ADHD: An Overview

emotional regulation.  

Because successful treatment of this disorder can have profound positive emotional, social, and family outcomes, an accurate diagnosis is tremendously important.  Requirements to diagnose ADHD include: professional education (graduate and post graduate), ongoing training, supervision, experience, and licensure.  Even with the essential professional qualifications, collaboration and input from current or former psychotherapists, parents, teachers, school staff, medical practitioners and/or psychiatrists creates more reliable and accurate diagnoses.  The value of collaboration cannot be understated.      

Sound ethical practice compels clinicians to provide the least restrictive and least risky form of therapy/treatment to youth with ADHD. Medication or intensive psycho-therapeutic services should only be provided when the client would not favorably respond to less invasive treatment approaches. Therefore, it is crucial to determine whether “functional impairment” is or is not present. Clients who are functionally impaired will fail to be successful in their environment without specialized assistance, services, and/or psycho-therapeutic or medical treatment.  Once functional impairment is established, then it is the job of the treatment team to collaborate on the most effective method of treatment.    

All too often, a person is mistakenly diagnosed with ADHD, not due to attention deficit issues, but rather because of their unique personality, learning style, emotional make-up, energy and activity levels, and other psycho-social factors that better explain their problematic behaviors.  A misdiagnosis could also be related to other mental or emotional conditions (discussed next), a life circumstance including a parent’s unemployment, divorce, family dysfunction, or medical conditions.  In a small but significant number of cases, this diagnosis of ADHD better represents an adult’s need to manage a challenging, willful and oppositional child, who even with these problems may not have ADHD.    

It is critical that before an ADHD diagnosis is reached (especially before medication is prescribed), that a clinician consider if other coexisting mental or medical disorders may be responsible for the hyperactive, impulsive, and/or inattentive symptoms.  Because other disorders share similar symptoms with ADHD, it is necessary to consider the  probability of one mental/psychological disorder over that of another that could possibly account for a client’s symptoms.  For example, Generalized Anxiety Disorder and Major Depression share the symptoms of disorganization, lack of concentration, and work completion issues. A trained and qualified ADHD specialist will consider differential diagnoses in order to arrive at the most logical and clinically sound diagnosis.  Typical disorders to be ruled out include: Generalized Anxiety, Major Depression, Post Traumatic Stress Disorder, and Substance Abuse Disorders.  Additionally, medical explanations should be similarly sought: sleep disorders, nutritional deficiencies, hearing impairment, and others.  

When a non-medical practitioner formally diagnoses a client with ADHD, i.e. a licensed psychotherapist, it is recommended that a second opinion (or confirmation of the diagnosis) be sought from a psychiatrist.  Psychiatrists are medical practitioners who specialize in the medical side of mental disorders.  Psychiatrists are able to prescribe medicine that may be necessary to treat ADHD.  In collaboration, the parents, school personnel, the referring psychotherapist, and the psychiatrist, will monitor the effectiveness of the medical component of the ADHD treatment.  

In summary, ADHD is a mental health and medical disorder that has become increasingly more accepted and consequently treated more effectively.  To achieve high professional assessment, diagnostic, educational, and treatment standards, it is important that trained and qualified practitioners understands the multidimensional aspects of ADHD: history, diagnosis, statistics, etiology, and treatment. Training, experience, a keen interest for details, a solid foundation of information, and a system of collaboration creates the potential for positive outcomes in the treatment of ADHD.

References
1.  Genetic factors, not necessarily sex of child, influence ADHD by Jim Dryden    
http://record.wustl.edu/archive/1999/04-15-99/articles/ADHD.html
2.  What are the risk factors and causes of Attention Deficit Hyperactivity    
Disorder
http://www.adhdissues.com/ms/guides/adhd_risk_factors/main.html
3.  What Causes ADHD?
http://add.about.com/od/adhdthebasics/a/causes.htm
4.  History of ADHD by Keith Londrie

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