 |
    |
Diagnosing
Parents often want to know if their child’s problem is ADHD, or if their child is having attentional problems because of another underlying medical issue, and there are, in fact, medical causes for attentional problems. The most obvious ones are hearing loss or visual loss; if you can’t hear well or see well, you can look very much like you have attentional problems. Leonard Rappaport, MD, MS, Director, Developmental Medicine Center ADHD, according to the American Academy of Pediatrics, is a disorder that should be diagnosed and treated by a pediatrician, and only when there is something unusual about it should there be a referral to a specialty practice. However, there are some pediatricians who are uncomfortable with the disorder; they don’t feel there is a clear-cut way to diagnose it. Diagnosing ADHD is different than when diagnosing, for instance, diabetes, where you have a Fasting Plasma Glucose Test that tells you if you have diabetes or not. With ADHD, there is not a specific test you take or a black and white differentiation that tells you if you have it or not. Some pediatricians feel uncomfortable with that, especially if there are other co-morbid conditions present. If a patient has ADHD and some other disorder, depending on the co-morbid condition, a pediatrician might be inclined to consult a different provider. So for instance, if a patient has anxiety or depression or an evident mood disorder, then the patient will be referred to a psychiatrist, perhaps. But if the patient is having problems in school, there is inattentiveness, a lack of concentration or hyperactivity, the family might come see a pediatric neurologist. Alcy Torres, MD, Pediatric Neurologist Making sure parents and children know it is a chronic issue The majority of children with ADHD do not out grow it. For about two-thirds of kids it is a lifelong illness that you have to learn how to live with and compensate for. If parents and children get the idea that they are going to have to live with this illness and it is not going away, they develop the needed behavioral and emotional skills and understand how to use medication when appropriate. Thinking about it as something they have to live with instead of as something that’s just going to go away helps parents and children address the problems presented by ADHD more completely and effectively. Stuart Goldman, MD, Director of Medical Education, Department of Psychiatry In my conversations with parents, once a diagnosis of ADHD is confirmed, I provide psycho-education about the symptoms, development, the family’s and the child’s strengths, and that ADHD is a neurobehavioral disorder that does have a chronic course, and symptoms tend to present along developmental lines. It is one of the most difficult messages that’s I communicate, but I stress that children and parents have many strengths, can learn and add to the skills they may already have to manage the symptoms of ADHD. Marcus Cherry, PhD, Child and Pediatric Psychologist Probably around 60 to 85 percent of the kids who have ADHD as young kids will still have ADHD symptoms and meet full criteria when they become teenagers. About half the people who have ADHD as children will meet full criteria as adults. But 90 percent of people who had it as kids will actually have at least 4 or 5 symptoms of ADHD, which is not enough to meet full criteria but still enough to cause impairment. These people may still benefit from treatment. Joseph Gonzalez-Heydrich, MD, Chief, Psychopharmacology Program About 90 percent of cases of ADHD seem to be genetic. There are some neurological disorders like epilepsy, or head injury, or strokes that can produce ADHD symptoms. Kids who were born premature, or with low birth weights, or who had stress during the birthing process, or whose mothers smoked cigarettes or drank alcohol while pregnant all are at higher risk for having ADHD. There has been a lot of research examining the brains people with ADHD through using imaging techniques, and the research has found differences in brain regions for people with ADHD and people without ADHD. These differences help support the notion that ADHD is a brain-based disorder. Joseph Gonzalez-Heydrich, MD, Chief, Psychopharmacology Program I’ve had parents think their child has ADHD because of something they didn’t feed their child, bad parenting, family conflict, or spoiling their child too much. The research that exists on ADHD does not indicate that psychosocial factors cause ADHD. There is evidence that ADHD is associated with impairment of the frontal lobe of the brain, which is responsible for carrying out executive functions like managing attention, focus, and planning. There is also evidence of a genetic component. In the course of an evaluation, I provide a great deal of information about normative child development and how ADHD can impact that development. I also provide psycho-education about ADHD that makes sure parents truly understand the causes and that they don’t rely on the myths that bad parenting, parental conflict, trauma, etc. cause ADHD. Marcus Cherry, PhD, Child and Pediatric Psychologist Meeting the parents where they are When explaining the ADHD diagnosis to the parents, I often review what the criteria are for ADHD from the DSM-IV. I might do that very formally by getting my book down and showing them what you have to have symptom-wise to meet the criteria for ADHD according to the DSM-IV. Or I might do it more informally depending on who the parent is. A lot of parents who I see speak Spanish and have an interpreter, and because I don’t speak Spanish, I sometimes do it through the interpreter. I adapt to what the need of the parent is and also to what they know about ADHD already. Many parents have information from the Internet, and sometimes they have misinformation or have gotten mixed messages about ADHD. I try to find out from the parent what his or her understanding of ADHD is, and then really go from there. Frances Johnson,Advanced Practice Nurse,Outpatient Psychopharmacology Program We all have inattentiveness to a certain degree. Diagnosing ADHD is a like diagnosing other psychiatric disorders— you don’t treat everyone for an anxiety disorder that gets anxious on the first day that they feel anxious. It requires a little bit more of an extreme, and identifying a child who truly has ADHD is the job of the physician, as well as to exclude the other potential diagnoses, and then to treat the child’s symptoms appropriately. Alcy Torres, MD, Pediatric Neurologist |
Top of Page 
 |
Copyright © 2007, Children's
Hospital Boston Department of Psychiatry. All Rights Reserved. The information on this website should not be taken as medical advice, which can only be given to you by your personal health care professional. Updated: February 12, 2007 |
 |