ADD and ADHD can be a bewildering diagnosis for parents. In today’s pedcast, Dr. Smolen tries to shed some light on the diagnosis and it’s biologic basis. See if he can convince you that ADD is a real thing.
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Today we are going to discuss a common and controversial diagnosis, ADD.
I am going to give you the DocSmo view. That’s all I have.
I have not done research, I am not a psychologist and have very little psych training, however I feel I have a valuable point of view.
After all, 30 years of general pediatric practice must be useful for something.
Let’s get into, shall we?
First, my worldview when it comes to behavior.
I believe that much of our personalities are genetic. Not an individual behavior but our temperament and general reactions to the world are to a large degree predetermined by our genes.
Experiences play an important role but I feel that temperament often trumps experience.
So for me, it is not a leap to believe that some children, about 5% of especially males, are born with a tendency to be very impulsive, inattentive, and distractible.
All human traits fall on a continuum and attention and impulsiveness is no different.
The 5% figure comes from the fact that this group is inattentive enough that, when they reach school, have great difficulty being successful in the classroom.
It’s that simple.
Here are some other observations to ponder.
The 5% figure is pretty constant cross culturally…to me that means biologic.
Many if not most children with this pattern of behavior have a close relative with the same difficulty… to me again, that means biologic.
Adults who have neurological illness or injury often develop typical ADD symptoms very similar to children with ADD even though they did not demonstrate this behavior in childhood… to me again that means biologic basis.
Have I convinced you that ADD is a physical problem or do you believe that is stems from a weak character or lack of discipline?
My view is the former.
So now you know where I am coming from. I believe that the ADD behavior pattern is a biologic trait, very much like blue eyes or dark skin are. I admit, this is simply my belief. Remember, there are no biologic tests that confirm the diagnosis. I have no more evidence than that mentioned before.
Lets define what ADD is; a behavioral disorder that presents with a child usually of school age who has enough difficulty sustaining attention, chronically, in multiple settings, as to interfere with learning.
Notice the definition includes impairment of attention, chronically, in multiple settings, with interference in learning. Got to have all this to qualify.
Lots of look alikes… children with anxiety and other mood difficulties, children who are bored, children with seizures or mental retardation, children with hearing or visual impairments, children with learning disabilities, and even children with serious psychiatric problems like schizophrenia and bipolar disease.
Here is another opinion; Teachers are in the best spot to recognize a child with ADD. After all, they have 20-30 other children to compare this child with and a lot of hours to watch.
This is almost always a disorder of school age children.
And…I don’t believe that teachers have any reason to want to over diagnose their students with this diagnosis.
I think almost all their referrals are legit. I listen when they speak and I think parents should as well, especially if you hear this from more than one teacher.
Question: So is involved in the process of diagnosing a child with ADD?
We are talking about a complex thing here, human behavior.
Lots of determinants. A good evaluation by a psychologist is really important to get the diagnosis right. Insist on it.
If your child is struggling, insist that this evaluation be done. Remember, the squeaky wheel gets the grease! You and your child’s doctor are your child’s best advocate.
If the psychologist and the teacher feel that your has significant problems, next you need to speak with your child’s pediatrician or family doctor.
He or she can really get the ball rolling, nudging the school to get a special educational and behavior plan for your child as well as discussing the pros and cons of medication for your child.
If your child has physical problems like sleep difficulties, seizures, vision problems your doctor can help there as well.
Your child’s pediatrician can also provide a lot of experience and wisdom and let you and your child know you are not alone in this process. It is a frightening experience for many families and you doctor can be of great help.
School is tough and expectations are high.
Many children will struggle at some point with academics given the immense pressures today. They don’t all have ADD!
Not all children are on the same developmental plane at the same age and some of what is called ADD is simply a child who is behind their peers.
Navigating all this can be tough but don’t despair, almost all children do well in the end.
I will say this, overall, I think that the extra attention children with academic and behavior difficulties receive can be extremely beneficial.
Thanks for joining me today. This is your host, Dr Paul Smolen.
Hoping this short talk improved your understanding of a complex and controversial disorder.
As always, comments welcome.
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This is Dr Paul Smolen, DocSmo, broadcasting from studio 1E in Charlotte, NC… hoping your child’s teacher never has a mention, about your child’s attention.
Until next time