Misdiagnosis of Attention Deficit Hyperactivity Disorder As Conduct Disorder in A Bullying Context

Authors

  • Sarah Alnaher
  • Farees Ahmad Khan
  • Aos Ameen
  • Muhammad Zeshan

DOI:

https://doi.org/10.53819/81018102t4276

Abstract

Misdiagnosis misinforms treatments and results in undesired outcomes in clinical and psychiatric practices. Such incidences are common in psychiatric spaces and clinics, with attention deficit hyperactivity disorder (ADHD) misdiagnosis for Conduct Disorder (CD) emerging as a common occurrence. This case critiques ADHD’s misdiagnosis for CD in a 13-year-old Indian-American, unveiling the effects of environmental stressors, bullying and racial discrimination on the symptoms of ADHD. A 13-year-old Indian-American attends a special education facility and faces racial discrimination. The rejection on the school bus in the morning and the classroom provoked aggression and hyperreaction. The racial discrimination and environmental factors aggravated CD symptoms, prompting a misdiagnosis of ADHD as CD. The Indian-American boy was bullied by White peers. His teachers complicated the case by providing inaccurate information about the boy’s behaviour. This information misled the diagnosis and, hence, treatment. The DSM-V diagnostic model was used to diagnose the boy’s condition.  The bullied Indian-American boy responded to the environmental stimuli through hyperactivity, and aggression by bringing a toy gun to school. He pointed the gun at the tormentor as a response to the stimuli, replicating the environmental influence on his actions. Even though inaccurate, this would be the teacher’s basis of narratives about the boy’s behaviour. In response, peer group therapy and amphetamine were indicated to the boy as treatments against CD. This case underscores the importance of a thorough psychiatric evaluation that considers environmental and psychosocial factors, especially in culturally and racially diverse populations. The Indian-American boy underwent peer group therapy to enhance problem resolution and amphetamine treatment to alleviate psychosocial problems. By mocking his tormentors, his teacher thought that the boy was in full-blown conduct disorder. Racial discrimination and bullying on the bus significantly exacerbated his actions, which led to the misdiagnosis. Based on the teacher’s misinformation and other factors, the boy’s ADHD was confused for CD.  

 

Keywords: ADHD Misdiagnosis, Conduct Disorder, Bullying Context, Pediatric Behavioral Disorders, Differential Diagnosis

References

American Academic of Child and Adolescent Psychiatry. (2007). Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 46(7), 894–921. https://doi.org/10.1097/chi.0b013e318054e724

American Psychiatric Association. (2020). Racial disparities in ADHD.

Español-Martín, G., Pagerols, M., Prat, R., Rivas, C., Ramos-Quiroga, A., Casas, M., & Bosch, R. (2023). The impact of attention-deficit/ hyperactivity disorder and specific learning disorders on academic performance in Spanish children from a low-middle-and a high-income population. https://doi.org/10.3389/fpsyt.2023.1136994

Fadus, M. C., Ginsburg, K. R., Sobowale, K., Halliday-Boykins, C. A., Bryant, B. E., Gray, K. M., & Squeglia, L. M. (2019). Unconscious Bias and the Diagnosis of Disruptive Behavior Disorders and ADHD in African American and Hispanic Youth. https://doi.org/10.1007/s40596-019-01127-6/Published

Hesapçıoğlu, S., Meraler, H., & Ercan, F. (2017). Bullying in schools and its relation with depressive symptoms, self-esteem, and suicidal ideation in adolescents. Anatolian Journal of Psychiatry. https://doi.org/10.5455/apd.268900

Källmén, H., & Hallgren, M. (2021). Bullying at school and mental health problems among adolescents: a repeated cross-sectional study. Adolescent Psychiatry and Mental Health, 15, 74. https://doi.org/10.1186/s13034-021-00425-y

Pityaratstian, N., & Prasartpornsirichoke, J. (2023). Does Anxiety Symptomatology Affect Bullying Behavior in Children and Adolescents with ADHD? Child & Youth Care Forum, 52, 85–103. https://doi.org/10.1007/s10566-022-09681-1

Unni, A. K., Blake, J. J., Salter, P. S., Luo, W., & Liew, J. (2022). “No, but where are you really from?” Experiences of perceived discrimination and identity development among Asian Indian adolescents. Frontiers in Public Health, 10. https://doi.org/10.3389/fpubh.2022.955011

WHO. (2024). One in six school-aged children experiences cyberbullying, finds new WHO/Europe study.

Wolke, D., & Lereya, S. T. (2015). Long-term effects of bullying. https://doi.org/10.1136/archdischild-2014-306667

Wolraich, M. L., Hagan, J. F., Allan, C., Chan, E., Davison, D., Earls, M., Evans, S. W., Flinn, S. K., Froehlich, T., Frost, J., Holbrook, J. R., Lehmann, C. U., Lessin, H. R., Okechukwu, K., Pierce, K. L., Winner, J. D., & Zurhellen, W. (2019). Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics, 144(4). https://doi.org/10.1542/peds.2019-2528

Downloads

Published

2024-07-29

How to Cite

Alnaher, S., F. A. Khan, A. Ameen, and M. Zeshan. “Misdiagnosis of Attention Deficit Hyperactivity Disorder As Conduct Disorder in A Bullying Context”. Journal of Sociology, Psychology & Religious Studies, vol. 6, no. 1, July 2024, pp. 86-94, doi:10.53819/81018102t4276.

Issue

Section

Articles