When is it ADHD and when is it just normal attention issues?

[Anonymous]

"And as for the notion of getting stuck with the diagnosis... so what?"

There is a "so what" in an overzealous diagnosis in terms of expense for therapy, stress, or in the extreme adopting approaches that normally would not fit your child or family life that are unproductive or worse putting your child on prescription drugs when it is not appropriate. There is a significant controversy on how many kids are being over medicated. For some with serious disorders the medication is a godsend but detrimental for others who are overdiagnosed.

[Anonymous]

Honestly, I don't know any child who was medicated based on a misdiagnosis. I'm sure it happens, but it must be pretty rare. ADHD meds are typically in and out so if they are ineffective or create side effects, its over within hours. I know far, far more children who were not diagnosed with something they absolutely have than children who are given a diagnosis that is incorrect.

I don't know about "significant controversy" about kids being overmedicated. I know there's a lot of fear expressed in the media but the vast majority of experts say kids are being undermedicated and that underserved children in particular are not receiving the treatment they should.

I think this fear of misdiagnosis is one thing parents tell themselves when they are afraid of what they may learn. I've been there, I know. But your child is who your child is and avoiding an evaluation doesn't help him any.

[Anonymous]

The diagnosis is what it is. You don't need to get services for it if you don't want to. If you decline then no one will know- not even the classroom teacher in most cases. I'm not sure why anyone would do that, but that is my own opinion.
In my line of work I've seen first hand the damage caused by parents in denial of a diagnosis. I've worked with and around a lot of doctors and pediatric patients. The only times I have ever witnessed what my less-trained opinion would deem to be over medication is when the parents convinced the doctors there was a lot more going on than there really was. But take that with a grain of salt, because it is speculative at best.
If you doubt the diagnosis get a second opinion. Doctors are really very cautious in prescribing meds for kids, and they will usually outline multiple different treatment options that may or may not include meds. The younger the child the more they rely on parents for information, but they will never tell you to do something that isn't right for you or your family. and if they did- who would keep going there?

[Anonymous]

Anonymous wrote:"And as for the notion of getting stuck with the diagnosis... so what?"

There is a "so what" in an overzealous diagnosis in terms of expense for therapy, stress, or in the extreme adopting approaches that normally would not fit your child or family life that are unproductive or worse putting your child on prescription drugs when it is not appropriate. There is a significant controversy on how many kids are being over medicated. For some with serious disorders the medication is a godsend but detrimental for others who are overdiagnosed.

I don't want to come across as snarky but I've reviewed a lot of the research regarding medication and it seems the people who feel there is a "significant controversy" are the people who are opposed to medication from the start, haven't studied peer-reviewed research or don't live with kids with challenges.

I haven't seen any research on "overzealous" diagnosis or treatment - just anecdotal stories. When I read/hear those stories, I wonder if the parents did their own research or if they just blindly accept what the professional tells them to do. No matter the condition, no matter the treatment, you need to use good judgment when determining a course of treatment. We've had our own negative experiences with medication and expensive therapies that didn't work. Each time, we considered the cost/benefit and when the costs became too high, we discontinued. That doesn't mean we were wrong to try it or there was harm in doing it. People need to make informed decisions and getting evaluations in order to better understand what you're dealing with is crucial to that process. With the exception of Greenspan (God bless him), every professional we dealt with was understanding when we indicated an approach was beyond our means or that wouldn't be a good fit for us.

Finally, even though my kids have been diagnosed ADHD/SPD and developmentally delayed, I don't consider them "stuck" with a diagnosis. The diagnosis doesn't define them. For me, it's shorthand for describing them in the same way I say they've got brown eyes. A diagnosis isn't going to stigmatize my kids.

[Anonymous]

My DD takes medication for ADHD. I don't consider this a "serious disorder." her ADHD is relative mild and she could probably get by without the meds, but with considerable stress, distress and a very heavy burden. With the medication, she is a top student at a rigorous school. I rarely even think about the fact that she has ADHD. I agree with what PP says -- it doesn't define her at all.

[Anonymous]

Some of the previous posted are very emotionally vested in their opinions. This is OK but you have to realize it is not necessarily helpful to other parents to push this onto them. You are incredibly defensive about dismissing anything that is different from you now believe. Parents, doctors, and educators who disagree and do see evidence that ADHD is overdiagnosed and that this leds to harm are not poorly educated or uninformed.

This issue really is not whether it defines the child or whether the family does or does not feel a stigma about a label.

My sister work in special education and sees far more parents seeking a diagnosis than avoiding one. The parents have the best interests of the child at heart and are worried. They wonder why their child is having behavior problems like not sitting in circle time or talking in the halls or acting out or why their smart child is not the top student, they hear from a teacher or a friend (not a developmental ped) that their child sounds ADHD. If the child is fine under some circumstances or doesn't show symptoms during the observations, the parents will hear from a friend that the child must have been compensating and seek another consult.

In other cicumstances, it is sadly the case that you need a diagnosis to get appropriate instruction for a child who does not have ADHD but can not manage the new environments within schools today. It is not a coincidence that the rise in ADHD has corresponded to the explosion in classroom sizes, cut back in recess and PE, increased academic rigor and competitiveness, increased focus on testing, articifical dyes and high sugar content of the school food, and budget cuts. The school environment is not developmentally appropriate today for many children who either do or do not have ADHD.

You just can't expect a 6 year old to sit quietly with no physical outlets and strawberry sugar loaded milk for lunch. You can't expect every 6 year old to be at the same developmental level and achieve twice what a 6 year old 20 years ago would have done. It is natural for many of these kids to act out from frustration.

For high school students the burden is even higher with great pressure to be at the top to deal with the competition for college admission. High school kids often are morw ired not to be able to go to sleep at 8pm but because we can't afford more buses and sports need to be done by 4:45 they are starting school at 7am and exhausted throughout the day. They have junk food and soda between classes. They have grown up with enough screen time to have become visual and kinetic learners but are in a classroom environment focused on lecture/auditory methods. There is nothing wrong from a learning style that is more participatory, visual, and kinetic but if it missmatches what the teacher is delivering the kids struggle to comprehend or stay engaged. Its no wonder many need medication to survive.

For a parent you can't change the school system fast enough to benefit your child so going down the path of finding a diagnosis and medication that helps them cope with the inappropriate and articifical situation is your only recourse. I would do the same thing.

This is no way means that there are not individuals who have serious chemical imbalances or disorders that require close medical attention. It also does not mean that parents who do have a diagnosis of ADHD are wrong in some way. My point is that we need to look at the societal factors that driving this rise and create more healthy environments where more children can thrive without parents struggling to find consults, invest in expensive therapies, and resort to pharmaceutical behavior modification to give their kkids the best shot at life.

[Anonymous]

I am not emotionally invested in meds but I still can't see the benefit -- if a parent is concerned -- of not consulting with a professional. It doesn't mean you will get a diagnosis. Our pediatrician often finds that a diagnosis isn't appropriate but a list of learning and developmental differences is, so that the parents can match the child with the right educational environment. With all due respect to your sister, her professional area of expertise is education, not neurodevelopmental disorders. I would be shocked if the parents of children she teaches didn't seek out an evaluation of why they are in need of special ed. How else would those parents know what the best environment for their children is? How else could they address their children's educational needs. Of course she sees more parents seeking a diagnosis than avoiding one, she teaches special education! The fact that she resents parents who seek an understanding of their children's learning differences makes me question if she is in the correct field.

And you've obviously been biased by you sister's bias. It isn't just about the educational environment. This is a big piece of it, but many of these kids also face challenges at home. And it isn't just about meds -- many times meds aren't appropriate and when they are they are only a portion of the answer.

There hasn't been an increase in ADHD, there's been an increase in treating ADHD. That's a good thing. Many kids who would have been destined for far more difficult lives in the old days are now thriving and succeeding because of recognition of what they need. As a parent, I am incredibly grateful for this.

And i deeply resent your line about "pharmaceutical behavior modification." Talk about emotionally loaded language. I am not modifying their behavior through drugs. My parenting is what controls their behavior. The medication treats a very particular medical disorder, and allows them to take advantage of this parenting. Any parent of a child with ADHD would tell you this. We aren't trying to produce super children and we deeply resent the implication. We're just trying to give our children the same shot at a happy life as yours.

[Anonymous]

"I think this fear of misdiagnosis is one thing parents tell themselves when they are afraid of what they may learn. I've been there, I know. But your child is who your child is and avoiding an evaluation doesn't help him any. "

You need to be careful with the evaluations. I learned this the hard way not for ADHD but speech. I'm a self admitted nervous helicopter parent. I know my ped is very conservative, probably why we mesh well but we have been sent to more than a few unnecessary second opinions. As an example, my ped sends any infant with even mild plagiocephaly to a neurosurgeon for a second opinion, much to the annoyance of the neurosurgeon. We went to a pediatric opthamologist because DS failed his vision screening. It was pretty obvious she was goofing around at one point (giggling and I thought she was saying the wrong letters on purpose) but the ped thought it was better to have a specialist evaluate him rather than doing the screening a second time. Of course when we saw the specialist and had had the talk about you need to tell them the real letters, he passed perfectly. I mentioned what had happened to the specialist and she of course asked why didn't you just repeat the screening test?

DS at 2 was just barely hitting the speech milestones and the sounds he did make were unclear to me. Ped of course recommended an evaluation. We went to a private SLP for an evaluation and the report that came back showing serious delays in speech, attention span, OT you name it. They recommended extensive therapy that their establishment provided. The eval session was a disaster and the SLP was incredibly disorganized but I didn't know what to expect. The report just did not in anyway reflect DS. I knew it was wrong but now I am even more nervous. I went for another evaluation and this one came back with only a mild speech delay and he tested above his age in all other areas (which in the other report he had been significantly behind). So now I have two completely different diagnoses. What do I do? Do I just follow the one that I as a parent think is correct or am I injecting bias. I honestly did not know if I was seeking or avoiding just trying not to make a mistake and ruin my child's life. I went for a third evaluation and it matched the 2nd one so we went with that and all is well now.

This whole ordeal ended up costing us hundreds of dollars which I can afford to throw out the window but many can not. What if I had gone with the first wrong one? How many hours and how much money would I have spent on unnecessary therapy. DS goes to a great preschool. If I had followed the 1st eval we would have put him in the special ed preschool the evaluators company offered.

If a few years from now a teacher tells me DC is too active and may have ADHD you can bet I am going to be very cautious about why, how, when, and if I go for an evaluation.

[Anonymous]

There needs to be a dialogue about what is causing the rise in ADHD diagnoses. There needs to be more focus on changing the school systems to support a broader range of students , more tolerance of normal child behavior, and more accomodations for all kids. As a parent, I know it can't be right when almost all the boys in our K class are being sent for ADHD evaluations. I know it can't be right when most of the teens scoring top grades are on medications. I know something is wrong when almost everyone I know with a son is considering holding him back one year before kindergarten at the encouragement of their preschool. Every kid deserves to learn to love learning. As a parent I should not have to seek out consultations, therapies, and medication to achieve this unless it is TRULY necessary.

[Anonymous]

"My son what I'd describe as a pretty typical 4.5 yo boy - very energetic, very active, loves superheroes/Ben 10 (and knows all the dozens of characters by name) - but seems to have some problems with his focus. His pre-school teachers recently brought up that they were concerned that he seems distracted easily and over focussed on things like Ben 10 aliens. My 4.5 yo has been evaluated by Child Find and scored in the average/advanced range for everything (expressive language, etc.) but has some speech (mostly pronunciation) issues. The comments by the pre-school teachers though have me worried.

I find that my son focusses just fine when he wants to (e.g., when doing an interesting art project, playing video games - I know, not ideal, but they certainly get his attention, doing a fun puzzle). It isn't like he can't finish ANY projects. The teachers are also worried that he doesn't seem to know all his classmates by name. Part of me feels like this is actually a school issue (both my son and my nanny, who volunteers there every now and again when they need help) have mentioned that it is boring.

But I don't want to brush aside a real issue if there is one.

I would appreciate anybody's insight as to whether this appears normal or whether he does seem to have some ADHD qualities. For what it is worth, my MIL always talks about how my DH was the exact same in school. Teachers always thought he had a hearing problem b/c he would get so focussed on something that he would tune out everything else. My son definitely seems to do this...

TIA "

OP Childfind would have picked something up during the overall evaluation. I would trust them over your preschool teacher.

[Anonymous]

to 11:26
I hear what you are saying about our public educational system, and how developmentally inappropriate instruction can excerbate normal behaviors in young children so that they can appear pathological. That being said, walk a mile in my shoes before you speak about over-diagnosing and over medication. My older two children (11 and 8) attend a small, nuturing private school (not a special needs school) where they recieve lots of physical activity and an enriched curriculum including art, music, social studies and science. My children are not "taught to the test" and recieve lots of individualized instruction and differentiation within the classroom. They have never been "problem" kids, and don't present much in the way of behavioral issues in the classroom. And yet, both are ADHD, and recieved their dx's around age 7, when my DH and I felt that their symptoms were beginning to significantly impact their functioning at home and at school. We are a very close family, and we have a third child who clearly does not have attention issues. We had full evals that made total sense to us and clearly id'd the issues they have. My husband was dx'd with ADHD as an adult, after struggling for years and suffering mightily because of it. The medication is a godsend. It allows us to implement behavioral modifications and actually have them work. (try giving my kids a to-do list when they are off meds - hilarious! Stickers and prizes? They don't matter if they can't remember or pay attention to what they are doing).

So for our family, ADHD is real and frankly exhausting, but because of adequate interventions my kids don't feel stupid or inadequate. ADHD does not define them, but they understand that some things are more difficult for them. What is especially frustrating is when well-meaning friends or strangers question our decision to treat our kids (medication, limited screen time, careful diet, adequate sleep etc), because our kids seem so "normal" and "nice". Unbelievable.

[Anonymous]

PP here - that smiley face should be an eight.

[Anonymous]

Anonymous wrote:Some of the previous posted are very emotionally vested in their opinions. This is OK but you have to realize it is not necessarily helpful to other parents to push this onto them. You are incredibly defensive about dismissing anything that is different from you now believe. Parents, doctors, and educators who disagree and do see evidence that ADHD is overdiagnosed and that this leds to harm are not poorly educated or uninformed.

It's not an emotionally based opinion or belief, it's what peer reviewed research shows. In fact, the peer-reviewed research indicates that it's under-diagnosed and under-medicated.

http://www.ncbi.nlm.nih.gov/pubmed/17709814
http://www.ncbi.nlm.nih.gov/pubmed/11122941

I agree that the demands on kids have increased over the years and they would benefit from less pressure and more exercise. But, your whole post is based on opinion. Your sister's bias has clearly influenced your opinion and as seen in the under-diagnosis of ADHD the norm is not to seek a diagnosis.

[Anonymous]

Anonymous wrote:"I think this fear of misdiagnosis is one thing parents tell themselves when they are afraid of what they may learn. I've been there, I know. But your child is who your child is and avoiding an evaluation doesn't help him any. "

Anonymous wrote:".........If a few years from now a teacher tells me DC is too active and may have ADHD you can bet I am going to be very cautious about why, how, when, and if I go for an evaluation.

Exactly, that's why parents need to use good judgment. That doesn't mean you should avoid evalutions. Big difference.

BTW - ADHD isn't just about being active. It's a common misperception that you have to be active in order to have ADHD. You don't.

[Anonymous]

"Anonymous wrote:
"I think this fear of misdiagnosis is one thing parents tell themselves when they are afraid of what they may learn. I've been there, I know. But your child is who your child is and avoiding an evaluation doesn't help him any. "

Anonymous wrote:
".........If a few years from now a teacher tells me DC is too active and may have ADHD you can bet I am going to be very cautious about why, how, when, and if I go for an evaluation.

Exactly, that's why parents need to use good judgment. That doesn't mean you should avoid evalutions. Big difference.

BTW - ADHD isn't just about being active. It's a common misperception that you have to be active in order to have ADHD. You don't. "


I'm 11:59 and my experience will lead me to avoid evaluations or at least more carefully consider whether going for one is well founded or not. I don't think my experience was perfectly fine because I used my judgement not to go down the wrong path. I'll never have the attitude that getting an evaluation will not hurt anything so why not again.