A mother takes her daughter to the family doctor because she's always tired and lacks energy. The doctor notes that the linings of her eyelids are pale and concludes that she has iron deficiency anemia. The doctor prescribes iron.

Another mother hears from her daughter's teacher that she isn't sitting still and paying attention in class. The teacher does some rating scales that confirm this observation.

The mother takes these comments and forms to the family doctor, who says, 'Why don't we put her on Ritalin (or Adderall or Dexedrine or Strattera....)?'

In each case, the doctor has observed symptoms that suggest a problem. However, before treatment is started, it's critical to clarify the specific cause of it. Clearly, in the first case, the doctor would do several diagnostic tests before concluding the cause of anemia and starting a treatment plan.

This approach is just as critical in making a diagnosis of ADHD.

Yes, your child or adolescent might be overactive, inattentive, and/or impulsive. But these behaviors could be caused by anxiety, depression, academic frustration, family problems, or even pinworms (which can cause itchiness around a child's rear end). It's essential that the physician explore and find the cause of the behavior (see Diagnosing ADHD, left).

More than ADHD

While it's essential for a physician to make a definitive diagnosis of ADHD, it's equally important for him or her to look for other problems that often coexist with it. These are called comorbidities. Once a diagnosis is made, starting treatment with the appropriate medication is critical. But medication isn't the sole answer. In fact, kids who are only on medication have less successful outcomes than those who receive help for other problems they might have.

Your family doctor may not know this. So you must be informed to shape the evaluation process and treatment plan. Toward that end, here is what you should know about the most common conditions associated with ADHD and a basic treatment plan for each:

Learning disabilities

Fifty percent of children and adolescents with ADHD also have some type of learning disability (LD), such as dyslexia or auditory processing disorder. An LD may explain why a child on medication can sit still and stay focused and yet do poorly academically. There could also be another reason for academic failure. If the ADHD diagnosis isn't made until the fourth or fifth grade, it's possible that a child will have gaps in basic skills, especially math and language arts, prior to receiving treatment for ADHD. While this student may not have a learning disability, he will need academic interventions to help him or her catch up.

Course of action: Speak with your school professionals about assessing your child to see if he or she has a learning disability. If they refuse, you might try getting a private assessment. If your student has an LD, he/she will need special education services, along with appropriate accommodations in the classroom.

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