A 2013 article on ADHD in the Chicago Tribune provides some reasonably solid information about the treatment of ADHD, despite a somewhat alarmist headline, “ADHD diagnoses rising: Researchers seek causes of increase in cases*.” The article focuses on two studies by Kaiser Permanete. The first study focused on how oxygen deprivation in utero places children at greater risk for ADHD. However, the article correctly notes that ADHD is primarily a genetic disorder. The second study, found an increase in the diagnosis of ADHD at Kaiser Permanete sites. However, this increase was noted to be higher in Hispanic and African American populations, and also in girls, all groups where most experts believe ADHD is under-diagnosed. Moreover, the author correctly notes that the increase in rates of diagnosis, to 4.9% of children in the Kaiser sample, was still well within the commonly accepted rates of prevalence for ADHD. Thus, it is likely that the study simply reflects an greater awareness of ADHD.
The article also quotes Mark Stein, PhD, a professor of psychiatry, at University of Illinois at Chicago. Dr. Stein highlights several important points regarding the diagnosis of ADHD. First, that very young children exhibit behaviors that could be considered symptoms of ADHD, in older children. Second, that it is critical to have a thorough and thoughtful evaluation before making a diagnosis of ADHD. These points are critical. ADHD needs to be considered in a developmental context. Specifically, behaviors that would be considered problematic at one age, are normal at a younger age. Thus, impulsive behavior and short attention spans are normal in preschool age children, but a far more serious concern in older children. Moreover, ADHD is difficult disorder to diagnosis and careful evaluation is called for before a diagnosis is made. For example, it is important to keep in mind that many ADHD symptoms are also symptoms of other disorders, e.g., difficulties concentrating is a symptom of both ADHD and depression. In addition, children may act in disruptive ways when they are distressed or upset by problems and stresses in their lives.
Finally, in discussing treatment the article focuses on the story of one child, but also highlights the importance of parent training and parent education, i.e., of parents clearly understanding the nature of ADHD and what strategies are more effective in helping children with ADHD. However, by highlighting “tips” from a “professional ADHD coach” the article does present a slightly misleading view of the most effective approaches for treating ADHD. Research clearly shows that medication based treatment is by far the most effective treatment intervention, something the article fails to stress. Moreover, some of the coaching tips are likely to be of questionable utility, e.g., teaching a child “self-talk,” strategies to decrease impulsive behavior is unlikely to be helpful because by definition impulsivity precludes stopping to think before acting.
Overall, this article makes a positive contribution to the general understanding of ADHD. It might have been more helpful for the author to highlight how ADHD is primarily a genetic disorder and to provide more of a discussion of medication based treatment. However, the general tone of the article is positive. Specifically, the article stresses the importance of careful evaluation before diagnosing ADHD as well as the importance of providing education and treatment for families who have a child (or adult) with ADHD. In addition, the article notes that ADHD exits in adults, and that adults benefit from diagnosis and treatment as well as children.
*”ADHD Diagnoses Rising” by Kristen Kridel, Chicago Tribune, Health & Family, February 27 2013.