Common Mental Health Misdiagnoses in Children
Here, Jill Fodstad, Ph.D. discusses the two most commonly misdiagnosed mental health conditions in children.
These days, there’s a lot more awareness of, and attention paid to, mental health disorders in children. But the downside of that heightened awareness, says Jill Fodstad, Ph.D., a psychologist at Riley Hospital for Children at Indiana University Health, is that some children are being misdiagnosed.
“Any time that a child may not confirm to what we view as normal, people often think that there might be something psychological going on, and that can lead to an inaccurate diagnosis,” she says.
What’s more, adds Dr. Fodstad, there’s a lot of overlap between mental health conditions, which makes misdiagnoses more common. Here, Dr. Fodstad discusses the two most commonly misdiagnosed mental health conditions in children:
Attention Deficit Hyperactivity Disorder (ADHD)
Many parents worry about ADHD if their child shows signs of inattention, impulsivity or hyperactivity, but Dr. Fodstad says in many cases, a child’s behavior is actually appropriate for his or her age.
For example, one mother of a three-year-old was concerned that her son had ADHD because he wasn’t able to sit still at bedtime while his mother was reading a story. “I asked her how long the story was, and she said thirty minutes,” Dr. Fodstad said. “That’s normal for a child that age.”
For older children, inattentiveness in class may not be due to ADHD but to a lot of other things that are not mental health-related. “If it’s an early morning class at school, maybe the child did not sleep well, or maybe he forgot to eat breakfast and so he’s having a hard time concentrating because his stomach is grumbling,” says Dr. Fodstad.
Also, keep in mind that even if a child is prescribed ADHD medication and the behavior improves, that doesn’t necessarily mean he or she has the condition. “Some kids will respond well to a stimulant regardless of whether they have ADHD,” she adds.
While it’s true that autism rates have increased, the condition is actually a lot rarer than a lot of people think, says Dr. Fodstad. “A recent study determined that one in 68 children has autism, which if you do the math, is only a little bit above one percent,” she said.
“Some parents will tell me, ‘my child has as a touch of autism,’” which is not possible,” she adds.
The two main characteristics of autism are problems with social communication and restrictive and repetitive behaviors, and a child must meet both of these criteria in order to receive a diagnosis of autism spectrum disorder, says Dr. Fodstad.
A small child who rarely or never talks may have autism, but they may also have a significant speech impairment, she says. For older kids who are non-verbal, the cause may be anxiety.
In some cases, a child who is thought to have autism may actually have obsessive compulsive disorder (OCD). “With both of these conditions, we see that children have a lot of rigidity with routine,” says Dr. Fodstad. The difference is that with OCD, the reliance on routine is anxiety-driven.
“The child with OCD may need to read the same book every night as a way to neutralize a distressing feeling or thought,” she says. Another difference, she says, is that children with OCD don’t have the problems with social communication that children with autism do.
Dr. Fodstad cautions, however, that a child who wants things done the same way every night isn’t necessarily autistic or OCD. “I have an eighteen month old at home, and he thrives on routine,” says Dr. Fodstad. “Before he goes to bed, he asks for his milk cup, he wants to read Good Night Moon, and he wants two kisses. That’s just the phase of life that he is in right now.”
If you’re concerned about your child’s behavior, especially if it’s interfering with their ability to function, the best thing to do is make an appointment with his or her primary care provider, Dr. Fodstad advises. “Your child’s PCP will be able to evaluate your child and determine if they need to see a specialist,” she says.
-- By Patricia Scanlon