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MYTHS AND FACTS ABOUT ADD AND ADHD
Lately, many children are diagnosed or are suspected to have ADHD because they are disruptive or show no interest learning in the classroom (the problem always occurs in the classroom, seldom at home). Many ADHD children are put on medication. Over the past year, we also have seen more and more cases of youngsters and adults who have been diagnosed as dyslexic and have gotten seemingly sophisticated treatments, accompanied by tremendous expenses and time consumption, and yet continue to fare poorly and, worse, develop a sense of despair and stigma about the "disease". Much trial and tribulation and frustration have resulted from these diagnoses.
What exactly is ADHD? Strictly speaking, we don't know. The name is a mouthful: it stands for attention deficit and hyperactivity disorder. The actual definition is vague, because it covers two broad but significant areas of mental defects: inattention and hyperactivity/impulsivity.
To further confuse things, the DSM-IV lists nine subcategories of behavioral symptoms under Inattention and nine under Hyperactivity/impulsivity. For example, impulsivity and talking excessively are under Hyperactivity, and losing things or daydreaming fall under Attention Deficit. Thus, according to the DSM-IV, we have ADHD-Predominantly Inattentive Type or ADHD-Predominantly Hyperactive-Impulsive Type, or ADHD - Combined (314.01).
And there are no objective and logical ways to define "inattention" and "hyperactivity." For example, what type of attention? Is it deficient attention to all school tasks? Or in math homework only? Or in reading history? Or attention deficit while playing computer games? (highly unlikely) And in what setting does the deficit occur? In the classroom? Or at home? And how "hyper" should a child be before he is hyperactive? I used to have images of a boy who bounced up the wall, but I have seen diagnosis based on 'fidgeting'. Besides the broadness problem, the objectivity of the definitions is also compromised by the frequency of the symptoms. For example, how active should a child be before he crosses the threshold to become 'hyper'-active? Getting out of the seat every 2 minutes? Or every hour? A boy could also have ADHD if he "frequently" doesn't sit properly in class and doesn't wait for his turn. But how does one define "frequently"? Once every hour or once every 15 minutes?
When a diagnosis can include so many varied behavioral symptoms, it becomes non-specific, and many of these symptoms are also shared by other diagnoses (co-morbidities) such as Oppositional Defiance Disorder, Autism, Depression, etc. The DSM-IV tries to get around the broadness by specifying that a person must have had at least six out of the nine subcategories for six months before one of the three ADHD diagnoses be given. Still, many clinicians in practice use much less stringent criteria, resulting in over-diagnosis, i.e., people who should not be called ADHD end up being called so.
If your child is diagnosed ADHD based on one or two symptoms with unspecified length of onset, be skeptical!
Unlike a medical diagnosis, ADHD is not biologically or neurologically defined but is vaguely behaviorally defined. The vague definition allows professionals to use the term in different ways. As a result, you can have 10 children bearing the ADHD label but showing different symptoms. Many children that used to be called "naughty," "mischievous," or even "energetic" are suddenly now suffering from ADHD, and many previously called "lazy" (a taboo word) are now ADD.
The Treatment of ADHD.
A whole host of expensive treatments exists, among them sophisticated apparatuses to activate the left brain and drugs to "tone down" the brain. Tremendous anxiety and cost are expended by parents and often to no avail.
We adopt a pragmatic, result-oriented treatment. We maintain that motivation, discipline, life style and previous learning history of the child have much to do with ADHD. The individual is usually not interested in school, but can be very intense and attentive on things he likes to do. In treatment, the key is to have a thorough, logical analysis of the problem, the settings and the consequences. This can be best achieved through professional training on motivation/study habits/time management and in more severe cases augmented with supervised study sessions and/or structured, one-to-one tutoring.