ATTENTION DEFICIT DISORDER – WHO SHOULD MAKE THE DIAGNOSIS ?
Ideally, it should be a TEAM – with medical, psychological, & educational participants – working for the family, not the school…
Traditionally, ADD has been thought of as a medical diagnosis. Therefore, Pediatricians, Neurologists, and Psychiatrists have been the “big three” specialties called upon to decide whether a child has ADD. More recently, however, in part because the “big three” often spent too little time, effort, and care at this (and were thus perceived by many as not being very good at it) both Psychologists and Educators have developed techniques of their own for identifying ADD. While it still requires a physician to prescribe medications, increasingly the role of diagnosis is being left to, or taken over by, others.
The problem, however, really is to determine WHY a child is not attending. Was she was born with weak brain “wiring” for attention; i.e. she is neurologically unable to pay attention? If this is the only or primary problem, that is true ADD. However, there are plenty of other reasons why a child might display ADD-like symptoms that have nothing to do with neurologic ability. These include: social and emotional problems (poverty, divorce, violence, drug abuse, etc.) drawing the child’s mental energy away from what it should be focused on; psychiatric conditions (e.g. depression, bipolar disorder, anxiety disorders, autism); medical problems (hearing loss, traumatic or infectious brain damage, stroke, seizure disorders); and finally children with learning disabilities, some of whom essentially adopt inattention as a strategy to avoid work which is difficult and frustrating for them. None of these situations represents true ADD, but each is easily and often misdiagnosed as it. This can be due to evaluation by a single professional who, while very good in their field, only really has expertise in one or a few of the above areas.
To say every inattentive, distractible, impulsive child has ADD is like saying everyone with cough has pneumonia. It is necessary to systematically look for, and rule in or out, all the other possible causes of cough (allergy, asthma, heart failure, cancer, and simple URI). Unless ALL the above causes of inattention are similarly looked for, failure to fully address the question of WHY naturally results. Unfortunately, no one professional has the expertise and training to do this sort of thing with childhood attention difficulty. Therefore, diagnosis of ADD requires a team approach. The team should have AT LEAST these three essential, minimal components: MEDICAL (e.g. Neurologist, Developmental Pediatrician), PSYCHOLOGICAL (Psychiatrist, Psychologist), and EDUCATIONAL (LD teacher or specialist). Such a team might also optionally include other professionals – all of whom could add depth/perspective to the assessment. Without such a team approach, any of the above professionals alone will be prone to error. No matter how good they are, they can’t “cover all the bases”. Finally, be suspicious of the diagnosis coming from personnel on school contract or payroll, since they may be biased and have a personal or professional “stake” in the outcome of the evaluation.