ADHD: The debate continues

Mar 21, 2013 at 3:00 p.m. ET

An estimated five million children in the U.S. have ADHD, but the diagnosis — or misdiagnosis — is under fire. How can you know for sure whether your child is displaying bad behavior or has ADHD?

Hyper kid in school

While bad behavior often accompanies other symptoms of ADHD, bad behavior in isolation is not ADHD. There are ways that professionals can determine if your child has ADHD — it's not just about having a bad day in school.

ADHD symptoms

Children with ADHD simply cannot contain their impulses and active behavior like other kids, says Gary M. Unruh, MSW LCSW, and these symptoms resemble bad behavior:

  • Inattention — daydreaming, lack of organization, inability to start or stick with routine tasks

  • Impulsivity — saying and doing things that are inappropriate (interrupting, being disruptive) on a regular basis

  • Hyperactivity — fidgeting, needing to move around, talking excessively

"It can be difficult to distinguish ADHD and bad behavior," agrees Dr. Richard Horowitz, parenting coach and author, because not only do the symptoms resemble bad behavior, they can also lead to bad behavior.

Step back and observe

Paul Ahrens, president and CEO of Global Learning, encourages parents to begin by finding a baseline. "To tell the difference between bad behavior and ADHD, observe behavior over time and in different situations such as at home, at school, at a park, at the movies and at the dinner table," says Ahrens. "If the behaviors persist over six months and across settings, it could be ADHD."

But it's important to note that there are 18 criteria for a professional ADHD diagnosis, and none of them are about bad behavior, advises Stephen Guffanti, MD. "The most common reason for bad behavior in school is a learning style mismatch between the teacher and the student," says Dr. Guffanti. "Seventy percent of those labeled with ADHD are misdiagnosed." Guffanti explains that if your child is able to follow directions and stay on task at home but not at school, then the issue is the school environment, not the child.

Misbehavior can look an awful lot like ADHD, and a great number of ADHD diagnoses are based on questioning parents and teachers, adds Dr. Fran Walfish, psychotherapist and author. There is too much over-diagnosing of children with a label of ADHD.

And be careful when observing very young children. "It's difficult to determine if behavior has an underlying cause, especially with a child under the age of 7," warns Nancy Konigsberg, pediatric occupational therapist. "Very young children, particularly boys, have immature nervous systems and can often present as if they have ADHD."

Address the behavior

ADHD is not an excuse for inappropriate behavior, says Leah Aharoni, who has a 9-year-old daughter with ADHD. "We teach our daughter to control her fits and take responsibility for her own behavior," says Aharoni. "Parents must establish firm boundaries while also showing understanding for the child's challenges."

Customer relations expert Mitch Gooze is on the same page as Aharoni. "The issue isn't whether it's bad behavior or ADHD but rather how to teach the child to modify inappropriate behavior," says Gooze. "ADHD is a catchall diagnosis that is often contained within other issues. Teach your child to recognize unacceptable behavior and modify it."

But Bill Dueease strongly disagrees. Dueease and his two children have ADHD. "The behavior of ADHD children is often labeled bad or disruptive, but people with ADHD are and do act differently," argues Dueease. "They cannot be expected to sit, be quiet, and give undivided attention to things they do not like."

Former special education teacher, Deborah Crim, believes in correcting bad behavior whatever the cause. "A misbehaving child is one who understands directions and chooses to not follow them," she says. "Of course, a child may be afflicted with ADHD and be bad. In this case, punishment must address the behavior, not the ADHD."

Consult a professional

ADHD can look like a bunch of other conditions and bad behavior can be goaded by a bunch of emotional factors so, really, a person needs to be diagnosed to know for sure, says ADHD coach Margrit Crane.

Charlotte Reznick, Ph.D., educational psychologist, and associate clinical professor of psychology at UCLA, recommends these next steps:

  • Talk to your child's pediatrician.
  • Make an appointment with a child psychiatrist to review specific ADHD symptoms.
  • Request a neuro-psychological evaluation (from school, a mental health clinic or private psychologist).
  • A good evaluation will look not just at the possibility of ADHD but also possible learning disabilities that may make a child's behavior look like ADHD.

"ADHD is a real neurological issue," says Dr. Reznick, "and you want to make sure you are getting the correct diagnosis."

More on ADHD

Parenting Guru: Is ADHD good?
ADHD: Overdiagnosed and overmedicated
ADHD symptoms diagnosis and treatment