By Ashwal, Stephen
The Exceptional Parent , Vol. 33, No. 1
According to the U.S. Department of Education, nearly 2.5 million children under the age of 18 in the United States have ADD/ADHD.
Skeptics argue that one-tenth of the country's children cannot possibly be affected by a behavioral disorder. According to these critics, either this disorder is not valid or too many children are being wrongly diagnosed as suffering from it. However, two renowned psychiatrists-Dr. Joseph Biederman of the Harvard Medical School and Dr. Larry Silver, author of Attention Deficit Disorder: A Clinical Guide to Diagnosis and Treatment--feel that ADD/ADHD is still underdiagnosed
The fact of the matter is that ADD/ADHD is the most common neurobehavioral disorder in childhood and comprises about 50% of all referrals to child neurologists, neuropsychologists, behavioral pediatricians and child psychiatrists. The reason is quite simple: ADD/ADHD is an extremely difficult, challenging and complex disorder to accurately diagnose.
Children with ADD/ADHD, like chameleons change colors, behaving differently with different people (person-specific--symptoms) in different situations (task-specific-symptoms). For example, Michael's parents bring him to see the doctor because he swirls like a top and seems to be in constant motion at home, but in the physician's office he sits quietly. The doctor concludes that nothing is wrong with Michael. Jeffrey's mom is beside herself, because he does not listen to her and moves endlessly from one task to another, never completing anything while his father is at work. When his father comes home, Jeff stays still. Dad thinks that his wife does not know how to handle Jeff. The classroom teacher is pulling her hair out because Peter talks continuously in class and keeps interrupting her, but he plays peacefully with Madden Football at home or watches television without making a sound. Peter's parents think that his teacher is crazy and has lost control of her class.
The diagnosis of ADD/ADHD is often delayed because of its changing symptoms. Parent's keep vacillating between "our child is fine" and "our child has a disorder." Critics of ADD/ADHD use this variability to "prove that ADD/ADHD is not a disease." They argue that if ADD/ADHD were a disease, it would manifest itself under all circumstances and situations, whether in school, at a party, with the father or with the mother, doing homework or playing a football game video. However, ADD/ADHD is not unique among diseases to have variable or intermittent symptoms. Despite an underlying tendency for asthma, some children with asthma wheeze only under certain circumstances, and symptoms can vary in severity from one episode to another. We do not, however, brush aside asthma as a disease nor do we blame parents of asthmatic children for poor parenting because they allowed their children to be exposed to allergens, dust and fumes. Migraine is intermittent, and so is epilepsy. Symptoms of other behavior disorders, such as depression and schizophrenia, wax and wane also.
In fact, the very nature of this complex puzzling disorder is one of the reasons why child neurologists are often consulted and the pediatrician refers the family to a child neurologist for a more in-depth work up ... a differential diagnosis ... to confirm a diagnosis of ADD/ADHD and help develop an appropriate treatment regimen to be followed.
Child Neurologists are uniquely qualified to evaluate children suspected of having ADD/ADHD because they are trained to spend the time on taking a patient history so vitally important to forming a proper evaluation and assessment of coexisting conditions from depression to organic brain dysfunction to developmental problems. …