October 29, 2025 • 19 mins
Every October 31st, kids go wild - costumes, sugar, excitement - but what if that same energy is quietly shaping ADHD diagnoses? In this Doctor’s Desk episode, Justin and Kylie unpack a fascinating new study showing a 14% spike in ADHD diagnoses on Halloween day. They explore what this says about subjectivity in diagnosis, the risks of overlabelling kids, and how our environments - not just our children - might need rethinking.
KEY POINTS:
- A new Harvard study found ADHD diagnoses rise 14% on Halloween compared to surrounding days.
- ADHD remains a subjective diagnosis — there’s no blood test or scan to confirm it.
- Why environment and maturity often explain behaviours mistaken for “disorder.”
- The real risks of misdiagnosis — medication, labelling, and self-perception.
- Why it’s time to look at what’s happening around kids, not just within them.
QUOTE OF THE EPISODE:
“There isn’t anything wrong with her — she just doesn’t fit the mould of what we consider normal.”
RESOURCES MENTIONED:
- Study: Halloween, ADHD, and Subjectivity in Medical Diagnosis (National Bureau of Economic Research)
- Searching for Normal by Sami Timimi
- The Parenting Revolution by Justin Coulson
ACTION STEPS FOR PARENTS:
- Before seeking a diagnosis, consider context — sleep, stress, diet, and school environment.
- Avoid rushing to label; focus on understanding and supporting your child’s unique needs.
- Ask questions — about treatment pathways, environment, and alternative perspectives.
- Create calmer spaces where kids can regulate, play, and thrive.
See omnystudio.com/listener for privacy information.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
Today this is the Happy Families podcast, and tomorrow it
is one of the most important days on.
Speaker 2 (00:10):
The calendar.
Speaker 1 (00:14):
For people who love traditions like running around neighborhoods looking
like Goblin's guls which is skeletons and those europumpkin and
knocking on the doors of strangers and asking for treats.
Today it's a doctor's Desk episode with a difference. Recent
research indicates that one of the most popular, one of
(00:37):
the most common childhood diagnoses is related to Halloween. We're
going to explore that, what it means, what the implications
are for us as parents, and for this specific diagnosis
not to mention Halloween right after the break.
Speaker 2 (00:54):
Stay with us.
Speaker 1 (01:00):
Real parenting solutions every day in Australia's most downloaded parenting podcast.
That's just one the Happy Family's podcast where Justin and
Kylie calls some parents of six kids.
Speaker 2 (01:06):
I'm the co host and parenting expert.
Speaker 3 (01:09):
Show Parental seriously slowed down, what do you mean you're
like and energizer Bunny.
Speaker 1 (01:16):
It's a doctor's desk episode. I get very excited about
doctor's desk.
Speaker 3 (01:20):
That's one of us.
Speaker 1 (01:21):
Yeah, I can see the enthusiasm oozing just oozing out
of your pause. You know it's going to be oozing
out of everyone's paws tomorrow. Sugar, sugar, Yeah, Halloween tomorrow.
Our opinion this year, like we've gone gung ho a
couple of times with Halloween, our opinion this year is
not couldn't be bothered too much, sugar, too tired, too
(01:42):
much else going on too hot?
Speaker 2 (01:45):
Can you come up with another to something just just
not happening?
Speaker 3 (01:49):
I came up with the best Halloween decoration. Oh yeah,
our new pool has colored lights. I'm just going to
make the pool.
Speaker 2 (01:57):
Red blood red.
Speaker 3 (01:58):
Done.
Speaker 2 (01:59):
That's gross, It's done, all right.
Speaker 1 (02:01):
Today's Doctor's Desk, Kylie, you set it up because I'm
going to do a lot of talking in this one.
This is probably that's why you don't like the doctor's Desk?
Isn't it because I do all the talking. I get
science y? Is it the science or is it the
fact that you're not talking as much as you want to?
Speaker 2 (02:15):
Look?
Speaker 3 (02:15):
I don't. I don't keep very quiet about the fact
that I don't really enjoy many of the doctor's desks.
But I am actually intrigued about this one.
Speaker 2 (02:23):
This one's a cracker.
Speaker 3 (02:24):
So there's been some research done recently that would suggest
that ADHD diagnoses actually increase during Halloween.
Speaker 2 (02:36):
Correct. Okay, so this is a brand new study.
Speaker 1 (02:38):
It came out a couple of months ago, and it
caught my attention because over the years, ADHD, even though
more and more people are aware of it, more and
more people are being diagnosed with it. ADHD has become
an increasingly provocative diagnosis. I mean, most diseases, as we
learn more about them, they become easier for us to understand.
But ADHD seems to be going the other way. And
(03:00):
in a recent working paper that was published in the
National Bureau of Economic Research, and the paper is called
Halloween ADHD and Subjectivity in Medical Diagnosis, some Harvard research
has spotted an opportunity for a wonderful natural experiment that
the calendar provides with the Halloween holiday and kids getting
a little bit hyper because of all the sugar and
(03:20):
the social opportunity and the running around the neighborhood and
doing what they're doing. So, though, were really curious where
the changes in young patients' behavior related to the excitement
of wearing a costume and collecting lawies on Halloween might
influence the diagnosis of ADHD. Now analyze the data on
more than one hundred million pediatric visits. Okay, so this
is no small sample. This is legitimately a serious study.
(03:44):
And what they found is this, there's a fourteen percent
increase in childhood ADHD diagnoses on Halloween compared to the
ten surrounding weekdays. I'll say that again, a fourteen percent
increase on Halloween compared with the ten surrounding weekdays.
Speaker 3 (04:03):
So when you're talking about a hundred.
Speaker 1 (04:06):
Million pediatric visits, yep.
Speaker 3 (04:10):
Fourteen percent is a big deal.
Speaker 2 (04:12):
That's a large number. That's huge.
Speaker 1 (04:14):
Yes, Yes, for that particular diagnosis on that particular day
compared to all the other days around it. There must
be something particularly unique about October thirty first that makes
for ADHD diagnoses more likely.
Speaker 3 (04:28):
As you're talking, it reminds me of a conversation I
just recently had with your mum. She actually was going
through some old journal entries and she shared the funniest one.
She's acknowledged that she's been on a bit of a
rampage and she was really unkind to everybody. And then
she kind of paused and she said, I wonder if
(04:49):
it had anything to do with the fourteen Ferrera rishiance
that I hate that day, so I don't think this
is just a kid thing.
Speaker 2 (04:57):
Yeah, that's such a good story. I was hearing where
you're going there. I do remember that story. I ate
fourteen Ferrero risches and.
Speaker 1 (05:03):
Then I was horrible to everybody. For us today made
me feel good, but it made everyone else really really annoying.
Speaker 3 (05:08):
But the funniest part was she says, I'm never going
to eat chocolate again. Right, Your mom is the biggest
chocoholic I know.
Speaker 1 (05:15):
I think that I've heard her say that over the
years since I've known her at least four hundred times,
at least probably four thousand times.
Speaker 3 (05:23):
And you tell her that you're giving up chocolate and
she just keeps skipping.
Speaker 1 (05:27):
She yeah, that's right because when she gives up chocolate
as meaningless. So if anyone else is giving it up,
they mustn't be giving it up either. All right, let's
talk about this study. Does that spark any questions for you?
Is there anything that you'd like to know?
Speaker 3 (05:39):
Well, I guess let's go back to the beginning. How
is ADHD actually diagnosed?
Speaker 1 (05:44):
So this is really important because in medicine, the first
step is you've got to get the diagnosis accurate.
Speaker 2 (05:50):
And yet there's a whole lot.
Speaker 1 (05:51):
Of conditions including attention deficit hyperactive. I can't say now
ADHD attention deficit hyperactive hyperactivity disorder that requires pediatricians and
GPS and mental health professionals to rely on much more
subjective criteria like the observation of symptoms and behaviors. See,
(06:12):
you can do a blood test and work out whether
somebody is diabetic. You can do an X ray and
work out whether somebody's broken their arm, but you cannot
scan a person's brain or take a blood test and
discover whether they have ADHD. We do not have objective
measures for it, and this is one of the major
criticisms of ADHD. So to diagnose ADHD, which is getting
(06:35):
to the core of the question you asked, there is
a formalism that goes into the diagnosis, but ultimately it's
a snapshot of somebody's subjective opinion. So pediatricians, shod mental
health specialists, whoever it is. What they do is they
assess a pattern of behavior across school life and life
at home, maybe other context as well, if they're relevant.
(06:55):
They get information from parents, from teachers, and then they
pretty much what's going on here. But the actual diagnosis
will happen on a specific day, So when the doctor's
making that diagnosis, the conditions that are occurring on that
specific day could influence whether or not. Let's say that
mental health specialist is on the fence, but on that
(07:18):
particular day, it's Halloween and the kids are a bit
hyper and there's a whole lot of sugar and junk
and costumes and excitement, and they're like, yeah, your child
does seem pretty edgy today. And they're not thinking hm,
because it's Halloween. They're just going, your child seems edgy.
And we're talking about ADHD. So ADHD is diagnosed subjectively.
There are no objective measures for it. The criteria are
loose and are becoming looser. They have become looser over
(07:39):
the last couple of decades, and that is problematic. I'm
not gonna lie about it, like that is a really
big problem for ADHD diagnosis.
Speaker 3 (07:49):
Can you elaborate a bit more on the subjectivity of
this diagnosis.
Speaker 1 (07:53):
Yeah, So we've been through this with our own kids,
so you.
Speaker 3 (07:55):
See, Well, I'm thinking back to that experience, and I'm
thinking back to the day I walked in. I mean,
I was convinced that we had a very different child
to the rest of our children. But that particular day,
it was like she pulled out every conceivable behavior challenge
(08:16):
that we'd had and displayed it for the psychologists. Literally,
I had never seen her that bad before, but she
had displayed all of those things individually at different times.
Speaker 2 (08:31):
Yeah, that's right.
Speaker 3 (08:32):
It wasn't Halloween eitherm No.
Speaker 1 (08:34):
Well, who knows it could have been, but it wouldn't
have been a big deal for us anyway, because we
don't really do much about it.
Speaker 2 (08:38):
So the diagnosis, the.
Speaker 1 (08:39):
Diagnostic criteria for ADHD is literally subjectivity is baked in.
It's part of how you assess ADHD. You cannot assess
ADHD without the subjective responses. So, and I remember you
saying this as we went through the checklist for our children.
There's a question like, is this child fidgety?
Speaker 2 (09:00):
They restless?
Speaker 1 (09:01):
Do they move their bodies a lot? Do they talk
when they should be talking? They interrupt and.
Speaker 3 (09:07):
They are all childlike behaviors.
Speaker 1 (09:08):
Well, every child does, that's right, And so to adults,
what do you mean. I would never interrupt anybody, my goodness,
And so obviously, when you're talking about parents, they don't
necessarily know how everyone else's kids are. Teachers will have
a much broader population to sample from and say, oh
my goodness.
Speaker 3 (09:27):
But I guess that's why part of that testing process
involves other professionals to kind of collaborate.
Speaker 1 (09:35):
Well supposedly, but they're going to be guided by what
the parents are saying and by what the teachers are saying.
So that's only so helpful. But that's how the subjectivity
comes into play. This is the Doctor's Desk episode of
Heavy Families podcast. We're talking about ADHD and Halloween and
whether or not the diagnosis that you get are actual
diagnosis or whether there's too much subjectivity involved. More on
this in just a sex Stay with us. We're back
(10:04):
with the Happy Families podcast, Real Parenting Solutions every day
on Australia's most downloaded parenting podcast. You have another question
on the tip of your ton.
Speaker 3 (10:12):
Well, from what you've shared previously, it would suggest to
me that you think that often there's misdiagnosis happen and
if that's the case, what is problematic with that?
Speaker 1 (10:25):
So this is really really difficult because this whole conversation,
I know that we're going to get emails from people
who say that I'm invalidating their diagnoses or that I'm
giving short shrifts to ADHD. I mean, I've got a
course out there to help parents who are raising kids
who have a diagnosis. Right, So I recognize that if
you've got a constellation of behaviors that are challenging, then
(10:45):
you need help with them. And you can call it
ADHD or you can call it challenging behavior. It doesn't
really matter. What we've got to do is work out
how to help. And I'm concerned about treatment pathways. That's
the medical jargon, the technical term for when you get diagnosis.
Here are the steps that are supposed to be followed.
This is what most people will be focused on. So
let's say, in the context of this study, you take
(11:08):
your child in on the wrong day and the likelihood
of them getting a diagnosis is significantly higher. Let's say
you've got two or three kids that are being diagnosed.
Two might be diagnosed on in a given day, but
on Halloween that goes up to three because the subjective
cultural environment that's changing things. And the problem to answer
(11:31):
your question with misdiagnosis is that means that that's one
more child that's wearing a label. It means it's one
more child who is going to potentially end up with
a medication prescription, one more child that's going to end
up on speed, one more child who's going to now
feel like not only do they already feel different, but
now they've got a label confirming they're different. And I've
(11:52):
always been pretty clear on the podcast, I understand that
in some cases labels can be really, really helpful, but
I find all too often that labels are used to
explain away, rather than support change in behavior.
Speaker 3 (12:04):
Recently, I had a conversation with a specialist in relation
to our daughter, and they definitely wanted to push me
down a specific line of treatment, and I just said
to her, I said, at this point in time, she's
completely unaware that she's different. And I said, I just
(12:24):
I'm going to bubble that for as long as I can,
because she doesn't think there's anything wrong with her.
Speaker 1 (12:31):
So this goes to what I think is a much
deeper and broader discussion about ADHD. And it's also a
really hard one to talk about. And again, this is
the kind of thing that gets people really upset. I'm
not trying to be insensitive. This is a sensitive but.
Speaker 3 (12:44):
The reality is there isn't anything wrong with her, thank you.
There isn't anything wrong with her, right she just doesn't
fit the mold of what we consider normal.
Speaker 1 (12:55):
And there's so much variation in normal. That's exactly why
I'm reading this book. I'm almost finished Searching for Normal
by Sammy Timimi. I love this book. I also hate it,
but I love this book. This book is worth so
much in terms of the conversations and the provocations and
the thoughtfulness that it gives. And what this study does
is it reaffirms a lot of what I've been reading
(13:17):
in this book and certainly some of my own misgivings
about this specific diagnosis over the last decade as I've
learned more and more and more about it and gone.
Speaker 2 (13:25):
Deeper and deeper into it.
Speaker 1 (13:26):
So about ten percent of Australian kids and now being diagnosed.
Boys are significantly more likely to be diagnosed than girls
because they mature later, they learn to regulate and inhibit later.
And there are really big questions being asked because there
is no blood test and there's no brain scan, there's
(13:47):
no objective criteria here. Some people are saying, well, is
it really a disorder, like these are questions that we
were asking twenty years ago, and now we've gone really
hardcore for the last twenty years down this Yes it is,
diagnose it that path, and now we're having really really
smart people, really incredible people, say we need to rethink this.
(14:08):
We may not have gotten this right. Is this within
some range of normal? To speak to your point, that's
what brought me back to where we are here. Medication
is the right answer. So this is a massive debate,
massive debate in educational circles, in psychological circles, in medical circles,
in psychiatric circles. It's a really big thing. People are
concerned about overdiagnosis. They're concerned about drugs, they're concerned about overtreatment,
(14:31):
they're concerned about harm, and they're also concerned about underdiagnosis
and undertreatment of kids in populations where help is often
not available. It's a really, really tricky thing to discuss
without upsetting people. But again, you look at what the diagnosis,
the diagnostic criteria are. You look at the fact that
you've got more kids than ever in the younger stage,
(14:54):
younger parts of the cohort getting the diagnosis, and you've
got to wonder if we're actually diagnosing ABA or immaturity.
Speaker 3 (15:01):
More than that, though, when we look at the increase
of diagnoses over the last decade or so, would it
not be wise to actually question the environment our kids
are in.
Speaker 2 (15:16):
You haven't read the book, but this is what sent
me to me.
Speaker 1 (15:18):
Me says, He says, Let's stop saying that there's a
problem with this child individually, and let's start saying what
is going on in the environment that so many children
are now receiving a diagnosis that once upon a time
did not even exist.
Speaker 3 (15:29):
That's exactly right. You take a child out of that
specific environment, and all of a sudden, their behavior changes.
Speaker 2 (15:36):
I had this exact conversation with some parents the other day.
Speaker 1 (15:39):
I made a glib and strong statement about ADHD, probably
much stronger than I really meant to. Someone got offended,
and then we had a much broader, in depth conversation
like this, And that's the point that I made. You
take that child out of the classroom or out of
a screen soap setting.
Speaker 2 (15:54):
And put them into a play basis.
Speaker 1 (15:55):
Or out of the dictatorship, right and give them some autonomy.
Speaker 3 (16:00):
And all of a sudden, we see such a different
child presented.
Speaker 2 (16:06):
That's right.
Speaker 1 (16:07):
So this is an important study. I really think that
it's an important study because it's again raising questions and saying,
what are we doing here with this diagnosis?
Speaker 3 (16:15):
So does it actually shed any light on ADHD itself?
Speaker 1 (16:18):
I only and this is a very quick answer. It
just highlights how subjective the diagnosis is. To me, that's
the critical thing.
Speaker 3 (16:25):
We've kind of touched on this a few times, but
just a little bit of clarity here. It is interesting
to me that with all the research we have on
ADHD these days, comparative to ten twenty years ago, why
is it that we still I feel like we've got
less clarity now with all the research we have than
(16:46):
we've ever had around ADHD.
Speaker 1 (16:49):
So Annaple Jenna, who was one of the researchers here,
wrote a book a few years ago called Random Acts
of Medicine, and there's a finding reported in that book,
but also reported in Countless of a PAS that kids
who are born at the late part of the year
tend to be much more likely to be diagnosed with
ADHD than kids born at the start of the year. Okay,
(17:11):
so in Australia the school year, if you're born later
in the year. It depends on where the cutoffs are,
but basically, if you're the youngest kid in the year,
you're much more likely to be diagnosed with it. The
reason is that you're the youngest person in the class,
so your behavior is a bit different and we start
to make these diagnoses. So realistically, what I think here
is that the implication is that a lot of the
(17:32):
kids that are getting a diagnosis may not have ADHD.
They're just different because they've been alive for one year
less than the older kids in the class. And if
you're a general practitioner or if you're a psychologist and
you're making an ADHD diagnosis, you want to make sure
that you're taking into account birthday, and you want to
take into account gender, and you want to take into
(17:54):
account what else has been going on in that child's environment.
Speaker 2 (17:57):
There is so much other stuff that.
Speaker 3 (17:59):
Screen and how much outdoor time and how much connective
time they're having, Like, there's so many factors to a
round out a healthy human being.
Speaker 1 (18:09):
And that is our doctor's desk episode. I mean, I'd
love to keep talking about it, but our time as well,
and truly up, do you have any other questions?
Speaker 3 (18:15):
No, I think we've covered it.
Speaker 2 (18:16):
All all right, nowhere is it all?
Speaker 1 (18:18):
So we'll link to the study in the show notes.
We'll also link to Sammy to Mimi's book Searching for
Normal in the show notes. I'm very excited. Just as
I started to finish the book, as I moved into
the last chapter, I got an email from the publicist
of the book and they said, would you like him
on your podcast? So We're going to interview him early
next year and I'm going to go into a lot
(18:38):
of depth on exactly this topic. It's just too important
to not talk about more.
Speaker 3 (18:42):
Oh, I'm looking forward to that one.
Speaker 1 (18:43):
I love it when you look forward to my interviews
with amazing people. Hey, thanks so much for listening to
the Doctor's Desk episode of the Happy Families podcast. The
podcast is produced by Justin Roland from Bridge Media. Mim
Hammond's provides admin, research and additional support.
Speaker 2 (18:56):
And if you'd like.
Speaker 1 (18:57):
More info about the stuff we've talked about, please have
a quick look at the show notes and we will
link to everything that you need there. If you'd like
a resource to help because you've got a child who
is behaving in challenging ways, check out my book Parental guidance.
You can get it online wherever you find books in
bookstores and happy families dot com, dot A, you
Today this is the Happy Families podcast, and tomorrow it
is one of the most important days on.
Speaker 2 (00:10):
The calendar.
Speaker 1 (00:14):
For people who love traditions like running around neighborhoods looking
like Goblin's guls which is skeletons and those europumpkin and
knocking on the doors of strangers and asking for treats.
Today it's a doctor's Desk episode with a difference. Recent
research indicates that one of the most popular, one of
(00:37):
the most common childhood diagnoses is related to Halloween. We're
going to explore that, what it means, what the implications
are for us as parents, and for this specific diagnosis
not to mention Halloween right after the break.
Speaker 2 (00:54):
Stay with us.
Speaker 1 (01:00):
Real parenting solutions every day in Australia's most downloaded parenting podcast.
That's just one the Happy Family's podcast where Justin and
Kylie calls some parents of six kids.
Speaker 2 (01:06):
I'm the co host and parenting expert.
Speaker 3 (01:09):
Show Parental seriously slowed down, what do you mean you're
like and energizer Bunny.
Speaker 1 (01:16):
It's a doctor's desk episode. I get very excited about
doctor's desk.
Speaker 3 (01:20):
That's one of us.
Speaker 1 (01:21):
Yeah, I can see the enthusiasm oozing just oozing out
of your pause. You know it's going to be oozing
out of everyone's paws tomorrow. Sugar, sugar, Yeah, Halloween tomorrow.
Our opinion this year, like we've gone gung ho a
couple of times with Halloween, our opinion this year is
not couldn't be bothered too much, sugar, too tired, too
(01:42):
much else going on too hot?
Speaker 2 (01:45):
Can you come up with another to something just just
not happening?
Speaker 3 (01:49):
I came up with the best Halloween decoration. Oh yeah,
our new pool has colored lights. I'm just going to
make the pool.
Speaker 2 (01:57):
Red blood red.
Speaker 3 (01:58):
Done.
Speaker 2 (01:59):
That's gross, It's done, all right.
Speaker 1 (02:01):
Today's Doctor's Desk, Kylie, you set it up because I'm
going to do a lot of talking in this one.
This is probably that's why you don't like the doctor's Desk?
Isn't it because I do all the talking. I get
science y? Is it the science or is it the
fact that you're not talking as much as you want to?
Speaker 2 (02:15):
Look?
Speaker 3 (02:15):
I don't. I don't keep very quiet about the fact
that I don't really enjoy many of the doctor's desks.
But I am actually intrigued about this one.
Speaker 2 (02:23):
This one's a cracker.
Speaker 3 (02:24):
So there's been some research done recently that would suggest
that ADHD diagnoses actually increase during Halloween.
Speaker 2 (02:36):
Correct. Okay, so this is a brand new study.
Speaker 1 (02:38):
It came out a couple of months ago, and it
caught my attention because over the years, ADHD, even though
more and more people are aware of it, more and
more people are being diagnosed with it. ADHD has become
an increasingly provocative diagnosis. I mean, most diseases, as we
learn more about them, they become easier for us to understand.
But ADHD seems to be going the other way. And
(03:00):
in a recent working paper that was published in the
National Bureau of Economic Research, and the paper is called
Halloween ADHD and Subjectivity in Medical Diagnosis, some Harvard research
has spotted an opportunity for a wonderful natural experiment that
the calendar provides with the Halloween holiday and kids getting
a little bit hyper because of all the sugar and
(03:20):
the social opportunity and the running around the neighborhood and
doing what they're doing. So, though, were really curious where
the changes in young patients' behavior related to the excitement
of wearing a costume and collecting lawies on Halloween might
influence the diagnosis of ADHD. Now analyze the data on
more than one hundred million pediatric visits. Okay, so this
is no small sample. This is legitimately a serious study.
(03:44):
And what they found is this, there's a fourteen percent
increase in childhood ADHD diagnoses on Halloween compared to the
ten surrounding weekdays. I'll say that again, a fourteen percent
increase on Halloween compared with the ten surrounding weekdays.
Speaker 3 (04:03):
So when you're talking about a hundred.
Speaker 1 (04:06):
Million pediatric visits, yep.
Speaker 3 (04:10):
Fourteen percent is a big deal.
Speaker 2 (04:12):
That's a large number. That's huge.
Speaker 1 (04:14):
Yes, Yes, for that particular diagnosis on that particular day
compared to all the other days around it. There must
be something particularly unique about October thirty first that makes
for ADHD diagnoses more likely.
Speaker 3 (04:28):
As you're talking, it reminds me of a conversation I
just recently had with your mum. She actually was going
through some old journal entries and she shared the funniest one.
She's acknowledged that she's been on a bit of a
rampage and she was really unkind to everybody. And then
she kind of paused and she said, I wonder if
(04:49):
it had anything to do with the fourteen Ferrera rishiance
that I hate that day, so I don't think this
is just a kid thing.
Speaker 2 (04:57):
Yeah, that's such a good story. I was hearing where
you're going there. I do remember that story. I ate
fourteen Ferrero risches and.
Speaker 1 (05:03):
Then I was horrible to everybody. For us today made
me feel good, but it made everyone else really really annoying.
Speaker 3 (05:08):
But the funniest part was she says, I'm never going
to eat chocolate again. Right, Your mom is the biggest
chocoholic I know.
Speaker 1 (05:15):
I think that I've heard her say that over the
years since I've known her at least four hundred times,
at least probably four thousand times.
Speaker 3 (05:23):
And you tell her that you're giving up chocolate and
she just keeps skipping.
Speaker 1 (05:27):
She yeah, that's right because when she gives up chocolate
as meaningless. So if anyone else is giving it up,
they mustn't be giving it up either. All right, let's
talk about this study. Does that spark any questions for you?
Is there anything that you'd like to know?
Speaker 3 (05:39):
Well, I guess let's go back to the beginning. How
is ADHD actually diagnosed?
Speaker 1 (05:44):
So this is really important because in medicine, the first
step is you've got to get the diagnosis accurate.
Speaker 2 (05:50):
And yet there's a whole lot.
Speaker 1 (05:51):
Of conditions including attention deficit hyperactive. I can't say now
ADHD attention deficit hyperactive hyperactivity disorder that requires pediatricians and
GPS and mental health professionals to rely on much more
subjective criteria like the observation of symptoms and behaviors. See,
(06:12):
you can do a blood test and work out whether
somebody is diabetic. You can do an X ray and
work out whether somebody's broken their arm, but you cannot
scan a person's brain or take a blood test and
discover whether they have ADHD. We do not have objective
measures for it, and this is one of the major
criticisms of ADHD. So to diagnose ADHD, which is getting
(06:35):
to the core of the question you asked, there is
a formalism that goes into the diagnosis, but ultimately it's
a snapshot of somebody's subjective opinion. So pediatricians, shod mental
health specialists, whoever it is. What they do is they
assess a pattern of behavior across school life and life
at home, maybe other context as well, if they're relevant.
(06:55):
They get information from parents, from teachers, and then they
pretty much what's going on here. But the actual diagnosis
will happen on a specific day, So when the doctor's
making that diagnosis, the conditions that are occurring on that
specific day could influence whether or not. Let's say that
mental health specialist is on the fence, but on that
(07:18):
particular day, it's Halloween and the kids are a bit
hyper and there's a whole lot of sugar and junk
and costumes and excitement, and they're like, yeah, your child
does seem pretty edgy today. And they're not thinking hm,
because it's Halloween. They're just going, your child seems edgy.
And we're talking about ADHD. So ADHD is diagnosed subjectively.
There are no objective measures for it. The criteria are
loose and are becoming looser. They have become looser over
(07:39):
the last couple of decades, and that is problematic. I'm
not gonna lie about it, like that is a really
big problem for ADHD diagnosis.
Speaker 3 (07:49):
Can you elaborate a bit more on the subjectivity of
this diagnosis.
Speaker 1 (07:53):
Yeah, So we've been through this with our own kids,
so you.
Speaker 3 (07:55):
See, Well, I'm thinking back to that experience, and I'm
thinking back to the day I walked in. I mean,
I was convinced that we had a very different child
to the rest of our children. But that particular day,
it was like she pulled out every conceivable behavior challenge
(08:16):
that we'd had and displayed it for the psychologists. Literally,
I had never seen her that bad before, but she
had displayed all of those things individually at different times.
Speaker 2 (08:31):
Yeah, that's right.
Speaker 3 (08:32):
It wasn't Halloween eitherm No.
Speaker 1 (08:34):
Well, who knows it could have been, but it wouldn't
have been a big deal for us anyway, because we
don't really do much about it.
Speaker 2 (08:38):
So the diagnosis, the.
Speaker 1 (08:39):
Diagnostic criteria for ADHD is literally subjectivity is baked in.
It's part of how you assess ADHD. You cannot assess
ADHD without the subjective responses. So, and I remember you
saying this as we went through the checklist for our children.
There's a question like, is this child fidgety?
Speaker 2 (09:00):
They restless?
Speaker 1 (09:01):
Do they move their bodies a lot? Do they talk
when they should be talking? They interrupt and.
Speaker 3 (09:07):
They are all childlike behaviors.
Speaker 1 (09:08):
Well, every child does, that's right, And so to adults,
what do you mean. I would never interrupt anybody, my goodness,
And so obviously, when you're talking about parents, they don't
necessarily know how everyone else's kids are. Teachers will have
a much broader population to sample from and say, oh
my goodness.
Speaker 3 (09:27):
But I guess that's why part of that testing process
involves other professionals to kind of collaborate.
Speaker 1 (09:35):
Well supposedly, but they're going to be guided by what
the parents are saying and by what the teachers are saying.
So that's only so helpful. But that's how the subjectivity
comes into play. This is the Doctor's Desk episode of
Heavy Families podcast. We're talking about ADHD and Halloween and
whether or not the diagnosis that you get are actual
diagnosis or whether there's too much subjectivity involved. More on
this in just a sex Stay with us. We're back
(10:04):
with the Happy Families podcast, Real Parenting Solutions every day
on Australia's most downloaded parenting podcast. You have another question
on the tip of your ton.
Speaker 3 (10:12):
Well, from what you've shared previously, it would suggest to
me that you think that often there's misdiagnosis happen and
if that's the case, what is problematic with that?
Speaker 1 (10:25):
So this is really really difficult because this whole conversation,
I know that we're going to get emails from people
who say that I'm invalidating their diagnoses or that I'm
giving short shrifts to ADHD. I mean, I've got a
course out there to help parents who are raising kids
who have a diagnosis. Right, So I recognize that if
you've got a constellation of behaviors that are challenging, then
(10:45):
you need help with them. And you can call it
ADHD or you can call it challenging behavior. It doesn't
really matter. What we've got to do is work out
how to help. And I'm concerned about treatment pathways. That's
the medical jargon, the technical term for when you get diagnosis.
Here are the steps that are supposed to be followed.
This is what most people will be focused on. So
let's say, in the context of this study, you take
(11:08):
your child in on the wrong day and the likelihood
of them getting a diagnosis is significantly higher. Let's say
you've got two or three kids that are being diagnosed.
Two might be diagnosed on in a given day, but
on Halloween that goes up to three because the subjective
cultural environment that's changing things. And the problem to answer
(11:31):
your question with misdiagnosis is that means that that's one
more child that's wearing a label. It means it's one
more child who is going to potentially end up with
a medication prescription, one more child that's going to end
up on speed, one more child who's going to now
feel like not only do they already feel different, but
now they've got a label confirming they're different. And I've
(11:52):
always been pretty clear on the podcast, I understand that
in some cases labels can be really, really helpful, but
I find all too often that labels are used to
explain away, rather than support change in behavior.
Speaker 3 (12:04):
Recently, I had a conversation with a specialist in relation
to our daughter, and they definitely wanted to push me
down a specific line of treatment, and I just said
to her, I said, at this point in time, she's
completely unaware that she's different. And I said, I just
(12:24):
I'm going to bubble that for as long as I can,
because she doesn't think there's anything wrong with her.
Speaker 1 (12:31):
So this goes to what I think is a much
deeper and broader discussion about ADHD. And it's also a
really hard one to talk about. And again, this is
the kind of thing that gets people really upset. I'm
not trying to be insensitive. This is a sensitive but.
Speaker 3 (12:44):
The reality is there isn't anything wrong with her, thank you.
There isn't anything wrong with her, right she just doesn't
fit the mold of what we consider normal.
Speaker 1 (12:55):
And there's so much variation in normal. That's exactly why
I'm reading this book. I'm almost finished Searching for Normal
by Sammy Timimi. I love this book. I also hate it,
but I love this book. This book is worth so
much in terms of the conversations and the provocations and
the thoughtfulness that it gives. And what this study does
is it reaffirms a lot of what I've been reading
(13:17):
in this book and certainly some of my own misgivings
about this specific diagnosis over the last decade as I've
learned more and more and more about it and gone.
Speaker 2 (13:25):
Deeper and deeper into it.
Speaker 1 (13:26):
So about ten percent of Australian kids and now being diagnosed.
Boys are significantly more likely to be diagnosed than girls
because they mature later, they learn to regulate and inhibit later.
And there are really big questions being asked because there
is no blood test and there's no brain scan, there's
(13:47):
no objective criteria here. Some people are saying, well, is
it really a disorder, like these are questions that we
were asking twenty years ago, and now we've gone really
hardcore for the last twenty years down this Yes it is,
diagnose it that path, and now we're having really really
smart people, really incredible people, say we need to rethink this.
(14:08):
We may not have gotten this right. Is this within
some range of normal? To speak to your point, that's
what brought me back to where we are here. Medication
is the right answer. So this is a massive debate,
massive debate in educational circles, in psychological circles, in medical circles,
in psychiatric circles. It's a really big thing. People are
concerned about overdiagnosis. They're concerned about drugs, they're concerned about overtreatment,
(14:31):
they're concerned about harm, and they're also concerned about underdiagnosis
and undertreatment of kids in populations where help is often
not available. It's a really, really tricky thing to discuss
without upsetting people. But again, you look at what the diagnosis,
the diagnostic criteria are. You look at the fact that
you've got more kids than ever in the younger stage,
(14:54):
younger parts of the cohort getting the diagnosis, and you've
got to wonder if we're actually diagnosing ABA or immaturity.
Speaker 3 (15:01):
More than that, though, when we look at the increase
of diagnoses over the last decade or so, would it
not be wise to actually question the environment our kids
are in.
Speaker 2 (15:16):
You haven't read the book, but this is what sent
me to me.
Speaker 1 (15:18):
Me says, He says, Let's stop saying that there's a
problem with this child individually, and let's start saying what
is going on in the environment that so many children
are now receiving a diagnosis that once upon a time
did not even exist.
Speaker 3 (15:29):
That's exactly right. You take a child out of that
specific environment, and all of a sudden, their behavior changes.
Speaker 2 (15:36):
I had this exact conversation with some parents the other day.
Speaker 1 (15:39):
I made a glib and strong statement about ADHD, probably
much stronger than I really meant to. Someone got offended,
and then we had a much broader, in depth conversation
like this, And that's the point that I made. You
take that child out of the classroom or out of
a screen soap setting.
Speaker 2 (15:54):
And put them into a play basis.
Speaker 1 (15:55):
Or out of the dictatorship, right and give them some autonomy.
Speaker 3 (16:00):
And all of a sudden, we see such a different
child presented.
Speaker 2 (16:06):
That's right.
Speaker 1 (16:07):
So this is an important study. I really think that
it's an important study because it's again raising questions and saying,
what are we doing here with this diagnosis?
Speaker 3 (16:15):
So does it actually shed any light on ADHD itself?
Speaker 1 (16:18):
I only and this is a very quick answer. It
just highlights how subjective the diagnosis is. To me, that's
the critical thing.
Speaker 3 (16:25):
We've kind of touched on this a few times, but
just a little bit of clarity here. It is interesting
to me that with all the research we have on
ADHD these days, comparative to ten twenty years ago, why
is it that we still I feel like we've got
less clarity now with all the research we have than
(16:46):
we've ever had around ADHD.
Speaker 1 (16:49):
So Annaple Jenna, who was one of the researchers here,
wrote a book a few years ago called Random Acts
of Medicine, and there's a finding reported in that book,
but also reported in Countless of a PAS that kids
who are born at the late part of the year
tend to be much more likely to be diagnosed with
ADHD than kids born at the start of the year. Okay,
(17:11):
so in Australia the school year, if you're born later
in the year. It depends on where the cutoffs are,
but basically, if you're the youngest kid in the year,
you're much more likely to be diagnosed with it. The
reason is that you're the youngest person in the class,
so your behavior is a bit different and we start
to make these diagnoses. So realistically, what I think here
is that the implication is that a lot of the
(17:32):
kids that are getting a diagnosis may not have ADHD.
They're just different because they've been alive for one year
less than the older kids in the class. And if
you're a general practitioner or if you're a psychologist and
you're making an ADHD diagnosis, you want to make sure
that you're taking into account birthday, and you want to
take into account gender, and you want to take into
(17:54):
account what else has been going on in that child's environment.
Speaker 2 (17:57):
There is so much other stuff that.
Speaker 3 (17:59):
Screen and how much outdoor time and how much connective
time they're having, Like, there's so many factors to a
round out a healthy human being.
Speaker 1 (18:09):
And that is our doctor's desk episode. I mean, I'd
love to keep talking about it, but our time as well,
and truly up, do you have any other questions?
Speaker 3 (18:15):
No, I think we've covered it.
Speaker 2 (18:16):
All all right, nowhere is it all?
Speaker 1 (18:18):
So we'll link to the study in the show notes.
We'll also link to Sammy to Mimi's book Searching for
Normal in the show notes. I'm very excited. Just as
I started to finish the book, as I moved into
the last chapter, I got an email from the publicist
of the book and they said, would you like him
on your podcast? So We're going to interview him early
next year and I'm going to go into a lot
(18:38):
of depth on exactly this topic. It's just too important
to not talk about more.
Speaker 3 (18:42):
Oh, I'm looking forward to that one.
Speaker 1 (18:43):
I love it when you look forward to my interviews
with amazing people. Hey, thanks so much for listening to
the Doctor's Desk episode of the Happy Families podcast. The
podcast is produced by Justin Roland from Bridge Media. Mim
Hammond's provides admin, research and additional support.
Speaker 2 (18:56):
And if you'd like.
Speaker 1 (18:57):
More info about the stuff we've talked about, please have
a quick look at the show notes and we will
link to everything that you need there. If you'd like
a resource to help because you've got a child who
is behaving in challenging ways, check out my book Parental guidance.
You can get it online wherever you find books in
bookstores and happy families dot com, dot A, you
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