The Diagnostic Puzzle, Part 3
There are many possible misdiagnoses. A child who seems to meet the diagnostic criteria for attentional impairment might actually be suffering from sleep apnea, a condition that interferes with restful sleep. A child who is having trouble focusing at school may merely be bored — intellectually gifted but not stimulated by the curriculum.
Some children misdiagnosed with ADHD are showing the effects of post-traumatic stress disorder, or PTSD. "An extremely traumatic event, such as a death in the family, a severe physical injury or illness, or even an abusive home environment, can cause an inability to attend and focus," says Alessia Gottlieb, M.D., co-medical director of the UCLA Child and Family Trauma Center and staff member at the National Center for Child Traumatic Stress in Los Angeles.
Coping with comorbidities
Ten-year-old Matt Moncovich, of Wilmington, North Carolina, had done well in preschool and kindergarten. But soon after starting first grade, he began to get in trouble on a daily basis. A few weeks into second grade, Matt's mother, Yvonne, discovered that he was far behind his classmates academically. Matt's teacher suspected that he had ADHD.
A psychological evaluation confirmed the teacher's suspicions. But it also suggested that Matt might also have an anxiety disorder, and possibly OCD, in addition to ADHD. Fast-forward two years: "After trying every stimulant on the market," says Yvonne, "we've finally found one that works. Unfortunately, my son's hair-twirling and lip-sucking haven't lessened."
Yvonne now suspects that OCD and anxiety are Matt's primary problems — not secondary to ADHD. She plans to state her concerns at Matt's next doctor visit.
Dr. Taylor urges parents to do their homework. "Read all you can, not only about your child's diagnosis, but also about similar or related diagnoses," he says. You may recognize symptoms that don’t indicate ADHD alone.
Never give up!
The road you follow may have its twists and turns—but eventually you'll get there.
"Not all kids fit neatly into the diagnostic categories that have been created by the field," says Dominic Auciello, Psy.D., a clinical neuropsychologist at the New York University Child Study Center in New York City. He says some children never get a clear diagnosis, much less a treatment regimen that solves all their problems. Yet, he says, there are always ways that parents can help their children learn to live with — and work around — their problems.
Remember Robb Wheeler? He was ultimately diagnosed with ADHD, along with a form of mild depression known as dysthymic disorder, generalized anxiety disorder, and dysgraphia, which is an inability to process written language. Oh, yes, and his I.Q. falls within the superior range. Now a high school senior, Robb takes a mix of special-education and honors classes, plays sports, works part-time, and has a girlfriend. This fall, he plans to attend a technical or community college, and, after that, go on to earn a four-year degree.
Robb is doing well now—but only because his mother, Kristen, never stopped fighting for the services and academic accommodations he needed to succeed. "I know the journey's not complete," says Kristen. "I anticipate more bumps in the road, more tears and more sleepless nights. But I'm confident that my son is turning out to be the lovable nerd I always knew he'd be!"