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During my daughter鈥檚 challenging first year of school, we discovered how much effort it took her to sit and learn.

She was the youngest in her class, placing her at听听of being diagnosed with听听(attention deficit hyperactivity disorder).

While she struggled with attention and hyperactivity, her problems were always more frustrating than truly impairing. Still, constant battles over finishing tasks, the amount of time (and nerves) spent on a child that needs that extra bit of attention and the anger or sadness on her face made me wonder if we should try to get some support.

Maybe a diagnosis could be a straightforward fix to the problem?

What鈥檚 the problem?

Increasing awareness of ADHD has led to听听in the number of children diagnosed with and听听it, both internationally and in Australia. This would be good if it meant we were getting better at finding, diagnosing and helping children impaired by inattention or hyperactivity.

However, my听听in JAMA Network Open finds these increases in ADHD diagnoses may be largely due to children like my daughter, whose behaviours fall within a normal (but frustrating) range. I conducted this research with colleagues from the University of Sydney and Bond University.

Our study concluded these children are unlikely to benefit from being labelled with ADHD and may, in fact, be harmed by it.

This surge in diagnoses also results in limited resources being stretched thinner听, ultimately taking away from those with severe problems who would benefit from more support.

What is ADHD? And why is it so controversial?

础顿贬顿听听鈥減ersistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development鈥�.

It鈥檚 one of the most common childhood disorders, affecting about听-听of children. Over the past decades, debate on the appropriateness of diagnoses has grown in line with the rate of diagnosis.

Allen Frances, a prominent American psychiatrist, has been one of the most vocal critics of the trend. He听听as the medicalisation of 鈥渆very day experiences that are part of the human condition鈥�.

However, others suggest the increases in diagnosed children are largely due to听听in previously undiagnosed children.

听听of the debate claim to have proof. But we were surprised to discover no-one had ever summarised the scientific evidence for the key reasons behind increasing diagnosis rates.

So we reviewed the results from over 300 studies on ADHD over the past 40 years to determine which children are being newly diagnosed and if they benefit. Our听听allowed us to summarise a huge variety of studies in a way not done before.

What we did and what we found

We found that since the 1980s, increasing numbers of school-aged children and adolescents around the world have been diagnosed with ADHD and medicated for it.

We know ADHD-related behaviours exist on听听with no or minimal hyperactivity and inattention on one end and severe ADHD on the other.

Many children can get distracted easily, are forgetful, find it difficult to sit still or wait their turn. In most children, these behaviours are mild enough to not interfere with a 鈥渘ormal鈥� life.

However, there is no clear biological cut-off point above which someone just 鈥渉as鈥� ADHD. Ways of diagnosing ADHD also vary between countries and change over time, with criteria generally becoming less stringent.

Together, this ensures many potentially new cases could be discovered, depending on how low the bar is set.

, for example, almost half of all children diagnosed with ADHD have mild symptoms, with only around 15% presenting with severe problems. Only about听听in an Italian study had severe ADHD-related behaviours. And, in general, children today are听听than 20 years ago.

All this led us to conclude a substantial proportion of these additional diagnoses (children who would not have been diagnosed 20 years ago) are, at best, borderline cases.

For example,听听shows while diagnoses increased more than five-fold over ten years in Sweden, there was no increase in clinical ADHD symptoms over the same time. This means that with the lowering of the diagnostic bar, children diagnosed with ADHD are, on average,听听and more similar to those without an ADHD diagnosis.

As a result children like my daughter, who are听, are at risk of being labelled with ADHD because their relative immaturity can be enough to push them over the threshold into the zone of 鈥渁bnormal鈥� behaviour.

Why it鈥檚 important to get it right

For children with mild symptoms

Children with mild ADHD symptoms are unlikely to benefit from a diagnosis. They (and their families) also incur听听as well as potential harms from the diagnosis and treatment. That鈥檚 because:

• instead of drumming up extra support, an ADHD label can have听听social, psychological and academic effects, when compared to similar young people without a diagnosis
• medication听听in children with mild ADHD (however it is beneficial in many severe cases)
• medication for young people with milder symptoms also has no positive, but a potential negative, effect on听听(such as maths and reading scores) when compared to unmedicated young people with similar behaviour. Also, medication doesn鈥檛 reduce the risks of听听and听听as much as in those with severe symptoms.

For children with severe symptoms

It鈥檚 also important children with more severe ADHD symptoms are correctly diagnosed so they don鈥檛 miss out on much-needed support.

With听听of ADHD, schools are increasingly struggling to adequately support every child with a diagnosis: the slice of funding and support every child can receive gets smaller and smaller, the more children are included.

In turn, this often means those with the most severe problems听.

What can we do?

In light of the potential risks associated with diagnosing a child with milder ADHD symptoms, we recommend doctors, parents and teachers work together following a 鈥溾��. This ensures swift and efficient diagnosis and treatment in severe cases. For those with milder symptoms, taking some time to watch and wait may mean many of them won鈥檛 need to be labelled or treated.

Not only will this avoid potential harm for individual children, it also ensures resources are allocated where they are needed most and will be most effective.

Luise Kazda is a PhD Candidate at the Faculty of Medicine and Health at the University of Sydney. This article was first published in .