Hyperactive or Just Plain Hype?

Spurrier had heard about attention deficit/hyperactivity disorder (ADHD), but decided Christopher didn't quite fit the model as she understood it. In fact, his problem seemed the very opposite of attention deficit: He would focus all his attention on one stimulus to the point of fixation.

When Christopher turned five, Spurrier, of Maple Grove, Minn., found out how wrong she had been. A trusted pediatric psychiatrist diagnosed the boy with ADHD and oppositional/defiance disorder (ODD). Christopher was treated accordingly and showed marked improvement.

"ADHD is a disorder of inhibition, not attention," says Ray Guarendi, a psychologist and Register "Family Matters" columnist. "It is an inability to inhibit behavior."

Nor is ADHD a new disorder. Disorders involving hyperactivity, impulsivity, inattention, distractibility and inappropriate arousal patterns have been described throughout medical history. In the early 1900s, the diagnostic emphasis was on the hyperactive component. Today, the focus is on diagnosing and treating impulsivity and inattention.

"If you look at it as the far end of the temperamental continuum, it makes more sense than saying you either have a disorder or you don't," says Guarendi. "We all probably have a little ADHD in us."

ADHD is different from attention deficit disorder (ADD) in that it recognizes the hyperactive component that is common in many sufferers. Then, too, ADHD is often coupled with other conditions, including mood and learning disorders.

"If the patient has anxiety and depression, we need to treat the whole person," says Christine Mayhall, a consulting psychologist at The Affinity Center, a private center in Cincinnati for the diagnosis and treatment of persons with attention deficit and related disorders.

Boys are diagnosed with ADHD three to four times as often as girls, but the gap has been closing. This seems mostly due to the increased recognition of inattentive ADD, which affects more girls. A person with the Type I hyperactive component is always reaching for stimulation and is more easily identified, according to Walt Larimore, vice president of medical outreach for Focus on the Family in Colorado Springs, Colo.

"Parents are most unaware" of attention deficit disorder, says Larimore. Why? Because, he explains, the girl who stares out the window during class is still more likely to adapt socially and academically than the boy who speaks out of turn and runs around the classroom. Therefore, she is not always identified as suffering from attention deficit disorder.

"Neuroscience is showing that men and women are not the same. Male and female brains are dramatically and significantly different from birth," adds Larimore. "The corpus collosum, connecting the left and right brains, is dissolved by testosterone. Therefore, men can usually only pay attention to one stimulus at a time, while women can attend to several stimuli simultaneously."

The availability of effective medications to treat ADHD has led some to question whether the condition is over-diagnosed. Are medical professionals over-eager to medicate every child who presents a discipline problem? Maybe but not a few think the problem is exactly the opposite: Children who could benefit by ADHD treatment are missing out and their lives are being negatively impacted by the negligence.

"One of the problems [in assessing the extent of the problem] is that it is sometimes prematurely diagnosed," says Guarendi. "People are making diagnoses without expertise in ADHD."

Due Diligence for Diagnoses

A study by the Mayo Clinic seems to demonstrate that there is no over-prescription of drugs like Ritalin and Adderall, and that there may be an under-diagnosis of children with ADHD.

"The condition is under-diagnosed," says Mayhall. "It's not showing up in outward behaviors, whereas people with hyperactive ADHD are usually identified." She agrees that ADHD is often being diagnosed by professionals who do not have the expertise to differentiate between it and other conditions. "The foundation of good treatment is a good diagnosis," she says, adding that the diagnosis should include the collection of data from parents and teachers.

"If ADHD is not treated, it's harmful to children," says Larimore. "If it is treated, the results can be magnificently rewarding." He points to statistics showing that 40% of kids with untreated ADHD will be arrested by their 18th birthday. Meanwhile, kids with treated ADHD have an 84% less incidence of drug abuse. "The data shows there is a significant danger in not treating or under-treating ADHD," says Larimore.

Guarendi concurs. "The No. 1 outcome of pure ADHD is poor school performance," he says. "Behavioral problems build upon untreated ADHD. The adolescent gets more oppositional, into more danger and fails more at school."

The experts agree that parents who suspect their child has ADHD ought not delay in having the child evaluated. The diagnosis can properly come from a physician or psychologist who has expertise in ADHD. It's usually wise to seek out a second and third opinion and physicians are obligated to provide it, says Larimore. "Focus on the Family believes parents have the primary responsibility in getting help for their child," he adds, "but physicians must be enlisted."

Spurrier recalls how difficult it was to accept the ADHD label, even though she was prepared for it by the time Christopher was diagnosed. "It's every parent's wish to raise a perfect human being," she says. "For a while, the diagnosis blew my hopes and dreams." It was a long time before she told anyone, other than the school district, because she didn't know how people would react. Now, with five years' experience to draw from, she helps educate teachers groups about ADHD.

One of the most common areas of concern she finds herself speaking to: possible addictions to ADHD medications, such as Ritalin, that have made some parents wary of filling prescriptions for their children. In fact, five lawsuits were filed in the past few years, charging conspiracy between the American Psychiatric Association, the association Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) and Novartis, the manufacturer of Ritalin. The lawsuits have all been either dismissed by the courts or withdrawn by the plaintiffs.

Drugs vs. Parenting?

Some charge that ADHD and medications used in its treatment are a cover-up for poor parenting and poor schooling. Are they on to something?

"Conspiracy theorists want to 'parent-bash,'" says Larimore. "We, as physicians, shouldn't harm families by blaming them or blaming the schools. The best studies show a response rate at 80-95% for the first medicine when ADHD is diagnosed correctly. Secondary medications can help, too."

Research shows that medication is best for behavioral change if the diagnosis is accurate, says Guarendi. "You still need good parent training and discipline, though," he adds. "Whether a child is diagnosed or not, on medication or not, parents need to be firm disciplinarians. If a child has ADHD, parents need to be more structured, not loosen the reigns."

Mayhall says that studies have found medication and regular therapy to bring about the best results in younger children. "Medicine allows better concentration," she says, "but not without time management and understanding diagnoses."

Michelle Spurrier says that she would never tell parents to medicate their child. "All I can do is relate my experience to them," she says. "If you don't have a child with ADHD, you can't imagine what it's like to live with it."