01/16/98

Are We Overdiagnosing ADD-ADHD?

Restless, impulsive children with short attention spans and difficulty concentrating have trouble learning in large groups. They miss instructions, develop gaps in their knowledge, tip their chairs back, and show more interest in the flight path of a fly than in a teacher's carefully prepared test review session -- only to flunk the test the next day. Are these signs of a personality type, a learning disability, family problems, a neurological disorder? They could be signs of one, all, or none of the above. In the extreme, these children often fare poorly in school without carefully planned interventions based on what we have learned about a diagnosis called Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivy Disorder (ADHD). No definitive diagnosis can be made without a comprehensive evaluation by trained professionals.

Interventions for ADD-ADHD include, but are not limited to, behavior modification plans, tutorial help, carefully structured and organized lessons, frequent feedback during new learning, multi-sensory teaching/learning and counseling. Physicians sometimes prescribe stimulant medication for children with ADD or ADHD, the most common of which is Ritalin. The medications help some children pay attention and concentrate better. I have known children for whom the results have been dramatic and others for whom the medication seems to make little or no difference.

In response to last week's "Ask a School Psychologist" segment about ways a parent might get more school support for her fifth grade daughter with ADHD, readers made constructive suggestions, shared personal stories, and vented frustrations about this condition. Some readers say that ADD-ADHD children may give their parents and teachers 'fits,' but they often become highly successful adults, especially in fields which require constant new ideas and quick reactions to change.

Several reader opinions about ADD-ADHD follow:

• Both my children (eight and ten years old) have several rude, disruptive and uncontrollable students in each of their classrooms. Though these boys, who all come from wealthy "nanny" families, are labeled ADD, I think they are completely spoiled by parents who leave everything up to the school, but fly off the handle if their children are disciplined in even the mildest manner.

  As a parent who consistently works to bring my children up as respectful, caring, and (usually) well behaved students, I wonder about the broad brush which paints the ADD segment. I see it as a medical wonder that this disease predominately affects white, middle- and upper-class American boys while the rest of the world seems to be immune. In many cases the abbreviation, ADD, signifies Adult (or Administrative) Discipline Disorder, where irresponsible parents, doctors, and educational staffs rely on Ritalin (whose manufacturer pays millions into the medical community and ADD lobby) to "cure" lazy parenting.

  I am a single father, having brought up my two boys alone since they were one and three. I work for myself as a landscaper and adjust my schedule to that of my children. My boys are respectful of others, especially adults; they are compassionate, friendly, and outgoing and I continually receive compliments from teachers, friends, and strangers regarding their courteousness, behavior, and overall positive attitude. When I am asked how I have coped without help, the answer is as simple as it is natural: hard work, consistent limits, self-sacrifice, and mountains of openly displayed love. Too many modern parents do not realize their own epidemic selfishness and would be shocked if it were pointed out to them. Sorry, but true.

  So how do we deal with the fact that a few "ADD victims" are ruining the entire classroom experience for other children...that the teachers are not allowed to discipline these kids...that the disruptive children's parents simply shrug and blame it on a "disease" convenient to their lifestyle?

  Even though ADD-ADHD is a medically identifiable disorder which requires special care and medication for some children, I think the diagnosis has become a trash bin for lazy adults at home and in the schools. What do other readers think and where do we go from here? -- ADD, a Label for Lazy Parenting

• My son, who has ADD, went from zero self-esteem ("I'm nobody, I'm nothing") to success as a high school freshman taking two honors classes and two regular academics with help from a resource teacher. His special interests are marching band and computers. He uses Ritalin for academic work and when learning complicated marching routines. It bothers me when I read about ADD-ADHD being overdiagnosed. I can speak to the difficulties experienced by someone with this condition who said, "It is like trying to work through a fog or with the TV on and tuned to several stations at once." -- Consistency Is Important

• I am amazed that many teachers still do not know what ADD-ADHD is all about. My son was diagnosed, finally, in the third grade. Since first grade he has had poor organizational skills and could not attend or focus, making it difficult to finish tasks. Easily distracted and fidgety, his teacher labeled him lazy and a troublemaker. "He doesn't have ADD," she said. "He's too smart for that." Children with ADD are, in fact, often smart and creative. Parents need to educate themselves about ADD so they can become effective advocates for their children.

  As the parent of a child with ADD you may have to:

  1. Educate the teachers about ADD-ADHD.
  2. Request a teacher change if a teacher's negative attitude is harming your child's self-esteem.
  3. Consider treatment with Ritalin. (It has been a God-send for my son.)
  4. Arrange for psychological counseling with someone experienced working with ADD children.
  5. If all else fails, consult a child advocate (attorney) to assert your child's rights to the support services he or she needs.
  -- Parents Must Become Advocates

• I am a 33 year old with ADHD and have a 7 year old son with it also. My academic performance was always poor. This condition was not well understood in the past, and it still isn't. Today I am fine and making a nice living in spite of ADHD. My son also does well in the 2nd grade. We have adjusted our environments and the expectations of our peers. My advice is to avoid Ritalin. I have taken it myself and got away from it. Try to manage ADHD without drugs. ADHD isn't a disorder; it's a different type of individual. Mostly affecting men, it is a genetic adaptation to a hunting lifestyle rather than a farming lifestyle. A thousand years ago, ADHD was quite useful. There are several high paying jobs that lend themselves to ADHD, such as sales, marketing, computer science, law enforcement, and emergency rescue. There isn't necessarily something wrong. Learn to leverage your unique powers. -- ADD People Have Unique Powers

• ADD-ADHD is not a fad. I have worked with the handicapped for over 10 years. We knew something was wrong with our son by the age of two. He was diagnosed at four and finally medicated at seven, when his school work began to suffer horribly. There is a huge discrepancy between what he is capable of doing and what he turns in when left to himself. Do not laugh off a diagnosis of ADHD. -- ADD-ADHD is Not a Fad

Please send questions or comments to bbruno@snet.net.