Your child might be taking an ADHD drug he doesn't need

Some kids kick off the new school year with their best behavior. Others squirm, fidget, run about excessively, fail to pay attention, make careless mistakes, interrupt, lose their homework, and forget their books. That's normal childhood behavior. Yet those are also the symptoms of one of the most common behavioral disorders diagnosed among school-age children in the U.S.: attention-deficit hyperactivity disorder (ADHD).

That blurry line makes ADHD hard to diagnose. As a result, some children who don't have ADHD or have only mild problems will be unnecessarily labeled and medicated, according to a recent analysis by researchers in Australia and the Netherlands published in the British Medical Journal. That can do your child more harm than good. So it's important to get an accurate diagnosis and make sure your child's symptoms are serious enough to require a drug. Here's what you need to know.

Read the Consumer Reports Best Buy Drugs report for more on drugs used to treat ADHD.

ADHD is difficult to diagnose

There is no MRI, CT scan, or any other objective test for ADHD. Instead, parents and teachers typically check off the child's symptoms on questionnaires that are used to help doctors diagnose ADHD. But many people have ADHD symptoms without having a disorder. To distinguish between normal and abnormal behavior, guidelines for diagnosing ADHD also require that symptoms occur often and in several locations, for example, at home, in the classroom, and in the playground. Symptoms should persist for at least six months, and make it difficult for the child to get along with others or do well in school.

Yet many children get an ADHD diagnosis without meeting all of the requirements, the BMJ study authors say. They're also concerned that new criteria could potentially lead to more uncertain diagnoses. For example, symptoms can now start by age 12 instead of age 7. As a result, difficult behavior that normally crops up during puberty might be confused with ADHD. 

ADHD diagnosis is increasing

Diagnoses of ADHD among children and adolescents have increased, along with prescriptions for drugs to treat it, reports suggest. A 2013 study by the national Centers for Disease Control and Prevention found that the number of diagnoses of ADHD in American children ages 4 to 17 jumped 42 percent in the previous eight years. More than one in 10 kids in the U.S. have received a diagnosis of the disorder.

The increase may reflect better detection of ADHD, but it may also stem from inappropriate diagnoses. The number of diagnoses of ADHD varies widely between states in the U.S. and between countries, raising questions about how carefully and consistently the disorder is diagnosed. The requirements for a diagnosis of ADHD have also changed several times, each time expanding to include more children. In addition, studies show that the youngest children in a classroom are more likely than older children in the same classroom to be given an ADHD diagnosis. Younger children are typically less mature, and their comparative immaturity may be mistaken for ADHD.

Medication not always necessary

Most American children with ADHD have mild or moderate forms of the disorder, yet the majority of those with the diagnosis are prescribed medication. A 2014 report from the CDC on ADHD care in Georgia, 4- and 5-year-olds in the Georgia Medicaid system with the disorder diagnosis were more likely to receive medication than behavioral therapy, even though therapy—not drugs—is the treatment of choice for very young children.

Even more disturbing, the CDC estimates that at least 10,000 toddlers in the U.S. may be medicated for ADHD. There are no guidelines for diagnosing and treating ADHD in children younger than 4 and most of the drugs aren't even approved for children younger than 6.

Read about other drugs used to treat ADHD: Are too many kids taking antipsychotic drugs?

There are risks with taking ADHD drugs

The main drugs used to treat ADHD are stimulants. While generally safe, they may have troubling side effects. The drugs can suppress your child's growth (long-term growth effects are being studied), cause psychotic symptoms such as hallucinations or manic behavior, and worsen other conditions, including tics and bipolar disorder. They may cause liver damage and suicidal thoughts, and have been linked to rare cases of sudden death in children and adolescents with heart problems.

A label of ADHD can lead to additional harms. Other kids may assume the child is less intelligent. Teachers and parents may expect the child to do poorly in school, and that could create a self-fulfilling prophecy.