This information was provided by St. John’s Mercy Child Psychiatry.

Today there are concerns that children have been overly diagnosed and treated for ADD. While these concerns are significant, there are many factors to weigh in today’s society to appropriately evaluate the question of over-diagnosing. Some frequently asked questions by parents are:

1. Why is ADD being diagnosed now when it wasn’t before?
ADD was not diagnosed as accurately years ago, as there was less research and knowledge of the effects. Today adults are being diagnosed who spent a lifetime of compensating to overcome ADD. Many adults have devised techniques to remember and organize, and they struggle to complete tasks that often require two to three times the effort others have to put forth. Most of these adults have average to above average intelligence.

2. Is ADD genetic?
Often one or the other parent has a history of being ADD as a child. Often parents feel that if they managed to get through it, so can their children. Mothers at times will be more cognizant of the child’s ADD behavior than the father due to varying work schedules and time spent with the child, making it difficult for fathers to accept if they have experienced the behavior less. It is important on any evaluation to have both parents present so they equally are aware of the concerns and each can have their questions answered.

3. Why can’t my child have special attention and help? Schools should adapt to the child!
Society is now more fast-paced. With advanced technology, children are often asked to fit in but usually not at the expense of a child’s special needs. Children do need to adapt to the classroom and peer relationships within reason. Schools do provide special behavior modification programs, resource-room help and testing for learning disabilities. However, there is a point when a child is seriously unable to pay attention enough to learn, and an evaluation for ADD may be helpful.

4. I don’t want my child on medications!
As a parent, this is your right. No parent should give a child medication unless they are comfortable with the decision. On the other hand, don’t blatantly rule out medications at all cost if it might help your child. Avenues to try before considering the possible need for medication would be reward plans, behavior modification, reducing external stimuli, structuring the environment and resource-room help. For many, medication has changed the lives of the child and family in a positive manner. When medicating, the least amount of medication should be used to bring out the best of the child. Only a child/adolescent psychiatrist, pediatrician or family physician that is comfortable and knowledgeable about regulating ADD medications for children should prescribe any ADD medication. Consider the effects that ADD may be having on your child before you rule out medications.

5. What medications are available? I have heard bad things about Ritalin, and it scares me.
Ritalin is a safe medication that has been prescribed successfully for years. The regulation of this medication is adjusted with the doctor based on feedback from the child, family and teacher about the changes noted. The adjustment for each child is individualized according to their specific needs. Some children may only take medication on school days but not on weekends, holidays or the summer. Others may require more consistent dosing. It is important to remember that learning does not only occur at school but in fun relationships with peers and family. Some children on Ritalin may experience a decrease in appetite. Most parents adjust medication after the meals, provide nutritious snacks and observe food intake. For some children on high doses at a young age, there have been concerns it may slow growth. Research has found the child’s growth returns to normal over time. For many parents, Ritalin has been a miracle that allowed them to discover their talented child. Adderall is a new, safe medication that originally was very effective for ADD and is now found to have a positive response for ADHD with minimal side effects. Other medications used may be Cylert, Dexedrine, Wellbutrin, Effexor, Depakote. New once-a-day medications Concerta and Adderall XR are now available. The key when medicating a child is to bring out the best of the child’s capabilities with the least amount of medication.

6. Why can my child pay attention to video games or computers but not at school?
ADD children seem able to focus on fast moving action such as a video game or computer. There is some belief that the rapid action matches their rapid thinking, which helps to retain focus.

7. My child seems to have low self-esteem and I am worried. What should I do?
Most children want to do well. ADD children try hard to please and are often puzzled when, try as they might, they still get in trouble. Often the child is blamed, scolded, or given time-outs for his behavior or lack of homework completion. They may be held in from recess, then become teased by peers, labeled, and begin to isolate from normal peer fun relationships. Eventually the child blames himself, feels he is stupid, becomes discouraged and gives up.

8. I am frustrated as a parent, and I don’t know what else I can do.
There is usually a family cycle of frustration. The parent wants their child to succeed and when the child doesn’t, parents feel they need to do a better job of parenting. "I know he has the ability to do this, he is just lazy or unmotivated." Parents feel they have failed and need to try harder, so they stress more intensely the expectations to concentrate, listen, do the work that is not within their ability to do. They often have the intellectual ability but not the concentrating ability. The child feels more pressure, is unable to meet the expectations, often becomes frustrated then anger escalates out of control and the whole family becomes discouraged. The child again feels bad because they have not pleased mom or dad. Often the child is brighter than the average student but is unable to produce evidence of their abilities without medication.

9. What is going on in my child’s mind?
Often their thoughts are racing, many different thoughts are occurring at one time which prevents the ability to listen and learn. Some children daydream, are easily distracted, unable to sit still enough to absorb information. If you don’t absorb information how can you use it? The child needs help to absorb and retain information so they can productively use it.

10. Are there screening tests for ADD?
Yes, most schools have access to the Conners Inventory for Parent, Teacher and Youth Self Report. Most child/adolescent psychiatrists and pediatricians have access to these screens. CHADD is an online web site for ADHD with helpful information.

11. What should I look for in a good assessment for ADD?
It is important that numerous areas are evaluated to rule out the possibility of other concerns that may be affecting the child, with or without ADD. Areas to evaluate are: family history and issues, developmental history, medical history, school performance, stresses current and past, drug and alcohol use, past treatment, and characteristics of ADD. It is important to receive information from numerous sources as parents, teachers, and others in the child’s life. When numerous sources provide input, patterns and themes of behavior may become apparent that support a fully evaluated diagnosis of ADD.

12. How is ADD diagnosed? What does ADD, ADHD mean? Is it all the same?
ADHD means Attention Deficit Hyperactivity Disorder. To diagnose this, there are specific criteria established in the DSM IV (Diagnostic and Statistical Manual of Mental Disorders). There are three diagnostic categories:

• ADHD- Inattentive Type – A child has difficulty concentrating, paying attention, is distracted easily, daydreams, forgets a lot, something is always missing as is hard to organize every expectation of the whole in comparison to his peers.
• ADHD- Hyperactive/Impulsive Type – A child has difficulty sitting still, talks excessively, is disruptive, fidgety, impulsive, has non-stop energy, is difficult to manage.
• ADHD- Combined Type – These children experience both ADD and the hyper characteristics.

13. If you believe your child needs an evaluation, here are some resources:

• Check with your school for teacher concerns.
• Discuss your concerns with your pediatrician.
• ADHD assessments are now available at St. John’s Mercy Child Psychiatry. Some insurance plans cover the assessment, and they are also available as self-pay. For an appointment, call 314-251-6898.

ADHD assessments are now available at St. John’s Mercy Child Psychiatry. Some insurance plans cover the assessment, and they are also available as self-pay. For an appointment, call 314-251-6898.

For more information about ADHD, please visit our Attention-Deficit / Hyperactivity Disorder (ADHD) Web module.

For physician referral information, please call 314-FOR-DOCS or 1-888-700-7171.

Other online resources:

American Academy of Child and Adolescent Psychiatry

American Academy of Pediatric (AAP)

American Psychiatric Association

American Psychological Association

Children and Adults with Attention Deficit Disorder