). Sex and SES significantly moderated the associations between some lifestyle behaviours and eight diseases/conditions were examined.

Conclusion

Australian adolescents experience considerable rates of noncommunicable diseases and developmental conditions, highlighting the significance of this public health issue. ..."

45.6% of nation's teens have at least one chronic disease, ADHD or autism

Almost 1 in 2 Aussie teens living with a chronic disease or developmental condition

Prevalence of noncommunicable diseases and developmental conditions in 5014 Australian adolescents, and their correlations with diet, other lifestyle behaviours and mental health (open access)

There's no autism epidemic. It's an autism diagnosis epidemic

A provocative headline! Do we also have diagnosis epidemics in other areas of healthcare? I bet. How about Covid-19 pandemic related deaths, hospitalizations, infections etc.?

Autism Spectrum Disorder is a nebulous term under which almost anything and everything can be diagnosed. It is questionable if this is helpful to the patients

"s there an autism epidemic? No. The increase in the autism rate recently reported by the Centers for Disease Control and Prevention represent an autism diagnosis epidemic.

Writing in the weekly journal MMWR, CDC researchers reported that autism rates in the United States increased from 1 in 150 children in 2000 to 1 in 54 in 2016, and the rate now stands at 1 in 44 children. ...

I believe that the rise in the autism rate is social, not biological. It’s not that more children are developing symptoms of autism, but multifaceted sociological and political factors are increasing the diagnoses and documentation of this condition.  
The first of these factors was a diagnosis of autism fit the message of the deinstitutionalization movement better than mental retardation because the public believed that children with autism lagged behind only in some areas and could improve with behavioral therapies. In contrast, children with mental retardation were believed to lag behind in all areas and could not improve with therapy, justifying banishing them to institutions away from society. ...
a diagnosis of autism fit the message of the deinstitutionalization movement better than mental retardation because the public believed that children with autism lagged behind only in some areas and could improve with behavioral therapies. In contrast, children with mental retardation were believed to lag behind in all areas and could not improve with therapy ... As autism diagnoses increased, diagnoses of mental retardation and other learning disabilities decreased. ...

Another powerful factor behind the rise in autism rates is the passing of insurance mandates. Since 2001, all 50 states have instituted mandates requiring non-self-funded private insurance plans to cover behavioral therapies for autism. These mandates can save families up to $50,000 a year on treatment. ... Insurance mandates increase autism rates because, in borderline cases, practitioners and parents push for a diagnosis that ensures a child receives coverage for the help the child and family need. ... The families of children with developmental disorders other than autism must often rely on broad laws such as the Individuals with Disabilities Education Act (IDEA), which vaguely states that each child must receive a “free and appropriate public education in the least restrictive environment.” IDEA’s implementation is underfunded by Congress and largely depends on each state’s interpretation of it. With such limited options for children with special needs, it makes sense that caring practitioners might push for a diagnosis that guarantees children receive the help they need. ...
These factors were crystalized by the CDC’s changing methodology to measure autism rates. In 2013, the American Psychiatric Association narrowed its criteria for an autism diagnosis. ..."

There's no autism epidemic. It's an autism diagnosis epidemic - STAT