A little girl sits at the back of the room and daydreams through
the school day. Down the hall, a boy is driving a teacher to
distraction with his non-stop antics.
Do these kids need a trip to the principal's office for a good
talking to, or a visit to a doctor's office for a medical
evaluation and treatment?
More and more children are being diagnosed at an early age with
Attention Deficit Disorder and its cousin Attention Deficit
ADHD is characterized by impulsive behavior and hyperactivity.
It occurs more often in boys than in girls. ADD is
characterized by an inability to focus, pay attention and organize.
The disorders, which are physiologically based, can be
accompanied by other conditions such as learning disabilities,
oppositional defiant disorder ("I'm not going to do it, and you
can't make me"), conduct disorder (breaking societal norms) and
Both disorders can be treated with a combination of counseling
and behavior modification, and often medication such as Ritalin.
Left untreated, children with ADD and ADHD can become depressed,
anxious, have low self-esteem, and are at higher risk for
substance abuse, teen pregnancy and dropping out of school.
Attention deficit disorders occur in 3 to 5 percent of children,
researchers say, although some estimates put the number as high
as 10 percent.
Critics say the number is too high.
Child psychologist Wade Horn, a former president of the Children
and Adults with Attention Deficit Disorder national support
group, said ADD is "far too popular and kids are being
over-diagnosed. Parents shop for the diagnosis. They get mad at
you if you refuse."
Mary Ann Dyal, a counselor at Alimacani Elementary School in
Jacksonville, said she worries about the diagnosis.
"It is a pretty widespread problem," she said. "I'm almost
afraid we are over-labeling. It's almost the popular thing
right now to label children that way.
"We walk a thin line between wanting to identify children who
are ADD, but we don't want to get into the danger zone of
over-labeling these children as well. But I have seen some
dramatic improvements in children who were diagnosed."
Psychiatrist Edward Hallowell of Boston, author of Driven to
Distraction, said he doesn't think the disorders are being
over-diagnosed, although he said that some children are
The difference between ADD/ADHD children and children who
misbehave is that ADD/ADHD children want to behave. "They want
to do well, to fit in, to shape up," Hallowell said.
The children who are misbehaving want to break the rules and
push the limits. However, the ADD child can't help himself.
"The good news is we have discovered this condition," he said.
"So children, instead of being given a moral diagnosis that they
are bad and moral treatment (i.e. punishment, ridicule or
physical punishment), are given a medical diagnosis and
Stephen Commins, a pediatric neurologist at Nemours Children's
Clinic, said if there is over-diagnosis it is because of
Neither ADD nor ADHD can be diagnosed in a single office visit,
Commins said. There is no simple test that detects either
disorder. Diagnosis is ultimately a judgment call.
"A child shouldn't be diagnosed as ADD or ADHD until everything
else has been ruled out," Commins said.
Other problems can mimic attention deficit disorders, he said. …