Is it ADHD or Something Else?
ADHD Symptoms and Other Disorders
Often I get questions from parents wondering if their child's symptoms are related to Attention Deficit Hyperactivity Disorder (ADHD). The answer is often times elusive as some of the symptoms of ADHD mirror other disorders.
The DSM V symptoms for ADHD includes: Poor attention, easily distracted, careless mistakes, trouble staying on task in activities, trouble listening and following instructions, not finishing assignments or chores, difficulty organizing tasks and items, losing things, and avoiding tasks that require sustained effort. [Full criteria can be found at: http://www.cdc.gov/ncbddd/adhd/diagnosis.html]
Some of these same symptoms can be due to depression, anxiety, family dynamics, loss or grief, giftedness, gluten intolerance, and medical problems. According to National Institute of Mental Health, "ADHD symptoms usually appear early in life, often between the ages of 3 and 6, and because symptoms vary from person to person, the disorder can be hard to diagnose. Parents may first notice that their child loses interest in things sooner than other children, or seems constantly "out of control." Often, teachers notice the symptoms first, when a child has trouble following rules, or frequently "spaces out" in the classroom or on the playground."
Working with a mental health professional and your primary care physician is a good way to sort out the diagnosis.
Getting to a Definitive Diagnosis
There are many things to rule out as causes contributing to symptoms that could appear to be ADHD. The Global Center For Healing lists: hypoglycemia, allergies, learning disabilities, thyroid problems, hearing or vision problems, seizure disorders, sleep disorders, vitamin deficiencies, etc. [Get the full list at: http://www.globalhealingcenter.com/adhd/50-conditions-that-mimic-adhd]
As a result of the all the various mental health and medical reasons for symptoms that would mirror ADHD, it's best to work with both your primary care doctor and a mental health professional to sort things out.
The Reach Institute has published best practices for arriving at an ADHD diagnosis. "The healthcare provider should obtain information about the child's positive and problems behaviors in all of the settings he/she interacts - at home (including differences in the child's interactions with mothers, fathers, and siblings), at play with peers, and at school. In addition to the doctor's careful interview of knowledgeable adults, ADHD experts performing state-of-the-art assessments nowadays use carefully-researched "rating scales" or behavior checklists, completed by adults who know the child well (e.g., parents, day care providers, other relatives, teachers). But because rating scales, just like laboratory tests, can sometimes give a "false positive" or a "false negative," the careful history (based on the doctor's interview) and a physical examination are always essential." (http://www.thereachinstitute.org/adhd-diagnosis-treatment.html)
Often times when care is not taken in reaching a diagnosis of ADHD then proper treatment is not utilized leading to poor results.
Did You Have ADHD?
How Was Your ADHD Treated?
Best practices for treating ADHD require that parents, teachers, mental health professionals, and primary care physicians work together.
Magellan Health Services (2009) lists the following as best practices in treating ADHD:
- Behavioral training on child management skills for parents and teachers.
- Contingency management such as positive reinforcement, time-outs, response cost and token economy.
- Clinical behavioral therapy such as training in problem-solving and social skills
- Cognitive-behavioral treatment such as self-monitoring, verbal self-instruction, development of problem-solving strategies, self-reinforcement (AAP, 2001; Barkley, 1998b; Pelham, Wheeler, & Chronis, 1998).
A family approach to treatment is advocated over individual work with just the child. Parent Management Training (Kazdin) is a best practice model that assists in educating parents about their responses to their child's ADHD and helping them to more structure their child's environment if needed. You can learn more about Parent Management Training via Kazdin's book. [http://www.amazon.com/Parent-Management-Training-Oppositional-Adolescents/dp/0195386000]
Medication management of ADHD symptoms is also a best practice. Left untreated ADHD can progress into an oppositional defiant disorder or a conduct disorder. Medications for ADHD can be found on this web page by Web MD. [http://www.webmd.com/add-adhd/adhd-medication-chart]