Jun 17, 2008
Attention Deficit Hyperactivity Disorder (ADHD): Accurate Diagnosis is the Key to Effective Interventions
At Mindworks (our private clinic), we frequently receive inquires from parents concerned about ADHD. In this article, I will try to present some general information to help parents become a bit more familiar with this relatively common disability. One of the first things we all associate with ADHD is hyperactivity—the kid you see running around like he’s wearing a jetpack with a frantic mother chasing him. While hyperactivity does occur in many children with ADHD, the fact that your child is very active does not necessarily warrant a diagnosis. The Diagnostic and Statistical Manual of the American Psychiatric Association contains three subtypes of ADHD, including Hyperactive, Inattentive, and Combined. ADHD is a constellation of symptoms and behaviors that cannot be explained by any other cause (such as anxiety, learning disability, or a thyroid disorder). Contrary to what many people assume, ADHD is not just having a short attention span. Many parents are confused by the fact that their child can happily spend two hours playing a video game, yet can not complete a short homework worksheet. ADHD is a neurological disorder that has a significant, pervasive impact on learning and behavior.
As Dr. Larry B. Silver has noted, ADHD is a ‘life disability.’ It is not just problems at school. Children with ADHD experience difficulties across settings, meaning that these children have problems with tasks that require sustained attention to detail wherever they go, from the Cub Scout meeting to the homework table. There are two major characteristics of children with ADHD that make life harder for them and the people who love them. One is a weakness with ‘Executive Functioning.’ Executive functioning is our ability to work efficiently, strategically, and to execute our plans mindfully. For example, writing and reading comprehension tend to be the downfall of many children with ADHD, because successful reading and writing depend on executive functioning. Another problematic symptom is difficulty with impulse control (also known as behavioral disinhibition). The child with ADHD has little ability to control his or her impulses, and may routinely violate rules, irritate other people, make careless mistakes, or complete tasks in a haphazard manner.
When talking to parents about testing for ADHD, I recommend investing in at least one very through, comprehensive psychological evaluation. One of the reasons for this is that I want to be able to recommend the most effective academic and behavioral interventions that will match the child’s particular pattern of strengths and weaknesses. Just as importantly, I do not want to be wrong in my diagnosis. ADHD is known as a ‘diagnosis of exclusion,’ meaning that the person making the diagnosis must make sure that nothing else could be causing the symptoms. Doing a quick parent interview or a couple of symptom checklists is not adequate. Additionally, it is currently estimated that as many as 50% of children with ADHD also have specific learning disabilities. Not only are these children at risk for school problems, they are far more likely than peers to have significant levels of anxiety, depression, or behavioral problems. Researcher Dr. Russell Barkley has described children with ADHD as being several years less emotionally mature than typical peers. This means that both parents and child are likely to need additional support. Once you have an accurate diagnosis, your medical, psychological and educational team can be most effective in helping your child achieve his potential.
-Dr. Rebecca Resnik
Licensed Clinical Psychologist