ADHD: Overdiagnosed and overmedicated

Apr 03, 2012 9:00 AM by Kori Ellis

Posted in Parenting / Parenting Tips & Advice / Child Development & Health

Are Meds Necessary Or Are You A Lazy Parent?

Just because a young child is active doesn't mean you need to run to the doctor for an ADHD evaluation. In recent years, more and more children are being diagnosed (and subsequently medicated) with ADHD. Some experts say it's often not the kid's problem -- sometimes it's the parents' problem. Read on to learn more about ADHD.

A different view of ADHD

Nine percent of children ages 5-17 are diagnosed with ADHD in the U.S., according to the CDC, with about 3 million kids on ADHD medications such as Ritalin and Adderall. While some psychologists or psychiatrists view ADHD as a true developmental disorder, others have a completely different perspective.

"ADHD is simply a set of behavior patterns that create a poor fit between the child and his/her parents and teachers, and which often annoys and frustrates adults."

"ADHD is a social construct," explains Dathan Paterno, Psy.D., author of Why Your Child Needs a Parent in Charge and How to Become One. "It is not, despite what it is often proclaimed in mainstream media, a disease like diabetes. ADHD is simply a set of behavior patterns that create a poor fit between the child and his/her parents and teachers, and which often annoys and frustrates adults. Sometimes, these behaviors are normal variants in temperament, sometimes they are behavior skills that have not been sufficiently trained and sometimes there are underlying learning, emotional, medical or relational problems which manifest in ADHD-like symptoms. Whichever explanation, it is almost never the case that there is something fundamentally wrong with the child. The good news is that whatever the underlying [reason], the parents can truly become the primary agents of change in the child's life!"

Like a fever

"ADHD certainly can be overdiagnosed or overmedicated, especially in communities that do not have enough child psychiatrists and other child mental health clinicians who can take the time to do a careful diagnostic evaluation," says Jacob J. Ham, Ph.D. Ham is the program director for Beth Israel program for Healing Emotions and Achieving Resilience to Traumatic Stress (BI HEARTS) in the Department of Psychiatry at Beth Israel Medical Center in Manhattan.

"Many of the symptoms of ADHD are like a fever. A fever can be caused by many different illnesses. In children, the behavioral symptoms of ADHD can be caused by stress and trauma, anxiety, bipolar disorder or even a mild form of autism. You can just treat the fever with aspirin, but if you don't know what's causing the problem, it might not go away. What's worse, some medications for ADHD, such as stimulants, can make problems worse -- particularly if the real cause is a mood disorder or traumatic stress."

Is your child just active or does he have ADHD?

All toddlers and preschoolers are active -- some are extremely active -- so it's sometimes difficult for parents to distinguish whether there is an issue with their child. How can you really tell if it's time for an evaluation?

"Compare your child to other toddlers the same age," says L. Eugene Arnold, M.D., M.Ed., Professor Emeritus of Psychiatry at The Ohio State University.

"If the child fits right in, it's probably just the normal high activity level of toddlers. If he or she sticks out as more active, disorganized, impulsive and inattentive -- can't attend to a story or puzzle appropriate for the age -- professional evaluation is indicated. Generally, the activity level of toddlers calms down with the development of speech."

"Thirty percent of 3-year-olds look hyperactive, while only five percent of 4-year-olds look hyperactive. So the first time most people can really diagnose ADHD is about 4 years old," says Daniel G. Amen, M.D.

"If you have an extremely hyperactive child at 3, he or she needs to see a child psychiatrist or psychologist to get a proper diagnosis."

Alternative approaches

Medications aren't the end-all answer, especially when it comes to our children. We received some more insight from Paterno about alternative approaches to treating ADHD. Here are some of Paterno's thoughts on the subject:

The first thing parents must realize is all ADHD-like behaviors are amenable to change without requiring foreign substances like psychostimulants. Parents must view themselves as the primary agents of change. Whether they are partly responsible for the child's behavior or not (let's be honest: Some parents are more responsible for these difficulties than others), the parent can make significant choices that will alter the child's behavior in the short term and over the long haul. Here are some key interventions:

Checking and, when necessary, altering the child's diet. Often, children are eating certain foods that trigger hyperactivity or poor self-control. Food dyes are a prime suspect.
Ruling out other medical problems, such as ear infections and sensory sensitivities. Children who are overly sensitive to certain stimuli respond by either shutting down or by becoming agitated, which often looks like hyperactivity.
Better or more consistent discipline. This is the most crucial factor in improving executive functioning, like self-control. Children who misbehave often are being rewarded handsomely by a parent's correction. Remember, attention is the No. 1 reward for children, so any attention a parent gives to a child will inadvertently reinforce the behavior that occurred just beforehand. Use "time out" properly to minimize giving the child attention when he or she is not exhibiting appropriate behavior.
Lastly, make sure the child is sleeping sufficiently. A tired child must rouse the central nervous system in order to avoid the highly uncomfortable sensation of sleepiness. This often manifests in the "overtired" phenomenon, which includes the emotional roller coaster, silliness and hyperactivity. Get the child on a consistent and sufficient sleep schedule.

Many other doctors believe you need to look at a variety of other factors and different treatments before reaching for medications. "Especially for young children, we have strong evidence that behavioral therapy and parenting training are efficacious -- they work to reduce symptoms for the vast majority of young children with ADHD," says Rahil D. Briggs, Psy.D., Director of Healthy Steps at Montefiore. "In very severe cases, where all other interventions have been tried unsuccessfully, medication may be considered."

More about diet and ADHD

Diet tips for ADHD:

eat more omega-3 fatty acids
eat a balanced diet
avoid excess sugar, food dyes and processed foods
give your child a daily multivitamin

A healthy diet is one component that shouldn't be overlooked if your child is experiencing ADHD-like symptoms. "Many kids are being diagnosed with ADHD and put on powerful medications when better diets, exercise, omega-3 fatty acids would make a huge improvement," says Amen. "Yet, at the same time, many people who have ADHD, especially the inattentive type, are being called lazy or stupid. ADHD is an important disorder that needs to be taken seriously."

Arnold also elaborates on the possible benefits of omega-3s.

"There appears to be a small beneficial effect from fish oil (make sure it's mercury-free) or other sources of omega-3 fatty acids," Arnold explains. "A balanced diet without excessive sugar, food dyes or processed foods (or in the absences of dietary balance, a daily multivitamin/mineral) is good for general health even if it does not help ADHD."

Before turning to medication for your child, seek a thorough evaluation and explore other methods to help your child, whether he/she actually has ADHD or not.

More on kids' health

5 Heart health lessons for kids
ADHD: The debate continues
Keeping your autistic child safe

Tags: adhd kids health

Comments

Comments on "ADHD: Overdiagnosed and overmedicated"

They should include that our "over processed foods", hormones in meat and cows milk also can cause this. Another thing is our soils have become so depleted so kids (and adults) are not getting the natural minerals. Magnesium is ver important and reasearching it, seems to help people calm. I know because I have symtomes of ADHDandit started going away once I became vegan, eat NO processed food or sugar,no caffiene, and drink two 1/2 teaspoons of magnesium citrate and high potency vitamin b12.

I am ADD and have a son who had been "diagnosed" ADHD! THE MEDICATIONS ARE HARSH and should be a LAST resort. I Was on medication as a child and I was taken off of them because they had tried everything on me and tested me for everything possible. Kids are going to be kids NO ONE and no child is the same or acts the same as they are ALL brought up differently and in different life styles. Learning how to control the ADD/ADHD symptoms is not as difficult as taking a harm medication that will later cause other physical health problems or even other MENTAL health issues! I HAVE DONE RESEARCH ever since I was able to read and play on the computer and I have spoken with many people about there own issues with this so called disorder. ADHD/ADD is a real diagnoses according to doctors. Teachers should be trained in all child health learning disabilities and learn to help these children rather then shoving PILLS down there throats. I will admit PARENTING does have some effect on a child and will/can cause ADD/ADHD symptoms as well. The day they come out with a REAL test (not just asking people or taking a simple paper writing test,,,Hear say) then I will start taking more serious action but as of right now it is horrible to medicate a child who's body is still simply developing. Think about what the medication is doing to there bodies as they GROW! Learn to just control your issues rather then trying to medicate the issues with drugs that will just kill you sooner or later. Raise your children rather then just trying to make your life easier. Love them for who they are there bright personalities... the more you judge them the more they act out. THINK ABOUT IT!!!! It is mind controlling and mind manipulating! I had learned to control mine and I have done really well in life and have LIVED A HAPPY LIFE with out medication. Yes I have a few slip ups but who doesn't??? Nobody is perfect and no will ever be perfect. Kids are going to be kids so let them be just that. Quit trying to convince your self there is no other way but to medicate a problem. Just plain ignorance and laziness to me. Just another way for doctors to make money as well as schools.

I HAD A SON WHO DIAGNOSED TO HAVE HYPERACTIVE ADHD.HES BEEN TAKING MEDICATION SINCE 2010 CONCERTA UNTIL 2012 IT INCREASE INTO 20MG TO 27MG....AND HIS UNDER THE SUPERVISION OF HIS PSYCHOLOGIST.BUT I DECIDED TO STOP TAKING MEDICINE WITHOUT PRIOR NOTIFICATION FROM HIS DEVELOPEMENTAL DOCTOR..FOR ME MEDS HE TAKE JUST TO CALM HIM ONLY AND YET STILL THE SAME IF HE TAKE OR NOT...AS OF NOW HES BEEN THE PROBLEM IN SCHOOL BECAUSE HE DONT HAVE FOCUS ON HIS STUDIES AND HE CANT STAY LONGER. IN CLASSROOM..PLEASE GIVE ME SOME ADVICE WHAT TO DO...IM REALLY NEED AS ADVICE...THANK YOU.

Sheila, I completely agree! This article and Marcia's comment lack any true understanding. Yes, ADHD is overdiagnosed. That is absolutely true. But, that doesn't make it any less real for those of us who truly live with brains that are simply wired differently. Yes, there are amazing tools available to parents with ADD/ADHD kids to help provide the structure and environment in which they can thrive. But, those tools are available because people who are really seeking to understand what ADD is have studied what it is and how it works. ADD is poorly named. It is not a disorder, per se, and certainly not a disease. It is having a mind that functions differently than the norm. There are ways to work WITH it to lessen the negative and draw out the positive parts of being this way. In many cases, medications do help, be it long term or for a while to help one get themselves to a more positive place. Whether or not you "believe in" ADHD, though, is irrelevant to me. Your belief doesn't change my reality. It doesn't change my own life experiences or that of my child. If you really want to help the issue, stop being so negative and inflammatory and start really educating yourself on what ADD/ADHD really looks like and feels like. Start educating teachers and schools on what to look for and how to help both the kids and their parents be more successful. Find a way to help rein in the overdiagnosing without attacking those of us who honestly do have ADD. I am an adult and have dealt with this kind of talk and misunderstanding my whole life, and I just don't care. But, what I do care about is how what you are trying to do might affect my ADHD child. Misinformation and miseducation about what ADHD *really* is are at least as harmful as the overdiagnosis is.

Obviously the person who wrote this does not have a ADHD/ADD kid or no knowledge of any scientific research. Please do not write articles, if you just have a gut feeling. Read some books and research topics and interview kids, parents and teachers who deal with this issue on a daily basis.

I wholeheartedly agree with Dathan Paterno that what we are calling ADHD is a social construct, not a disorder. ADHD is being used as a dumping ground for any challenging childhood behavior. Improvements always occur with wise parental discipline, better sleep and better diet. I would like to add one more important factor in children's behavior - schools, where children spend most of their day. Teachers need to bring movement into the classroom to help children focus, feel calmer, and learn to self-regulate. The positive results are immediate! Removing PE from our schools correlates with the drop in achievement in the U.S. Every child's brain requires mental and physical activity to grow and mature. The maturation of the child's brain links directly to behavior. No more ADHD when a child has an opportunity to move, eat right, get adequate sleep, and be guided with clear, loving discipline. Marcia Lee, Solutions Without Drugs, Children's Brain/Body Balancing