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Archive for the Category Diagnosis and Medication


The ADHD Excuse


ADHD symbol design isolated on white backgroundA parent I know is questioning if her second grader has ADHD. Maybe he does, maybe he doesn’t. There are many things that mimic the symptoms. It takes time to make an accurate diagnosis and well-trained professionals should always be consulted. Meanwhile, her son has picked up on the ADHD terminology. He’s saying he can’t focus on homework because his “brain is distracted.” When he gets caught doing something he shouldn’t – like swearing at his brother – he says he’s “being impulsive.” Are his problems due to an attention deficit? Perhaps. But he’s also complaining that sorting his laundry is way too hard. And the Legos that cover his bedroom floor can’t be organized, because, well – it’s “just too hard.” This boy is smart and I think he’s found a convenient get-out-of-jail-free card … an excuse he can call up whenever the going gets tough. Whether this boy has ADHD or not, excuse-making is a slippery slope. In time, he might start believing these limitations.


If you’re investigating a diagnosis of ADHD, or your child/teen currently has this diagnosis, here’s how to avoid ADHD excuses.


  1. ADHD should never be framed as a serious disability. Tell kids that ADHD is a brain style. It doesn’t completely define who they are or limit what they can do. In fact, this brain style can have great advantages (such as athletic skill, creative thinking, and healthy risk taking). ADHD also lends itself to a mind-set that we adults strive for – living more in-the-moment and being more mindful. Yet, there are potential downsides. There are struggles keeping on task, especially when there isn’t something novel or very interesting to focus on. Patience is a serious challenge. Delayed gratification can be hard too. And, not all risks taken are positive.


  1. Emphasize that what matters is how ADHD fits (of fights against) the demands that different environments place on people.


  1. Remind your child that any problems with ADHD (high motor activity, sustaining focus, and being impulsive) can be worked on with or without medications. Most important, remind them that ADHD symptoms tend to decrease (or drop away) as kids grow – as development of the frontal cortex catches up in teenage years.


  1. Remind your child that their brain always has the capacity to learn and change. Pushing oneself to improve, develop better work habits, and maintain healthy life routines – like getting enough sleep, exercise, and eating right – will help control ADHD symptoms. Watch over-exposure to screens too… those have been correlated to higher ADHD symptoms.


  1. Finally, and most important, push back on any ADHD excuse-making. ADHD should never be a reason to avoid trying new things or giving up.


Please contact Dr. Rao about reproducing any material found on these pages.

The Confusing Picture of ADHD

What causes ADHD? Is it a biological disease as many experts have stated? Is there something in the environment that causes children to excessively fidget, to be distracted and unfocused? It’s worth finding answers. ADHD is the most common pediatric problem facing American children.

The results of two recent landmark studies seem to have added confusion to the question of what causes ADHD. The first was published last month in The British Journal The Lancet. The lead author, Dr. Pellser, of the ADHD Research Center in the Netherlands, has turned the field of ADHD on its head. Her finding? Food is the main cause of ADHD. Using a randomized controlled trial she and her colleagues found sixty-four percent of children diagnosed with ADHD had food hypersensitivity, and when controlled diets were implemented, their behavior became normal. She’s quoted as saying that teachers and doctors were “flabbergasted” at the changes they observed. One teacher, Pellser said, referred to the results as “miraculous”. Her conclusions are that ADHD is not a disease, but a condition, and medications aren’t necessary for the majority of cases. For years, parents have been questioning the role of diet in ADHD symptoms, and experts have been dismissing the possibility as a fad. No longer can this be done. On the issue of diet and ADHD, it seems that parents may have been ahead of the medical curve.

Now to the second study, also published in The Lancet, five months earlier. Its findings pointed in the opposite direction. Analyzing “rare chromosomal deletions and duplications”, genetic evidence of ADHD was found. Widely contrasting research findings like these can be discouraging. It immobilizes the efforts of parents and professionals alike who are seeking reasonable treatments. It’s difficult to solve a problem when there’s no clear consensus over what causes the problem in the first place. Worse, the media sounds bites that surrounded the genetic study have lead many to throw up their hands in frustration. For example, many parents reported to me they felt discouraged using behavioral therapy, a highly effective treatment for ADHD, if the cause of their child’s problems were genetic.

We need a more sensitive analysis and reporting of important research findings. Otherwise, we get trapped in a black or white, nature versus nurture debate that limits our ability to synthesize important, yet seemingly contradictory messages. When looking deeper, findings across studies do begin to overlap and point us toward improved therapeutic efforts. Consider the two aforementioned studies.

No one can argue that ADHD, with its characteristic inattention, impulsivity, and hyperactivity almost certainly has genetic components, as everything does. Accomplished pianists and professional athletes will likely differ in genetic ways from one another, and from the rest of us who aren’t as coordinated or aren’t musically inclined. The influence of genes on every moment of life is unavoidable, as is the environment. As it turns out, searching beyond the headlines, genetic differences likely contribute only a small amount of what we see in ADHD. In the genetic study, eighty-five percent of children labeled with ADHD didn’t have the rare chromosomal deletions and duplications. Further, seven percent of kids without ADHD, the control subjects, did.

Genes seem to be playing a role, perhaps more as a risk factor, but there wasn’t a genetic link found in a majority of these children. This dovetails with the first study finding heavy influences of diet (an environmental factor) in a majority of children diagnosed with ADHD. Many other environmental interventions have also been shown by research to help treat ADHD, including improved parenting and teaching practices, ingesting less food additives, limiting exposure to electronic media, and getting healthy exercise.

Like most medical or psychological problems, there are multiple routes to the symptoms that make up that problem. ADHD is complex and difficult to accurately diagnose. Many things mimic its symptoms, such as vision and hearing problems, learning disorders, anxiety, sleep problems, and stress at home or school. For the millions of children diagnosed with ADHD, we need to follow all reasonable avenues to accurately explain why its happening, if its happening, and for those who truly have the disorder, consider all potentially useful treatments.

Please contact Dr. Rao about reproducing any material found on these pages.