The ADHD Conundrum

Different factions have claimed ADHD is underdiagnosed, overdiagnosed, or misdiagnosed. They are all correct.

ADHD (Attention Deficit Hyperactivity Disorder)is a neurological dysfunction, although for some reason it is classified as a psychiatric disorder. Because it is classified as a psychiatric disorder, it is commonly treated by psychiatrists and psychotherapists. In reality, because ADHD is a disorder of brain functioning (probably in the frontal lobes that control impulses and attention) it does not respond much to psychotherapy. The only purpose of psychotherapy for people with ADHD is to help them understand the illness and cope with the stress it creates.

Medication also doesn't cure ADHD, but it may be the only treatment that controls the symptoms. ADHD medications are usually stimulants that work to pep up the part of the brain that is malfunctioning. By supporting the part of the brain that controls impulses and increases attention and focus, the stimulant medications--seemingly paradoxically--make people calmer because they are less distracted.

It's my observation that many adults who've had chronic problems with disorganization and underachievement have ADHD that has never been diagnosed or treated. Meanwhile, many children who are diagnosed with ADHD are actually having a reaction to a negative environment, manifested in their behavior because it is primarily through behavior that children communicate (see my last post). In some cases, agitated behavior with no apparent environmental cause is diagnosed as ADHD but is really the onset of Bipolar Disorder. In these cases, the administration of stimulant medications designed to treat ADHD can make the patient worse.

An evaluation for an adult or a child with ADHD symptoms must include a comprehensive assessment of their environment and social, educational and/or vocational functioning. Psychological testing that includes an IQ test may be helpful, because a low IQ can also cause problems with functioning (unfortunately, there is no treatment that can make people smarter, so the best intervention for someone with a low IQ is vocational counseling to help them find something they can do in life).

I believe there are many, many persons with undiagnosed ADHD. At the same time, I believe there are many children who are diagnosed with ADHD who are really victims of parental neglect or abuse. Sadly, many clinicians do not take the time to do complete evaluations.