Introduction: Two of my children have been officially diagnosed with ADHD and both are taking medication to manage some of their more challenging behaviors. Dealing with these children is full of ups and downs. Lately, it has become increasingly difficult to effectively parent our older child with ADHD. In my search for information and help, I have come across some books about ADHD that seem to be helpful. In order for me to better process and retain the information, I have to summarize it.
Parenting Children With ADHD: 10 Lessons That Medicine Cannot Teach by Vincent J. Monastra, PhD. (all quotes and pages cited in this blog piece come from the 2010 edition that is linked here.)
The author is a clinical psychologist who conducts research about ADHD. In my google search on Dr. Monastra, it appears that he is still a practicing psychologist.
Chapter 1 summary:
Monastra sets the scene with the ever present debate about ADHD between two so-called "experts". I am more than familiar with all the ideas that ADHD is a false disorder and that it is a product of bad parenting or changed expectations for children. The accusation is also levied against big pharma companies that ADHD is a manufactured condition designed to force parents to buy expensive and unnecessary drugs. Indeed these accusations can be incredibly devastating to parents like myself who are struggling to cope with the demands that parenting a child with ADHD bring. We often feel that we ARE failures as parents, despite all the effort we put in on a daily basis striving to help our children.
The Nation Institutes of Health (NIH) organized a conference in 1998 where specialists from all over the world reviewed over one thousand scientific studies about the causes and treatment for ADHD. Based on research and the collective expertise of these specialists, they determined that "ADHD was indeed a health impairment that (when untreated) increased a person's risk for failure at school, for involvement in substance abuse and criminal activities, and for the development of a variety of problems at work and in social relationships." (pg. 13).
To provide clarity, Dr. Monastra provides information about the Five Diagnostic Criteria used to diagnose ADHD: Inattention and Hyperactivity-Impulsivity, symptoms must be present before age 7, some impairment must be present in a least two different settings, there must be clear evidence of significant impairment in the school setting, other medical causes must be ruled out.
Inattention and Hyperactivity/Impuslivity: There are 9 types of inattentive behaviors, 6 types of hyperactive behaviors, and 3 types of Impulsive behaviors. In order to accurately diagnose ADHD, the patient must have at least 6 types of inattentive behavior as well as 6 types of hyperactive and/or impulsive behavior, for a total of 12 types of problem behaviors. There are diagnostic forms that are usually given to parents and teachers to rate the children.
Symptoms must be present before age 7. The book makes it clear that the child doesn't have to be diagnosed by this age--indeed diagnosis can be made at any age, but usually in 5 major periods of the child's life. But symptoms should definitely be observed by age 7 for it to be considered truly ADHD.
Some impairment must be present in two different settings. It is really important to measure that impairment geniunely occurs in more than one setting. The diagnostic questionnaires are often filled out by both teachers and parents to see how the children do in different settings.
Significant impairment in the school setting is often determined through grades, teacher feedback, and school assessments.
Other medical causes must be ruled out. Dr. Monastra stressed that this criteria is often overlooked by health care professionals when diagnosing ADHD. There are a number of treatable conditions which can cause inattention such as: hypoglycemia, anemia, diabetes, thyroid disorders, sleep apnea, allergies, dietary insufficiences of zinc and magnesium. Concentration problems can be cause by problems with visual tracking and convergence. Dr. Monastra strongly encourages the reader to make sure other medical causes are ruled out before making a final ADHD diagnosis.
My thoughts: I appreciated the breakdown of how an ADHD diagnosis is made. It was especially helpful to consider that other medical conditions must be ruled out. I know that when my kids were diagnosed, the doctor followed the pattern described above, with one exception--as far as I know other medical conditions were not ruled out with blood work. I would like to follow up with my doctor.
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