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Driven to Distraction Diagnosing ADD

The diagnosis of ADD (attention deficit disorder), or its more severe cousin ADHD (attention deficit hyperactivity disorder), has become a controversial one. Attaching a diagnosis to a set of symptoms usually helps to solve the problem by suggesting a method of treatment. Once it is discovered, for example, that a child has pneumonia, the proper antibiotics can be prescribed and the illness is usually cured. Pneumonia has a relatively clear set of symptoms that suggest the disease, and the suggestion can be confirmed using laboratory tests. ADD is not like this.

Rather, ADD/ADHD is a loose set of behaviors that include hyperactivity, distractibility and impulsivity. As yet there is no objective diagnostic test, such as a lab test, that can give a definitive diagnosis. Instead, the disorder is usually diagnosed either by an anecdotal description of the symptoms to a medical doctor, or by use of a rating scale given to parents and teachers. This scale lists a wide range of behaviors and asks that the severity of the behavior be rated on a scale of 1 to 5.

There are two problems with this method of diagnosis. The first is that the ratings can be highly subjective. Attitudes towards the child can color the score given, as can a lack of experience with children in general. A teacher, for example, who has had little experience with children with behavior problems, may rate the behavior much higher than another teacher who works with difficult children frequently.

The second problem with diagnosis is much more fundamental. The behaviors that are being rated can be attributable to many other causes than ŒADD/ADHD'. Recently a 10-year-old youngster was referred to me for anger outbursts. He had been diagnosed as ADHD and placed on Ritalin, but there had been little change in his behavior. After looking into the problem it seemed more likely that his behaviors were the result of boredom caused by a very high intelligence level. IQ testing confirmed this diagnosis. Changes were made to the school program and parenting practices and the problem quickly disappeared.

This case is typical of the problem. There are many potential causes of the symptoms of ADD/ADHD including depression, allergies, high stress levels, and lack of discipline in the home. Similarly, ADHD symptoms are comparable to the early signs of such severe emotional disturbances as bipolar disorder and schizophrenia. This latter possibility was recently confirmed in my own practice with a 12-year-old who had been diagnosed as ADHD. Again, the standard drugs had not had any effect and the behavior was becoming worse both at home and in school. After listening to the symptoms presented it was clear that this lad was most likely suffering from early onset bipolar disorder. However, while his behavior had been a problem for a number of years, it was only recently that enough symptoms were present to make a differential diagnosis. Trying to determine the true cause of a child's behavior pattern is more complex than the mere administration of a rating scale. It requires a thorough look at the child's lifestyle and considerable experience with children.

According to the recent writings of Dr. Thomas Armstrong, a highly respected educator and psychologist, ADD/ADHD has become a popular diagnosis because it has become an explanation for behaviors caused by the complexities of modern life. It helps to rationalize actions that are in many cases caused by the erosion of the traditional family structure, the lack of respect for authority, the short attention spans created by the mass media, particularly television, and the high stress levels present in the modern world. By using drugs such as Ritalin and Dexedrine to control these behaviors, Dr. Armstrong feels we are not addressing the causes of the problems, but merely masking them.

Whether or not there is an actual disorder that can be called ADD now seems debatable. Certainly my own experience as an educator and psychologist confirms much of what Dr. Armstrong has to say. On the other hand I have known many children whose behavior improved greatly after being prescribed Ritalin or Dexedrine. Perhaps the most important lesson to be learned is that one should not leap to the diagnosis of ADD/ADHD, but instead should look carefully for other causes before any drugs are prescribed. It will not help the child for parents to either immediately embrace a diagnosis of ADD or to be biased against the use of any drugs on their youngster. Instead, they need to keep an open mind as to the causes of their children's behavior and possibly consult several professional sources before a course of action is decided upon.

Scott is a psychologist in private practice in Okotoks, specializing in teenage problems. He is the author of the best-selling 'Parenting Today's Teenager Effectively. Hear Me, Hug Me, Trust Me' as well as the recently released 'Rage, Rebellion and Rudeness: Parenting Teenagers in the New Millennium'. He also appears weekly on Global TV's 'Morning Edition' and every other week on CBC's 'Calgary Eye Opener' as a commentator on teenage issues.

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