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Is It ADHD?
Q: I took my son to a therapist due to increasing behavior problems at school and home. Based on a checklist, he suggested that my son might have ADHD. How can I tell for sure that this is the case? Is defiant behavior a sign for ADHD? I think my son my have emotional issues. Is suffering from emotional issues a result of ADHD?
A: While a checklist can be helpful in the diagnosis of ADHD, because it helps parents and others to identify behaviors associated with this condition, it shouldn't be the only or primary assessment tool. To confidently diagnose ADHD, the person doing the assessment should do an extensive family history. The diagnostician should look for the symptoms of ADHD in the child's history and in the history of close family relatives (parents, siblings, aunts, uncles, and grandparents). The older the relative, the less likely it is that anybody said they had ADHD, for it's a fairly new term. But if an uncle could never hold down a job because he was "restless" or "acted without thinking," you might be on the right genetic trail. Taking a thorough history is also important, since it allows the evaluator to look for other disorders, such as depression or medical conditions that might be associated with difficulties with attention, activity, or impulsivity.
In your son's case this is very important, since you feel your son may have emotional issues. A thorough work-up by a child psychiatrist, who is familiar with ADHD and other "look alike" conditions, is a must. You ask if defiant behavior is a sign of ADHD or if ADHD can cause emotional issues. The answer to both is sometimes. That's why it's important to have your son seen by someone who is experienced in the art of differential diagnosis. In order to treat the condition properly, it's important to know if your son has oppositional defiant disorder, depression, ADHD, or a combination of these disorders or other conditions. Ask your pediatrician for a referral to a pediatric psychopharmacologist. This is a psychiatrist/MD who is trained in helping you have more confidence in the diagnosis.
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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.