Saturday, August 16, 2008

ADHD Over-Diagnosed?

Looking at her sitting quietly, reading intently; no one would ever think that ten year old Samantha had attention problems. But last year was a different story. Her grades dropped suddenly. She got distracted in class and she struggled to keep up with all of her 4th grade assignments. Her teacher suggested she get tested for ADHD: Attention-Deficit/Hyperactivity Disorder. So her mom took her to a doctor for testing.

“She told me she was borderline ADHD and we were going to go ahead and treat her with 5 milligrams of Adderall,” says Connie Hodges, Samantha’s mother.

Both Samantha and her mom were unhappy with the results. “It was upsetting me because it was like she was drunk. She was moving really slow and just lethargic – just not Samantha,” says Hodges. And Samantha herself agrees. She wasn’t her normal energetic, active self. “It made me just want to sit down in one place,” she says.

So her mom took her to see a specialist for more tests. Dr. Thomas Burns, Director of Neuropsychology at Children’s Healthcare of Atlanta did the testing himself. “We did full cognitive battery of tests to rule out some of those other areas like learning disabilities or behavior problems. She did very well in testing – performed within the expected range – no evidence of any cognitive impairment. And from what I saw, at least in a one-on-one setting, she was certainly able to hold her attention and perform really well,” he says.

Burns says Samantha doesn’t have ADHD and that often, kids are diagnosed with the disorder when, in fact, their attention problems are symptoms of something else.

“It’s important to rule out the learning problems, the emotional, behavioral issues, adjustment concerns – whether it’s a change to a new school, or there might be changes in the family - divorces, deaths – things like that,” he says.

Samantha was easily distracted and had trouble keeping up with multiple assignments. Dr. Burns and her teachers have taught her how to get organized, focus, and complete tasks one at a time.

Samantha says, “They help me learn how to take the right notes and learn how to study right.”

Her mother adds, “I worked with her teacher and her counselor at school. She has taught Samantha how to organize her – not only her book bag, her desk, but her thoughts.”

And it’s working … without medication.

“I’m me again,” says Samantha.

“She’s not struggling like she was last year. She doesn’t hate school anymore. She’s not even the same child she was last year,” says her mother.

Tips for Parents

According to the American Academy of Child and Adolescent Psychiatry, ADHD occurs in 3 to 5 percent of school age children. The following are given as symptoms of ADHD:

Excessive talking
A tendency to interrupt or intrude on others
In addition, researchers found that boys with ADHD move two to three times as much and cover four times as much area as normal boys. Girls with ADHD move as frequently but their movements cover a smaller area.

What Parents Need to Know

Since judging the symptoms of ADHD can be very subjective, some children may be diagnosed with ADHD without actually having the disorder. A recent study suggests that parents’ and physicians’ preconceived notions about children’s behavior may interfere with the identification and diagnosis of ADHD and other disorders.

Because this possibility exists, it is very important to find a good pediatrician who will properly diagnose your child and around whom you and your child will feel very comfortable. Experts at BJC HealthCare and Children’s Healthcare of Atlanta suggest keeping the following points in mind when choosing a pediatrician:

Are you more comfortable with a doctor who is no-nonsense and businesslike, or do you need more handholding?
Would you prefer a doctor who sets aside a particular time each day to take phone calls or would you rather contact the office when questions arise and have the doctor return your call between patient visits?
Do you prefer a male or a female pediatrician?
Is age a factor for you? Are you more comfortable dealing with an older or younger doctor?
Are the office hours convenient for you? Do you need evening or weekend hours?
Is the office conveniently located?
How are after-hours calls and emergencies handled?
Do you want a doctor who is board certified or board eligible in pediatrics? (Board eligibility means the doctor has completed training at an accredited medical school and residency program. Board certification in pediatrics means the doctor has completed not only the accredited training but also specialized examinations in pediatric medicine every seven years.)
When you have narrowed down your list of potential pediatricians, you may wish to interview each candidate. This will give you a chance to learn as much as possible about the pediatrician and to evaluate your level of comfort with him/her. Children’s Healthcare of Atlanta suggests asking the following questions during your interview:

How many doctors are in your group?
Has the size of your group changed recently?
What are the special interests of the doctors in your group?
Do you use nurse practitioners? If so, what are their roles?
If your office is very busy and my child needs to be seen today, what is your policy? Will I have a primary doctor, or do I see whoever is handling sick patients that day?
How are calls for advice handled during office hours? What about during evening and weekend hours? What is your philosophy of providing care via the telephone?
What are your average waiting times for scheduling a routine visit? What about after arrival at the scheduled time?
What is your philosophy about discipline? Medication use? Antibiotic use?
How do you handle payment for services?
Will you assist me in evaluating doctors recommended by my health plan?
Until what age will you continue to see my child?
Do you refer only to pediatric specialists?
Do all of the doctors in your group participate in my insurance company or managed care plan’s provider network?
Are you still accepting new patients for my managed care plan?
Once you make your decision, you can take several steps to get the most out of your relationship with your new pediatrician. BJC HealthCare suggests following these rules to make your parent-pediatrician relationship a success:

Know your child’s medications and administer them as prescribed.
Come back for a return visit when you are asked to come back.
Make sure your child is up-to-date on all immunizations.
If you have questions, it might be helpful to write them down and take them with you to the next office visit.
Listen to your pediatrician and take notes if necessary.
Ask questions.
American Academy of Child and Adolescent Psychiatry
Children’s Healthcare of Atlanta
BJC Healthcare
Centers for Disease Control and Prevention