ADHD Diagnosis Observations- No Room For Complacency

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I have just been reading a report in Pediatrics where a study shows that if you are a minority child from Asian, African or Hispanic background, then you are much less likely to be taken for an ADHD diagnosis. 

The result is that among these minorities, the detection, diagnosis and treatment of ADHD is just way below that of white Caucasian origin.  The study was done after the researchers had followed about 17,000 children from kindergarten to the eighth grade.

The conclusion was that among these minorities as many as a half to two thirds were less likely to be diagnosed with ADHD than their white counterparts. This is not because ADHD is not present in these minorities. It is just that there are many factors at play here.

One may be the lack of awareness of what ADHD is and what the warning signs are. Other factors could be economic ones where access to healthcare is expensive or non existent so many of these children just go through their childhood and into adulthood without ever realizing that they have a problem.

Another issue is that minorities are just outside the diagnostic net while it could also be said that white children are being overdiagnosed. There is no definite agreement or consensus on this one.

All too often behavior issues which are plain and simple and need parental intervention. These cases have nothing to do with ADHD. Similarly, behavioral problems or learning disabilities at school may be the result of some other problem. But all too often, teachers want problem children quiet and calm and will often put pressure on parents to get the ADHD label, meds and all the other problems that go with that.

Misdiagnosing a case of ADHD is very serious as medication in the long term can lead to health problems.  

Even more worrying is that fact that original disturbance or disorder may never be properly diagnosed, with all the implications this has as the child moves into adulthood.

Problems and Solutions in ADHD Tests

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Let us look at what are the best ways of testing ADHD. Then we shall examine various approaches which are quite different in France and the USA.  We shall also survey the numbers and the risk of making an error when administering tests to diagnose ADHD.

What is ADHD?- biological, neurological or what?

Most experts are now agreed that ADHD is a neurological biological disorder which reveals itself in problems to do with the following areas of behavior at school and at home. These include:-

• restlessness,
• fidgeting,
• hyperactivity,
• lack of focus,
• inattention,
• distractability
• impulsivity

ADHD symptoms explained

Here we look at the ADHD symptoms but also in the second part how ADHD meds may be actually detrimental and are only a partial solution.

  Is it hereditary?

Most experts now agree that the condition has a strong genetic link. That means that bad parenting will not actually cause it but that the genetic makeup will be the determining factor. It is estimated that ADHD may well run in families and that there is a strong chance that one of the parents may also have this condition. A recent report in The Lancet recently confirmed that there is a gene which is responsible for ADHD behavior.

Why we have to get ADHD testing right.

Diagnosis of ADHD is not that easy and there are many different approaches. We know that in the USA, the condition is usually confirmed by the use of questionnaires and this mainly consists of ticking off boxes and getting an idea of where problematic behavior may lie in at least two settings. Numbers vary but in the US, it is now estimated that between 5% and 10% of the children will have this condition. Estimates for the UK are even higher and are pushing the 10% mark.

The fact that mistakes are made and the diagnosis procedure itself is full of holes has raised some alarm among the experts.  They are worried that:-

• one in five children in the USA may actually have been misdiagnosed
• there are over 50 childhood conditions which mimic many of the symptoms of ADHD
• there are many co- morbid conditions such as OCD, ODD, anxiety and depression which will also be present when properly diagnosed.
• between 50% to 60% of children will carry this into adulthood
• there is no pharmacological treatment which can actually cure the condition.
• only about 5% of children with ADHD actually graduate whereas among normal teenagers the rate is at around 28%.

Differences between France and the USA

When the French approach the problem of ADHD, they are much less prescriptive in their diagnosis and that is reflected in the actual numbers of children with this condition. They do not use the DSM IV (DSM V due in 2013). They have developed their own criteria which are contained in the CFTMEA (Classification Française des Troubles Mentaux de L'Enfant et de L'Adolescent).  

They particularly look at the social context of the child and take a much more holistic view in trying to get to the bottom of the causes. They are also much less likely to treat the condition with ADHD meds as in the USA and will make great efforts to do ADHD testing according to the social context of the child. There will be much more counselling and behavior therapy.  The Americans will home in on the biological imbalance and attempt to treat that with mind altering drugs.

The figures of ADHD in France reflect this much safer and altogether more sensible approach.. The numbers are much lower but that has to be balanced with their definition of what ADHD actually is, which narrows the field considerably.

The consequences of not doing ADHD testing properly

So, the attention deficit disorder test must be properly carried out and all the questionnaires  are gone through if we are to avoid the alarming statistic that one in five children are misdiagnosed and have to go through life and college with the wrong label with all the consequences that brings. Now that is scary!

Can You Treat ADHD? –Looking At Ways That Work.

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Many people think that ADHD treatments that work are just a few pills which happen to be based on amphetamines. That means they are strictly controlled and that there are some question marks about their safety and side effects and so on.  Why do you think that the FDA ADHD drug warning is the maximum that exists? The reason is that there are risks and that is why they get the black box treatment.

But let us move away from these meds because there are lots of other ways that can and do work and they are all based on how we organize a child’s life and the support he receives at home and at school.

We need to think outside the box because we know in our hearts that pills will not teach skills and we are thinking here about academic performance and also social skills and the organisation of an ADHD friendly home especially if we have ADHD ourselves.

When we mention the latter we are wondering how our child is going to learn to :-

• share
• fit into his peer group
• learn to listen
• understand about turn taking.

The fact that these skills need to be taught means a lot of hard work and monitoring by carers and parents. The fact is that the major task lies in raising awareness in the child that this is the way to make friends.  All too often  kids with ADHD are excluded form their peer groups, simply because they have no idea of what these social skills are. This is perfectly understandable in that the child’s mind is:

• operating at high speed
• distracted by sensory images
• highly impulsive
• hyperactive

Talking to children, you soon realize that they cannot seem to stop their mind from going all over the place. This is also a major reason for lack of motivation as the dopamine and histamine brain transmitters are all skewed and are also not connecting properly.

The next problem is media time because of we allow the free rein, then they are hyped up and they go into their hyperfocus mode.  ADHD children can concentrate so well on certain things that they simply cannot be torn away from them. The mind is getting instant gratification from video games and that means that it is extremely hard to focus on an activity like reading and homework afterwards. Studies show that kids just cannot focus after a video game and I am not surprised. But video games can be used by therapists to help train the neural pathways

We have to limit media time strictly and also make sure that the TV or computers do not take over   a child’s free time and that we ourselves are setting the example by limiting our own time on these devices.

Why not discover more about trying natural options for ADHD instead on relying on pills that will not teach skills. 

ADHD Study Tells Us To Talk More To Our Babies.

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Have you tried talking to your baby, cooing at it or laughing together, recently?  The reason I ask is that in a recent ADHD study, researchers at the University of Glasgow have found evidence that there may be a link with ADHD and/or other behavioral problems in childhood.

Their conclusions were that there seems to be some truth in the statement the more talk/interaction/vocalizations/sounds that the baby hears from the mother in the very early years will act as a sort of protection against ADHD developing.

Befoe they reached their conclusions, they watched videos involving 180 mothers talking to their one year old babies.  They found that there was a correlation with the amount of talk and interaction and the risk of developing ADHD. The more talk there was, the less the risk. They even calculated that with about 5 vocalizations less for every minute, the chances of a baby having ADHD was raised by 44%.

This is just one study so we should not draw too many conclusions from it and larger and more extensive studies will have to be done before we start chattering to our babies all the time!  Poor babies.

But maybe this would be a good thing anyway!  Just look at the moms you see in the shopping mall and on public transport. They are very often taking to their friends or texting their nearest and dearest and the baby in the buggy rarely gets any attention at all.

What about the number of times we have seen the TV and some screen device being used as a sort of babysitter?  That is a very frequent occurrence now as well.

Reactions to the study have been varied and many parents say that babies should be getting a lot more attention. However, I know of at least one mother with ADHD herself who has six children all with ADHD!

She has rejected that the amount of talk or lack of it is going to have any effect at all on whether the child goes on to develop ADHD.  She is convinced that the genetic factor is the one that determines whether a child has ADHD and she seems to be the living proof. She has stoutly maintained that she gave her children more than enough interaction to keep them going and that she even homeschooled them.  There are many parents who think like that.

In any case, this ADHD study is going to raise a lot of question marks. But before you send that text to your friend, why not put that off and give your baby some attention instead?