Attention-Deficit/Hyperactivity Disorder has gained a great deal of attention over the past 15-20 years despite that the disorder, under other names, has been around since the 1800s. I am of the opinion that AD/HD is an honest-to-goodness neurological disorder that produces a predictable pattern of symptoms in both children and adults. I am, however, also under the opinion that it is grotesquely over diagnosed.
I believe that it is over diagnosed for several reasons: 1) the pattern of symptoms is not uncommon to see in average 5-9 year old children, 2) It is not uncommon for frustrated parents to over report symptoms, and 3) It is not uncommon for practitioners to make a diagnosis based entirely on parental report. Further, the pattern of symptoms is also easily produced by a number of other things that are often overlooked such as anxiety or depression.
Therefore, when I am asked to evaluate a child for AD/HD, I use a variety of sources of information to get the most complete picture of the child as is possible. An ideal evaluation includes a developmental interview with the parents, observation of the child in a clinic setting as well as at school, teacher interview or behavioral rating scales, and parallel behavioral rating scales from the parents.
If the synthesis of the data point to a diagnosis of AD/HD, I am still unwilling to simply medicate the child. I instead propose a number of helpful techniques for the parents to use at home and I will consult with the teacher about suggestions for the classroom as well, if appropriate. If, after an adequate amount of time and careful execution of the suggestions, there still is not improvement, I might suggest referral to a psychiatrist for possible medication.
If the psychiatrist chooses to offer medication, I still consider it part of the evaluation and follow the child closely for at least 2 months. If there is not a significant amount of improvement, reflected on a second administration of the rating scales, my AD/HD evaluation is complete, the child is not diagnosed with AD/HD and it is suggested that medication be discontinued.
Although the AD/HD evaluation is complete, my overall evaluation is not yet complete because we still haven’t found the source of the child’s difficulty. The assessment will continue, along with treatment recommendations until something is found that works.
If medication proves to be beneficial, that also concludes the evaluation, the diagnosis of AD/HD is made. It is there that treatment with me begins. We work with parents, kids, and schools to help find techniques that will help the child cope with and compensate for his symptoms with the hope that medication may not be a permanent need.
