Diagnosis

4 Bad Reasons to Delay an ADHD Evaluation

Preschool teachers, relatives, and even friends have commented on your child’s abnormal hyperactivity, lack of focus, and daredevil behavior. You experience the extreme behavior every day, but you hesitate to pursue an evaluation for ADHD in no small part because it is scary to think your child has a neurological condition that will impact his health and happiness. Here are four reasons parents often give for delaying a diagnosis, and responses from ADHD specialists who strongly persuade them to reconsider.

Parents may be slow to pick up on symptoms formerly associated with Asperger's Syndrome in their child. Its subtle combination of clues that leave parents wondering if anything is wrong or if the symptoms are part of their child’s personality. When a child goes to preschool, social difficulties become more evident. Typically, AS kids are unable to make friends, have a hard time reading other people or understanding humor.
Parents may be slow to pick up on symptoms formerly associated with Asperger's Syndrome in their child. Its subtle combination of clues that leave parents wondering if anything is wrong or if the symptoms are part of their child’s personality. When a child goes to preschool, social difficulties become more evident. Typically, AS kids are unable to make friends, have a hard time reading other people or understanding humor.

In 2011, the American Academy of Pediatrics updated its guidelines for diagnosing ADHD. It now recommends full ADHD symptom evaluations for children as young as 4 years old who exhibit persistent and debilitating inattention, hyperactivity, and/or impulsivity. Previous guidelines stipulated that only children 6 or older could be evaluated for ADHD. Today, the scientific community agrees that, in extreme cases, ADHD symptoms are quite detectable — and treatable — even in preschoolers.

For these children, the American Psychological Association and the American Academy of Child and Adolescent Psychiatry recommend parent effectiveness training and behavior therapy. In the Preschool ADHD Treatment Study (PATS) sponsored by the National Institute of Mental Health, researchers found that one-third of the study participants (preschool children with severe symptoms of ADHD) were able to effectively manage their ADHD symptoms with behavior therapy alone, and never required medication. For the remaining two-thirds medication was needed.

A low dose of methylphenidate — such as Ritalin, Concerta, or Quillivant — is the American Academy of Pediatrics’ (AAP) recommendation to treat preschool-age children diagnosed with ADHD, when behavior therapy is tried first and is unsuccessful. Some doctors also prescribe amphetamine-based stimulant medications approved by the FDA to treat ADHD in kids ages 3 to 5, such as Adderall, Dexedrine, Evekeo, and Vyvanse.

While some experts and parents welcome the news of earlier diagnoses and treatment, others are concerned. Many parents believe that children are already over-diagnosed and overmedicated. Won’t the AAP’s expanded guidelines only exacerbate the problem?

“The goal of the new guidelines is not more diagnoses, it is more accurate diagnoses,” says Ari Tuckman, Ph.D., a psychologist and author of Understand Your Brain Get More Done: The ADHD Executive Functions Workbook (Specialty Press). Still, some parents hesitate to have their children evaluated before they are school-age. Here are four common reasons why they wait:

[Self-Test: Could Your Child Have ADHD?]

1. “I’m afraid to medicate my four-year-old.”

The new AAP guidelines say that when a preschool-aged child has been diagnosed, the first line of treatment should not be medication but behavior therapy. The guidelines do not mandate using medication. They merely inform families and clinicians that using medication in younger groups has been shown to be helpful and safe.

If behavior therapy has been tried (usually in an 8- to 12-week program) and found not to work, only then should a doctor consider putting a 4 or 5 year old on ADHD medication.

“Medication, at any age, is never a magic bullet,” says Michael Reiff, M.D., professor of pediatrics at the University of Minnesota, who served on the committee that developed the new AAP guidelines. “However, if your child exhibits dangerous behaviors that significantly impair his daily living, it seems reasonable to consider the possibility of medication management.”

[Free Resource: What a Thorough ADHD Diagnosis Includes]

“Parents should ask, ‘Would it be helpful to my child to explore what medications have to offer?’” says William Dodson, M.D., head of the Dodson ADHD Center, in Greenwood Village, Colorado. “As one pediatrician said, ‘We’re not talking about a tattoo on your child’s face. We are going to see what medication has to offer and then decide, based on knowledge rather than fear.’”

2. “Behavior therapy doesn’t work.”

“Behavior therapy won’t change the wiring of a child’s brain,” says Tuckman. “It can, however, minimize distractions and change the tone of the interactions between a child and parents or teachers. Behavior therapy enables a child with ADHD to function better, just as changing the way a diabetic’s diet can help him feel and function better without changing his ability to process sugar.”

3. “I don’t want my child to be labeled.”

Your child will be less likely to be labeled a “troublemaker,” a “bad kid,” or a “daydreamer” if you address his ADHD early.

“One study showed that a child with untreated ADHD received 20,000 negative messages in the first 10 years of life,” Dodson says. “If a child mostly hears, ‘You’re a little monster, you’re impossible to deal with,’ it affects how the child thinks about himself. Treating ADHD can help your child function and behave better, and will most likely build his self-esteem.”

4. “It’s normal for preschoolers to be hyperactive and have short attention spans.”

It’s true that preschoolers are naturally active and usually can’t focus as long as older children can, but there are differences between kids with ADHD and those without it. “Preschoolers with ADHD run out into the street without thinking,” says Patricia Quinn, M.D., a developmental pediatrician in Washington, D.C., and the director of the National Center for Girls and Women with ADHD. “Very young children with ADHD have more broken bones, more stitches, and more emergency room visits than children who don’t have the condition… There is also a lack of purpose to their activity. They’re the kids who spin around in a chair incessantly or jump up and down on a sofa. Having your child diagnosed and treated in preschool will help her manage symptoms and will likely keep her safe and sound.”

[The ADHD Road Map for Parents]

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