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Buyer Beware When It Comes to ADHD Diagnosis

Posted - Jun. 22, 2004 at 6:20 a.m.



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Q: Another parent told my husband and me that a local clinic run by a well-known physician and expert in the field has developed a means of diagnosing attention deficit disorder using a brain scan and/or sophisticated measure of brain activity. We have looked into it and are thinking of having it done with our son, age 8. Do you have any knowledge of this sort of thing, and would you recommend it?

A: A number of clinics across the country now advertise procedures of this sort for diagnosing ADD/ADHD. Whereas I'm not a medical doctor and therefore not qualified to comment on the procedures themselves, I can and will share some pertinent information obtained with the able assistance of Dr. DuBose Ravenel, a nationally-known developmental/behavioral pediatrician who serves as one of my consultants on medical matters.

The bottom line: As concerns the diagnosis and treatment of ADD/ADHD (attention deficit disorder/attention deficit hyperactivity disorder), let the buyer beware. No other contemporary "medical" issue is full of more myth, hype, and dubious advertising as this.

In 1998, an overwhelming majority of experts attending the National Institutes of Health Consensus Conference, after days of reviewing all of the available evidence, agreed there is no compelling evidence to the effect that ADD/ADHD is caused by or significantly and reliably associated with physical or biochemical "irregularities" (e.g., deficiencies in the left temporal lobe, biochemical imbalances) in the brain. They furthermore agreed that no objective test or set of criteria exists with which to accurately diagnose ADD. A 2002 book, "Attention Deficit Hyperactivity Disorder-State of the Science," written by a number of recognized authorities in the field, reported that the 1998 Consensus Conference findings remained unchanged.

To my knowledge and the knowledge of Dr. Ravenel, nothing has changed in the last two years. This means that brain scans and/or measures of brain activity are dubious means of diagnosing ADD/ADHD.

Furthermore, the fact that a person who supposedly "has" ADD/ADHD is found to have a functional or physical brain irregularity means nothing because such evidence, in and of itself, fails to prove that the irregularity caused the behaviors associated with ADD (problems completing tasks requiring sustained attention, lack of impulse control, inability to wait his/her turn or delay gratification, low tolerance for frustration, etc.). It is equally possible-in fact, it is equally if not more likely-that the behaviors in question, present over a significant period of time, caused the irregularity.

Solid research has shown, and beyond any reasonable doubt, that "differences" in the brain can be caused by features inherent to the child's environment (e.g., a chaotic, conflict-ridden family life, television and video games, lack of disciplinary structure). There is even good evidence to the effect that brain differences can also be brought about by the child's own behavior!

The good news in this regard is that the brain possesses the remarkable ability to "repair" itself once environmental and/or behavioral problems are corrected. The theoretical implication is that a child's brain that has been "corrupted" by television-watching or as the result of a lack of discipline can be set right again by eliminating television (and other forms of electronic stimulation) and instituting proper discipline. As goes the brain, so goes behavior.

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(John Rosemond is a family psychologist. Questions of general interest may be sent to him at Affirmative Parenting, 1020 East 86th Street, Suite 26B, Indianapolis, IN 46240 and at his Web site: http://www.rosemond.com/)

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(c) 2004, The Charlotte Observer (Charlotte, N.C.). Distributed by Knight Ridder/Tribune News Service.

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