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ADD, ADHD, or OCD?

LD and ADD/ADHD Expert Advice from Jerome J. Schultz, Ph.D.

Q: My eight-year-old daughter has been diagnosed with ADD from one professional, ADHD from another, and OCD from yet another. Somewhere in the middle, language-based issues have come up. We have spent quite a bit of money in tutoring to help her with her math skills. She has just started third grade with a beginning first-grade math level. My question is how do we figure out if it is ADD, ADHD, or OCD? How do we get her help with math that she will understand?

A: You should have your daughter evaluated by an experienced pediatric psychopharmacologist (preferably not an adult psychopharmacologist who occasionally sees kids). As a psychiatrist, the psychopharmacologist is trained in what's called differential diagnosis or determining which condition or conditions are present and if and how they overlap. He or she is also specially trained in the selection and proper dosage of medication for children with problems such as ADHD (Attention Deficit-Hyperactivity Disorder) or OCD (Obsessive-Compulsive Disorder). These conditions are believed to have a neurobiological basis. That is, they are caused by a difference in brain tissue or by disturbances in the production or use of certain chemicals in the brain. That's why it's so important to see someone who specializes in the diagnosis and treatment of these disorders.

The confusion about whether your daughter has ADD or ADHD comes from confusion about how to diagnose this condition. The "official" diagnostic label is ADHD. The professional doing the evaluation, using behavior checklists, observations, and interviews with several people (parents, teachers, specialists, etc.), determines whether the inattention or the excessive movement (hyperactivity) is the primary feature of the condition in your child, or if both characteristics are present and overlap. It is important to know how the ADHD affects your child, so that you and your child's teachers can use the proper strategies to help her. If she is hyperactive, and that gets in the way of her learning, the school will have to do many things to structure the activities for success. The modifications will be different for a child who is inattentive, but not hyperactive.

There is also the question about language-based learning difficulties. Ask the psychopharmacologist to recommend someone he/she has worked with who specializes in the evaluation of learning disabilities. These two people can gather data from the school, go over past testing, and coordinate their findings and make a presentation to the school. This should put some of the confusion to rest and get your daughter's teachers and your daughter on the right track. Using a tutor to provide extra support is fine, but make sure that she's a part of the team. It's important that all of the people working with your daughter are following the same plan.

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Jerome (Jerry) Schultz is the founding clinical director of the Learning Lab @ Lesley University, a program that provides assessment, tutoring, and case management services for children with learning challenges. Schultz holds a Ph.D. from Boston College, and has completed postdoctoral fellowships in both clinical psychology and pediatric neuropsychology.


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