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More kids are being diagnosed with ADHD for borderline (yet challenging) behaviours. Our new research shows why that’s a worry

During my daughter’s challenging first year of school, we discovered how much effort it took her to sit and learn.
She was the youngest in her class, placing her at higher risk of being diagnosed with ADHD (attention deficit hyperactivity disorder).
While she struggled with attention and hyperactivity, her problems were always more frustrating than truly impairing. Still, constant battles over finishing tasks, the amount of time (and nerves) spent on a child that needs that extra bit of attention and the anger or sadness on her face made me wonder if we should try to get some support.
Maybe a diagnosis could be a straightforward fix to the problem?
What’s the problem?
Increasing awareness of ADHD has led to consistent rises in the number of children diagnosed with and treated for it, both internationally and in Australia. This would be good if it meant we were getting better at finding, diagnosing and helping children impaired by inattention or hyperactivity.
However, my newly published study in JAMA Network Open finds these increases in ADHD diagnoses may be largely due to children like my daughter, whose behaviours fall within a normal (but frustrating) range. I conducted this research with colleagues from the University of Sydney and Bond University.
Our study concluded these children are unlikely to benefit from being labelled with ADHD and may, in fact, be harmed by it.
This surge in diagnoses also results in limited resources being stretched thinner among more children, ultimately taking away from those with severe problems who would benefit from more support.
Read more: How do I know if my child is developing normally?
What is ADHD? And why is it so controversial?
ADHD is a “persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development”.
It’s one of the most common childhood disorders, affecting about 5-7% of children. Over the past decades, debate on the appropriateness of diagnoses has grown in line with the rate of diagnosis.

Allen Frances, a prominent American psychiatrist, has been one of the most vocal critics of the trend. He describes it as the medicalisation of “every day experiences that are part of the human condition”.
However, others suggest the increases in diagnosed children are largely due to improved detection in previously undiagnosed children.
Both sides of the debate claim to have proof. But we were surprised to discover no-one had ever summarised the scientific evidence for the key reasons behind increasing diagnosis rates.
So we reviewed the results from over 300 studies on ADHD over the past 40 years to determine which children are being newly diagnosed and if they benefit. Our study design allowed us to summarise a huge variety of studies in a way not done before.
What we did and what we found
We found that since the 1980s, increasing numbers of school-aged children and adolescents around the world have been diagnosed with ADHD and medicated for it.
We know ADHD-related behaviours exist on a spectrum with no or minimal hyperactivity and inattention on one end and severe ADHD on the other.
Many children can get distracted easily, are forgetful, find it difficult to sit still or wait their turn. In most children, these behaviours are mild enough to not interfere with a “normal” life.
However, there is no clear biological cut-off point above which someone just “has” ADHD. Ways of diagnosing ADHD also vary between countries and change over time, with criteria generally becoming less stringent.
Together, this ensures many potentially new cases could be discovered, depending on how low the bar is set.
Read more: Five warning signs of overdiagnosis
In the US, for example, almost half of all children diagnosed with ADHD have mild symptoms, with only around 15% presenting with severe problems. Only about 1% of all children in an Italian study had severe ADHD-related behaviours. And, in general, children today are no more hyperactive or inattentive than 20 years ago.
All this led us to conclude a substantial proportion of these additional diagnoses (children who would not have been diagnosed 20 years ago) are, at best, borderline cases.
For example, one study shows while diagnoses increased more than five-fold over ten years in Sweden, there was no increase in clinical ADHD symptoms over the same time. This means that with the lowering of the diagnostic bar, children diagnosed with ADHD are, on average, less impaired and more similar to those without an ADHD diagnosis.
As a result children like my daughter, who are the youngest in their class, are at risk of being labelled with ADHD because their relative immaturity can be enough to push them over the threshold into the zone of “abnormal” behaviour.
Why it’s important to get it right
For children with mild symptoms
Children with mild ADHD symptoms are unlikely to benefit from a diagnosis. They (and their families) also incur substantial costs as well as potential harms from the diagnosis and treatment. That’s because:
instead of drumming up extra support, an ADHD label can have negative social, psychological and academic effects, when compared to similar young people without a diagnosis
medication reduces symptoms to a lesser extent in children with mild ADHD (however it is beneficial in many severe cases)
medication for young people with milder symptoms also has no positive, but a potential negative, effect on academic outcomes (such as maths and reading scores) when compared to unmedicated young people with similar behaviour. Also, medication doesn’t reduce the risks of injuries, criminal behaviour and social impairment as much as in those with severe symptoms.
Read more: Weekly Dose: Ritalin, helpful for many with ADHD but dangerous if abused by those without it
For children with severe symptoms
It’s also important children with more severe ADHD symptoms are correctly diagnosed so they don’t miss out on much-needed support.
With ever-increasing diagnosis rates of ADHD, schools are increasingly struggling to adequately support every child with a diagnosis: the slice of funding and support every child can receive gets smaller and smaller, the more children are included.
In turn, this often means those with the most severe problems get left behind.
Read more: ADHD prescriptions are going up, but that doesn't mean we're over-medicating
What can we do?
In light of the potential risks associated with diagnosing a child with milder ADHD symptoms, we recommend doctors, parents and teachers work together following a “stepped diagnosis approach”. This ensures swift and efficient diagnosis and treatment in severe cases. For those with milder symptoms, taking some time to watch and wait may mean many of them won’t need to be labelled or treated.
Not only will this avoid potential harm for individual children, it also ensures resources are allocated where they are needed most and will be most effective.
Co-authors on this article were: Alexandra Barratt, Professor of Public Health, University of Sydney; Katy Bell, Associate Professor in Clinical Epidemiology, Sydney School of Public Health, University of Sydney; and Rae Thomas, Associate Professor, Bond University.
Luise Kazda, PhD candidate, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
Yuri Gagarin's boomerang: the tale of the first person to return from space, and his brief encounter with Aussie culture
Alice Gorman, Flinders UniversitySixty years ago, Russian cosmonaut Yuri Gagarin became the first human to travel in space when he completed his historic orbit of Earth on April 12, 1961.
It was an extraordinary achievement, but created a dilemma for a world embroiled in the Cold War. Gagarin’s spaceflight heralded a vision of a unified planet.
However, in the battle between communism and capitalism, space technology was also a weapon to demonstrate the superiority of one political system over the other.
The Soviet Union was winning the battle. In 1957, it orbited the first satellite with Sputnik 1. Two years later, the Luna 2 probe was the first human artefact to make contact with the Moon. In February 1961 the Russians launched the Venera 1 probe towards Venus.
As congratulations for Gagarin’s feat poured in from around the world, the vehemently anti-communist Australian prime minister Robert Menzies stayed silent.
His views were echoed by members of the Australian scientific establishment. Sir John Eccles, president of the Australian Academy of Science, said the flight was of little value to humanity. Nuclear scientist Sir Mark Oliphant described it as a stunt.
Physicist Harry Messel said:
scientifically I am happy, but from the cold-war perspective I am sad […] it could very well threaten the freedom of the world if Russia continues to triumph in space.
Sputniks and vodka at the Sydney Trade Fair
The Australian public had other ideas. In August 1961, Sydney hosted an international trade fair with a large Russian pavilion.
Such was the buzz that Henry F. Jensen, the Labor Lord Mayor of Sydney, invited Gagarin to visit as part of his post-flight world tour. A request was sent through the Soviet embassy in Canberra, which passed it on to Moscow. Jensen said:
I am certain Sydney citizens will give him a very warm welcome if he comes here.
Throughout July and August, newspapers reported on whether the invitation had been answered. Anticipation was building.
The Russian pavilion had two life sized replicas of Soviet spacecraft and the public flocked to see them. It was the most popular pavilion at the trade fair (although the mini-bottles of vodka that were given away may have helped too).
Not everyone was happy about it. On August 12, an anonymous caller told police there was a bomb in the Russian pavilion. After evacuation, the bomb threat was proven to be a hoax.
It’s not known if the Lord Mayor’s invitation ever reached Gagarin. Over the next year the cosmonaut visited more than 25 countries on his world tour, but Australia was not among them.
The space boomerang
That said, Gagarin still had a close encounter with Australian culture. Australian journalist Wilfred Burchett and his British colleague Anthony Purdy were the first Western journalists invited to interview him privately.
Burchett was the first foreign war correspondent to enter Hiroshima in 1945, and had been hounded out of Australia by the government for his communist sympathies.
Burchett and Purdy met with Gagarin and his interpreters at the State Committee of Foreign Cultural Relations in Moscow, on July 9 1961. They wrote a book about it, contextualising the interview within the broader Soviet space program.
Burchett’s father George was on holidays in Moscow at the time. Just as Gagarin was leaving, George walked in with a boomerang he had in his luggage. He offered it to the cosmonaut, saying “please take this as a symbol of safe return”.
“It always comes back, and I hope you and your colleagues do too.”

Gagarin was delighted, examining the boomerang closely while the interpreters explained its use. They returned his thanks to George Burchett: “I shall treasure it. It’s a nice sort of symbol to have”.
The label on the back of the photograph, now in the National Library of Australia, says:

In January this year, nearly 60 years after Gagarin’s epic flight, a boomerang carved by Kaurna and Narungga man Jack Buckskin was taken onto the International Space Station by astronaut Shannon Walker.

Space politics in the global south
On one hand, Gagarin’s spaceflight was a symbol of unity and peace. On the other, it fostered the fear of Soviet aggression from space that started with Sputnik 1. The US also had to obscure its military objectives in space to create a public perception of peaceful intent.
The world tour was an important exercise in soft diplomacy, particularly when Gagarin visited countries such as Ghana and Brazil, which were not aligned with either the US or USSR.
Soviet technology’s promise of modernisation, as seen at the Sydney Trade Fair, was a powerful lure for nations in Africa, Latin America and Asia.
But many rejected the premise of the Cold War. In May 1961, a newspaper in Uruguay asked readers to imagine
the benefits to be gained if the American and Soviet scientists were to unite their efforts […] if these feats were intended to unite rather than divide.

The paradox is captured in one of the most famous photographs of Yuri Gagarin, where he holds a dove, an international symbol of peace, while wearing his military uniform and decorations.
This image is frequently displayed in the Russian segment of the International Space Station.
Gagarin never flew in space again. He was tragically killed in a jet crash in 1968. Around the world civil, revolutionary and international wars were being waged, the most well-known being the American War (also called the Vietnam War) which continued until 1975.
Perhaps no space traveller has ever returned to a world at peace.
Alice Gorman, Associate Professor in Archaeology and Space Studies, Flinders University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
Less than half of Australian adults know how to identify misinformation online

For most of us, it’s hard to imagine a media-free day.
Understanding what’s happening in the world, maintaining our social media profiles, staying in touch with family, being entertained, making new friends, engaging with governments, and with our democracy, are all activities that usually require media participation.
To do these activities regularly and effectively, we need to have at least a moderate level of media literacy.
Media literacy is about more than having a set of technical skills and knowledge about media. It is also about the ability to critically engage with media: to discern fact from fiction, decide which digital technologies and platforms to use and which to avoid, and to critique the power and influence media and technology companies have.
We carried out a national survey of 3,510 Australian adults to investigate their media literacy. We believe this is the first nationally representative survey to investigate the media literacy needs, attitudes and experiences of adult Australians.
We found most Australian adults have a low level of confidence in their media abilities including in areas such as checking if information online is true and checking if a website can be trusted.
This is a problem because people who are less adept at critically engaging with media are more vulnerable to influence from manipulative actors. Lower levels of media ability will result in fewer opportunities to participate in society socially and economically.
Lack of confidence for basic media tasks
Overall, we found Australian adult media literacy is low. Most adults had either no or a low level of confidence in ten out of 12 media abilities we listed.
While most people felt confident in their ability to perform a basic online search, far fewer were confident they could verify if information is true or not. And even fewer were confident they could create or edit media such as videos and photos.
Our survey also showed many people lacked the ability to safely navigate online environments: less than half (45%) of Australian adults had a high level of confidence in their ability to change the privacy settings on social media. And only 39% said they were confident they knew how to identify misinformation.
Even fewer adults (35%) were confident they knew what to do when they were harassed online and only a quarter (26%) were confident they could make sense of the terms and conditions of social media platforms.
Older Australians, people who have a lower level of education and people living in a low income household were far more likely to have a lower media ability. This is also true for people living with a disability or in a regional area.
Limited sources of support
We also found 30% of adults had received no help from any of the eight sources of support we listed which would help them analyse, use or create media. This included help from schools, friends, family and libraries.
Read more: 3 ways to help children think critically about the news
Among those who have access to support, the most common source they turned to was online resources (45%) followed by friends (42%) and family (41%).
Those with a low level of education were the least likely to have had any support to help them with media participation.
Strong support for media literacy education in schools
Four out of five Australians (81%) said children should receive media literacy education in school.
This significant level of support indicates people believe formal education should play a more central role in the development of media literacy.
But we found schools are not currently fulfilling this need. Only 14% of adults said they had received media literacy support in primary school, 22% received support in secondary schools and 25% received support via tertiary education.
Even for younger adults aged 18-24, schools were far from being a consistent source of media literacy support. Slightly more than half of this group (57%) reported having received media literacy support in high school, while 32% received support in primary school.
Thriving in a digital world
Misinformation has become one of the great challenges of our time. We have witnessed misinformation influence elections, threaten public health and safety and hamper democratic processes.
Most Australians (67%) said knowing how to recognise and prevent the flow of misinformation was extremely important or very important to them.
Yet our findings suggest some Australians are more likely to be vulnerable to the harms associated with misinformation.
Read more: Fake news was a thing long before Donald Trump — just ask the ancient Greeks
While most Australians said it was important to think critically about the media they consumed, those with lower educational attainment and lower household income were less likely to believe this was important.
Those who have had access to more sources of media literacy support over their lifetime tended to place greater importance on critical thinking skills when using media (78% for those with two or more sources of support) compared with those who didn’t receive any support (55%).
A lack of media literacy will contribute to increasing levels of social, cultural and economic exclusion for individuals, families and groups. In addition, a lack of media literacy may exacerbate the potential for broader social divisions and threats to our democracy due to the influence of misinformation.
Despite this, there is no federal funding or a national policy to advance media literacy in Australia. Given what is at stake, the responsibility for being media literate should no longer be simply left for people to work out for themselves.
Tanya Notley, Senior Lecturer in Digital Media, Western Sydney University; Michael Dezuanni, Associate professor, Creative Industries Faculty, Queensland University of Technology; Simon Chambers, Research Assistant, Western Sydney University, and Sora Park, Lead Author of Digital News Report: Australia 2020, Associate Dean of Research, Faculty of Arts & Design, University of Canberra
This article is republished from The Conversation under a Creative Commons license. Read the original article.
Disclaimer: These articles are not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of Pittwater Online News or its staff.