Its Not Adhd

8/11/2019 Its Not Adhd

1/7

From ADD itude s Experts

Its Not ADHD

3 CommonDiagnosis Mistakes

8/11/2019 Its Not Adhd

2/7

8/11/2019 Its Not Adhd

3/7

1

When ItIs Not ADHD3 Common Mistakes in ADHD DiagnosisDoctors or medical professionals sometimes diagnose ADHD too quickly orwithout considering all the symptoms. Heres what you to know to avoid amistaken ADHD diagnosis.

by Larry Silver, M.D.

Attention decit disorder (ADD ADHD) is not easy to diagnose. O -

ten when I am approached by parents who complain that medication hasnt helped, or that it helps, but my child is still struggling in school,the problem isnt the medication. Its that the person doesnt actually haveADHD or has more than ADHD .

Tree cases o patients who were mistakenly diagnosed with ADHD il-lustrate the mistakes that can be made by doctors evaluating patients withADHD-like symptoms.

Mistake # 1 : Trying medication to see if it helps without athorough evaluation.Mr. and Mrs. Q. are the parents o eight-year-old Fred. A ew months ago,they met with Freds third-grade teacher, who expressed concern that Fredwas having trouble sitting still in class. As the teacher explained, he ofenhad to intervene to help Fred re ocus on his work. Even then, he said,Fred rarely nishes his schoolwork.

When Freds parents shared the teachers observations with their pe-diatrician, she said, Maybe we should try Ritalin. Afer months o trying various doses o that drug, and later Adderall, Freds mother contacted me.

In my conversations with Fred and his parents, several themes began to

emerge. For one thing, his rst- and second-grade teachers had not deemedFred inattentive or hyperactive. At home, Fred exhibited these behaviorsonly when he was doing homework ; he wasnt hyperactive or inattentive atother times o day, nor during weekends, holidays, or the summer break.

Clearly, Freds symptoms were neither chronic nor pervasive so theproblem couldnt be ADHD. Te pediatrician had jumped rom descriptionto treatment without making sure that Fred met the diagnostic criteria.

8/11/2019 Its Not Adhd

4/7

When ItIs Not ADHD

from the editors of

2

As I continued to evaluate Fred, I noted that he was struggling withreading. His comprehension was poor, and he retained little o what heread. Whats more, his handwriting was iffy, as were his spelling, gram-mar, punctuation, and capitalization. I reviewed Freds report cards. Sureenough, in rst and second grades, teachers termed his reading and writ-ing skills still developing. A psycho-educational evaluation conrmedmy hunch: Fred has a language-based learning disability . Te restless be-havior and inattention were the result o rustration he elt over having tocope with this disability.

I took Fred off ADHD meds, and worked with his parents to securespecial education services. Te hyperactivity and inattention disappeared.

Mistake # 2 : Relying on inconclusive evidence.Alicia, a single parent, was concerned that her 10-year-old daughter, Marie,

had ADHD. Pain ully shy, Marie had struggled in school since rst grade.Alicia arranged to have Marie evaluated by a psychologist, who told Aliciathat her daughter had ADHD. Alicia went to her amily doctor, who took onelook at the psychologists report and started Marie on stimulant medication.

wo years passed. Despite steady use o the medication, Marie con-tinued to have problems in school and with her peers. At this point, withmiddle school looming, Alicia called me.

I looked over the psychologists report. It included several rating scales,completed by Alicia and the psychologist, that seemed signicant in in-dicating ADHD. It also included a computerized test ( est o Visual Acu-ity, or OVA) that was suggestive o ADHD. Yet the psychologist hadnever taken Maries developmental history or even asked Alicia i there wasany amily medical history that might be contributing to her daughterssocial and academic difficulties. Te psychologist had spent only an hourwith Marie not nearly enough time to get a true sense o her

I learned that Alicia had separated rom her husband when Mariewas three and had gotten divorced two years later. Te marriage had beenstormy long be ore the separation, and the divorce was acrimonious.

Alicia downplayed the impact that this conict had had on Marie. Yet

when I asked Marie about her athers new wi e and her mothers new boy-riend, she burst into tears. eachers had noted that Maries classroom diffi-culties were most pronounced on Mondays, and that things got better as theweek went on. I learned that Marie stayed with her ather every other week-end, and that Alicias boy riend was spending weekends in Maries home.

Tis helped convince me that Maries problems stemmed rom depres-sion and a sense o helplessness she elt about her amily situation. I recom-mended that Marie go off medication and start psychotherapy.

8/11/2019 Its Not Adhd

5/7

When ItIs Not ADHD

from the editors of

3

Maries behaviors did not meet the criteria spelled out in the Diagnos-tic and Statistical Manual. Her problems were not chronic; they began onlyafer her parents marriage began to break up. What went wrong in thiscase? Instead o taking a detailed history, the psychologist based his diag-nosis solely upon the rating scales and the result o one computerized test.But while scales and tests can conrm the presence o hyperactivity, impul-sivity, and/or inattention, they cannot explain what causes such behaviors.

Mistake # 3 : Failing to consider coexisting conditions.Virginia, a 40-year-old mother, thought she had ADHD. She was restless,easily distracted, disorganized, and struggling with planning and doingeverything she had to do to care or her our children.

When I met with Virginia, she did seem to have a history o chronicand pervasive hyperactivity, inattention, and impulsivity. She recalled be-

ing restless and hyperactive since early elementary school. She had alwaysbeen easily distracted by extraneous sights, sounds, and intrusive thoughts.She tended to interrupt people and to use poor judgment at work, withinher marriage, and with riends. I ound no other condition that would ex-plain her problems. She must have ADHD.

But that wasnt the end o my diagnostic workup. When someone hasADHD, theres a greater than 50 percent chance that he or she will alsohave a learning disability, anxiety, depression, OCD, or some other neuro-logical disorder. Given this high probability o coexisting conditions, itsessential to consider additional diagnoses.

And so I learned that reading had always been a problem or Virginia.She told me that the only way to retain what she reads is to read it again andagain, while taking notes. She told me that math, spelling, and grammarhad always been hard or her. She is perpetually misplacing things, and shecant get things done on time.

When I asked Virginia i she ever elt anxious, she described a li etimeo panic attacks. She told me she is a raid o closed spaces and cannot useelevators or be in crowded rooms. When I asked about obsessions or com-pulsive behavior, she could not stop talking about her desire or order. She

cleans her home compulsively, and, earing that others wont be so consci-entious, uses public bathrooms only i absolutely necessary.Yes, Virginia has ADHD. But she also has dyslexia and suffers rom

anxiety and OCD. o get better, Virginia needs to be treated or all ourconditions.

Knowing that ADHD ofen runs in amilies, I asked Virginia abouther children. It turned out that her oldest son, a sixth-grader, has alwaysper ormed poorly in school. Like his mother, he struggles with reading

8/11/2019 Its Not Adhd

6/7

When ItIs Not ADHD

from the editors of

4

and writing and ofen eels anxious. I recommended that he be evaluated,as well.

Tese three cases illustrate how not to be diagnosed with ADHD. Nev-er accept a hasty diagnosis or one based solely on diagnostic scales or tests.I you or your child is diagnosed with ADHD, make sure the doctor checks

or coexisting conditions. Good luck!

Larry Silver, M.D., is the author ofDr. Larry Silvers Advice to Parents on AD/HD and The Misunderstood Child: Understanding and Coping with Your ChildsLearning Disabilities. He is also a clinical professor of psychiatry at GeorgetownMedical Center in Washington, D.C.

Note: Adults who think that they or their children may have attention decitdisorder should consult with a physician or other licensed mental healthpractitioner.

For more information on diagnosing attention decit disorder:CDC: http://www.cdc.gov/ncbddd/adhd/diagnosis.htmlCHADD: www.chadd.org ADDitude Magazine: www.additudemag.comAmerican Academy of Pediatrics: http://www.aap.org. Search: ADHD

8/11/2019 Its Not Adhd

7/7

7ADDConnect com

Find comprehensive resources and advice forparents and educators affected by ADD and LD.

TRY A FREE ISSUE!

www.additudemag.com/subscribeORDER ONLINEyour complete resource for living well with adhd