ADD or ADHD: Diagnostic Pigeon Holes, Evaluation and Treatment

Reader’s Question

I’m concerned about my 7-year-old son. I have a daughter who is now 10 who was diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) when she was 7. I’ve also been diagnosed with Attention Deficit Disorder (ADD) — inattentive type, without the hyperactivity. So far, neither my daughter nor I have had great results with medication, so I’m not convinced that either of us has been properly diagnosed.

My son seems to have different symptoms. He’s quick to anger, and he has social problems (he thinks everyone hates him and has only one good friend). He’s very particular about who he likes or doesn’t like and is smart but perfectionist. He doesn’t have much problem concentrating but shows extreme hypersensitivity to taste, sound, light and touch, seems very shy and oversensitive when anyone argues, including his cats, hates being kissed but likes to hug/cuddle. He’s very kind and loving but is also always bored and not content to play alone for long. He loves soccer and speedskating but is not hyperactive or constantly moving. He does very well in school academically but he often says things without thinking and doesn’t perceive things as others do. When he was four and five, he displayed anger through kicking and punching, but now he screams a lot. When their dad was driving a truck for a living, we got the kids into a routine to keep them quiet while he slept by watching a movie every night before bed. Now that his dad’s not driving anymore, any night we do something else instead, even if it’s fun and there’s no time left for movie, my son gets very upset to miss movie time.

Do you have suggestions as these symptoms become more visible as to what we could do to best help him? His cousins have dyslexia and ODD. His grandpa has anxiety disorder, and his great aunt has ADHD. Thanks for your time. Any advice is appreciated.

Psychologist’s Reply

Mental health diagnoses are based on objective, observable behavior clusters and are not necessarily linked to some specific “underlying” cause. Further, as long as someone’s behavioral manifestations meet the criteria for getting a certain syndrome, they might well get that particular diagnostic label. People often get diagnosed with more than one condition, because not all diagnoses are mutually exclusive. For a variety of necessary reasons, diagnoses are not always made on the basis that the provider is absolutely sure of a particular underlying cause.

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In addition to the fact that most people don’t fit very conveniently into diagnostic “pigeon holes,” people also respond very differently to various medications and intervention strategies. So, proper and accurate diagnosis requires careful, comprehensive evaluation. It’s also rare that medication alone is sufficient to help a person with a genuine condition or conditions to function normally. That’s why interventions usually involve multiple types of therapy. To complicate matters even further, certain conditions or combinations of conditions can “mimic” the symptoms of other conditions, making an accurate diagnosis difficult. Although certain tendencies tend to run in families, every individual is unique. Finally, many times finding the best medications and/or adjunctive interventions is a matter of trial and error; not everyone will respond to a particular intervention in the same way. In the end, the optimal interventions might not even match the formal diagnoses given.

The key to getting your issues properly evaluated and treated is to maintain an open, solid relationship with a professional you know and trust and who has the proper expertise both to conduct a thorough assessment and to prescribe a comprehensive treatment plan. Don’t be afraid to speak up about any of your concerns. If something doesn’t seem to be working, your treatment provider will need to know that so that an alternative can be explored.

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