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I worry about the casual way in which many doctors pronounce an ADHD diagnosis. Attention deficit disorder (ADD ADHD) is not easy to diagnose, and doctors who make the diagnosis too hastily only perpetuate the problems that lead patients to consult them in the first place.
I can't tell you how many times I've been approached by parents who complain that medication "hasn't helped our child," or that it "helps, but my child is still struggling in school." In most cases, the problem isn't the medication. It's that the child doesn't actually have ADHD — or has more than ADHD.
In the past month alone, I've started to treat three individuals who were diagnosed with ADHD; two do not have it, and the third has problems beyond ADHD. These cases illustrate the mistakes doctors make when evaluating patients with ADHD-like symptoms.
Mistake #1: Trying medication to "see if it helps."
Mr. and Mrs. Q. are the parents of eight-year-old Fred. A few months ago, they met with Fred's third-grade teacher, who expressed concern that Fred was having trouble sitting still in class. As the teacher explained, he often had to intervene to help Fred refocus on his work. "Even then," he said, "Fred rarely finishes his schoolwork."
When Fred's parents shared the teacher's observations with their pediatrician, she said, "Maybe we should try Ritalin." After months of trying various doses of that drug, and later Adderall, Fred's mother contacted me.
In my conversations with Fred and his parents, several themes began to emerge. For one thing, his first- and second-grade teachers had not deemed Fred inattentive or hyperactive. At home, Fred exhibited these behaviors only when he was doing homework; he wasn't hyperactive or inattentive at other times of day, nor during weekends, holidays, or the summer break.
Clearly, Fred's symptoms were neither chronic nor pervasive — so the problem couldn't be ADHD. The pediatrician had jumped from description to treatment without making sure that Fred met the diagnostic criteria.
As I continued to evaluate Fred, I noted that he was struggling with reading. His comprehension was poor, and he retained little of what he read. What's more, his handwriting was iffy, as were his spelling, grammar, punctuation, and capitalization. I reviewed Fred's report cards. Sure enough, in first and second grades, teachers termed his reading and writing skills "still developing." A psycho-educational evaluation confirmed my hunch: Fred has a language-based learning disability. The restless behavior and inattention were the result of frustration he felt over having to cope with this disability.
I took Fred off his meds, and worked with his parents to secure special education services. Guess what? The hyperactivity and inattention disappeared.
Mistake #2: Relying on inconclusive evidence.
Alicia, a single parent, was concerned that her 10-year-old daughter, Marie, had ADHD. Painfully shy, Marie had struggled in school since first grade. Alicia arranged to have Marie evaluated by a psychologist, who told Alicia that her daughter had ADHD. Alicia went to her family doctor, who took one look at the psychologist's report and started Marie on stimulant medication.
Two years passed. Despite steady use of the medication, Marie continued to have problems in school and with her peers. At this point, with middle school looming, Alicia called me.
I looked over the psychologist’s report. It included several rating scales, completed by Alicia and the psychologist, that seemed "significant" in indicating ADHD. It also included a computerized test (Test of Visual Acuity, or TOVA) that was "suggestive" of ADHD. Yet the psychologist had never taken Marie's developmental history or even asked Alicia if there was any family medical history that might be contributing to her daughter's social and academic difficulties. The psychologist had spent only an hour with Marie — not nearly enough time to get a true sense of her “issues.”
This article appears in the February/March 2007 issue of ADDitude.
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To discuss this topic with others in the process of getting an ADHD diagnosis, visit the Is It ADHD? support group on ADDConnect.
