ADHD maybe one of the most controversial ‘diseases’ of childhood.
Claims of over- and under-diagnosis confuse parents. Estimates of incidence and prevalence vary widely, with somewhere between 3% and 11% of children diagnosed (depending on the source for statistics). Boys are over-represented in ADHD diagnosis, comprising approximately two-thirds of those given an ADHD label.
What is ADHD
In 1980, a new diagnosis, Attention Deficit Disorder (ADD), was added to the ‘bible’ of psychology and psychiatry – the Diagnostic and Statistical Manual of Mental Disorders (DSM). Seven years later, the label was changed to ADHD: Attention Deficit and Hyperactivity Disorder.
There are three types (or presentations) of ADHD: Hyperactive and impulsive; inattentive; and a combined type.
For a child to ‘have’ ADHD, he or she must present to the clinician with at least six of the following behaviours:
- Fails to give close attention to details or makes careless mistakes.
- Has difficulty sustaining attention.
- Does not appear to listen.
- Struggles to follow through on instructions.
- Has difficulty with organisation.
- Avoids or dislikes tasks requiring a lot of thinking.
- Loses things.
- Is easily distracted.
- Is forgetful in daily activities.
- Fidgets with hands or feet or squirms in chair.
- Has difficulty remaining seated.
- Runs about or climbs excessively.
- Difficulty engaging in activities quietly.
- Acts as if driven by a motor.
- Talks excessively.
- Blurts out answers before questions have been completed.
- Difficulty waiting or taking turns.
- Interrupts or intrudes upon others.
The combined presentation simply requires a child to present with symptoms from both lists.
Taking a look at the lists above may seem confusing for many parents. Don’t most children exhibit these behaviours at least a lot of the time? Is this suggesting that all children have ADHD?
We should also consider a number of other questions:
- Is the behaviour long-term (persisting for at least 6 months)?
- Is the behaviour excessive?
- Is the behaviour significantly different from most other children of that age?
- Is it context-specific or does it generalise to other places beyond home (or school)?
- Was the behaviour experienced before the age of 7?
One of the reasons ADHD is claimed to be over-diagnosed is that children are often treated as having ADHD due to symptoms, without underlying causes being investigated. Instead, some professionals use Ritalin and Adderall as their ‘go-to’ strategies. This is a significant concern. First, hacking at the leaves will never remove the root. To help children, we need to do better than to simply medicate. But second, both of these drugs are stimulants. The more they are consumed, the greater the tolerance that develops – and the more that is needed to create the same effect.
To really understand whether a child does have ADHD, we must rule out a number of other potential causes for children’s challenging behaviours. Here is a short-list:
- Parenting practices not being ideal (needing to show more love, or set limits more effectively)
- Learning issues/disorder (for example, dyslexia)
- Hearing issues
- Medical issues (for example, ear, nose, or throat problems)
- Family issues (for example, domestic violence or other forms of abuse)
- Lack of sleep
- Anxiety or depression
- Needs glasses
- Social issues (for example, bullying in the playground)
If your child does meet the criteria for ADHD, it is important to take time discussing the issue with your GP. Obtain a referral for a professional who can ensure that before your child is prescribed drugs, that all potential underlying issues can be examined and eliminated as causes. ADHD is a complicated and challenging concern. For those who experience it, the effects can be debilitating. We should take it seriously. But we should also be cautious that our diagnosis is careful, thorough, and accurate.