Tuesday, March 31, 2015

Think your child has ADHD? Think again ...

The diagnosis of ADHD is being made more frequently than ever before. However, many kids are being incorrectly diagnosed by busy pediatricians who don't take the time to ask some important questions.

Think your child has ADHD? Think again …

In 2010, a whopping 10 million children were diagnosed with ADHD, a 66 percent increase from 10 years ago. But not all those diagnoses were accurate. (AP Photo/University of Alabama-Birmingham, Jim Willett)
In 2010, a whopping 10 million children were diagnosed with ADHD, a 66 percent increase from 10 years ago. But not all those diagnoses were accurate. (AP Photo/University of Alabama-Birmingham, Jim Willett)

My child is having trouble at school. The teacher says I should ask about ADHD.”  Sound familiar to you? It should.

The diagnosis of ADHD is being made more frequently than ever before. In 2010, a whopping 10 million children were diagnosed with ADHD, which is a 66 percent increase from 10 years ago! What concerns me is that many are being incorrectly diagnosed with ADHD by busy pediatricians who don’t take the time to ask some important questions.

I once had a hyperactive 9-year-old patient with sleep apnea who snored so badly that he would stop breathing dozens of times each night. An operation by the ENT (Ear, Nose and Throat) surgeon cured his apnea and improved his behavior.

So what is ADHD? It stands for “Attention Deficit Hyperactivity Disorder.”  Children with ADHD can be impulsive and often have trouble waiting their turn. They are often forgetful, sloppy with schoolwork and chores, and have short attention spans. They are fidgety, squirmy and can be excessively talkative. Parents describe them as being so active that they seem to be “driven by a motor”.  I know what you’re thinking … don’t all children act like this? Yes, but children with ADHD have severe symptoms that impair the child’s functioning, specifically, their ability to do well in school, make friends and avoid injury due to reckless behavior.

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While ADHD treatment is generally safe and very effective, it is important to make sure that we are treating the right condition. With that being said, here are some important questions to consider before visiting your pediatrician:

Does your child get a restful sleep every night? Unlike adults who become groggy and slow after a bad night of sleep, children can become hyperactive and rowdy. Inform your doctor of any sleep disturbances such as frequent nightmares, fidgetiness, bedwetting, trouble falling asleep or trouble staying asleep. Make sure your child gets at least 8-10 hours of sleep each night. 

Does your child behave violently? Do they do things just to spite you? Violent behavior is not a criteria for ADHD. The real question is where did your child learn this behavior? At least once a month I see a child for “ADHD” who lives in a home where one parent is emotionally or physically abusing the other. Children are like sponges that can easily pick up on violent tendencies from their parents, television, movies and video games. Other possibilities to explain violent behavior include oppositional defiant disorder and conduct disorder.

Is your child easily embarrassed? Does he or she have low self-esteem? Is your child a worrier? Again, these are not part of the ADHD criteria. Your child might have depression or anxiety. I know it sounds strange to think that a young child could have depression, but it is more common than you may think.

Does your child misbehave only in school? If so, are there specific teachers, students or situations that seem to elicit this behavior? Perhaps your child has a learning disability? Perhaps vision or hearing problems make it difficult for your child to concentrate in school? Maybe your child is being bullied? All of these can be terribly distracting for a young child and can contribute to poor behavior. School problems may warrant an evaluation by the child’s school for learning disabilities and a hearing and vision screening by your pediatrician.

Want to really impress your doctor? Fill out the “Vanderbilt” ADHD assessment tool. There is a parent form and a teacher form. Your doctor will score the sheet. This very simple tool can help determine whether your child has ADHD or something else.

Are you concerned about your child’s behavior? Has anyone told you that your child should be evaluated for ADHD? Please share your experiences. 

Mario Cruz is is an assistant professor of pediatrics at Drexel University College of Medicine and an academic pediatrician at St. Christopher's Hospital for Children.

About this blog
Anna Nguyen Healthy Kids blog Editor
Sarah Levin Allen, Ph.D., CBIS Assistant Professor of Psychology at Philadelphia College of Osteopathic Medicine
Stephen Aronoff, M.D., M.B.A. Chair of the Department of Pediatrics at Temple University Hospital
Peter Bidey, D.O. Medical Director of Family Medicine at Philadelphia College of Osteopathic Medicine
Christopher C. Chang, MD, PhD, MBA, FAAAAI, FACAAI Associate Professor of Medicine in division of Rheumatology, Allergy and Clinical Immunology at UC Davis
Katherine K. Dahlsgaard, Ph.D. Lead Psychologist of The Anxiety Behaviors Clinic at Children's Hospital of Philadelphia
Gary A. Emmett, M.D., F.A.A.P Director of Hospital Pediatrics at TJU Hospital & Pediatrics Professor at Thomas Jefferson Univ.
Magee DeFelice, M.D. Division Chief of Allergy and Immunology at Nemours/Alfred I. duPont Hospital for Children
Hazel Guinto-Ocampo, M.D. Chief of Pediatric Emergency Services at Nemours duPont Pediatrics/Bryn Mawr Hospital
Rima Himelstein, M.D. Adolescent Medicine Specialist at Crozer-Keystone Health System
Jessica Kendorski, PhD, NCSP, BCBA-D Associate Professor in School Psychology/Applied Behavior Analysis at Philadelphia College of Osteopathic Medicine
Anita Kulick President & CEO, Educating Communities for Parenting
Janet Rosenzweig, MS, PhD, MPA VP for Programs & Research for Prevent Child Abuse America
Beth Wallace Smith, R.D. Registered Dietitian at Children's Hospital of Philadelphia
Emiliano Tatar, M.D. Pediatrician at Einstein Healthcare Network Roxborough Plaza
Jeanette Trella, Pharm.D Managing Director at The Poison Control Center at CHOP
W. Douglas Tynan, Ph.D., ABPP Director of Integrated Health Care for American Psychological Association
Flaura Koplin Winston, M.D., Ph.D. Scientific Director of the Children’s Hospital of Philadelphia’s Center for Injury Research and Prevention
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