When my son was in preschool, I did what many parents of excessively energetic and impulsive preschoolers have surely done: I worried whether his behavior might be a sign of attention-deficit hyperactivity disorder (ADHD). Then I sought input from two pediatricians and a family therapist.
The experts thought that his behavior was developmentally normal but said it was still too early to tell for sure. They offered some tips on managing his behavior and creating more structure at home. One pediatrician worked with my son on self-calming techniques such as breathing deeply and pushing on pressure points in his hands. He also suggested an herbal supplement, Valerian Super Calm, for him to take with meals and advised us on dietary adjustments such as increasing my son’s intake of fatty acids. Studies have shown that a combination of omega-3 (found in foods such as walnuts, flaxseed and salmon) and omega-6 fatty acids (from food oils such as canola and flax) can reduce hyperactivity and other ADHD symptoms in some children.
In the couple of years since trying these techniques, my son has outgrown most of those worrisome behaviors. I had just about written off the possibility of ADHD until a few weeks ago, when his kindergarten teacher mentioned that she was going to keep an eye on him for possible attention issues. Hearing that left me worried and heavy-hearted.
Why is it still so hard to diagnose ADHD? And why is there so much emotional baggage associated with treating it?
There are no firm numbers for the number of children with ADHD in the United States. The Centers for Disease Control and Prevention estimates that 9 percent of U.S. children ages 5 to 17 had received diagnoses of ADHD as of 2009.
It is far more prevalent in boys than in girls. Among those given the diagnosis, a small minority suffers extreme symptoms, and in those cases, diagnosis is fairly straightforward. Children with extreme cases tend to have trouble staying engaged in tasks, even those that they enjoy, for any length of time and find it impossible to stay still, particularly in classroom settings.
But for the vast majority of children who are not so severely affected or who only partially fit the criteria, symptoms are often blurred, making it much more difficult to assess the disorder.
“There is no line” that defines who does and does not have ADHD, says Lawrence Diller, a behavioral developmental pediatrician and an assistant clinical professor at the University of California at San Francisco. Except in the extreme, diagnosing ADHD is a “judgment call based on subjective opinion,” he says.
A flawed testing system
Schools play a major role in whether a child ends up with an ADHD diagnosis and is treated with stimulant medications. A large majority of referrals are generated by problems reported at school, Diller says, yet schools typically do not investigate the context of learning disorders and behavioral problems. “The whole system of diagnosis [of ADHD] is based primarily on symptoms of behavior only.”