It is important to understand how a diagnosis of ADD is made.  Many people are comforted by a diagnosis when that generates options for dealing with the situation, especially if they are parents with a child experiencing difficulties.

None of us like to feel powerless when it is our responsibility to do the best we can for our loved ones.  A diagnosis of a child’s challenges can give the family access to prescription medication that could provide benefits to the child and therefore the family.  There are other people who do not feel comfortable with these particular diagnoses because they do not envision their child as having ADD/ADHD or they simply do not want their child to carry that label.  We hope the following will contribute to an understanding of how a diagnosis of ADD or ADHD is made.

The National Institutes of Health has prepared a “consensus statement” (“prepared by a non-advocate, non-Federal panel of experts”) on the diagnosis and treatment of ADHD (available online at http://odp.od.nih.gov/consensus/cons/110/110_statement.htm); a less technical brochure directed toward families is available from the National Institutes of Mental Health (http://www.nimh.nih.gov/publicat/adhd.cfm).  The definition of ADD/ADHD is described in DSM-IV-R (Diagnostic and Statistical Manual, produced by the psychiatric and psychological community as a diagnostic tool; fourth edition; R means revised; the ADHD criteria and treatment details are available at http://www.surgeongeneral.gov/library/mentalhealth/chapter3/sec4.html#treatment).   In this manual, each of the characteristics that describe a diagnosis of ADD or ADHD requires a subjective judgment on the part of the person making the diagnosis.  

There are no standard tests such as blood tests, brainwave maps, or neurological and neuropsychological testing to establish the diagnosis of ADD.  For example, if someone is glucose intolerant, they can be described as having diabetes, and the diagnosis rests on the blood work that shows the glucose intolerance.  There is no such test for ADD.  The diagnosis is largely subjective, though a detailed neuropsychological evaluation (which can take many hours to perform) can significantly increase the confidence level of the diagnosis.  Still, research on what is described as “ADD” or “ADHD” is practically impossible. Because of the subjectivity of the process, the diagnosis for ADD or ADHD is different in Dharmshala, India v. New York, NY, or Shoofly, North Carolina v. Bugtussel, Alabama.

However, and perhaps more to the point, it is possible to safely study the effects of medication on the behaviors which are consistent with ADD/ADHD.  In a “double-blind, placebo controlled trial,” a child can be given one of three identical appearing pills (one a sugar pill, one a low dose of a drug such as Ritalin, and the other a higher medication dose) and her behavior observed and performance evaluated on a battery of neuropsychological test while on each – by observers/testers who do not know what’s in the pill (this should eliminate the problem of “wishful thinking” from the analysis).  At the conclusion of weeks of taking the medications and the analysis of the data, the “code is broken” and physician and family can see if there truly is an observable benefit from the medication.  If so, medical treatment may be justified.

For those who are relying on these diagnoses, it might be more empowering to say that right now the child displays the characteristics of ADD/ADHD.  If your child is displaying some characteristics of ADD or ADHD, some tools that might be of assistance for you or your family can be found HERE in What Can You Do.

A book that discusses other options is The Myth of the ADD Child by Thomas Armstrong.

Please note that all the options require a trial and error approach.  With any given therapy some children will experience great benefit while others will not.   Knowing the options, families can decide where to start.