Date of Submission

2015

Degree Type

Dissertation

Degree Name

Doctor of Psychology (PsyD)

Department

Psychology

Department Chair

Robert A DiTomasso, PhD, ABPP, Chair, Department of Psychology

First Advisor

Beverly White, PsyD, Chairperson

Second Advisor

Susan Panichelli Mindel, PhD

Third Advisor

Steven Berkowitz, MD

Abstract

Attention Deficit Hyperactivity Disorder (ADHD) has been one of the most diagnosed disorders in children since it was included in the Diagnostic and Statistical Manual of Mental Disorders−III (DSM−III) in 1980. The number of children who have been diagnosed since that time has grown significantly, raising concerns about the overwhelming number of young children being diagnosed and prescribed medication. According to the literature, young children are diagnosed at a higher rate by pediatric primary care physicians (PCPs) than clinical child psychologists (CCPs) because they are taken to a PCP’s office by a parent, rather than referred from a school environment, where such behaviors would be presenting as problematic. There is a concern that PCPs lack the knowledge and skill to properly diagnose ADHD, including the criterion that symptoms be present in at least two environments, such as home and school. Because young children are not in school, the potential for misdiagnosis is greater. PCPs and CCPs have little to no training in diagnosing ADHD in young children, and there are no criteria in the Diagnostic and Statistical Manual of Mental Disorders−IV (DSM−IV) for children under age 7. Also DSM−IV criteria do not address differences in symptom presentation between young children and school-aged children or between ADHD and PTSD as a differential diagnosis. ADHD also presents an additional diagnostic dilemma because the symptomatology overlaps with PTSD. PTSD could be overlooked and therefore yield a misdiagnosis of ADHD. Proper skill and training are necessary for PCPs and CCPs to make a diagnosis of ADHD by definitively ascertaining that all environmental/salient factors have been considered to rule out symptoms that may be transient due to adverse childhood experiences (ACEs) related to complex trauma or PTSD. The addition of PTSD for children 6 years and younger in the recent release of DSM−5 in 2013 may help PCPs and CCPs to differentiate between ADHD and PTSD. This study investigates the differences between PCPs and CCPs in making a diagnosis of ADHD or PTSD in preschool-aged children, along with the ACEs each utilized in their decision-making process.

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