Summary: Cautions in Diagnosis and Treatment
“Look-alike children” may fulfill the diagnostic criteria for AD/HD but have a completely different problem and, therefore, should receive a different diagnosis. All of the above conditions may cause a child to behave impulsively and show difficulties in attention and hyperactivity that are hard (and perhaps impossible in some instances) to distinguish from AD/HD. Particularly if a child’s situation is worsening with age, consider the possibility that AD/HD may not be the sole or even primary problem. Also, if the AD/HD is associated with bad dreams, bad moods or disturbing thoughts, or if there is a family medical history of psychiatric disorders, then it is important to be sure that mimicking disorders and additional problems are not present.
If a medical or other psychiatric disorder is presenting as AD/HD, a treatment that merely improves the AD/HD symptoms may leave a residue of untreated behavioral problems, mood abnormalities or disorders of physiology. In these cases, even if stimulants are helpful or if environmental changes improve the child’s self-control, it is critical to make sure that the other (and perhaps more serious) problems are not left to smolder.
Given the variety of disorders that can be mistaken for AD/HD, or that may coexist with AD/HD, a comprehensive evaluation of the child is always important. Numerous problems must be contemplated, assessed and “ruled out” before a diagnosis of AD/HD can be made. It is no longer sufficient to start treatment for AD/HD based on observations of “tuning out” or misbehavior. This disorder needs a comprehensive evaluation that matches our growing awareness of the complexity that goes by the simple name of AD/HD.
Copyright: Charlene Messenger, Ph.D. All Rights Reserved.