The Great Misdiagnosis
by Julian Stuart Haber, M.D., FAAP
The title of this book, ADHD The Great Misdiagnosis, is suggestive that this is just another book that talks about the 'myth' of ADHD or how attention deficit hyperactivity disorder is not a real medical condition.
Instead of writing an anti-ADHD or anti-Ritalin book, Dr. Haber offers help for parents and professionals who are looking to help get a correct diagnosis for children who are struggling at school, whether that diagnosis is ADHD, depression, a learning disability or some other disorder that can often be misdiagnosed as ADHD.
Why are children misdiagnosed with ADHD?
The main reason is that there is that unlike other medical conditions, like diabetes or a brain tumor, there are no simple tests that can tell that your child does indeed have ADHD. Instead, we usually have to rely on questionaires and observations from parents and teachers to see if a child has the symptoms of ADHD, which might include having a short attention span, being easily distracted, and/or being impulsive and hyperactive. But having the symptoms of ADHD does not necessarily mean that they are being caused by ADHD, and unfortunately, according to Dr. Haber, 'the symptoms of ADHD may be present in more than thirty other disorders, ranging from problems with the sensory systems, mental illness, or scholastic, psychosocial, and medical problems.'
It is also important to remember that even if children have all of the symptoms of ADHD, if they are not causing an impairment in his behavior or school performance, then he likely doesn't have ADHD.
So to avoid a misdiagnosis of ADHD, children should also be evaluated for all of the conditions that can also cause ADHD like symptoms, which Dr. Haber calls 'The Imitators'. These imitators of ADHD can include:
- hearing and vision problems
- learning disabilities
- gifted children, who might be bored in school
- dysgraphia or difficulties with writing
- mental retardation
- personality conflicts, either with a teacher or other students
- childhood psychosis
- oppositional defiant disorder
- Tourette's syndrome
- autism and pervasive developmental disorders
- instability at home, such as from illness or death in a family member, frequent moves, or divorce
- seizures, especially partial complex seizures and absence seizures (staring spells)
- lead poisoning and anemia
- chronic diseases
- thyroid disorders
- substance abuse
- sleep disturbances, either from just not getting enough sleep or from having sleep interrupted by a medical condition, like obstructive sleep apnea
Now all children with symptoms of ADHD don't need extensive testing for all of these conditions, but you and your doctor can look for hints or clues that your child's ADHD symptoms might be caused by an imitator.
Is your child sad or irritable most of the time? Then maybe she is depressed.
Does your child snore loudly at night? Then maybe he has OSA.
Is she just struggling in certain subjects? Then maybe it is a personality conflict with the teacher or a learning disbility.
Do you live in an older home and your child eats paint chips? Then maybe he has lead poisoning.
Is this a new problem in an older child? Then maybe he has a substance abuse problem.
Looking for or getting your child evaluated for these imitators that Dr. Haber describes is especially important if you don't agree with your child's diagnosis of ADHD, if he is not doing well with the medicine that he was initially prescribed for ADHD, if he has any symptoms of an imitator and especially if your child's initial ADHD evaluation was very brief or seemed incomplete.
In addition to talking about ADHD imitators, ADHD The Great Misdiagnosis has extensive chapters on treatments for attention deficit hyperactivity disorder, including traditional medical treatments, like stimulants, and alternative therapies, such as diet therapy, megavitamins, biofeedback, and herbal treatments. In describing these alternative treatments, Dr. Haber provides help so that parents 'avoid falling victim to the charlatans who seek to exploit their needs by charging enormous fees for products and services' and he concludes that 'most of those alternative treatments do not work.'
The chapter, Why Meical Treatments for ADHD?, would be good reading if one or both parents of a child with ADHD was against treatment. Dr. Haber offers a good example about the importance of treating 'true ADHD' in that 'we certainly would not deny treatment to an individual who had an ailing heart, asthma, infected lungs, or cancer when medical responses exist that can cure or control these maladies.'
Dr. Haber's book also includes a history of ADHD and tips for parents and teachers. Although these tips are very useful, they are only briefly explained. I would love to see another book from Dr. Haber that just expands on and better explains how parents and teachers can use his tips and 'techniques to modify the behavior of children with ADHD and to guide them.' It is a good place to start though, and helps alert parents to the fact that these techniques are available, such as preventing annoying behavior by pointing out the annoying behavior and then offering an alternative or expected behavior, avoiding arguments with your child, and being tolerant of behaviors (especially hyperactive behaviors) that are not disruptive or harmful.
Although a wonderful book, it is not for everyone. I think that it would be most helpful for parents of children who have been diagnosed with ADHD and who continue to do poorly and for parents who aren't convinced that their child has ADHD.
It should also be required reading for any professional that identifies or treats children with ADHD.
Rating: 4 stars
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