March 27, 2009
Does My Child Really Have Attention Deficit Disorder (add)?
Dr. Jared DuPree asked:
Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD) was the most common diagnosis given to children when I was working in community mental health. It is likely one of the most misdiagnosed disorders given to children as well. It is important to note that some children do have ADD or ADHD, but one should be careful in giving this diagnosis because there are so many other factors that create ADHD-like symptoms. Much of my time in community mental health was spent figuring out if a child really had ADHD. This can be a difficult task since there are so many other events or disorders that can look like ADHD.
First, what are the symptoms of ADHD or ADD. According to the DSM IV (this is the diagnostic book that almost any professional or doctor would use to diagnose), at least 6 of the following symptoms in either list 1 or 2 must be present for at least 6 months in which the child’s social, academic, or occupational functioning has been impaired:
List 1 (Inattention):
(a) often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
(b) often has difficulty sustaining attention in tasks or play activities
(c) often does not seem to listen when spoken to directly
(d) often does not follow through on instructions and fails to finish
schoolwork, chores, or duties in the workplace (not due to oppositional behaviour or failure to understand instructions)
(e) often has difficulty organising tasks and activities
(f) often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework).
(g) often loses things necessary for tasks or activities (e.g. toys, school assignments, pencils, books, or tools)
(h) is often easily distracted by extraneous stimuli
(i) is often forgetful in daily activities
List 2 (Hyperactivity and/or Impulsivity):
(a) often fidgets with hands or feet or squirms in seat
(b) often leaves seat in classroom or in other situations in which remaining seated is expected
(c) often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
(d) often has difficulty playing or engaging in leisure activities quietly
(e) is often “on the go” or often acts as if “driven by a motor”
(f) often talks excessively
(g) often blurts out answers before questions have been completed
(h) often has difficulty awaiting turn
(i) often interrupts or intrudes on others (e.g. butts into conversations or games)
In addition, some of the symptoms must have been present before 7 years of age, some of the symptoms must be present in at least 2 settings (i.e., school and home), and other disorders must be ruled out including mood disorders (i.e., depression), anxiety, or developmental disorders.
Furthermore, a good clinician or doctor will rule out other factors that may be contributing to the behaviors. For example, when I do an assessment, I examine the following possible causes of the behavior:
1. Food allergies - some food allergies create ADD-like symptoms.
2. Nutrition (red dye, caffeine, high amounts of sugar) - stimulants often cause someone to like they have ADD.
3. Giftedness or Learning Disabilities - boredom or learning frustration can look like ADHD.
4. Depression/Anxiety - mood disorders in children can often look like ADHD.
5. Family Conflict - many children I have worked with that are experiencing significant family problems exhibits ADD-like behaviors.
6. Trauma - children cope in many ways and some traumas can create ADHD symptoms.
After ruling out all the above behaviors mentioned, then I think about diagnosing someone with ADHD or ADD. It really is a serious diagnosis because most treatments include some powerful medications. In reality, this sometimes can be a test as well; if a child has ADHD or ADD and is taking medication and the symptoms get worse, it is likely that the child does not have ADD or ADHD. It’s important to understand that true ADD or ADHD is a chemical imbalance in which levels of norepinephrine are effected. ADD/ADHD medication is given to stabilize these levels; however, if the levels are already stable and a child takes a stimulant medication, they will like become even more hyper. It is important to note that there are a number of medications today that are not stimulants, but in general a medication is attempting to stabilize inattention and hyperactivity due to chemical imbalances.
Now, coming back to diagnosis. Who should diagnose a child? I highly recommend finding a specialist that has received training in ADD/ADHD. It is true that any medical doctor can diagnose a child along with psychologists, psychiatrists, and counselors depending on your region’s laws, but I would recommend finding someone that specializes in this area if possible. Who should not diagnose a child? Teachers, school counselors, educators, administrators, friends, family members, or yourself unless that person is licensed and trained to do so. In addition, always get a second opinion. So many people say,”That child has ADHD! I know it, I have seen it before.” Many times they don’t, but ADD or ADHD is an easy answer for some people. They may really have the diagnosis, but it is important to make sure.
My personal opinion is that many children diagnosed with ADD/ADHD do not really have the diagnosis. Parents and teachers often push for the diagnosis because it seems to be an easier answer than dealing with other issues that may be more difficult to treat. With that being said, I do believe that ADD/ADHD exists and that there are many diagnosed that do have the diagnosis.
What causes ADD/ADHD? We know through brain imaging that there are differences in the chemical makeup and functioning of the brain in persons with ADD compared with those that do not have the diagnosis. What we know so far is that the disorder does seem to have a genetic component. It seems to run in families. Other possible causes include brain injury before, during, or after birth and abnormal brain development.
For those that do have children or teens with ADHD, here are my recommendations:
1. Seek out a well-informed pediatricion that will work closely with a specialized therapist or psychologist.
2. If medication is something that is decided during the treatment process, attempt to use non-stimulant drugs if possible.
3. Remember that medication is not the only answer and generally is considered a temporary treatment that should be reduced over time.
4. Try to maintain a healthy diet for the child (less sugar, caffeine, red dye, and processed foods).
5. Try to help the child have an active life with plenty of exercise.
6. Seek out some parenting coaching from your therapist in order to understand how to adjust your parenting to help reduce ADD/ADHD symptoms.
7. Impulse control training and learning behavior modification has also shown to be effective.
8. Some relaxation techniques can be helpful to lower stress which seems to magnify symptoms at times.
9. Love your child, it’s always the best medicine
For more resources, check out the following:
Therapist Locator - family therapists for each region in Canada and the US with some international listings.
ADD/ADHD Update - summary of resources and information about ADHD.
CHADD - Children & Adults with ADD website.
Happy trails. Dr. J
Leonard
Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD) was the most common diagnosis given to children when I was working in community mental health. It is likely one of the most misdiagnosed disorders given to children as well. It is important to note that some children do have ADD or ADHD, but one should be careful in giving this diagnosis because there are so many other factors that create ADHD-like symptoms. Much of my time in community mental health was spent figuring out if a child really had ADHD. This can be a difficult task since there are so many other events or disorders that can look like ADHD.
First, what are the symptoms of ADHD or ADD. According to the DSM IV (this is the diagnostic book that almost any professional or doctor would use to diagnose), at least 6 of the following symptoms in either list 1 or 2 must be present for at least 6 months in which the child’s social, academic, or occupational functioning has been impaired:
List 1 (Inattention):
(a) often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
(b) often has difficulty sustaining attention in tasks or play activities
(c) often does not seem to listen when spoken to directly
(d) often does not follow through on instructions and fails to finish
schoolwork, chores, or duties in the workplace (not due to oppositional behaviour or failure to understand instructions)
(e) often has difficulty organising tasks and activities
(f) often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework).
(g) often loses things necessary for tasks or activities (e.g. toys, school assignments, pencils, books, or tools)
(h) is often easily distracted by extraneous stimuli
(i) is often forgetful in daily activities
List 2 (Hyperactivity and/or Impulsivity):
(a) often fidgets with hands or feet or squirms in seat
(b) often leaves seat in classroom or in other situations in which remaining seated is expected
(c) often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
(d) often has difficulty playing or engaging in leisure activities quietly
(e) is often “on the go” or often acts as if “driven by a motor”
(f) often talks excessively
(g) often blurts out answers before questions have been completed
(h) often has difficulty awaiting turn
(i) often interrupts or intrudes on others (e.g. butts into conversations or games)
In addition, some of the symptoms must have been present before 7 years of age, some of the symptoms must be present in at least 2 settings (i.e., school and home), and other disorders must be ruled out including mood disorders (i.e., depression), anxiety, or developmental disorders.
Furthermore, a good clinician or doctor will rule out other factors that may be contributing to the behaviors. For example, when I do an assessment, I examine the following possible causes of the behavior:
1. Food allergies - some food allergies create ADD-like symptoms.
2. Nutrition (red dye, caffeine, high amounts of sugar) - stimulants often cause someone to like they have ADD.
3. Giftedness or Learning Disabilities - boredom or learning frustration can look like ADHD.
4. Depression/Anxiety - mood disorders in children can often look like ADHD.
5. Family Conflict - many children I have worked with that are experiencing significant family problems exhibits ADD-like behaviors.
6. Trauma - children cope in many ways and some traumas can create ADHD symptoms.
After ruling out all the above behaviors mentioned, then I think about diagnosing someone with ADHD or ADD. It really is a serious diagnosis because most treatments include some powerful medications. In reality, this sometimes can be a test as well; if a child has ADHD or ADD and is taking medication and the symptoms get worse, it is likely that the child does not have ADD or ADHD. It’s important to understand that true ADD or ADHD is a chemical imbalance in which levels of norepinephrine are effected. ADD/ADHD medication is given to stabilize these levels; however, if the levels are already stable and a child takes a stimulant medication, they will like become even more hyper. It is important to note that there are a number of medications today that are not stimulants, but in general a medication is attempting to stabilize inattention and hyperactivity due to chemical imbalances.
Now, coming back to diagnosis. Who should diagnose a child? I highly recommend finding a specialist that has received training in ADD/ADHD. It is true that any medical doctor can diagnose a child along with psychologists, psychiatrists, and counselors depending on your region’s laws, but I would recommend finding someone that specializes in this area if possible. Who should not diagnose a child? Teachers, school counselors, educators, administrators, friends, family members, or yourself unless that person is licensed and trained to do so. In addition, always get a second opinion. So many people say,”That child has ADHD! I know it, I have seen it before.” Many times they don’t, but ADD or ADHD is an easy answer for some people. They may really have the diagnosis, but it is important to make sure.
My personal opinion is that many children diagnosed with ADD/ADHD do not really have the diagnosis. Parents and teachers often push for the diagnosis because it seems to be an easier answer than dealing with other issues that may be more difficult to treat. With that being said, I do believe that ADD/ADHD exists and that there are many diagnosed that do have the diagnosis.
What causes ADD/ADHD? We know through brain imaging that there are differences in the chemical makeup and functioning of the brain in persons with ADD compared with those that do not have the diagnosis. What we know so far is that the disorder does seem to have a genetic component. It seems to run in families. Other possible causes include brain injury before, during, or after birth and abnormal brain development.
For those that do have children or teens with ADHD, here are my recommendations:
1. Seek out a well-informed pediatricion that will work closely with a specialized therapist or psychologist.
2. If medication is something that is decided during the treatment process, attempt to use non-stimulant drugs if possible.
3. Remember that medication is not the only answer and generally is considered a temporary treatment that should be reduced over time.
4. Try to maintain a healthy diet for the child (less sugar, caffeine, red dye, and processed foods).
5. Try to help the child have an active life with plenty of exercise.
6. Seek out some parenting coaching from your therapist in order to understand how to adjust your parenting to help reduce ADD/ADHD symptoms.
7. Impulse control training and learning behavior modification has also shown to be effective.
8. Some relaxation techniques can be helpful to lower stress which seems to magnify symptoms at times.
9. Love your child, it’s always the best medicine
For more resources, check out the following:
Therapist Locator - family therapists for each region in Canada and the US with some international listings.
ADD/ADHD Update - summary of resources and information about ADHD.
CHADD - Children & Adults with ADD website.
Happy trails. Dr. J
Leonard
