Monday, April 13, 2009

Is It ADHD (Attention Deficit Hyperactivity Disorder)?

It may start out with a teacher suggesting your child be tested for ADHD or that he/she may benefit from stimulant medication. You become anxious and concerned.... or recognize that the teacher is affirming something you already suspected.

Before you rush your child to a psychiatrist with a list of symptoms, take a deep breath, and think this through.

After you take that deep breath, be brutally honest with yourself. After all, this diagnosis is based solely upon symptoms. These symptoms could be be triggered from many different causes ranging from an organic brain dysfunction ("true" ADHD") to a simple lack of adequate sleep (see: Sleep Issues Are Being Misdiagnosed as ADHD and other Mental Illnesses).

(I’ll assume that your child does not have what used to be termed “minimal brain damage” with a severe lack of impulse control. If so, your child is probably already on medication, and you wouldn’t be looking here for whether or not your child’s more mild symptoms are ADD/ADHD.)

Has your child been brought up on a diet of TV and video games—never having a chance to learn concentration, self-discipline and impulse control? Is there a problem with discipline in the household? Does your family have regular sleep/wake schedules? Does he/she go to bed early enough to get enough sleep? Does the child get plenty of exercise? How about your child’s diet? Sweets, caffeine and many food additives can cause symptoms in vulnerable children that mimic ADHD.

If these problems exist, obviously, lifestyle changes are needed to positively impact your child's mental and physical health. A change is needed in the child’s upbringing and environment (including diet).

~~OR~~

Perhaps your child may be like mine was—displaying symptoms that looked like ADHD—Inattentive Type even though she was eating a reasonably healthy diet, not watching TV or playing video games, had a sleep schedule and plenty of time for active, unstructured outdoor play with friends and was reasonably well-behaved.

Still, she was distracted by everything, and experiencing sensory overload.

After (mis)diagnosis with ADHD she exclaimed that her problem was not with a deficit of attention to the environment—the problem was with noticing too much!

I’d start with the pediatrician who really knows you and your child. Bring along both comments from the teacher, as well as your own. Be sure to compose a medical history, and note any medications your child is currently taking including non-prescription items. Include current sleep schedule, and behaviors. Take time to think through both the documentation you need to collect, and what you want the pediatrician to do.

You may wish to set up an appointment to go over everything without your child present.

One of the worst things we did with our daughter was assuming her attentional difficulties were due to ADHD and allowing her to be put on a stimulant. We did not rule out other things first.

Only in retrospect did we understand that some of what we were seeing was the result of possible seizures, sleep disorder, nutritional deficiencies (due to autoimmune problems in the gut), hormonal problems, metabolic problems, and more. Taken together, something was obviously wrong in the functioning of her body—every cell—affecting the functioning of her brain.

This whole thing is a like puzzle. Don't just look at pieces by themselves. Find all the pieces through all these tests so that you can lay them out and see the whole picture. It is important to do ALL the following testing because multiple problems can (and often do) co-exist.

This is called a biomedical and integrative, or a functional approach to testing and treatment. It tailors treatment to the individual based on the child’s own unique biology rather than to a label for a symptom—“attentional deficit.” Find out WHY that attentional deficit exists.

If any doctor you go to blows off your concerns, do not give up. Consult another and another until you find someone who does take your concerns seriously.

Proper vision testing is critical. You must ensure that the child’s near vision, far vision and binocular vision are checked. This goes beyond what most optometrists/opthalmologists routinely check. If a child’s eyes cannot properly track on a page, this might be the source of a teacher’s complaints that your child lacks “focus.” This can easily be mistaken for “ADD.” You may wish to consult specifically with a pediatric optometrist after examination by a pediatric ophthalmologist.

Hearing tests are quickly done by an audiologist.

Psycho-educational evaluation with a qualified psychologist will determine your child’s IQ, how he/she learns, and if there are any specific tasks, such as in written expression, writing fluency, reading or computation, that are very difficult for your child to accomplish. This specialist may make the determination whether or not ADD is suspected, and whether or not your child has dyslexia or another specific learning disability. The test for dyslexia may be a separate test, so make sure it is included.

Receptive and expressive language testing may be done through a speech pathologist.

Testing with an Occupational Therapist specializing in sensory integration or sensory processing issues is indicated if your child has any one of a number of sensory issues. Some of these include: a problem with how he/she moves in space, awareness of her body, being clumsy or awkward, lack of coordination, being hypersensitive to touch or sound, having problems with the feel of clothes, not liking certain movements such as swinging, or having trouble with fine motor control such as pencil and paper tasks.

Next, there are medical issues to consider.

Testing for nutritional and metabolic problems can be investigated with blood and urine testing which can be ordered by the pediatrician. Levels of a host of nutrients should be tested including vitamin D, B12, folate, calcium, magnesium, Ferritin, glucose, fatty acids, and CoQ10.

A Strep titer should be obtained if your child shows symptoms of OCD or tics.

Sleep disorders must be addressed. Your child should have a sleep study done.

Endocrine problems may exist. A thorough endocrine evaluation consists of dozens of tests which can be accomplished with one blood draw. Don’t settle for a check of “TSH” as being an “endocrinological work-up.” And if your child is already labeled with a psychiatric diagnosis and/or on psychiatric medications, don't settle for your child falling through the cracks as first one doctor then the other says "not my responsibility."

Allergy testing and testing for food sensitivities is important, but not just the skin-prick type the allergist does. In addition to the IgE tests, consider IgG and IgA testing for various foods (such as to gluten, dairy, etc) such as those done via Enterolab, Great Plains Laboratory, Genova Diagnostics, etc.

Neurological testing can investigate whether sleep or seizure disorders are contributing to attentional issues. Migraines, if they exist should be addressed.

Intestinal problems should be addressed: Consider candida overgrowth and treatment, including treatment with probiotics, which help restore intestinal health as well as possibly helping with allergies.

Depending on what is found in the medical tests, you may consider consulting with yet another specialist – an Integrative medical specialist since nutritional and herbal supplements can help with sleep, migraines, endocrine issues and more.

And remember, sometimes the right answer may come from asking the right doctor the right question.


Related Reading:

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Last Updated:
21 April 2012

3 comments:

Dominick M Maino, OD, MEd, FAAO, FCOVD-A said...

A pretty well written article...however, you wrote that:

... You may wish to consult specifically with a pediatric ophthalmologist....

If you child has an eye disease or eye problem requiring surgery, then the pediatric ophthalmologist is a good choice...otherwise go to an optometrist who specilizes in children.

One of the best ways to locate such a doctor is by going to http://www.covd.org and use this page's Find a Doctor function. This is the College of Optometrists in Vision Development. They should be able to help you.

For the latest research in children's vision you might also want to visit http://www.MainosMemos.blogspot.com

Dominick M. Maino, OD, MEd, FAAO, FCOVD-A
Professor of Pediatrics/Binocular Vision
Illinois Eye Institute/Illinois College of Optometry
dmaino@ico.edu

konnie said...

Thank you for your post. Allow me to learn more about the symptomsattention deficit disorder Great Article!

Anonymous said...

We hired an ADHD coach to help with our son, Alex. He's not medicated. Our coach advocated us restructuring our parenting approaches. She also had us use two different programs. We used www.adhdnanny.com to help us schedule routines and to provide consequences when the routine wasn't met. It's definitely for younger kids, but it really helped us manage. We also used www.playattention.com. It's a neat program that allows Alex to control their games like Harry Potter. He uses his mind to finish tasks and improve memory. It's a long road, but we're doing well. It's good to have someone sort through the clutter to get help.