Sunday, June 29, 2014

ADHD or Typical Boy Behavior?

I've read many a books, visited many websites, frequented many message boards and Facebook groups and yet I feel that I'm not any closer to an answer. When is behavior attributed to ADHD and when is it typical boy behavior?

Some books I've read have even gone as far as saying that ADHD doesn't even exist. These authors suggest that ADHD is an invented disorder to label hyperactive or busy children. There is a startling statistic that boys are diagnosed with ADHD at a much more frequent rate then girls are.  Also, many of these children are diagnosed based on behavior or academic issues at school. However, how much of that is ADHD verses different learning styles and personalities?

I'm going to share something - maybe a little shocking, or maybe not. So far all three of my oldest boys have been suggested to possibly have ADHD by their teachers. Only one has been diagnosed. My oldest son's teachers began to mention ADHD in as early as kindergarten. Every conference seemed to revolve around his behavior issues and ADHD. Finally we had him evaluated when he was in second grade. The pediatrician also ordered an IQ test. Our trusted pediatrician diagnosed my son not with ADHD but with being highly intelligent and bored, and his IQ test proved that "diagnosis". However,  still the school wouldn't accept that and even suggested we get a second opinion.  Thankfully my oldest son grew out of those behavior issues, thrived in school, and has succeeded on his own just fine. Imagine though if we had gotten a second opinion and that doctor had suggested medication. We would have been medicating him for no reason.

Then there is my second son. He's quite active and hyper. Teachers also began discussing his behavior very early on and throwing around the ADHD suspicions. I tried a new experimental program in which a pediatric psychiatrist from Children's Hospital met with my son and I via teleconferencing. He interviewed me and Brayden for an hour - asking a variety of mostly yes/no questions about his behavior. Afterwards he faxed a diagnoses of ADHD to our primary doctor along with a prescription for medication. I was really unhappy. I felt that it was way too easy to throw a prescription at us, and that he never got to actually get to know my son. The whole diagnosis process seemed to be far from an exact science. It would have been easy for me to over-exaggerate on my answers and receive the diagnosis and prescription even if my son hadn't had ADHD.
A couple years later we decided to try two different therapists. I think that the suggestions and information that they gave him helped a lot. They confirmed his diagnosis of ADHD. One of them suggested medication, and we decided to revisit that idea. The new psychiatrist evaluated Brayden on a couple different occasions as well as worked with his therapist. He prescribed medication and we decided to give it a go. Brayden's academics were also struggling now, and this was one of our biggest concerns. The medication had to be adjusted and changed a few times, but eventually it seemed to really work! He started middle school with A's and B's and got on the honor roll for the first time. Amazing! People were actually complimenting us on his behavior.
But then he started having adverse side effects from the medication. He developed a tic. Upon reading more about this medication, I really didn't like the idea of giving him a powerful stimulant for his growing and developing brain. So we switched medication again - this time a non-stimulant type. The tic seems to be going away finally. Yet, watching him and talking to others I really begin to doubt the ADHD diagnosis again. Yes, he's my most difficult child. Yes, he struggles with reading (although he got an A in writing!). Yes, he has impulse control issues. But he can also loves to spend  hours learning about something he loves - such as metal detecting, or rock hunting, or medical procedures. He says that he wants to be a surgeon when he grows up. He has behavior issues - but how much of that is his personality and how much of it is a disorder? And what about diet? Diet has become a big possible cause of ADHD and other disorders. Studies have shown that processed foods and artificial dyes can cause ADHD-like behavior. So then, is it his diet that is out of whack?

Lastly, there is my third son. My third son had a pretty successful kindergarten through third grade. However, fourth grade hit and he was becoming Mr. Social. He has always been silly and goofy, but he really started to get out of control in fourth grade. He gets into trouble at school WAY far less then my oldest two did, yet his teacher suggested that I have him evaluated for ADHD because he has a hard time concentrating on work in class.  I was surprised, yet not extremely surprised that the teacher brought that up at our last conference. It seems anytime a child has difficulties sitting still in their desk and focusing on work for long periods of time then they are suggested to have ADHD. natural is that? How natural is it for busy, active children to be expected to sit still in a desk and focus quietly for hours? Studies show how important it is for boys to get up and move around. Some classrooms have actually experimented with this by allowing children to stand at their desk or play with a ball, etc while listening to lessons. Results showed that the students were still listening and learning while doing that, if not better!

Don't get me wrong, I'm not saying that I believe that ADHD is a completely made up disorder. I know that some children really do have things they struggle with. I am merely speaking from my own experiences and asking my own questions.  Is ADHD over-diagnosed? I'm betting it is - based on my experience. So then, what exactly defines ADHD? Is it an exact science or is there room for error?


Simply, Sarah said...

One of the things we learned in foster care training was that children who have a hard time focusing (for any reason, but I think we were learning about Fetal Alcohol Affect) can focus a LOT better when their hands are kept busy during the lessons. They suggested playdoh manipulation, squeezing stress balls, or other similar activities.

Mike Gingerich said...

Very nicely and open-mindedly written!
I'm a retired ADHD Specialist. Your question is very common and a very good one.
Here's the problem: The vast majority of parents who suspect their child might have ADHD end up going first to their pediatrician or primary care doctor. Some may go to a mental health professional. Primary care physicians are the least knowledgeable about ADHD diagnosis and treatment. Mental health professionals not specifically trained in ADHD diagnosis/treatment aren't much better.
What you describe going through in the process of getting your children evaluated is, unfortunately, fairly typical. ADHD is a very complex disorder with many variations and many look-alike disorders.
Just to support my point: A study by the American Academy of Pediatricians in 2013 found that 92% of physicians who were the first to see most potential ADHD patients did NOT follow accepted guidelines for diagnosis and treatment. Now, think about the potential consequences of that!
Find a reputable ADHD Specialist.