A recent article in Psychology Today, “Diagnosed as an Adult,” explores the growing trend of individuals being diagnosed with neurodevelopmental disorders in later adulthood, such as ADHD and Autism Spectrum Disorder (Frye, 2024). The article provides examples of newly diagnosed adults gaining a sense of relief and validation, clarity, and an improved understanding of their lifelong struggles that fosters improved self-acceptance
Diagnosis is a necessary part of the counseling and treatment process required by the mental health profession. At its best, a diagnosis can predict a disorder’s future course, suggest appropriate treatment, and prompt research into its causes. However, the diagnosis process often leads to labeling issues and patterns that are much more complex and require deeper understanding.
Limitations of DSM-5
The diagnostic process is guided by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the most widely used tool for diagnosing mental health disorders. It provides standardized criteria to describe and classify various psychological conditions used by all mental health clinicians. The main strength of the DSM-5 is that, when necessary, it helps clinicians communicate effectively across different clinical settings regarding the problem and needs of the individual seeking care.
While the DSM-5 classification system has its utility and advantages, it is not without criticism. A significant concern is that it casts too wide a net, potentially classifying ordinary behavior as pathological. Many counselors have drawn caution over the progression of the DSM through its multiple editions. The first edition of the DSM contained 102 diagnoses. Today, the DSM-5 has 298, constituting a 192 percent increase from 1952 to the present (Suris et. al., 2016).
- Issues and challenges that were once considered normal or common in life have the potential to be viewed as pathological or even biological abnormalities.
Along with the rising number of mental health diagnoses, we see a rising trend of individuals being diagnosed with disorders such as ADHD and Autism Spectrum Disorder (ASD). For instance, the prevalence of ADHD in US children increased from 6 percent in 1998 to 10 percent in 2018 (Li et al., 2023). Despite the reported trend, experts believe the actual rate of children genuinely meeting the ADHD criteria is a much lower 3.5 percent. Researchers believe that the elevated diagnosis levels have been artificially elevated by differences in how ADHD has been redefined over time by the mental health field (Cordova et al., 2022).
With the broadening of diagnosis in the US, there is concern that the mental health industry, in an attempt to identify and address psychological issues, has started to pathologize everyday life. For example, normal grief reactions may be reclassified as depressive disorder, or active, assertive boys may be diagnosed with ADHD.
Another major concern with the DSM-5 is the subjectivity of labels. A label like “ADHD” or “Autism Spectrum Disorder” can carry heavy social weight. Instead of being used as a tool for treatment, these labels can sometimes become stigmatizing, negatively affecting how a person is perceived by others. Labels may even take on a life of their own, overshadowing the individual behind the diagnosis. It can lead the person or their family or peers to see them as biologically impaired.
- A diagnosis can become like a new identity, negatively changing how they are viewed by peers.
The Risk of Misdiagnosis
The incidence of misdiagnoses is a real concern, often stemming from professional bias or insufficient clinical data. One classic landmark study highlighting the dangers of misdiagnosis is the Rosenhan Study (1973). In this study, eight clinically normal individuals pretended to hear voices and sought help at psychiatric hospitals. Despite answering all other questions truthfully, every participant was diagnosed with schizophrenia and admitted to the hospital. They remained hospitalized for periods ranging from 7 to 52 days and were even prescribed antipsychotic medications (Navidad, 2023).
The infamous Rosenhan Study illustrated how subjective interpretations, misreporting by clients, and snap judgments, even by qualified professionals, can lead to grave misdiagnoses, causing unnecessary medication and even unnecessary and stigmatizing hospital stays. Professional bias, as noted above by the expansion of diagnosis, can play a significant role. The phenomenon where clinicians see what they expect to see rather than what is truly there continues to be a concern in mental health diagnoses today. For instance, it is commonly suspected that mental health professionals who are “experts” in a certain diagnosis or are themselves diagnosed, or who have a family member who has a certain diagnosis (especially a child) are more likely to make the same clinical conclusion in the course of treating their clients.
Caution in Using Labels and Diagnoses
The DSM-5, though invaluable, must be used judiciously. Clinicians and clients alike should understand that while the DSM-5 serves as a comprehensive diagnostic tool, it is not without limitations. Diagnosing a condition based solely on DSM-5 criteria without considering the whole person—their history, environment, and individual characteristics—can lead to over-pathologizing or misinterpreting normal behavior as disordered.
The increasing diagnosis of ADHD and ASD in adults highlights a shortcoming in the mental health industry. Making diagnoses that are typically neurodevelopmental childhood disorders in adulthood should be rare, not an increasing trend. Labels like ADHD or ADD, or Autism can powerfully alter a person’s sense of identity. Caution should always be used to arrive at this type of clinical conclusion, whether the person is an adult or a child.
What is more likely in the cases of hyperactivity, impulsivity, or social awkwardness is a complicated web of symptoms fueled by more complex underlying core issues that go beyond simple labels. Clinicians and clients are wise to take their time and realize that each person’s struggle is complex and unique and requires more profound understanding. This type of treatment transcends mere labeling and seeks to understand a more profound sense of the whole person, which can lead to a new sense of purpose, growth, and direction in life.
At CCA, the approach to diagnosis remains firmly rooted in a holistic view of the individual. Our staff receive ongoing training in neurodevelopmental disorders like ADHD and ASD to reduce industry or cultural bias. By incorporating continuous clinical training and supervision by seasoned clinicians, CCA ensures that diagnoses are based not just on the DSM-5 but also on a thorough, compassionate understanding of each client’s unique circumstances. This includes objective, ongoing clinical assessment that uses the latest evidence-based standards to guide diagnosis and treatment.
Are you or a loved one struggling with hyperactivity, impulsiveness, or social challenges? CCA is here to help! Call us today to begin your assessment and create a personalized plan of care to address the root causes and achieve positive change.
References
Cordova, M. M., Antovich, D. M., Ryabinin, P., Neighbor, C., Mooney, M. A., Dieckmann, N. F., Miranda-Dominguez, O., Nagel, B. J., Fair, D. A., & Nigg, J. T. (2022). Attention-deficit/hyperactivity disorder: Restricted phenotypes prevalence, comorbidity, and polygenic risk sensitivity in the ABCD baseline cohort. Journal of the American Academy of Child & Adolescent Psychiatry, 61(10), 1273-1284. https://doi.org/10.1016/j.jaac.2022.04.021
Frye, D. (2024, September 3). Diagnosed as an adult. Psychology Today. https://www.psychologytoday.com/us/articles/202409/diagnosed-as-an-adult
Navidad, A. E. (2023, September 7). Rosenhan (1973) experiment – ‘On being sane in insane places’. Simply Psychology. https://www.simplypsychology.org/rosenhan_experiment.html
Surís, A., Holliday, R., & North, C. S. (2016). The evolution of the classification of psychiatric disorders. Behavioral Science (Basel), 6(1), 5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4810039/
Li, Y., Yan, X., Li, Q., Li, Q., Xu, G., Lu, J., & Yang, W. (2023, October 4). The prevalence of ADHD in US children increased from 6.1% in 1997–1998 to 10.2% in 2015–2016. In 2018, the prevalence was estimated to be 9–10%. JAMA Network Open. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2810136
