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Addressing Attention Deficit Disorder

A psychiatrist shares his opinion on diagnosing ADHD

Young girl thinkingUnlike a peanut allergy or strep throat, attention deficit hyperactivity disorder (ADHD) has no clear-cut diagnostic test, leading many to question the validity of some ADHD diagnoses. 

A recent study reporting that nearly 1 million children in the United States may be misdiagnosed with ADHD has added more food for thought regarding this hotly debated topic.

The study, published in the Journal of Health Economics, found that the youngest kindergartners, the ones with birthdays just before the cutoff dates, are 60 percent more likely to be diagnosed with ADHD than the older kids in the same grade. Teachers are more likely to report symptoms of ADHD in these kids when in fact these children might just be more emotionally and intellectually immature, the study says. 

In an interview, Louis Kraus, MD, a child and adolescent psychiatrist at Rush, offered his take on ADHD and its diagnosis. 

Q: Do you think ADHD is overdiagnosed? 

Kraus: It's likely that there are children who are diagnosed with ADHD who don’t have it, and it's also likely that that there are children with ADHD who are not diagnosed with the condition.

The fact is, there are several conditions that can be misconstrued as ADHD — such as anxiety disorders, depression, pediatric bipolar disorders — because they lead to similar symptoms as ADHD: impulsive behavior, difficulty in concentrating, a high level of irritability, a high level of fidgetiness. To get to the right diagnosis, you can't just depend on what teachers observe in the classroom; you need a comprehensive clinical assessment by a well-trained child mental health expert. 

Q: Does age make a difference when it comes to diagnosis? 

Kraus: There's no question that younger kids tend to be more impulsive. A younger 5 year old may have more difficulty socially at the beginning of kindergarten, and most teachers are adept at recognizing that age may be the issue rather than a mental health problem. But I tell teachers not to make the diagnosis, simply to describe the behaviors to the parents and leave it to the parents to take the next steps. 

Q: What should parents do if a teacher tells them that their child is exhibiting behavior consistent with ADHD? 

Kraus: Determine the teacher's level of concern. How disruptive is the behavior and how often is the behavior occurring? If the teacher thinks it's a significant issue, talking to your pediatrician is an excellent next step.

The pediatrician should be able to comment on the age issue and may even have scales, or questionnaires, that can provide valuable insights. If the pediatrician lacks experience in mental health issues, he or she may refer you to a specialist (or you can ask for a referral), such as a child psychiatrist.

A solid clinical assessment takes about two hours, and it involves obtaining a history and clinical assessment as well scales to help validate the diagnosis. These scales are filled out by parents and teachers. One of the important parts of diagnosis of ADHD is that you need to see the behaviors in more than one environment. You can't just see it in school or just at home. Ultimately, you need to put all these pieces together to make a diagnosis.

October 2010