Is ADHD Just a Maturity Issue?
ADHD has been receiving a lot of press these last few months. First, we learned that the number of kids with the diagnosis has increased significantly. More recently, a study from Harvard Medical School showed that kids who start school earlier are more likely to be diagnosed with ADHD than those whose parents hold them back a year or whose districts have a later cut off birthdate for enrollment.
At first glance, it could seem as if ADHD is overdiagnosed and/or it’s really just an issue of maturity. The danger of jumping to this conclusion is that as a society, we might start to ignore ADHD symptoms where they really exist and fail to evaluate and treat kids who are genuinely suffering.
The problem has to do with how ADHD is usually diagnosed. Most of the time, a pediatrician gives parents and perhaps teachers a questionnaire to complete about a child’s behavior. If six out of nine symptoms about inattentiveness and/or hyperactivity are checked, the diagnosis of ADHD is met. Child doesn’t listen? Doesn’t pay attention to details? Doesn’t want to do things that require effort? Or, does she fidget? Has trouble sitting still? Had difficulty waiting his turn? Sounds like a lot of distracted or energetic kids I know, but most of them don’t have ADHD. This checklist method is a terrible way to diagnose ADHD. I don’t know about you, but too little coffee and I would meet criteria for inattentiveness and too much and I’m sure I could check off all nine items for hyperactivity.
True ADHD is a disorder of executive function. Children with ADHD have real impairment with problem solving, cognitive flexibility, mental organization, and working memory as well as sustained attention, task initiation and task completion. Their hyperactivity isn’t just excess energy that they need to burn off; it’s their brain’s way of driving energy up to the frontal lobes so that their executive functions can be strengthened.
A full assessment that includes IQ, academic achievement, and executive function evaluation is the only way to know for sure if a child or adult does or does not have ADHD. And remember, just because something might overdiagnosed in some cases doesn’t mean that it isn’t underdiagnosed or missed in others.