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Psychologist in Sussex, England » AD/HD
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AD/HD


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My Doctor said she thought my very active little boy may have AD/HD and I subsequently took him to two specialists. One agreed with her and one did not. How can you explain this, and what should I do next? Julie Wild, parent.

Dear Julie

AD/HD is a particularly difficult order to diagnose. This is for several reasons:

  • AD/HD is not an ‘all or nothing’ disorder like a broken bone. We are all somewhere on a continuum from those who have very short attention spans to those who are exceptionally focused.
  • There are many other disorders that cause a child to look as though they are ADHD when this is not the case. For example, children who are unhappy find attention difficult, and they can become restless, disruptive and oppositional.
  • There is no test - either psychological or biological - that is unique to children with AD/HD. This is not the case with other developmental disorders. For example only children with autistic spectrum disorders have problems taking the perspective of others (theory of mind).
  • Around two thirds of children with AD/HD have other developmental disorders such as dyslexia. If this disorder is diagnosed prior to AD/HD the initial diagnosis is thought of account for all of the child’s difficulties. The opposite is true: children with AD/HD should be screened for other disorders but this often does not take place.
  • The rating scales professionals use are all subjective: what one parent thinks is ‘hyperactive’ behaviour another will think quite normal.
  • Professionals sometimes fail to assess the child in more than one setting, and seeing a child only in their clinic (where the child is much calmer - at least for the first visit) can be misleading.
  • AD/HD is a cultural and social phenomomena as well as a genetic one. Some cultures are much more accepting of lively, inattentive behaviour than others, and this can influence the view of parents, teachers and even professionals.

I hope this goes some way towards explaining why you have received different views on your child.

What do you do next? If your child’s behaviour is not worrying you or his school, and he is a happy boy with friends, I would go no further. If however you and his teachers are concerned, I would find an educational psychologist who will help everyone to focus upon managing your son’s behaviour rather than labelling him. The strategies I recommend are applicable for any child who is impulsive, hyperactive and/or inattentive - whether or not they have a diagnosis of AD/HD.

It is only if your child has extreme problems that a diagnosis can become important, as you may wish to explore the option of using stimulant medication as part of an overall management plan. A psychologist can make a diagnosis of AD/HD, but cannot prescribe medication. For this reason, it is important to find a paediatrician or psychiatrist who has experience and knowledge of this disorder. Research shows that the efficacy of medication is twice as effective when it is properly planned, administered and monitored as when it is given routinely.

In my case, if I think a diagnosis is appropriate, and parents would like to consider this route, I like to ensure that appropriate educational strategies have been tried prior to making that diagnosis and referring the child to the paediatrician with whom I work.

If a child is taking medication I prefer to remain involved. This is to ensure that the medication is not seen as a ’stand alone’ treatment by school, and also to make certain that educational and medical interventions are managed in a coherent, integrated and well monitored fashion.

I hope all goes well for your son, but please get back to me if you need further advice.

Best regards, Jenny


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