There is an old saying, “Be careful what you ask for”. This holds very true with the diagnoses of ADHD, but most parents haven’t even thought about it.
Let’s look at a case to explain my point. I have a hypothetical friend named Johnny. Johnny is 8 years old and he is not doing so well in school. His grades are starting to fall and his 2nd grade teacher has written notes to his Mom informing her that he is struggling to stay on task. He is easily distracted by the other kids and seems to “zone out” often. He frequently forgets to take his homework home and therefore doesn’t turn in his assignments. He gets in trouble for talking and blurting out answers and fidgets frequently with his hands.
Johnny’s teacher implied that he may have ADHD by sharing that he exhibits characteristics similar to her son who was diagnosed with ADHD when he was in 2nd grade. She said she put her son on medicine and it made a dramatic improvement in his ability to perform in school.
The last note from the teacher stated that Johnny was refusing to do his work and had to be sent to the principal’s office for disrupting the class.
Johnny’s Mom feared that someone would mention ADHD to her eventually because she had noticed similar behaviors at home; especially surrounding homework completion. She also noticed that he is very active and needs frequent reminders to get his chores done. He has also become defiant at home and is refusing to comply with directions.
Like most parents in the 21st Century, Johnny’s Mom went to Google to obtain more information about ADHD. She found several articles that described Johnny perfectly and was convinced that he did in fact have ADHD. After diagnosing her son via the internet, Johnny’s Mom scheduled an appointment with Johnny’s doctor. When she arrived for her 20-minute appointment, Johnny’s Mom delivered a textbook description of Johnny’s symptoms. It’s no wonder that after about 5 minutes of speaking to the doctor and completing a survey, Johnny was officially diagnosed with ADHD and started on a stimulant medication.
There is just one problem – Johnny’s ADHD was NOT causing his problems in school. His real issue is that he has a learning disability and a processing disorder which was completely overlooked. Johnny’s Mom was not careful about what she asked for and she got it. She had convinced herself that Johnny had ADHD and her story was so accurate that her doctor didn’t look for any associated conditions. It took one full year and 4 failed stimulants before other medical conditions were considered.
The 80/20 Rule
One of the issues that I have with ADHD is that everyone thinks they are a subject matter expert. I can’t tell you how many times I will be in Walmart and a clerk will inform me that the kid in line before me “must have ADHD”. Unbelievably, every person that is hyperactive or inattentive does not necessarily have ADHD. The other important point is the 80/20 rule – 20% of individuals with ADHD have uncomplicated ADHD that will improve with a medication and behavior modification but 80% of individuals with ADHD will have a co-existing condition. These conditions include learning disabilities and processing disorders; behavior problems like oppositional defiant disorder and conduct disorder; mood disorders like anxiety, depression and bipolar; and neurodevelopmental disorders like autism and Intellectual Disabilities. Unfortunately, because everyone thinks that they know ADHD often the other co-existing conditions can be missed and they may be the condition that is causing the most problems.
The Diagnostic Process
So how do you know if you or your child’s ADHD is in fact the problem? You must ensure that your symptoms have been thoroughly evaluated and assessed. The gold standard assessment for diagnosing ADHD is a survey, either the NICHQ Vanderbilt Assessment Scales or the Connors Rating Scales. This typically needs to be completed by the individual or parents for the home environment and then also a teacher for the school environment. If symptoms of inattention and/or hyperactivity exist in two separate environments and those behaviors cause academic or social problems then the diagnosis of ADHD is given. That is just the first part of the evaluation. The next part needs to consider the possible co-existing conditions. A comprehensive interview and review of past medical history, family history, educational and developmental history and a history of present concerns will highlight additional potential conditions that should be considered. The history will dictate which batteries of cognitive testing should be completed by a psychologist who will look at ADHD but also learning and processing issues. Lastly, there needs to be a behavioral assessment (which can also be completed by a psychologist or a counselor) looking specifically at mood disorders and behavior problems. If symptoms of autism are identified, then specific assessment for autism should be completed by the psychologist or developmental pediatrician.
With thorough and comprehensive assessment of ADHD and the potential co-existing conditions a specific treatment plan can be selected to ensure that support is provided to help you or your child reach your greatest potential academically, socially and in life.
Don’t forget to be careful what you ask for.