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Re: Careful Dx of ADD

Posted by Noa on February 24, 2000, at 13:59:34

In reply to Adderol, posted by sharon miller on February 24, 2000, at 13:23:52

I agree that careful diagnosis is important, and that there are times when families, educators, or doctors jump right to treating a child with a stimulant without a proper evaluation. However, there seems to be equally as much anti-medication hysteria about children and ADD, and that hurts kids who need the treatment.

An appropriate eval always should include a thorough medical check up, including vision and hearing. In addition, screening should be done to rule out a learning disability, and if there are indications from the screening, a full psychoeducational assessment should be done. With or without the psych testing, observations from teachers and parents should be obtained, using a normed screening tool. It is important to get data from two or more reporters, as kids are different in different settings and with diffrerent folks. A thorough developmental history is taken from the parents, and any developmental, education, psych and health records should be reviewed. A clinical interview with the child, of course, should be done. Then, all the data is reviewed and a dx made. Unfortunately, it is rarely done this way. It is often done in a 15 minute doctor's visit at the pediatrician, with no input from the school or anyone else. What should happen is the pediatrician refers out to a child psychiatrist or other mental health professional, but most managed care companies put up disincentives for referring.

Still, there are many more undetected cases that need to be detected than there are false positives, even though I agree with you that this, too is a problem.


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