ADHD is a lifelong, genetic neurobiological disorder that impacts up to 11% of American children. The core of the disorder is not hyperactivity, as people generally believe, but inattention, poor executive functioning, and an inability to stay on task. Although boys with ADHD are more likely to be hyperactive than girls, ADHD affects equal numbers of boys and girls.
Hyperactivity may be manifested differently as a child matures. For example, a young child may shake in his chair or constantly tap his foot, but as an adolescent, he may instead become anxious and tense. Such changes may make ADHD look like an anxiety or mood disorder—but it is still an attention disorder, the symptoms of which are just showing up differently.
The challenge for parents and professionals is to understand whether other issues are co-existing conditions or are the result of the ADHD.
If they’re co-existing conditions they must be treated separately; if they’re the result of the ADHD they may resolve themselves once the ADHD is properly treated.
Accurate Diagnosis Before Treatment
Every treatment and intervention depends on having a correct diagnosis. Providing the treating doctor with highly specific information from parents helps her make an informed diagnosis. The wrong treatment—based on an inaccurate diagnosis—can lead to failure for your child and frustration for the family.
Half of all children with ADHD present solely with ADHD—either the inattentive or hyperactive type. The other 50% have co-existing conditions, most significantly learning disabilities and mood disorders, such as anxiety or depression.
Chicken or Egg Dilemma?
When diagnosing and considering treatment, it is imperative to determine if the learning disability or mood disorder is a true co-existing condition or is secondary to the ADHD. If it’s a true co-existing condition, it must be addressed separately and specifically, in addition to the treatment prescribed for the ADHD. If, instead, it’s secondary to a primary diagnosis of ADHD, treatment for the learning or mood issues will be dependent on the child’s response to his ADHD treatment.
For example, if a child with inattention or hyperactivity has a true co-existing language processing disorder, he will need highly specific interventions in decoding or reading comprehension, in addition to treatment for his ADHD.
If, on the other hand, the child with ADHD is struggling with reading because of his inattention (if the reading issues are secondary to the ADHD) the attention issues must be addressed first. Once the inattention or hyperactivity is under control, he will be more available for learning and can then be taught to read like a typical child with no reading disability.
The same is true for anxiety or depression, both of which occur frequently among children. Ask friends and teachers about your child’s temperament and behavior; find out what issues cause him to become moody or to act out.
If your child is irritable, presents with a flat affect (little show of emotion), and has no sense of joy, even for things that would normally excite him, don’t assume that’s just the way he is. He may have a co-existing mood disorder, which should be taken seriously and addressed with pharmacological and behavioral treatments.
On the other hand, your child may be anxious or depressed because he can’t stay focused, keep his thoughts straight, and function successfully in a school setting, or because teachers and coaches demean him in front of his peers. Similarly, with conduct issues, your child may be frustrated from being criticized constantly and may be pushing back in order to stay afloat. Under those circumstances, your child does not have a mood or conduct disorder; he has understandable frustration. Once his ADHD is treated and his attention and focus are under control, he will probably no longer appear as anxious, depressed, or oppositional.
The more you know . . .
- the better care your child will receive
- the better your emotional health will be
- and the better your relationships will be with your child and your child’s providers
Trust your instincts, and don’t be overwhelmed by experts. The parent is always right unless proven otherwise. If you don’t understand something, or if what you’re being told doesn’t sound like your child…
- don’t be passive: jump in and ask questions
- continue to seek out information: If you don’t get the answers you need from one source, get them from another
- do not give up
This article is based on a presentation by Alan Wachtel, MD, sponsored by Smart Kids with Learning Disabilities. Dr. Wachtel is a psychiatrist and noted expert in the treatment of ADHD. He is the author of The Attention Deficit Answer Book: The Best Medications and Parenting Strategies for Your Child. Eve Kessler, Esq., an attorney with The Legal Aid Society, NYC, is President of SPED*NET Wilton, CT and a Contributing Editor of Smart Kids.
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