Tag Archives: diagnosis

ADHD–Part I

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ADHD (Attention Deficit/Hyperactivity Disorder) often comes to my attention in my private practice; it’s frequently the reason that parents call me for help with their child. I worked in the school system for many years and ADHD was the most frequent reason that children were referred to me for assessment, counseling, or parent and teacher consultation.  What exactly is ADHD and how can I manage my child, both at home and at school?

ADHD is one of the most common chronic health conditions affecting school-age children.  It is a specific developmental disorder with respect to controlling and/or regulating behaviors, impulses, and/or attention, and is observed in both children and adults.  About  5-8% of the childhood population and 4-5% of the adult population meets the criteria for ADHD that has been established and researched by the medical field.  The latest research now points to ADHD as a disorder of inhibition and self-regulation.  Although their have been many names for this disorder, it is now referred to as ADHD.

What causes ADHD? There is a very strong biological contribution to its occurrence although specific causes have not yet been determined. Several genes associated with the disorder have been identified, however, it is such a complex disorder, it’s almost certain that more genes will likely be identified. Given that ADHD represents a set of complex behavioral traits, a single gene is unlikely to account fully for this disorder.  The popular notions that excessive sugar, food additives, excessive TV viewing, or poor behavioral management by parents contribute in some way to ADHD have not been supported by research. Factors that MAY contribute outside heredity include difficulties during pregnancy, prenatal exposure to tobacco and alcohol, prematurity or low birth weight, excessive lead levels in the body, as well as postnatal injury to the prefrontal area of the brain.

ADHD presents with both core and peripheral, or related, symptoms that tend to occur together to spell this diagnosis. The core symptoms are related to inattention, hyperactivity, and impulsivity. Peripheral symptoms include academic problems, social skills deficits, behavioral problems, and other disorders such as anxiety or depression.  The expression of ADHD is highly variable so that all children won’t likely have all of the core and peripheral symptoms. Individuals with ADHD demonstrate vast differences from each other within the ADHD diagnosis.

Given the above, there are specific diagnostic criteria for ADHD, too numerous to mention here. To reach a diagnosis of ADHD, symptoms must cause impairment in school, social, or work settings and signs of this must present before age 7.  Some impairment must be present in two or more settings (such as school AND home). The symptoms must not be better accounted for by other mental disorders, such as anxiety disorder, mood disorder, dissociative disorder, or a personality disorder, nor can it be explained by a different diagnosis, a stressful experience, or any other factor within the child’s environment.  Finally, the child’s symptoms must create dysfunction for the child in areas such as academic performance and interpersonal relationships.

There are three types of ADHD based on specific diagnostic criteria:

  • ADHD, predominantly inattentive type:  This is identified if criteria for inattention are met, but criteria for hyperactivity/impulsivity are not met for the past 6 months.
  • ADHD, predominantly hyperactive/impulsive type:  Identified if criteria for hyperactivity/impulsivity are met but criteria for inattention are not met for the past 6 months.
  • ADHD, combined type:  If both criteria for inattention and hyperactivity/impulsivity are met for the past 6 months.

There is NO treatment that has been found to cure this disorder, but many treatments exist to help manage the symptoms.  Next time, I will write about assessment and treatment options for ADHD.  If you have any specific questions, please address them to me at rtlapidus@gmail.com or respond via this blog in the upper right corner’s speech balloon.

Can I Advocate for My Child’s Mental Health Needs? (*Of course, you can!!)

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Since 1949, May has been declared National Mental Health Awareness Month to draw attention to mental health issues that affect many Americans. As part of this effort, the first week in May is National Children’s Mental Health Week, which raises awareness about the importance of children’s mental health to their overall healthy development.  Today’s blog will focus on advocacy for your child regarding their mental health.

According to the U.S. Surgeon General, 1 child in 5 experiences significant problems with a psychiatric disorder. Sadly, only less than 1 in 3 is receiving the treatment that they need. This issue has come to the forefront due to several recent tragedies and the realization that mental health treatment is so often not available for those children who need it. Early detection and screening of children is also hotly debated around the country as to its effectiveness in the prevention of violence.

NAMI (National Alliance on Mental Illness) recently shared an article on tips for parents to advocate for their child regarding their child’s mental health. As written by Dr. David Fassler, Child and Adolescent Psychiatrist, I found these tips to be quite informative and helpful for individual advocacy. I hope many of you will find these tips useful, as well:

  • Get a comprehensive evaluation for your child to address your concerns. This may include several visits to a mental health professional. A careful and accurate diagnosis will yield effective treatment.
  • Look for the best clinician in your area pertaining to your child’s condition.  Check their credentials carefully: Are they appropriately licensed or certified in your state? If he/she is a physician, are they board certified? Push schools, insurance companies and state agencies to provide the most appropriate and best possible services, not merely those that are deemed adequate or sufficient.
  • Ask lots of questions about any diagnosis or proposed treatment, and enlist your child’s questions, as well. Child disorders may be very complex and simple solutions usually don’t exist. Most, if not all treatments have both risks and benefits.
  • Seek family centered treatment that builds on your child’s strengths. Ask about goals and objectives of treatment and how you will know if the treatment is helping. If treatment does not work, ask about options or alternatives.
  • Remember to keep all copies of consultations, treatment reports, and assessments in an organized place. Ask and insist on your own copies of all evaluations and maintain your own file on your child. This avoids unnecessary duplication of previous treatment efforts and future unnecessary testing.
  • Feel free to seek a second opinion. Any mental health professional should be happy to help with referrals and sharing information for the benefit of your child.  If you question a diagnosis or a treatment for your child, absolutely arrange an independent consultation with another clinician.
  • Help your child learn about their specific condition in an age appropriate fashion.  Use books, pamphlets, or the Internet to access information that your specific aged child can understand. Remember not to overload your child with more detail than they want or need.
  • Work with your child’s school. Be included in all school meetings held to discuss your child. Request school records and keep them at home in your organized file.  Make sure their educational program is meeting their specific needs.
  • Know the details about your insurance policy and how it affects your access to mental health care. Know their coverage of “specialists.”
  • Learn about your state’s reimbursement and funding systems. How does Medicaid work? Which services are covered and which are excluded? What other sources of funding is available for your child.
  • Seek out support from other parents by joining a local parent support group.  If none exists, think about starting one in your area.
  • Attend local and national conferences of parent and advocacy organizations where information is shared, ideas are offered, support is given and camaraderie is available.

Advocacy is hard work; there is no right or wrong way to be an advocate for your child.  It takes a lot of time and energy to advocate for better mental health access, but in the end you will help not only your own child, but also others who deserve access to appropriate and effective mental health treatment.

How do you advocate for your child or children in general?  I’d love to hear your stories and as always, thank you for sharing.