Attention Deficit and Hyperactivity Disorders













Is it ADHD or ADD? Is it a real disorder or simply a much overused "catchphrase?" Is medication the only treatment? One thing is for certain: there is much misinformation and confusion over Attention Deficit/Hyperactivity Disorders. This article will hopefully clarify some of the confusing questions surrounding the subject.

First, it is important to understand that Attention Deficit/Hyperactivity Disorder (ADHD) is indeed a true disorder that has been well-documented and well-researched and does affect millions. More than two million children have been diagnosed with some form of attention and/or impulse problem. Two thirds of these children will still experience the symptoms as adolescents, and a smaller percentage will carry these symptoms into adulthood.

For children and adolescents suspected of having ADHD, the best method of determining whether or not they have such a disorder is with a thorough individual assessment. Without such a comprehensive approach many children may get misdiagnosed as having ADHD when, in fact, there is some other basis for their symptoms. It is important to note that the symptoms of inattention, lack of focus, impulsivity and/or hyperactivity are only descriptive and we need to determine what the underlying cause for these behaviors may be. The cause is not always ADHD and can in fact be stress in the child’s environment, allergies, a learning disability, or other contributing factors such as poor diet and inadequate sleep.

What’s in a Name?

There is much confusion over the terms ADD and ADHD. In truth, the term ADD is not used any longer among professionals. The correct term is Attention Deficit/Hyperactivity Disorder (ADHD). This is the official general name for disorders of inattention, impulsivity and hyperactivity. ADHD is then divided into "subtypes" which can primarily display as inattention or hyperactivity/impulsivity, or a combination. A child may therefore be diagnosed with ADHD-Inattentive Type, ADHD-Hyperactive/impulsive Type, or ADHD-Combined Type.

Accurate Diagnosis: No Short-Cuts

There is currently no single test to accurately diagnose ADHD. The best way to find out whether or not your child truly has ADHD is to have them thoroughly evaluated. Components of a complete evaluation might include a developmental & family history, parent and teacher behavior rating scales, full-scale IQ and achievement testing, a physical exam, and a continuous performance testing (CPT). A CPT usually uses a computer to objectively measure the core symptoms of ADHD. Your pediatrician or family physician can provide a thorough physical and can often provide parent and teacher rating scales. The school system also has rating scales available and can provide full-scale I.Q. and achievement testing if requested. A psychologist can also perform full-scale I.Q. and achievement testing, and some have a CPT as well. However, parents are left on their own to obtain each of these services and then integrate what is sometimes contradictory information into a meaningful whole. Failure to comprehensively evaluate leads to incorrect diagnosis and/or failure to identify some of the associated disorders. Optimally, parents should locate a comprehensive evaluation package, where medical, psychological, behavioral and educational components are brought together, provided under one roof and consolidated into a comprehensive, meaningful assessment of the whole child. The assessment process can then be followed by a sharing of findings conference and written report with specific individual recommendations for the child. In the sharing of findings meeting, the professionals involved in the child’s evaluation present the individual components of the evaluation and explain how each contributes to the conclusion.

Treatments

Medication should not be prescribed without an accurate diagnosis but is a very helpful part of the treatment for the correctly diagnosed child. A child’s response to medication should not be used as "proof" of a proper diagnosis, but rather a proper diagnosis should first be established in order to safely treat a child with ADHD. There is legitimate public concern surrounding the use of ADHD medication. This concern, in my opinion, is the result of inaccurate and/or hasty diagnosis, one-dimensional treatments and too much emphasis on medication. There are very few, if any, medical conditions that should be treated with medication alone. This is definitely true for ADHD, which research has shown is much better managed with a combination of treatments.

Parents should seek out a comprehensive treatment approach with attention to diet, the child’s self-concept, other medical conditions (i.e., allergies, endocrine disorders, etc.) and utilization of non-medicinal therapies such as biofeedback and other forms of sensory-motor integration training. Parental education and behavior management training are of at least equal importance to proper medical management and should part of any treatment approach.


About the Author

Corey J. Wolff, M.D., M.S., F.A.A.P. is a board certified pediatrician with over twelve years experience in general pediatrics. In addition to specializing in ADHD, Dr. Wolff also maintains his general pediatric practice at The Wolff Center.



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