Hyperactivity and attention deficit

4 common problems that arise in the diagnosis of ADHD in children

For some time now, there has been more talk about Attention Deficit Disorder and / or Hyperactivity. However, when it comes to make the diagnosis with ADHD in children, psychologists we find some problems. In the first place, there is a discussion about whether this disorder really exists or if it has been 'invented' and, on the other hand, we are faced with certain prejudices and circumstances that generate many doubts when diagnosing it. We will talk about all this below.

Some professionals open a debate on the existence or not of Attention Deficit Disorder with / without Hyperactivity (ADHD). The key is not deciding whether or not it exists, nor is it a decision that a group of professionals must make. If one thing is clear, it is that neuroscience reveals that people with ADHD have unusual features of brain function, such as a slower brain development pattern in certain areas of the brain.

Taking into account the data from different studies (such as the recent Hoogman et al. 2017), the debate about the existence or not of the disorder has little relevance.

Today, we know that ADHD is a neurodevelopmental disorder characterized by a series of symptoms such as deficits in attention, impulsivity and / or hyperactivity that are maintained for a prolonged period of time greater than 6 months, among other criteria, as indicated by the American Psychiatric Association.

Professionals detect, in our day-to-day clinical practice, some barriers that make it difficult to make a good diagnosis of ADHD. Here are some of them:

1. Overdiagnosis

We must admit that ADHD is a disorder that is 'in fashion', that is talked about a lot and that makes us think about it with great ease when some attention difficulty, impulsivity or hyperactivity is detected, either in children or in adults.

Therefore, some data reveal that, at present, there is an overdiagnosis of this disorder. The incidence of this disorder may have increased, but Are there really more cases of this neurodevelopmental disorder? Or is it true that attention and impulsivity difficulties tend to be more frequently labeled ADHD due to a poor differential diagnosis?

2. ADHD can occur together with other disorders

These last questions give us the opportunity to comment on other barriers that professionals encounter, and that is the high comorbidity of ADHD with other disorders, that is, ADHD can coexist with others such as Learning Disorders (TANV), Behavior Disorders, Autism Spectrum Disorders, etc. as pointed out in studies such as that of Hervás and Durán in 2014.

Furthermore, deficits in attention or impulsivity are also present in other disorders, which makes a good differential diagnosis very difficult. Above all, at early ages when there is still a great variability in symptoms and many cognitive functions have not acquired optimal development.

3. You don't educate yourself by setting rules and limits

The next barrier we find to make a good diagnosis is knowing how to differentiate between whether the child has ADHD or whether he has been educated without limits. Does the child not finish the task, does not remain still or does not respect the turn to speak due to attention difficulties and impulsivity? Or the child does not follow rules of behavior and do what you want?

In some cases, the neuropsychological profile of the child is within the average for their age group and the key to their impulsive and disruptive behavior is the result of disobedience because no rules and limits have been established.

4. Pharmacological treatment as the first choice

Generally speaking, when there is a diagnosis of ADHD, the first choice of treatment is usually pharmacological. As you can imagine, medication in children is a controversial topic and one that many parents oppose. Therefore, many of them avoid carrying out a neuropsychological evaluation of their son or daughter in order to avoid said diagnosis and thus rule out the possibility of a pharmacological treatment for him. If, in the end, the child has ADHD and the appropriate measures are not taken, this will affect their academic performance, interaction with their peers (social area) and their self-esteem (emotional area).

Currently, there is no curative treatment for ADHD, but multimodal treatment, which combines pharmacological and psychological interventions, is the approach that has been shown to be the most effective in this disorder, as has been demonstrated through the working group of the 2017 Clinical Practice Guideline on Therapeutic Interventions in ADHD.

In summary, these are just some of the barriers that professionals encounter when making a good diagnosis of this disorder; not to mention others such as the prejudices or beliefs of each person (each father and each mother). Therefore, to do a good differential diagnosis of ADHD is essential to use objective measures for the evaluation of cognitive functions and discard evaluation tools based on opinions and observations of parents, legal guardians and / or teachers, such as self-reports and questionnaires for parents.

Bibliographic references

  • American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders. Fifth edition. DSM-V. Masson, Barcelona.
  • Working group on the Clinical Practice Guideline on Therapeutic Interventions in Attention Deficit Hyperactivity Disorder (ADHD). Clinical Practice Guide on Therapeutic Interventions in Attention Deficit Hyperactivity Disorder (ADHD). Ministry of Health, Social Services and Equality. Aragonese Institute of Health Sciences (IACS); 2017 Clinical Practice Guidelines in the SNS.
  • Hervás, A. & Durán, O. (2014). ADHD and its comorbidity. Comprehensive Pediatrics XVIII (9): 643-654
  • Hoogman, M. et al. (2017). Subcortical brain volume differences in participants with attention deficit hyperactivity disorder in children and adults: a cross-sectional mega-analysis. The Lancet. 4 (4), 310-319

Melina Núñez Martín. General Health Psychologist

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