ADHD or Just Active?

A mother called my office recently and said, "Jason's teacher thinks he has ADHD and wants me to ask you to prescribe medication. Aren't there other ways to manage this problem?"

"You bet!" I assured her.

Then I explained that every aspect of her son's life is his treatment: nutrition, exercise, fresh air, water, sunshine, sleep, stress management, recreation (without TV/video/computer), social and emotional development, problem-solving skills, and hands-on learning (including arts and crafts, music, and chores). Correcting his neurochemistry is a bare foundation. She and Jason would need to build his healthy lifestyle, including physical, mental, and emotional factors.

As a pediatrician, I know that God talks to mothers' guts. So if someone suggests to you that your child may have ADHD, first consider what you think about your child. You may not know names for what's wrong, but you always know when you're worried deep down inside. If you keep telling yourself that your son is "all boy" or that other people "don't understand" your daughter, you're sensing a problem somewhere.

If your child is hyperactive, impulsive, and inattentive, you're right to suspect ADHD because it's so common (5 to 10 percent of schoolchildren are diagnosed with it). But at least a gazillion other answers might be right: delayed grief, environmental allergies, undiagnosed learning disabilities (especially dyslexia and central auditory processing disorder), undisclosed sexual abuse, emerging mood disorders (agitated depression, anxiety states, Bipolar II,) other neurobiological dysfunction, or behaviors associated with autism, genetic abnormalities, and certain seizure types. And remember, superficially, all 2-year-olds "look" autistic and/or ADHD!

When is it real?

According to official guidelines, your doctor can diagnose ADHD only if the core symptoms are not better explained by another condition. Educators, psychologists, and physicians sometimes forget that "only if." To determine your child's diagnosis, arrange a thorough evaluation by a developmental-behavioral pediatrician, child psychiatrist, or pediatric neurologist (or highly trained general pediatrician).

You need a specialist to integrate educational and psychological assessments, review family background, perform a complete medical history and examination, understand your concerns and insights, and interpret your child's constellation of symptoms. Whatever the diagnosis, you deserve peace of mind about it, and your child deserves appropriate comprehensive treatment.

You might also want to read ADHD: A Complete and Authoritative Guide, which is put out by the American Academy of Pediatrics and is the best book on the topic.

And what about Jason? He took a social skills class this past summer, and he changed schools from the regular school where he was considered a "bad boy" or "wild child" to a special school set up to give normal children with special emotional or academic needs a second chance-a chance to start over and make a good record (with extra support) and then go back to regular school in a year or two, really ready to succeed. Jason is happy with his teachers, is making friends, and is doing well scholastically. His little face went from pinched and anxious to relaxed and smiling!

Helene Hubbard graduated second in her medical school class at East Tennessee State University. She interned in family practice at Florida Hospital and was in the first group ever to be board-certified in developmental-behavioral pediatrics. She holds a Ph.D. in educational psychology and has a pediatric practice in Florida.

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