ADHD – A Disorder Under Continued Investigation

As of 2007, there were 5.4 million children in this country who had been diagnosed with ADHD (Attention-Deficit/Hyperactivity Disorder) and, sadly, every year that total rises.  A recent study looking at adult men who had been diagnosed with ADHD as children found that these men had greater struggles in the educational and social arenas than their peers (without ADHD).  Clearly, the breadth of ADHD and its long-term impact on society is a problem; yet, the medical community has not developed any new tools to help properly identify the disease and keep pace with this epidemic.  Unfortunately, there are no specific blood tests or imaging tests that can recognize this condition.  Physicians rely purely on a set of diagnostic criteria based on symptoms manifested by the child, which can be applied subjectively even by the most well-trained physicians.  Given that this disorder is not diagnosed very precisely, doctors and parents must both analyze the situation with high scrutiny before making the decision to treat a child with serious medications.

The initial indication of a child possibly having ADHD occurs when either a parent or teacher complains about the child’s behavior.  This is usually followed by a physician’s examination as well as a battery of tests, including visual and hearing tests to exclude other conditions.  Once other diseases have been ruled out, the physician evaluates the child using a set of guidelines from the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders).  There are 18 symptoms listed and the child must have a specified number of them to be diagnosed with the condition.  A few examples of these criteria used to diagnose ADHD include the following: often fails to give close attention to details or makes careless mistakes in schoolwork; often easily distracted by extraneous stimuli; often leaves seat in classroom; and, often has difficulty awaiting turn.  Understandably, some people look at this and wonder whether this is even scientific enough to 1) diagnose a medical condition, and 2) determine the treatment by medication of a young child.  The general treatment for ADHD includes behavioral therapy and medications, with some of the more commonly known medications being Ritalin and Strattera.  The downside to medications, however, is their clear potential for adverse effects.  The use of Ritalin can cause anorexia, weight loss, tics, and sleep disturbance, while Strattera has been implicated in causing suicidal thinking.

There is no doubt that ADHD is a common problem and is here to stay.  The pervasiveness has undoubtedly been increasing, although this could be due to the fact that there is greater general awareness about the condition.  Nevertheless, the diagnosis continues to be based on symptoms and behavioral characteristics, rather than physical medical evidence such as blood or tissue samples, and on account of this, more research is necessary to better understand the physiology of this disease.  Given the arbitrary way in which this disorder is identified, the decision to start medication must be made cautiously and on an individual basis.

One thought on “ADHD – A Disorder Under Continued Investigation

  1. I understand your feeginls exactly. I am constantly stressed about my son’s social interaction. School started off so great this year, his meds seemed at just the right combo, he started with an IEP in the special ed classroom for help with organization, and his school has been wonderful. He has a therapist there and was seeing one on the outside. I am now starting to get the reports of troublemaking, of having a difficult time with friends, etc you name it. I just want to cry. I started to feel like we hit a groove and things were staying great now the train is coming off the tracks again. In the past I would take him in to the neurologist and this would mean he would get his meds increased. I hate to keep on this endless circle. He is already on a large dose (at least to me) of Concerta and takes 1 mg of Intuniv with it. the neurologist told me he has pretty severe ADHD. I just wish I could feel at ease for longer than a few weeks at a time.

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