Author: Sue Labar Yohey, M.ED., M.S.
Attention Deficit Disorder, also known as ADD and sometimes as hyperactivity, has become a very popular diagnosis in recent years. There are magazine articles and television specials, which list the symptoms and lead many to wonder if this is not a problem, which may be affecting members of their families, particularly their children. Not listening, not doing homework and fidgeting are frequently cited as indicative of Attention Deficit Disorder. Other symptoms such as being always on the go and having difficulty waiting for a turn are also listed in most of these popular press articles.
One problem with the symptom lists in the popular press is that they lend themselves to over-generalization. While it is true that these are legitimate behaviors associated with Attention Deficit Disorder, it is also true that nearly every child in the world has at some time or another shown these same, exact behaviors. It is part of the definition of “child” to be impulsive, to fidget and not always to mind his elders. If one accepts this as a given, one question then becomes, “how much of these behaviors is normal and how much is too much?” A second question is “if these behaviors are occurring too much, why are they occurring?”
To answer these questions is not, unfortunately, as simple as looking at a checklist. While it is true that the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) contains a “checklist” of characteristics for ADD, it also cautions the clinician to bear many other things in mind.
One of these is the child’s developmental level. A child with lower mental ability should be expected to be more like a younger child in his ability to attend and to control his behaviors than like his chronological age peers. Thus, a measure of functioning level should be obtained.
A measure of functioning level such as an intelligence test combined with a measure of achievement can also help to diagnose a learning disability. Many children who are distracted in class and do not complete assignments are actually sending veiled messages that the material is too hard and that they are coping with this by acting out and procrastinating. When the learning environment is modified to fit the learner, these inappropriate behaviors should decrease.
Talking to the child’s teacher and getting ratings of the child’s behaviors in class are also an important step towards answering our two questions. Not only can this yield valuable information about functioning level and other learning problems, it can also provide observations and an opinion from a second setting with a trained professional who is aware of what is “normal” for a given age. If the attentional problems are situational – such as he listens to mother and his teacher, but not to father – it is most likely a management issue and not attention deficit.
Child professionals are well aware that social and emotional stresses can be signaled by inattentiveness, poor work habits and excessive activity. It is important for the professional attempting to ascertain the presence of ADD to also consider the possibility of underlying emotional issues. In addition to taking a full history from the parent and interviewing the child, more formal assessments of emotional concerns and therapeutic techniques might be utilized.
At Bloomsburg Psychological Center, LLC our approach to an “ADD Evaluation” is not to do just an ADD Evaluation. It has been our observation that an ADD Evaluation may “find” ADD but may fail to consider other possible causes of the disruptive behaviors. We prefer to provide our clients with a more global evaluation which touches upon the areas outlined above. We think that it’s a better approach and trust that you will too.