A knowledgeable professional is needed to advise and encourage parents who are often bewildered and frustrated by behavior they can neither control nor understand. Finding a physician both trained and especially interested in caring for ADHD can be critical. In addition, there are numerous treatment options that can seem overwhelming when parents are trying to find help for their child. So, let's consider some medical and nonmedical interventions.
Diagnosing ADHD
The first step any good doctor is going to take is a comprehensive history of the problem. The most accurate diagnostic list is now felt to be the standardized checklist used in the DSM-IV. This is a diagnostic manual used by psychiatrists and other mental health professionals to guide their diagnosis of mental health conditions. In addition to the DSM-IV criteria, many physicians use standardized questionnaires for both the child's parents and teachers to fill out.
After the history, the physician should perform a complete physical exam to be sure that there are no other physical or neurological problems present. Most physicians will order a basic set of blood and urine tests - once again, to rule out any medical problems that might mimic ADHD.
Although some physicians will use brain scans - such as a computerized tomography (CT) scan, a magnetic resonance image (MRI) scan, a single photon emission computed tomography (SPECT) scan, or a positron emission tomography (PET) scan - the only valid use for such an exam, outside of experimental protocols, is to make sure there are no other problems with the brain. In the future, such tests may be used in confirming a diagnosis of ADHD; however, the current state of the research does not allow for the routine use of these scans in the diagnosis of ADHD.
In the past, physicians (including myself) have used what we call "therapeutic trials" of prescription medications in the diagnosis of ADHD. Instead of doing a lot of expensive tests, we'd prescribe a stimulant medication, like Ritalin, and see if it helped or not. If the medication helped, that would (we thought) help make the diagnosis.
However, this technique is no longer considered either valid or safe. For one reason, the stimulants can cause fairly severe side effects in kids who don't have ADHD. Second, a positive response to Ritalin can be seen in conditions other than ADHD. In this case, the falsely positive therapeutic trial would falsely label the child, prevent the child from getting a correct diagnosis, and cause him or her to take an unnecessary prescription. Third, as you are learning, ADHD treatment requires much more than just a prescription. What Is Adhd In Children Treatment
Diagnostic Criteria for ADHD
Most professionals who care for patients with ADHD use even more exact diagnostic criteria. In fact, these are the specific criteria for diagnosis from the DSM.IV:
A. Either (1) or (2):
(1) Six (or more) of the following symptoms of inattention have persisted for at least six 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 (for example, 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 six 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 inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
(d) Often has difficulty playing or engaging in leisure activities quietly
(e) Is often "on the go" or often acts as if "driven by a motor"
(f) Often talks excessively
lmpulsivity:
(g) Often blurts out answers before questions have been completed
(h) Often has difficulty awaiting turn
(i) Often interrupts or intrudes on others (for example, butts into conversations or games)
B. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years C. Some impairment from the symptoms is present in two or more settings (for example, at school [or work] and at home)
D. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning
E. The symptoms do not occur exclusively during the course of pervasive developmental disorder, schizophrenia, or other psychotic disorder and are not better accounted for by another mental disorder (for example, mood disorder, anxiety disorder, dissociative disorder, or a personality disorder). What Is Adhd In Children Treatment
Although studies show that a mother's evaluation and description of these behaviors is very reliable and accurate, it is also clear that a morn or dad is unable to make the actual diagnosis. I want to emphasize that I list these criteria not so that you can make your own diagnosis. That is unsafe and inappropriate - specially in light of all the medical and emotional problems that can mimic ADHD. But I do think seeing these criteria can be helpful to us as parents, especially if you feel your child is not getting a proper evaluation or treatment.
It is also important to point out that the criteria specifically indicate that the symptoms are "not due to oppositional behavior or failure to understand instructions." This is important to understand, as another common disorder in children and teens is the Oppositional-Defiant Disorder (ODD), which manifests itself with a pattern of persistent arguing with multiple adults, losing one's temper frequently, refusing to follow rules, blaming others, deliberately annoying others, and showing recurrent anger, resentfulness, spitefulness, and vindictiveness.
Dr. Bill Maier recently pointed out to me that between "40 and 60 percent of kids with ADHD may also have ODD.
Many researchers believe that untreated ADHD can actually contribute to the development of ODD - a disorder which can wreak havoc on parents, teachers, and society.''
Since we are able to do a simple diagnostic whether our kids have ADHD or not, next post, we'll talk about nonmedication treatments. At mean time, you can get further information from What Is Adhd In Children Treatment.
