Avoiding a Dubious Diagnosis, Part 2
I learned that Alicia had separated from her husband when Marie was three and had gotten divorced two years later. The marriage had been stormy long before the separation, and the divorce was acrimonious.
Alicia downplayed the impact that this conflict had had on Marie. Yet when I asked Marie about her father's new wife and her mother's new boyfriend, she burst into tears. Teachers had noted that Marie's classroom difficulties were most pronounced on Mondays, and that things got better as the week went on. I learned that Marie stayed with her father every other weekend, and that Alicia's boyfriend was spending weekends in Marie's home.
This helped convince me that Marie's problems stemmed from depression and a sense of helplessness she felt about her family situation. I recommended that Marie go off medication and start psychotherapy.
Marie's behaviors did not meet the criteria spelled out in the Diagnostic and Statistical Manual. Her problems were not chronic; they began only after her parents' marriage began to break up. What went wrong in this case? Instead of taking a detailed history, the psychologist based his diagnosis solely upon the rating scales and the result of one computerized test. But while scales and tests can confirm the presence of hyperactivity, impulsivity, and/or inattention, they cannot explain what causes such behaviors.
Mistake #3: Failing to consider coexisting conditions.
Virginia, a 40-year-old mother, thought she had ADHD. She was restless, easily distracted, disorganized, and struggling with planning and doing everything she had to do to care for her four children.
When I met with Virginia, she did seem to have a history of chronic and pervasive hyperactivity, inattention, and impulsivity. She recalled being restless and hyperactive since early elementary school. She had always been easily distracted by extraneous sights, sounds, and intrusive thoughts. She tended to interrupt people and to use poor judgment at work, within her marriage, and with friends. I found no other condition that would explain her problems. She must have ADHD.
But that wasn't the end of my diagnostic workup. When someone has ADHD, there's a greater than 50 percent chance that he or she will also have a learning disability, anxiety, depression, OCD, or some other neurological disorder. Given this high probability of coexisting conditions, it's essential to consider additional diagnoses.
And so I learned that reading had always been a problem for Virginia. She told me that the only way to retain what she reads is to read it again and again, while taking notes. She told me that math, spelling, and grammar had always been hard for her. She is perpetually misplacing things, and she can't get things done on time.
When I asked Virginia if she ever felt anxious, she described a lifetime of panic attacks. She told me she is afraid of closed spaces and cannot use elevators or be in crowded rooms. When I asked about obsessions or compulsive behavior, she could not stop talking about her desire for order. She cleans her home compulsively, and, fearing that others won’t be so conscientious, uses public bathrooms only if absolutely necessary.
Yes, Virginia has ADHD. But she also has dyslexia and suffers from anxiety and OCD. To get better, Virginia needs to be treated for all four conditions.
Knowing that ADHD often runs in families, I asked Virginia about her children. It turned out that her oldest son, a sixth-grader, has always performed poorly in school. Like his mother, he struggles with reading and writing and often feels anxious. I recommended that he be evaluated, as well.
Now you have seen three ways not to be diagnosed with ADHD. I urge you not to accept a hasty diagnosis or one based solely on diagnostic scales or tests. If you or your child is diagnosed with ADHD, make sure the doctor checks for coexisting conditions. Good luck!
This article appears in the February/March 2007 issue of ADDitude.
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To discuss this topic with others in the process of getting an ADHD diagnosis, visit the Is It ADHD? support group on ADDConnect.