(2014-09-17) Alexander Joint Over And Underdiagnosis

Scott Alexander: Joint Over- and Underdiagnosis. Today I had several more terrible lectures on ADHD.

So I asked one of my attendings, Dr. L, which one it was. Are we overdosing ADHD? Or underdiagnosing it? He answered that we are both overdiagnosing and underdiagnosing ADHD, the same as every other psychiatric disease, and then explained this so it made perfect sense and I was embarassed for not realizing it before.

The Conners Continuous Performance Test is a commonly used test that evaluates children for ADHD. It is found to have a sensitivity of 75% and a specificity of 73%. In theory our system is based on faith that a trained psychiatrist can do better than a neuropsychological test; in practice they probably do much worse.

So we have three things that, surprisingly, all happen at once:

1. We have an excellent psychiatrist who outperforms the tests and is right 85% of the time.
2. The majority of people who are on Ritalin, shouldn’t be.
3. The majority of people who should be on Ritalin, aren’t.

Once I understood this joint-overdiagnosis-and-underdiagnosis problem, several other candidate situations immediately leapt to mind. Antidepressants are almost certainly both overprescribed and underprescribed. So are opiate pain medications.