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Dear Dr. Lanny: My 6-year-old son has been doing poorly in school. His first-grade teacher says he’s easily distracted and disruptive to the other children. She suggested he be evaluated for attention deficit hyperactivity disorder (ADHD). My heart sank when I heard that. What do we do now?

A: Unhesitatingly, the first thing you do is go back a few steps and try (I realize this isn’t easy) to relax a little. One teacher’s concern is not a diagnosis of ADHD. With an estimated prevalence in the United States of 3 percent to 5 percent of the childhood population, attention deficit hyperactivity disorder and its non-hyperactive sibling, attention deficit disorder (ADD), are frequently seen problems. Varying estimates of the prevalence suggest that there remains much to be understood about this condition.

A diagnosis of ADHD in a child your son’s age—and it is by far sons rather than daughters—should include several symptoms. As mentioned in your question, the child is usually easily distracted. He is likely to be disruptive (not mean) to other children, and to be hyperactive as well. Impulsivity—not thinking about the consequences of one’s actions—is another usual characteristic: “Gee, Mom, piling up four chairs to reach the light bulb seemed like an OK idea.”

But human beings often don’t follow precise symptoms, and many children may have some of these characteristics and not others. Do they have ADHD, or are they normal kids?

A number of years ago I ran into a mother I knew who told me she had seen my sons on the roof of our three-story home, throwing snowballs at cars and pedestrians. A slight slip and they would be over the edge: dead or certainly severely injured. When I “discussed” this with Daniel, the younger of the two, his response was “Did it happen?” Certainly this was impulsive, but did they have ADHD or were they just foolish or less than ideally brought up? They may have had other problems, which we can talk about over coffee, but they didn’t have ADHD. My point is that one characteristic does not make the diagnosis.

Unfortunately there is no test, blood or otherwise, that will confirm or rule out the diagnosis. This is a diagnosis arrived at by discussion with the parents (and, one hopes, with the child as well), input from the schools, and possibly with the help of a school or private psychologist. There are useful questionnaires that your doctor may have you and your son’s teachers complete. Putting together these different pieces of information may not be perfect but altogether the process will provide a fairly accurate picture of the child.

If your son attended preschool and kindergarten without negative comments about his behavior, you have to question this teacher’s concerns. Could this be a teacher who needs absolute order in class? Could there be relationship problems with other students? Perhaps the chemistry is just wrong between your son and his teacher.

If this is ADHD, almost certainly there should have been prior hints, and it is likely that the teacher’s concerns don’t come as a total surprise to you. ADHD does not exist only in school. Part of the definition includes having problems in more than one setting. I often ask parents, “Would you take him out to dinner?” Most of the time the answer is along the lines of “Why don’t I just throw my money down the toilet?” My point here is that parents are usually aware that there is a problem well before the teacher calls.

If there is any question that a problem may exist, then a meeting with your doctor is certainly a wise idea. I would always recommend that both parents and the child (if this is a two-parent family), but no siblings, meet with the doctor. There are other conditions that can mimic ADHD, such as sleep apnea or depression, and be diagnosed by a good history and physical exam.

Two last brief notes: Despite stories in the popular media, I have not found teachers “pushing” to medicate children. Secondly, I would counsel you not to be immediately depressed by the possibility of ADHD or ADD. If the diagnosis is correct, there are safe and helpful treatments to aid your son. Think of this as a possible bump in the road, rather than a roadblock.
Dr. Alan Freshman, father of two grown boys, practices at Syracuse Pediatrics. Consult your own physician before making
decisions about your family’s health care. Send e-mail to him at editorial@familytimes.biz.

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