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Is It Always ADHD?

ADHD is being diagnosed at high levels these days. Do they all really have this disorder? After 25 years of seeing alternative explanations many of the symptoms, I firmly believe the answer is no.

ADHD is being diagnosed at high levels these days. What started in the 1970’s and 1980’s as being a disorder that was rarely heard of, ADHD has progressed to a place where it’s hard to find a child who hasn’t had the label slapped on them or an attempt made to do so. The percentages are huge!

Do they all really have this disorder though? After 25 years of seeing alternative explanations of many of the symptoms, I question if the cause is always the same. I see the label ADHD as a catchall label for lots of different symptoms that can be caused by lots of other things.

I have always felt that ADHD medication has been handed out too fast. Since the medications have side effects and can change body chemistry, I believe every detail should be looked at before deciding to go that direction.

Being a parent coach, Child Psychologist and expert in this area, let me share a few examples of the kids I have worked with that confirmed my suspicions and taught me how lots of symptoms can have other explanations. See if any of these sound like kids you know.

DIFFERENT TRAINING:

A 10-year-old boy who was in 5th grade would get out of his seat without asking permission to do what he wanted to in the classroom. Despite repeated efforts by the teachers to get him to stay in his seat, nothing worked. The parents came to me because the inevitable ADHD diagnosis was bandied about and the teachers were pulling hard for ADHD medication. I did one meeting with the parents to ask about his history to determine what else might be going on. Turns out he was at Montessori for all the years prior to this one. Now, while I love the Montessori program and tell a lot of people to go there, there is a big difference in the way Montessori operates and the way the public school operates. Public school requires kids to sit and passively take instruction. Montessori wants the kids to follow their own instincts to learn what they are interested in. This child spent all the years prior to this one trained to get up when he needed something for what he was learning. The public school was a totally different way of doing things, but the child was operating on the past training. ADHD Medication would have been a huge mistake here and without my short intervention, I believe this would have been a disaster for this child.

HIDDEN ALLERGY:

A 7-year-old girl was doing OK with grades in school, but was having a really hard time sitting still. She was wiggling all day long and also having a problem remembering things she heard in class so she had to re-learn it at night, making homework really long and horrible. The school had already recommended that she be put on ADHD medication. The parents were absolutely against it. So the parents hired me as their private advocate to go into the classroom to do an observation to watch what was happening. I immediately noticed that she was scratching a lot. She would only stop for a couple seconds and then find somewhere else to scratch. When she was asked to answer a question, I noticed that she sounded like her nose was stuffed. I asked the teacher if this was common for this child, and she agreed it was, but said she had never really thought about it before. I asked the parents if it happened at home. They said they had never noticed it. I recommended a trip to the allergist who found allergies to be an issue, put her on Claritin for the school day, and voila-problem solved. Immediate improvement. Again, ADHD meds would have been a misdiagnosis and disaster.

BAD CLASSROOM:

A 6-year-old little boy was accused of getting out of his seat, crawling under his desk, not paying attention, crying, having behavior problems, and not knowing what to do on assignments in the classroom. Again, quick recommendation for ADHD medication, parents hired me to do an observation. I watched as the teacher gave instructions on the craft they were going to do. The directions were also on the board and the little boy was trying to write them down. Nothing unusual to begin with. When the teacher gave the go-ahead for the kids to go get their supplies to do the craft, the classroom erupted in a level of activity that scared even me. Kids running everywhere-some running in circles. Grabbing papers and scissors, some of which were flying. Kids bumping into each other and falling down. The noise level was crushing. Where was my little subject? Crying and crawling under his desk, to form a protective barrier around him from the chaos in this badly managed classroom. He was trying to finish writing the directions on the floor while crying. In my report, I recommended that the teacher be evaluated for ADHD and put on meds. Being a bit sarcastic here, but once again, a little one who narrowly averted body and mind altering chemicals based on misinterpreted symptoms.

One more…

PROCESSING HABITS THAT NEVER GOT TO GROW:

A 12-year-old boy was being recommended for ADHD meds because he could not pay attention in class, couldn’t do his homework on his own, would forget things constantly, and had to have constant help. This boy had a complicated history. Since he was very young, he had repetitive fluid in his ears and mini seizures that were not noticeable to an untrained person. As she didn’t want more meds, the mom wanted him to work with me. The ear fluid had been clear for a long time when he came to me and he was already on meds to control his seizures, but his skills hadn’t improved over the years. The explanation is simple: No one had ever practiced the right skills with him to catch him up. When we are babies, we are like sensory sponges taking in everything around us through our eyes, ears, touch, etc. If those are blocked by anything, those skills never get practiced and need to be trained and caught up. We did that with this child. Once he was able to automatically coordinate his visual, auditory, fine motor, etc. he improved greatly. The mom came in crying happy tears one day because he had actually REMINDED HER to wash his basketball uniform. Usually she had to remind him of everything. ADHD is not always the problem and more medication is not always the answer.

Many kids have a problem coordinating their visual and auditory skills from lack of practice and use. Most of them get accused of having ADHD. Compensation plays a part too. Kids who have fluid in their ears when young will learn to use their eyes instead because the other sensory skill was blocked off and not able to be used. Like all human beings, those kids compensate by depending on the strong skill, all the while allowing the weaker one to keep getting weaker. The ability to coordinate the skills together virtually disappears, creating frustration and looking like ADHD or behavior problems. We are survival creatures. If something doesn’t work well, we will find something to make up for it to move on. That can work for a while, but when the demands become greater and the weaker skill is required, you see problems.

If you don’t know what is causing the symptoms, you can’t be sure of the direction. Many problems can be helped without medication, in many cases, if the right investigation and training are done.

I was thrilled to be there and to be a part of helping these parents discover the truth about their kids and to help them avert a wrong diagnosis and a disastrous, misguided ending.

For these four stories there are hundreds of other kids I have met, who had different things impeding their ability to process information. They developed HABITS that began to look like symptoms of something else.

At least to me, it seems that over the last several decades and last several revisions of the Diagnostic and Statistic Manual, the definition of ADHD has grown much broader, to include many more people who are in need of medication. In light of the large amounts of people on medication, the many stories of kids dropping dead on the sports fields and the quick jumps to this diagnosis without a lot of investigation, I have a problem with that.

I just want to help parents and kids be sure about what else could be causing the symptoms before a misinterpretation gets made and potentially sends a child down a wrong and dangerous path.

 

Dr. Sherri Singer, Psy.D. is a Child and Family Psychologist and Parent Coach helping parents to help their kids avoid behavior problems, physical behavior, and ADHD symptoms without medication while developing fast processing speed, multi-tasking and memory skills. She provides low fee Skype online sessions and telephone coaching from anywhere in the USA. Contact her at http://www.happyfamilysite.com

 

This post is contributed by a community member. The views expressed in this blog are those of the author and do not necessarily reflect those of Patch Media Corporation. Everyone is welcome to submit a post to Patch. If you'd like to post a blog, go here to get started.

Dorinda Campbell February 08, 2012 at 05:02 AM
I agree with Dr. Singer that we must look only at the symptoms and their probable causes and then treat the child from that perspective. If medication is indicated a psychiatrist who takes time to gather all the data and observe the child in a natural environment is best.
Dorinda Campbell February 08, 2012 at 05:18 AM
IMO, MD's should not make a diagnosis of ADHD and/or medicate, based on seeing children in their office given ancillary stories of symptoms, behaviors and (my personal favorite), "issues" by the parent. The problem is time and money for the MD, of course. Ideally, I would like to see more psychiatrists who diagnosis/medicate work closely with psychologists, OTs, SLP and other professionals in the same environment. In addition to medication, other types treatment should be considered. That would lend a lot more credibility to the diagnosis. Also, as Dr. Soloman eludes to, close monitoring of the actual improvement, or lack thereof, using evidence based supported data collection should be used in determining how and why to continue using medication in a brain that is still developing.
Dorinda Campbell February 08, 2012 at 05:21 AM
I agree with you Sully. I see many parents fishing for a diagnosis so they can qualify their child for services, rather than being concerned about how medication might change the neuro-developmental process of a brain that is being formed right before their very eyes.
Sully February 08, 2012 at 11:15 AM
Dorinda, i wasn't even referring to the impact of side effects from medications. I was referring to parents who knowingly or not, prevent their children from learning responsibility and good work ethics. These children are given the message that because of their ADHD, they can't be expected to do the same things as their non-disabled peers. Rather than learning compensation strategies, they believe they should just do less or be given special accommodations in order to succeed. What a terrible message for a young person to receive. I'm in no way saying these kids shouldn't be given accommodations. I'm saying that when their parents are continuing to make excuses for them year after year after year as to why they can't do something or why they shouldn't be held responsible, they do not learn what it takes to be successful.
annie February 08, 2012 at 01:42 PM
Yes, ADHD does exist. It does not have to be considered a disability to a kid. My best friends son was diagnosed in 3rd grade. During the testing, the drs said, we think your husband has it too. Both take ADHD medications. The son is now a sophomore at Univ of IA. He was accepted into the Nuclear Physics program as a freshman. This program only accepts 13 kids in the country per year. He went to hs in the am, and college in the afternoon during his high school years. He also has dyslexia. The father is an engineer. I don't they consider themselves "disabled". Another friends kid, has Asbergers which is a form of Autism. The parents worked with him, to help him adapt to social cues, which Asbergers people miss. He is graduating from Purdue University and wants to be a scientist. He also has a job lined up, when he graduates next spring. As parents, from the time kids are born til about 13, we are with them constantly. After that, they become independent, and start making their own choices, good and bad. At age 18, they are considered "adults" on some things but not all things. At that point, they have to learn themselves, the parents are doing them a favor, by letting them stumble and fall, and pick themselves up. It has nothing to do with ADHD, etc.
What a great post Patsy! You are so right. All people have something that challenges them. Different people have different things. My husband has been legally blind throughout his enitre life but to meet him, you'd never know it. We can be limited by our challenges or we can reach greatness in spite of them. Sounds like your "boys" have chosen the 2nd one which is great. My concern is about that but also about those kids who are actually having a problem of a different nature but are being grouped incorrectly. Those kids get told they have a challenge they might not have and who knows what they will miss because of that!
Sully February 08, 2012 at 09:28 PM
Sherri, I'm not sure I understand exactly what you are saying. You say "being grouped incorrectly". What does that mean? Also you say, "have a challenge they might not have and who knows what they will miss because of that!" To what are you referring? I'm not necessarily disagreeing; I just need some clarification.
Hi Sully, I am just talking about those kids I have seen in my practice who might have been diagnosed with ADHD but actually had an auditory processing problem or some other issue that is now getting overlooked or not addressed because someone has said ADHD and now think the meds should do it. That child like all the others I have seen over 25 years who are in the same situation, continue to suffer and struggle even on the meds. These kids keep going downhill until the real issue that is effecting them gets looked at so other things can get done. That is why I am so intense about this issue. Have seen it happen too many times. It always concerns me, even with the kids who are diagnosed with ADHD and meds get prescribed, when adults stop at meds. Meds are meant as a symptom reducer, not a way to train better behavior, skills etc. Too many end up just minimally better without actually working on the core cause of what might be happening to them.
Sully February 09, 2012 at 02:19 AM
Okay. I for one, am not too wild about the words "auditory processing disorder" and have never found much validity to it's diagnosis. "Auditory processing" is too broad and too vague. If one does not understand the all encompassing characteristics of ADHD, auditory processing is surely not going to be a piece of cake. So we'll have to disagree on that one.
Actually it's not too vague at all. Central Auditory Processing Disorder is real. Lots of kid have fluid in the ears when little. The Eustachian tube is very small/narrow when kids are little, thus fluid can get trapped, especially if there are allergies/colds. Sometimes fluid being trapped can happen w/o parents knowing. It can show itself as delayed language skills/ear infections. Even when parents do know & they try to treat it with medicines, tubes, etc., it can still cause problems/delays until the child grows & the tubes get larger so the blockage doesn't happen anymore. If you think about the fact that little ones use their senses to absorb the world, if one doesn't work right, they will get very used to using another. Compensation. Just like blind people who have excellent hearing skills & deaf people who have excellent visual skills. Same concept. The strong skill gets stronger by using it more. But guess what happens to the weaker skill as it is ignored. It gets weaker and weaker. Kids who have this problem do ok for a while, by leaning on the visual skill and help, but as time goes on and more of a demand is needed for the auditory skill, if they have not used it because it was not available to them-blocked, it becomes very difficult for them to use it later on. This impacts school skills & can result in avoidance, frustration, homework problems, anxiety, depression. If a mistake gets made and stimulant meds used, it would not only not work, but may cause damage.
Sully February 09, 2012 at 11:04 AM
I didn't say auditory processing difficulties don't exist. Central Auditory Processing Disorder was a huge fad in Special Education some years ago, but the diagnosis is far less prevalent today (I've been around for a while too!). I don't believe that this disorder is really the cause behind so many other diagnoses. I've found that advocates use this term far too often when pushing for certain Special Education IEP goals and/or accommodations.
annie February 09, 2012 at 01:53 PM
I think parents need to be diligent in trying to get the right diagnosis/medication for their kids. If one thing doesn't work, you try another way. I remember a teacher telling me when my son was in 1st grade, that he doesn't follow directions. "When I tell him to open the door in the classroom, it takes him too long to get to the door". She said she would count to 20 before he would get up and most kids would be at the door by the count of 10. Well, he is in college, has an apt, has a job, has a 4.0. He figured it out and must be doing something right! Parents are their kids best advocate. You know your child better than anyone. So, trust your gut, and keep going with it.
Yes, I think there is a great reason why it seems it doesn't exist anymore. The pharmaceuticals have blanketed this population with adhd meds advertsiing (which btw I think should be illegal-the public doesn't benefit from the ads-that's what the docs went to school for-of course in this day and age, what a Doc says doesn't matter much anymore). Meds can mask lots of other things but does not necessarily help the misdiagnosed kids whatsoever. Also, listen to the commercials sometime and see if the list of side effects look good to you. Lots of people in the mental health field are very aware of CAP disorder being very valid and existing. Just because the general population has been convinced otherwise, doesn't matter to whether something exists or not.
Yes Patsy, you are right. This one size fits all approach to calling something ADHD has to stop. This is exactly where things go wrong. They have this idea of what ALL kids should be able to do, but there are lots of variations that are still within a normal range. Also, I have seen many kids do much better just from changing certain habits like sleep, diet, allergy issues. You'd be amazed at how uninformed many parents are about what a normal amount of sleep is for their child. Sleep deprivation symptoms can look a lot like all the ADHD symptoms. Lots of things can cause these symptoms which was why I wrote the article. I get very frustrated with people who can only see straight down the tunnel to ADHD and will not take any other possibilities as the problem. There has been a huge marketing campaign about it for years and that has permeated the population and convinced everyone that there is only one possibility and the end product of that possibility is their product.
Sully February 09, 2012 at 08:24 PM
I agree about medication commercials. They should not be allowed. I also have never stated drugs are not over-prescribed. I know they are. But I still do not believe auditory processing is as overlooked as you believe, and I could say there are just as many professionals who do not believe in the validity of CAP. I believe it exists, but I do not believe it is a high percentage. William- it's spelled PSYCHOLOGIST, with an "H".
Dorinda Campbell February 09, 2012 at 11:50 PM
I thought there was a movement afoot whereby all medication commercials would be discontinued. I don't believe in the CAP diagnosis. I like to be more holistic in looking at all the senses rather than just AP. Certainly auditory can be the primary problem, however, in my experience other challenges exist as secondary and tertiary sensory processing challenges.
Hi Dorinda, I hadn't hear anything about that but I would welcome it! I agree that there are many other issues that can happen. I just used CAP as an example.
I can live with that. Thanks for the spell check. Always good to help! :)
Dorinda Campbell February 10, 2012 at 03:18 AM
The auditory nerve is sensory and works with the vestibular never to modulate motion. The neuroscience of it is complex. The sensory system is one big transducer to the central nervous system which integrates all the information in order to make an appropriate motor response. When one part of the system is dysfunctional for any reason, the entire sensorimotor system is affected.
Sully February 10, 2012 at 10:51 AM
Dr. Sherri, if I may ask, from where did you get your Psy.D? What are your credentials? Looking at the information you provided for Patch, and then viewing your website, you strike me as nothing more than a salesman. I could be mistaken, but I really have to question your "expertise" and your qualifications as to what you advertise. I'm sorry if this offends you, but i find it extremely irresponsible to mislead parents the way you seem to be doing.
casey kline February 10, 2012 at 08:07 PM
Sully - from her website: Got my expertise in many places along the way..... BA: University of Illinois, Champaign Doctorate/Psy.D.: Forest Institute of Professional Psychology Therapist at Bresler and Dugo, Ltd. Therapist at Child and Adolescent Service Center Therapist at Shipley Behavior Disorder Center Therapist at Institute for Behavioral Services Therapist at Hillside Academy Behavior Disorder Program Owner of Dr. Singer’s Happy Family Center
casey kline February 10, 2012 at 08:08 PM
..and yeah, I had a similar impression
Sully, No offense taken. You're entitled to your opinion ,but me talking about my past experiences with clients I have seen and being passionate about what I saw them go through, to help others, hardly makes me a salesperson. Do I sell sell services? Yes. Just like all other Psychologists, I make a living helping others to deal with their problems. My opinion about whether medication is a good thing or not will not be changed because someone doesn't like it. My resume and experiences are all clearly listed on my website and I am proud of every experience I have had. Many in this country seem to have a need to always turn to the medical alternative and it is their prerogative to do so. As I mentioned before, I have worked with plenty of people who are on meds and helped them to change some other things in their lives. I doubt highly that this makes me a salesperson. Again, you are entitled to your opinion of my writing, but to say I am misleading parents is a gross overstatement. I would ask you for proof of how my opinion would be misleading in any way. I'd also like to see your credentials to know why you are so passionate about accusing me of being misleading. Certainly if you have some research that I have not seen that says that ADHD is in fact the only disorder that can effect a child and that meds are the only thing that will help, I'd love to see it. Until that time, I will trust the parents who have given me great feedback on what I do for them.
Thanks for doing the research Casey. My resume is also there to see as well. I have a rich history with a lot of great experiences that I wouldn't trade for anything.
Oh an btw @deadcatbounce, I've seen some of your responses to his posts and more power to you! :)
Deadcatbounce February 11, 2012 at 02:37 AM
I've stayed out of this fight up to now.   My son was diagnosed ADHD many years years ago and of course drugs was the treatment of choice by doctors and teachers.  After a few years I had enough, adderall  was only making my son stay up all night and act mopey.  I don't like drugs and feel doctors like to push pills on too many kids.  Drugs should be the very last option and behavior modification should be stressed.  I know of another kid that was diagnosed with ADHD and drugged.  Found out one year after drug treatment he was really dyslexic and the medication damaged his heart.  Too many doctors with sterling credentials push these pills because it is easy.  Easier than discovering a learning disability or realizing that many boys have a harder time sitting still than girls.   I have no problem with your column Dr. Singer, keep up the good work.
Susan Schaefer February 11, 2012 at 06:38 AM
Hi Dr. Sherri, I had an interesting thing happen with my son, who was diagnosed ADHD in 3rd grade along with a processing disorder and learning disabilities in language arts. He was on various medications for his ADHD, which really didn't seem to make a difference as far as I could see. We moved to CT the summer between 6th and 7th grade. Due to upheaval that came with moving, I got behind on filling my sons prescription so he was off his meds when school began. At his first IEP at his new school his teachers said they saw no reason for him to be on meds and we decided to keep him off unless his teachers recommended it. The teachers continued to believe he did not need meds. Now he is in 10th grade, has not been on meds, and is a solid B student. His high school has been very supportive in helping him become a successful student.
Susan Schaefer February 11, 2012 at 06:49 AM
However, I do believe ADHD exists and medication is necessary at times. I work with ADHD students teaching them executive functioning skills to help them compensate for the skills they lack and utilize behavior modification plans to help my students reach their goals. I also think it is diagnosed, and medication given, too quickly in many cases when there are other underlying reasons for various behaviors.
Hi Susan, Yes I think that the symptoms are more intense for some kids than others. My problem is it seems that it is the first thing that is thought about, and the only direction in many cases that gets followed up on. I am glad for your son, that things happened the way they did. I don't question whether kids are struggling with the symptoms as I have seen it over the last 25 years. My problem is in the way it is growing exponentially, how many kids I see being medicated and how many of those kids I have seen end up with a different problem than was actually thought. My article wasn't intended to say that ADHD does not exist, just that I think that parents need to be diligent about making sure they look at all possiblities to be sure of what the resulting treament is. All of us are multi-dimensional and to say that one thing is the only possibilty becomes very suspect to me and I just wanted to share that opinion with parents. Btw, Susan, I like your blog!
Patti February 11, 2012 at 06:30 PM
Reading all these comments it seems that all this has done is become a "pissing" contest instead of discussing what the real issue is. Yes, ADHD exists and yes, it is misdiagnosed. My son went through a battery of tests and was monitored constantly. Yes, he was medicated, but that was AFTER exhausting everything else first. I was lucky that I had a wonderful pediatrician and provided me with tons of material to read and research myself. I also have family who is in the medical field who could explain what something meant when I didn't understand the term. When he was old enough to understand the process he was given the choice of whether to stay on the medication or not. He did not do as well in school after ending the medication and chose not to attend college. He is a hard worker and knows the chances of him ever holding a desk job are next to nil....he needs to keep his hands busy or he cannot stay focused. These discussions, when handled properly, are good for parents so they know that they are other options, they can get 2nd even 3rd opinions to find out what is the proper way to treat their child. ADHD, whether with or without hyperactivity, is a very hard condition to diagnose and what works for one does not always work for another.

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