According to a recent study by a Michigan State University economist, nearly one million children in kindergarten in the United States are misdiagnosed with ADHD. The study attributes this to the disparity of ages in a kindergarten classroom. Most kindergarten classrooms have children who are either 5 or 6 years old. The study shows that the younger children are more likely to be rated by their teacher as being inattentive and hyperactive. However, these ratings may more likely reflect the immaturity of these children rather than a mental disorder.
ADHD is considered a developmental disorder. There is always a disparity in when children within the same age range reach a given developmental milestone and this of course is more pronounced when there is also a disparity in age as well. Actually most children do not develop selective attention until 6 or 7 years of age. For years, studies have shown that teachers will rate 50% of the children in the class with scores indicating possible ADHD when the prevalence is known to be no more than 10%.
Children are starting kindergarten later due to increased academic demands. It make sense that a class of kindergarten children are able to do first grade work since many of them are 6 years old. Imagine the stress of a five year old who may be somewhat on the late side of developing selective attention being required to achieve at least one grade level above his age level. The pressure from teachers and parents and peers can lead to acting out behavior that might be expected under the circumstances but could lead to a professional evaluation.
Parents, teachers, and physicians should be careful to consider not only the chronological age of the child but also the developmental age when considering a possible diagnosis of ADHD. Perhaps the child should be placed in a pre-K class where he or she is truly with peers and the work is more appropriate to the child’s development. This would be a far more appropriate intervention than medication. Unfortunately, I have found that school districts may not want to put a 5 year old in preschool or pre-K because they may not receive funding for the child when state guidelines say a child of 5 must be in kindergarten.
For now, hopefully, this study will evoke caution in all concerned so that decisions will be made based on all of the factors that should be considered. In the future, the whole issue of the mismatch between child development and academic expectations needs to be re-evaluated but that is another blog post.
A recent research study to be published in the August 2010 issue of Child Psychiatry and Human Development found that low blood levels for zinc and iron are associated with symptoms of attention deficit hyperactivity disorder based on scores on the Conner’s Parent Rating Scale through the low levels were not associated with higher scores on the Conner’s Teacher Rating Scale.
There were 118 with ADHD (ages 7-14 years). While Conduct Problems and Anxiety were associated with lower zinc levels, increased Hyperactivity scores were related to both lower zinc and iron levels. It is known that these two minerals as involved with dopamine metabolism, one of the two neurotransmitters related to ADHD.
Parents may want to ask their child’s physician to check these levels and recommend supplements if they are found to be out of the normal range. Parents should be cautioned however, to not rush to some the supplement products on the market containing zinc and/or iron. Unless a child’s level is low for either of these two minerals, there is no evidence that boosting normal levels would be beneficial and could be harmful.
It is known that a healthy diet and regular exercise is good for brain development for all children and certainly beneficial for children with attention deficit hyperactivity disorder. With the exception of fish oil with Omega 3 antioxidants, no other supplements containing mega doses of vitamins, minerals or other “natural” substances have been proven through rigorous scientific research to be beneficial for kids with ADHD.
Parents concerned about their child’s ADHD symptoms should rely on treatment recommended by professional organizations which are (1) behavioral interventions, (2) school interventions and (3) stimulant medication for severe symptoms that do not respond to the first two approaches.
Many parents find it difficult to find an effective, affordable and user friendly option for behavioral interventions. Total Focus is a comprehensive behavioral program using evidence-based techniques to improve behavior, learning, self-esteem and social skills. Parents and children work together as a team to bring about real lasting change involving activities that are fun and require less than an hour per day. Total Focus costs less than one visit to a mental health professional.
The word “disorder” conjures up images of illness, disease and serious disabilities. All parents want to see their child as the smartest, most capable and best liked boy or girl on the block. So why would they want to have a label attached to them that often coveys just the opposite–such as slow learner, under-achiever or Attention Deficit Hyperactivity Disorder?
What a difference one word can make. Suppose we changed the last D in ADHD from “disorder” to “difference.” We could then say that a child with ADHD has some significant differences in his cognitive ability, emotional sensitivity and activity level when compared to other children. This difference is probably inherited. His “skill set” is different from 95% of the children in his class.
Unfortunately, the environment in which he spends most of his time is geared toward the other 95%. However, we then could look at helping him to adapt successfully to this environment, using his own set of strengths rather than helping him to with this environment due to his weaknesses. We then might say that this child may need psychostimulants and/or psychological intervention to enable him to concentrate on boring tasks and control spontaneity in a highly regimented environment.
“I never suspected my nine-year-old daughter’s inability to concentrate was due to ADHD,” said Diane, the mother of three girls. “She isn’t ‘hyper’ or noisy—in fact, just the opposite. Kayla is the middle child—she’s quiet and tends to daydream a lot. We were frustrated because she couldn’t ever seem to concentrate or get her schoolwork done…But we were still really surprised when our pediatrician finally diagnosed her with ADHD last year.”
When many people hear the term ADHD, the first thing that usually comes to mind is a young, out-of-control boy running all over the place or having a major meltdown at the mall while his frantic parents try to calm him down. Unless you personally know a girl struggling with this disorder, the “wound-up boy” is the image most associated with ADHD. Of course, one reason for this is the fact that boys with the diagnosis outnumber girls by a whopping 3 to 1. Another reason is that ADHD in girls is more often associated with impaired attention and concentration—girls who are labeled as either “dreamy” or “spacey,” rather than hyperactive and impulsive.
Unfortunately, research has shown that this stereotype often leads parents, teachers, and health professionals to misdiagnose girls with depression or anxiety. Sometimes the significant difficulties they’re experiencing are dismissed altogether. Whether boy or girl, a child who has trouble learning and maintaining healthy peer relationships is more likely to be ignored, while the child exhibiting disruptivebehavior is not only more likely to be noticed, but also more likely to be referred for evaluation and treatment. The sad result is that girls are often under-treated, which results in years of suffering in silence, and subsequently leads to self-doubt and low self-esteem. Recent studies have even shown that women with ADHD suffer from depression much more frequently than men with the same disorder. Continue reading →