At age 4, Jeremiah Ryans routinely refused to wait in line at the water
fountain at his summer day camp. Sometimes he'd get so cranky he would hit his
classmates. But an alarm bell went off when he grabbed a pair of children's
scissors and cut his teacher's hair.
Just a kid being a kid -- or extreme behavior that may need medical help?
The answer isn't clear-cut, and it's different for every family.
ADHD is a complex condition and is sometimes difficult to diagnose.
There is no single test for ADHD. Doctors diagnose ADHD in children and teens after discussing symptoms at length with the child and parents -- and possibly teachers -- and observing the child's behaviors. The doctor will also gather information about any similar problems that run in the family, and consider all possible causes.
To confirm a diagnosis of ADHD and/or learning differences, a battery of tests may...
"He was on the verge of being expelled from day care," remembers his
mother, Mimi, of Columbia, Md., who, with her husband, Richard, adopted
Jeremiah when he was 16 months old.
As the father of a teenager from a previous marriage, Richard did not
consider Jeremiah's behavior typical. So he and Mimi took Jeremiah to a
therapist, who diagnosed separation anxiety. The Ryanses were unconvinced.
Then, after the scissors incident, they opted for a complete physical
examination for Jeremiah. A pediatric and neurological specialist independently
confirmed that it was attention deficit hyperactivity disorder (ADHD). Mimi's
reaction? Fear of putting her child on drugs. "I didn't want Jeremiah to be
one of those kids who was misdiagnosed and overmedicated."
Mimi's concerns about ADHD drugs are well-founded. Parents, physicians, and
educators are questioning the rising numbers of kids under 18 now on ADHD
medication. According to a recent report in the journal Psychiatric Services,
ADHD-related doctors' office visits by children ages 3 to 18 more than doubled,
from 3.2 million to 7.4 million, between 1993 and 2003. The number of visits
that included a prescription for an ADHD medication also more than doubled,
from 2.7 million to 6.6 million.
And experts are currently debating whether these same medications, which are
used widely in children, should carry a warning label about the risk of heart
attack or even suicide. Other experts argue that these frightening
side effects are extremely rare and that the drugs' benefits outweigh the
The jury remains out. In February 2006 an FDA advisory committee recommended
that stimulants prescribed for ADHD carry a "black box" label -- the
FDA's strongest warning -- informing consumers about the risk of heart attack,
sudden death, and stroke. The
committee reviewed 25 cases of sudden death, 19 of them in children who were 18
and younger, associated with ADHD drugs. Because some of these people had
previously had underlying heart disease, the reviewers did not think the
data were definitive in proving cause and effect.
The recommendation for the black-box warning created controversy, with some
FDA consultants maintaining that the label was especially important for adults
(increasingly being prescribed ADHD medications), who might have high
blood pressure. Many calling for the warning label concede that the
drugs have important benefits but say that increasing the awareness of the
potential risks is crucial.