ADHD, depression, or what?

[jerseyjeff]

My wife and I are most concerned about our 8 year old son. He has had difficulties in school, not participating, acting out, being disruptive. The teacher suggested several months ago that we see a child psychologist who, after several meetings over 6 months, decided Spencer had a form of ADHD. His teacher and my wife and I disagree. Spencer can concentrate on reading, can amuse himself for hours, and shows no sign of hyperactivity. According to the list of symptoms he must exhibit to have a diagnosis of ADHD, he doesn't have it. The child psychologist disagrees and thinks Spencer should start on some form of medication. His teacher, who spends all day with him and has a son with ADHD, said he absolutely does not have ADHD and should not be on medication for that. But his behavioral issues continue. He will provoke the neighbor girl or his own twin sister, he will act wacky in CCD class, he will disrupt school assembly by talking and other inappropriate behavior. His mother has been keeping daily charts for him that reward him for good behavior and remove privileges as a consequence of bad behavior, and his results have actually been pretty good. He buys into this and he cares about it. His teacher keeps these daily charts as well, which are turned over to the child psychologist, and he has made some progress. But every day seems to bring a new problem, and every day he is getting further admonishment and warnings. We don't want to be constantly landing on him or threatening him. It is too much and I am starting to sound like my own father, lecturing him constantly. My wife wants him to see a neurologist, which I reluctantly agreed to, and another psychologist which I freely agree to. But she believes that there may be a pharmacological solution to Spencer's behavioral issues and I am not so sure. I think some emotional maturity will help but my wife is tired and at the end of her rope with all this. Spencer is a lovely boy, loving and kind, very bright, an excellent reader, but he is a bit small for his age and seems to have problems of self-esteem. He doesn't feel adequate at sports like other boys his age and has serious problems controlling his impulses. His own birthday party ended in fighting and punching, admittedly after a long day and then cake and ice cream, but he is causing too many problems for himself in his personal relationships and at school. His parents, his teacher and child psychologist are all trying to help him, but we are not having the results we would like. He sometimes seems moody, but shows great enthusiasm for his artwork, for writing stories, for playing on the computer, etc. And he does play hockey, soccer, baseball and performs well, seems to enjoy the camaraderie and accomplishment. Anyhow, we are going to go see another child psychologist and see what she says, but in the meantime, what light can you shed? Does this seem like a medication situation? What do we do next? Thank you for any insight you can provide.

[Kevin Kennedy, Ph.D.]

This may be a moot point now, since you are transferring to another psychologist. But I wonder about the array of symptoms the psychologist concluded warranted a diagnosis of ADHD. Children who display ADHD can dispay symptoms along three axes: Inattention, Hyperactivity and Impulsivity. It might be that the psychologist was struck by your son's level of impulsivity and on that basis thought that a trial on medication might be useful. It does not sound like the behavior is symptomatic of mood disorder. It would not be at all surprising if the major psychological characteristic of your son is his impulse-ridden personality. Systematic plans for behavior management, such as you described, are highly recommended for such children. It is important to be rigorous in your adherence to the system. Generally, systems which provide for multiple rating periods throughout the day, focusing on one or two major behaviors, with rewards contingent on accomplishment of goals, tend to be the most effective. Whether medication might help remains to be seen. Impulsivity is a difficult symptom to address via medication, though it is not impossible. Some impulsive children do well on the psychostimulants - the only way to know would be to try. Perhaps a trial of several months on an amphetamine-based psychostimulant such as Adderall (adderrall) XR would be useful.

[hopefortoday]

I am not a medical professional but read in a newspaper about a person whose son also was thought to have ADHD. It turned out to be an iron deficiency. Have your child's pediatrician run bloodwork to rule out any medical problems.