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The Informed Parent

A.D.D. Fact or Fiction?

by John H. Samson, M.D., F.A.A.P.
Published on Apr. 01, 1998

The debate rages among educators, Psychologists, parents and physicians. Is A.D.D. fact or fiction? Should these people be treated with diet, behavior modification, medication, or just allowed to grow up? It is often not easy to arrive at the correct answer because the wrong question is being asked. The main problem is not whether it does exist, but how does one properly diagnose a potential A.D.D. patient. The unqualified term "Attention Deficit Disorder" alone is not truly an etiological diagnosis, but rather a statement depicting a set of symptoms. These may be any constellation of the following: over-activity, impulsiveness, easy distractibility, aggressive behavior, daydreaming, forgetfulness, inability to sustain attention to a task or to follow instructions, and scholastic underachievement. This leads to major confusion.

Different Therapies, Similar Results

Therapist #1 has treated patients with A.D.D. syndrome using behavior modification.

Therapist #2 has successfully obliterated the A.D.D. syndrome by counseling which salvaged an entire family.

Therapist #3 corrected an errant child with A.D.D. symptoms by teaching the parents to be disciplinarians. Each felt secure in their belief that A.D.D. was best managed by counseling. Medication was not needed in their cases and, therefore, should never be used.

Therapist #4 encounters little Billy. He remains disruptive in the classroom and suffers severe scholastic underachievement despite her best attempts with behavior modification and family counseling. Billy's mother sees the pediatrician, who agrees with the A.D.D. diagnosis and prescribes a psycho-stimulant. Almost immediately Billy becomes calm and attentive, and, gradually, his academic performance undergoes a dramatic improvement. This team of therapist and pediatrician assumes that the only way to treat A.D.D. is with medication.

Avoid Jumping To Conclusions

Five health professionals see the same syndrome or collection of symptoms in four different patients. Three respond to behavioral therapy and the fourth only to medication. It becomes apparent that A.D.D. is a generic term and, in-and-of itself, does not give a clue to etiology. Therefore, proper therapy cannot be given until the cause of the symptoms is known.

From a clinical standpoint a complete diagnosis needs an etiological statement. The treatment must be aimed at the causative agent and not the symptoms. Using the term A.D.D. alone is like offering a diagnosis of "cough", "abdominal pain" or "headache". If you are told that your child has a cough as a diagnosis, a particular therapy could not be selected. If, on the other hand, you are told that your child has a bacterial pneumonia, specific antibiotics can be ordered and a cure affected.

A useful clinical delineation of Attention Deficit Disorder would be to divide the diagnosis into primary A.D.D. and secondary A.D.D. The primary type refers to a central nervous system dysfunction. It emanates from a malfunction that prevents the patient from prioritizing stimuli input to the brain or controlling random impulses. This type is a nervous system disorder that responds to stimulant therapy. It is not completely alleviated by the best methods of behavior modification or psychotherapy.

The secondary type refers to the presence of signs and symptoms of A.D.D. due to another primary cause. The instigators may be mental retardation, a learning process disorder, family disharmony, physical impairment, emotional stress or psychiatric disease. Attacking the primary cause eradicates the A.D.D. symptoms.

If we now go back to the initial question armed with the above information, we can see a clear answer. Therapists #1, 2 and 3 see A.D.D. as a behavioral disorder and not a neuro-medical condition which needs medication. They would say that A.D.D. as an entity is a myth. Therapist #4 and the physician see A.D.D. as a primary entity that needs medical therapy. Thus, they see it as a medical fact and not a myth.

If all of these practitioners could communicate openly, they would see the first three patients had a secondary A.D.D. to a behavioral or emotional cause. The fourth patient had a primary A.D.D., the neuro-medical fact which needs medication in addition to counseling.

Primary A.D.D. is a real neuro-medical condition necessitating medication. Secondary A.D.D. is s syndrome of behavior due to another underlying cause. If your child is given the diagnosis of A.D.D., ask the clinician if it is primary or secondary. If it is secondary, then what is the causative condition? And most of all, be sure the therapy is aimed at the real cause.

Giving a child stimulant medication for behaviors generated by poor parenting is totally inappropriate and will not be successful. In the same vein, trying to counsel a child out of his primary A.D.D. would be as sensible as trying to talk a patient out of epilepsy. Any parent of a child with primary A.D.D. will tell you that stimulant medication was a life saver. A therapist who says she has successfully treated all of he A.D.D. syndrome patients with behavior modification or parent counseling has never managed a case of true primary A.D.D.

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