ADHD and the Importance of Accurate Diagnosis
Nearly 10 percent of children and 4 percent of adults in the U.S. have been diagnosed with ADHD. But studies suggest that while many people with ADHD still go undiagnosed, others are wrongly diagnosed with ADHD when they are instead suffering from a range of other disorders. ADHD is frequently portrayed and covered in the media and it is now part of the American lexicon. Many people notice that their children are struggling with a lack of attention and quickly assume that they must have ADHD. Often, parents and teachers can feel so certain that a child has ADHD that their strong beliefs can influence important medical decisions. With the absence of psychoeducational testing confirming or disconfirming the presence of ADHD, psychiatrists, pediatricians and general practitioners often prescribe stimulant medication to children who superficially appear to have ADHD, but many times actually do not!
Like many DSM-IV diagnoses, the symptoms of ADHD actually overlap with many other diagnoses making a correct ADHD diagnosis more difficult than it may seem. Inattention is just one individual symptom of ADHD, not the hallmark of the disorder that many think it is. ADHD is a disorder of the brain’s frontal lobe. The frontal lobe controls what are known as Executive Functions which include the skills of: Planning, Working Memory, Attention, Problem Solving, Cognitive Flexibility, Emotional Regulation and Inhibitory Control of Behavior. The hallmark symptoms that separate ADHD from all other diagnoses involves the disruption of one’s Executive Functions and manifest as a lack of self control, recklessness, thoughtlessness, and an inability to think of about behavior before acting. This kind of impulsive behavior can range from being extremely disruptive (i.e. the child that runs around the room during class) to more mild (i.e. the child who interrupts others while they are speaking).
Basing an ADHD diagnosis solely on criteria such as inattention or hyperactivity is what frequently leads to misdiagnosis. An incorrect diagnosis of ADHD can potentially be extremely damaging to a child (or an adult) because academic and medical decisions are frequently made based on this diagnosis. Parents who are concerned about their children having ADHD should consult with an expert in the field who conducts psychoeducational evaluations in order to correctly differentiate ADHD from learning disorders, anxiety disorders, depression, Bipolar Disorder, and Asperger’s Syndrome. These other diagnoses are frequently mistaken for ADHD and all lead to diverging courses of treatment and academic intervention.
Children who are experiencing depression and anxiety are often preoccupied with anxious and depressed thoughts which can be extremely distracting and may manifest as a child who is struggling to pay attention due to a mood disorder rather than ADHD. Children with ADHD can sometimes struggle socially because they may be so scattered in their thinking that they have difficulty listening to what peers say leading them to miss subtle social cues. This is often mistaken for Asperger’s Syndrome which is a much more severe disruption of a child’s ability to function in social settings. At times the highly energized and impulsive behavior of a manic episode is mistaken for ADHD. This is particularly dangerous as the stimulant medication that is successful in treating ADHD, makes manic episodes much worse. The symptoms that differentiate a manic episode from ADHD are severe insomnia, irritability, and grandiosity.
Given the wide range of disorders that can mimic the appearance of ADHD, it is prudent for concerned parents to seek a psychoeducational evaluation for their children to ensure that the diagnosis that is made is the correct one. This will lead to much more effective and expedient treatment and remediation of academic weaknesses.
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Dr. Maloff is a Clinical Psychologist who practices privately in Beverly Hills. He specializes in psychological and psychoeducational testing. His work is frequently used to inform medical, educational and psychotherapeutic decision making. Dr. Maloff frequently participates in IEP meetings to ensure that private schools and public school districts are meeting a child’s academic needs. He also provides expert testimony regarding psychological and psychoeducational testing in legal proceedings.
Jared Maloff Psy.D.