⌐ 1995, Susan Setley. All rights reserved. This file may be distributed to anyone in any form including print and electronic IF copyright and ordering information are included.
DIAGNOSIS OF ATTENTION DEFICIT DISORDERS
The purpose of an educational diagnosis is to turn a child who struggles into a child who learns. Many kinds of practitioners possess the legal right to diagnose (or rule out) attentional problems in children. The difficulty parents face is that these professionals, although they all mean well, vary greatly in their skills and knowledge of the problem. Specialists who diagnose ADD or AD/HD include pediatricians, pediatric neurologists, child psychologists, child psychiatrists, and school diagnostic teams. Some diagnosticians do excellent jobs, but some aren╒t really up to the task.
Inexperienced or inadequately trained diagnosticians frequently confuse ADD or AD/HD with other childhood problems. They may mistake ADD for some other difficulty, or they may diagnose ADD when some other, serious problem actually accounted for the child╒s difficulties.
The people who diagnose childhood problems take on a complex task. No one test exists that will prove with 100% confidence that your child does or does not have ADD. Inattentiveness, hyperactivity and distractibility╤the benchmarks of ADD and AD/HD╤are superficial signs of several other childhood problems as well. These problems include temporary anxiety from family upheaval╤such as recent divorce or long-term chaotic home life.
Severe family dysfunction, such as when the parents are severely alcoholic or when the child suffers physical, psychological or sexual abuse, can mimic ADD at first look. Furthermore, significant family dysfunction of all kinds occurs more frequently when one or both parents have attentional problems. So, because ADD tends to be passed genetically from one generation to the next, many children in troubled families also have ADD.
Finding serious problems within the family doesn╒t rule out ADD but makes it more difficult for the specialists to make a good diagnosis. In addition some medications can aggravate ADD or mimic its symptoms as a side effect, especially some medications for asthma, some cold/allergy medications and some anti-convulsants.
Another diagnostic complication has its basis in the nature of children with ADD. They behave differently in different settings. Sometimes, captivated by all the intriguing sights, sounds and smells of a medical office, they appear fully in control. They ask what the equipment is used for and engage the doctor in interesting conversation. The doctor gets the impression of a bright, curious child, not a flighty and unfocused one.
That doctor might get a wholly different impression if he ignored the child╒s questions, took control of the conversation and asked the child to do some math problems.
Parents╒ best protection from diagnosticians who aren╒t ╥up to speed╙ on ADD is to read everything they can get their hands on about the problem before taking their child to be tested. Then they can ask intelligent questions, and they╒ll be more likely to know whether they╒re getting accurate and detailed answers or not.
Some questions to ask might be:
Ñ How many children have ADD?
Ñ How many of the children who come to you end up diagnosed with the problem?
Ñ What criteria do you use for diagnosis?
Ñ What else looks like ADD on the surface, and how do you make sure the child has ADD and not some other problem?
Ñ What treatments do you feel are most effective?
Ñ How would you describe your success rate?
Another problem in diagnosis turns on issues mentioned earlier in this chapter. Some diagnosticians see ADD under every rock; others think the problem quite rare. Neither view is accurate. One way to sort this problem out is to ask the examiner how many children, in his or her opinion, have ADD or AD/HD. If the examiner reports that 10% or even 20% of children have ADD, this person may have a too-strong bias toward diagnosis.
But you must also avoid bias against diagnosis as well. Whether the specialist sees ADD where it doesn╒t exist or overlooks the problem when it╒s present, it╒s your child who runs the risk of an inaccurate diagnosis. If the specialist says something like ╥3%╨5%, but we╒re not absolutely certain because we know some children go undiagnosed...╙ this person has a good perspective on how common the problem is.
Diagnostic criteria for Attention-Deficit/Hyperactivity Disorder3
According to new guidelines contained in the Diagnostic and Statistical Manual (DSM-IV), the child must meet the criteria under either (1) or (2) below:
(1) Six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:
Inattention
(a) often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
(b) often has difficulty sustaining attention in tasks or play activities
(c) often does not seem to listen when spoken to directly
(d) often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
(e) often has difficulty organizing tasks and activities
(f) often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
(g) often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
(h) is often easily distracted by extraneous stimuli
(i) is often forgetful in daily activities
(2) Six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:
Hyperactivity
(a) often fidgets with hands or feet or squirms in seat
(b) often leaves seat in classroom or in other situations in which remaining seated is expected
(c) often runs about or climbs excessively in situations in which it is in appropriate (in adolescents and adults, may be limited to subjective feelings of restlessness)
(d) often has difficulty engaging in leisure activities quietly
(e) often is ╥on the go╙ or often acts as if ╥driven by a motor╙
(f) often talks excessively
Impulsivity
(g) often blurts out answers before questions have been completed
(h) often has difficulty awaiting turn
(i) often interrupts or intrudes on others (e.g., butts into conversations or games)
Some of the symptoms that caused the difficulties must have been present before the age of 7 years. In addition the impairment must be observed in more than one setting, such as home and school. There must also be clear evidence that the child is actually impaired significantly either socially or academically (in people old enough to hold a job impairment at work would be considered significant as well). Finally, for a valid diagnosis of Attention Deficit Disorder the difficulties cannot be caused exclusively by a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder. The person╒s difficulties can╒t be explained better by some other mental disorder, such as Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder.
Getting to yes or no
Diagnosis is the process of confirming some hunches while ruling out others. We gather information from a variety of sources. Teachers and parents fill out questionnaires about the child╒s behavior and characteristics. A physician rules out medical causes for the child╒s difficulties, such as seizure disorders, side-effects of other medication the child has to take, or other physical conditions that can affect attention span.
The examiner interviews child and parents, and a really good evaluation includes observations of the child in school. Individual testing determines overall intellectual potential and detects any other learning problems that might be present. Other specialists may be called in if needed. The author prefers to see the child╒s learning style as well as attentional abilities explored. Diagnosis is made by combining information from all these sources.
3American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, pp. 89-90. American Psychiatric Association, Washington, D.C., 1994.
Excerpt from TAMING THE DRAGONS: REAL HELP FOR REAL SCHOOL PROBLEMS. ISBN 1-886243-04-2. Available from Bradburn School Supply (800) 782-2490. Also available through The Learning Disabilities Association of America.
