By AMANDA MASCARELLI
The Washington Post
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).
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 his kindergarten teacher mentioned that she was going to keep an eye on him for possible attention issues.
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. But for the vast majority of children, symptoms are often blurred, making it 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 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 is based primarily on symptoms of behavior only.”
Many doctors and some schools rely on the Vanderbilt Assessment Scale, a questionnaire meant to flag symptoms of ADHD and identify other underlying conditions. It includes general statements — such as “Is distracted by extraneous stimuli” and “Is forgetful in daily activities” — and asks the person completing the form to rank how often each applies to the child throughout the day.
But the test does not provide the necessary insights into a child’s home life — discipline patterns, inadequate learning environments, familial difficulties.
Diller says: “If the behavior crosses the threshold on these forms, the parent is likely to be told the child has ADHD, even though there can be a host of other reasons why the kid is acting that way.”
Diller recommends that parents first address discipline and learning issues before turning to medications, particularly in children younger than 6.
For “the kids who are in this gray zone, it can be difficult,” says Thomas Insel, director of the National Institute of Mental Health. “What we usually say is to err on the side of trying to provide kids with structure and feedback. If that doesn’t help, then you think about medication.”