The ridiculous epidemic-like level is most surely a mistaken exaggeration caused by careless neglect of differential diagnosis. Doctors are prescribing stimulant drugs for a hodgepodge of childhood disorders and for basically normal kids who happen to be on the active and distractable side of the spectrum.
An accurate assessment of ADHD requires comprehensive and repeated interviews of the kid and parents; gathering information from teachers; a differential diagnosis that also considers comorbid conditions; and an evaluation of whether the symptoms and behaviors are severe and persistent enough to be considered clinically significant; and much more.
First, there is no doubt that 2% or 3% of children and adolescents suffer from a serious and treatable disorder, for whom medication or CBT or both is required to avoid the serious lifetime impairments.
Second, no child should be diagnosed with ADHD without a thorough clinical assessment that includes self-report by the child or adolescent, a family psychiatric history, and developmental history of the child. Reports from teachers are essential and represent one of the most neglected sources of information in ordinary pediatric practice. Treatment almost always requires working together on school-related problems.
Third, it is apparent that the DSM's are part of the diagnostic problem, providing definitions that are too loose and insufficient guidance to the practitioner on how to make a proper diagnosis.
Finally, the public should be skeptical both of the diagnostic enthusiasts who see ADHD everywhere and the diagnostic nihilists who see it nowhere.
What should parents do when they suspect their child may need treatment?
First, remember that most medication is prescribed by pediatricians, and these days many do not specialize in developmental behavior problems. Those who do have a specialty are more likely to have the time and experience to recognize and treat real ADHD. They will give advice on other therapies in addition to medication.
Even some specialists (like child psychiatrists or child psychologists) lack the background or training for ADHD or may have biases that fail to account for the particular needs of the child. So don't hesitate to check credentials, and look for those who have a record of extensive care of ADHD. Ask what tests or procedures are being used to identify ADHD, and do not accept cursory, brief examinations that do not involve a complete picture of family environment, school, and development from an early age.
Although medication can sometimes provide dramatic initial relief from a serious situation, additional help with school, peer, and home problems is almost always needed.
ADHD can be a frequently changing, up-and-down experience for a child and family. Make sure that your doctor or therapist follows the situation regularly, and adjusts the treatment as needed in order to maintain gains or deal with new problems as they arise. This applies to both medication dosage and behavioral or cognitive treatments.
Parents need to understand that severe, chronic ADHD can be a mind-numbing experience that can wear any family out- never accept a neighbor's view that you are the cause of the problem. To avoid burnout, get all the help and support and once in a while try to take a vacation away from the stress of raising a lovable but difficult ADHD child.
If you are wondering whether your child has ADHD, The National Resource Center has trained staff to answer your questions at 1-800-233-4050. For help in your area contact the National Dissemination Center for Children with Disabilities by logging on to http://www.nichcy.org/ or 1-800-695-0285 . These sources can also put you in touch with CHADD, a national organization of parents of ADHD which is likely to have meetings in your area and will supply all of the literature you need to understand the facts about ADHD.
If your child is already being treated with medication, but still has significant handicaps in dealing with peers, with school adjustment and learning, or dealing with problems within the family, it may be time to seek out additional help. Ask yourself these questions:
Is the medication being checked and adjusted frequently for necessity and adverse reactions? Have you received help on specific methods for homework and in-class school behavior? Does your child receive help in social skills and peer behavior? Does your physician seek out reports from school teachers as well as from you?
If any of these answers are "no," then you should discuss these issues with your physician, and if not satisfied with the answers, consider getting second or third opinions.
Finally, as your child moves towards adolescence or young adulthood, many additional issues will be have to be faced, so adjustments in a treatment plan will surely be needed. As many as half of children with ADHD continue with significant problems in learning, work, or social problems as they move to young adulthood and need continued treatment. But adolescents and young adults are also the group where over-medicating is most common. Careful re-evaluation for your child may be required. New forms of help in school or college or the workplace, as well as alertness to possible over-medication will be mandatory. Be mindful that drug companies are now directing their misleading, high pressure sales pitch to the adult ADHD market."
Wow, what great advice. Thanks so much, Keith. Just a couple of closing thoughts. Parents need to be super informed and should feel free to ask lots of questions and expect clear answers.