Diagnosis of ADHD, part 2 of 4

by drcase on December 2, 2009

labcoat

When a child’s behavior or academic performance starts troubling teachers, they usually make the preliminary ADHD diagnosis and report it to the parents.  The parents then take the child to a general practitioner or a pediatrician who makes the final diagnosis and prescribes a stimulant medication, typically Ritalin.  The problem with this scenario is that the people involved aren’t the right ones to be making the diagnosis.  Before placing a child on medications and pinning him or her with a diagnosis of ADHD, first get a second opinion from a healthcare professional that specializes in this disorder, such as a psychiatrist, psychologist, or doctor specializing in neurology and/or in ADHD specifically

But even for a qualified specialist, ADHD is not always easy to diagnose. ADHD belongs to a spectrum of neurological disorders.  The spectrum goes from attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD) through learning disabilities, obsessive-compulsive disorder (OCD), and Tourette’s syndrome, to pervasive developmental disorders and autism. The neurological mechanisms involved in all the disorders are very similar.  Besides, there is increased co-morbidity among these syndromes, meaning that a child can have multiple disorders.  For example, 50 percent of the ADHD patients will have OCD, and 50 percent of patients with Tourette’s syndrome will have ADHD.  Early-onset mania or bipolar mixed state may be particularly difficult to distinguish from ADHD, or may also be co-morbid.

On the other hand, some children may be at the high end of the normal range of activity, or have difficult temperaments. Poor attention may also be caused by impaired vision or hearing, seizures, head trauma, acute or chronic medical illness, poor nutrition, insufficient sleep, anxiety disorders or realistic fears, depression, or the sequelae of abuse or neglect. Various drugs (including phenobarbitol) may interfere with attention. 

Similar symptomatology and co-morbidity of conditions increase the possibility of misdiagnosis.  ADHD is not a learning disability, but it can affect the ability to progress in society and the ability to learn. Many children are misdiagnosed with ADHD because they have learning disabilities or language problems.  Some children may simply have difficulty learning certain subjects, but schools often push to diagnose the child with ADHD.  There have always been children who learn at different speeds, but it almost seems easier to put a diagnosis of ADHD on the child and deal with the learning difficulties in that way. 

Communication with the child and his/her parents is the key to a correct diagnosis.  We need to understand the frustrations the child has.  Is he/she too active?  Bored?  Do they have dyslexia or a different learning pattern?  It can be a behavior problem, problems at home, or frustrations with the teacher’s style. If the child is a visual learner, and the teacher is not teaching towards that learning style, the problem may be the child is not being taught in a way he can learn.  As adults, if we went to a conference where the speakers taught in a way we can’t learn, we would be frustrated and would start to misbehave—we’d leave or chat to the person sitting next to us.  The same thing applies to children.

The traditional way of diagnosing ADHD seems to follow a cookie-cutter principle. The very diagnosis of ADHD is based on the questionnaire laid out in the DSM-IV5 or other diagnostic manuals.  If the child’s parents or teachers identify as positive six out of nine criteria for inattention, or six out of nine criteria for hyperactivity and impulsivity, the child leaves the doctor’s office with a drug prescription and a new personality label.  The patient is basically at the mercy of the medical doctor’s clinical experience—and 60 percent of doctors agree that there aren’t enough properly qualified ADHD diagnosticians, according to a Canadian survey performed in 1999.

Therefore, if your child has been diagnoses with ADHD, please make a point of seeing a specialist to confirm the diagnosis and other possible contributing syndromes the child may have.

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