ADHD: an epidemic?-Ask Dr. Paul Library

DEAR DR.PAUL: I keep hearing all kinds of things about ADHD (Attention Deficit Hyperactivity Disorder) and medication issues. It seems that more children have ADHD today. Is there a true ADHD epidemic?

PEDIATRICIAN DR.PAUL Answers: You ask a very popular question, as it seems that it has become fashionable to label children with seemingly any type of behavior or school problem as "Hyper". Although there are many concerns about medication use, let's focus on the basics of making the diagnosis of ADHD which in itself is not very simple. The three main features of ADHD are impulsivity, inattentiveness and hyperactivity. In order for the diagnosis to be made, these must be present for at least 6 months and interfere with both school and social functioning. Parents also do not realize that there are social problems related to ADHD such as difficulty in making and keeping friends and low self esteem. In addition, ADHD can be associated with other conditions such as learning disabilities, anxiety or mood disorders and oppositional or defiant disorders.

Importantly, non-ADHD conditions/situations can make a child seem to have ADHD. For example, children with home or family related stress may act out at school and on the surface, be labeled as having ADHD. In today's stressed society, an increasing number of children are acting out and have school difficulties. Facing budget cut-backs and lack of resources, school and social service authorities are often quick to look for the possibility of ADHD in these children, when in fact, the behavior is related to home/family problems. The possibility that children can exhibit ADHD-like symptoms, without having ADHD, and that ADHD may be associated with other conditions, makes the diagnostic process difficult, yet all that more important.

ADHD can be accurately confirmed only with the involvement of all the people caring for the child, both at home and at school. Other key members of the team include the doctor and other consultants such as a psychologist or school specialist. The process involves gathering information from the school about the child's academic and social performance and interactions with other children. Equally important are the parent's observations. Both of these observations can be scored on a Conner's (Scale) Sheet, a useful aid in helping confirm ADHD. Psychological tests will evaluate how a child works academically, will assess the child's intelligence level and screen for learning disabilities. A full medical evaluation will make sure that there are no medical problems mimicking AHDH. As you can see, there is no one single test that exists to diagnose ADHD. Only after the gathering of all the above information from what I like to call the "Hands on Team", can the diagnosis be made. If we sift through all of this and look at the actual number of cases diagnosed with ADHD, we see that the rate of properly diagnosed ADHD has not increased over some time in spite of media alerts about "An ADHD Epidemic".

The following is a quick questionnaire to screen for any school difficulties:

As a quick way of screening for ADHD and possibly other learning problems the American Academy of Pediatrics suggests that parents respond to these questions during routine check ups:

  • How is your child doing in school?
  • Are there any problems with learning that you or your teacher has seen?
  • Are you concerned with any behavioral problems in school, at home or when your child is playing with friends?
  • Is your child having problems completing class work or homework?

If the answer is not well for the first question and/or yes to any the rest, you should discuss this further with your child's school and doctor.

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