Over the last couple of decades ADHD (commonly referred to as “ADD”) seems to be pretty casually diagnosed from all I can tell. It doesn’t take much to get “diagnosed.” The parent fills out a rating scale, which usually comes up positive for things like distractible and inattentive. The child’s history is reviewed and the diagnosis follows.
Sometimes there will be a large battery of computerized tests complete with fancy electrodes put on the child’s head that give the air of being scientific and which yield sophisticated looking data, but other than costing the patient (or the insurance company) thousands of dollars, these have never been shown to be all that valid as an approach to assessing ADHD.
As a result of the significant numbers of children diagnosed with ADHD, parents stream into schools requesting 504 Plans for their child.
Let’s take a step back and look at 504 plans. Section 504 of the Rehabilitation Act of 1973 was written as a federal civil rights law to address discrimination against people with disabilities in the work place and in school. Like other civil rights legislation, it was a major game-changer.
To illustrate some of the issues in the real world, let’s look at Ryan, a 7th grader I recently evaluated who was previously diagnosed by a medical practice specializing in assessing ADHD. I was to be offering a second opinion while his mom was in the process of pushing the school to offer 504 plan accommodations.
After evaluating him, I didn’t see all that much ADHD with Ryan. It was my view Ryan had, at best, quasi-ADD (a term I made up). Largely, he was so caught up in a myriad of screen preoccupations (YouTube, Fortnight, etc.) that school and homework were just basic annoyances that he had to deal with to primarily get his mom off of his back.
Ryan never seems to know what he has to do. Mom’s blood pressure is rising over her son’s seeming obliviousness. Frustrated that Ryan never writes down any assignments (“Why should I,” says Ryan. “It’s on line somewhere.”), to lower her blood pressure, mom has taken to downloading the Google Classroom App on her phone so that she can try and figure out what he has to do.
Ryan thinks that’s pretty cool his mom has Google Classroom App, because it relieves him of having to write anything down, which he has stated as, “is so hard to do” (said in a plaintive, whining voice).
Recently Ryan has not been handing in homework or meeting his basic responsibilities. It’s the mom’s view that the school should be relaxing the deadlines for turning in his work due to his “ADD.”
I pushed back some on the mom. I wasn’t buying that Ryan wasn’t handing in his work due to a disability.
It struck me that the purpose of 504 accommodations in school was essentially to “level the playing field” for children with handicapping conditions, not to be giving Ryan the message that he can hand in homework when he chooses or not at all because of his “diagnosis.”
I have a good relationship with Ryan. While his mother tells me what she feels the school should be doing (extending deadlines), I give Ryan one of those squinty-eyed (“come on man”) looks and he smiles back at me. His nonverbal says to me says something like, “I know, I know. I just don’t want to do my homework.”
It was my view that it wasn’t a 504 issue. It was a lifestyle issue. That is, Ryan had a pretty cool lifestyle and he wasn’t about to compromise it.
ADHD (ADD) is casually diagnosed. There is no pure objective measure of ADHD. As a parent you need to double check what you are asking for in a 504 and what message it is sending the child
(I will elaborate on Ryan, 504 plans and lifestyle in Part II of this blog next week.)
Richard: You hit the nail on the head with this one. Always a fan.
One of my favorites is mothers who enable (usually) girls to not do math homework. The refrain is something like- “Some peoples brains just cannot do math. They can still be smart. I couldn’t do math, but I’m smart…….”
That is still not an excuse to not open the book.
Thanks, Jerry…appreciate the comment and your being a fan. Hope you are well.
Rather than a list of symptoms where one needs a majority of symptoms to diagnose Attention Deficit disorder inattentive or hyperactive, comprehensive questionnaire (20 pages) such as ANSER completed by the school and parent followed by a Neurodevelopmental assessment is the current accepted method for accurate diagnosis. Many of these children have associated learning differences which should be determined. Only after this type of comprehensive assessment usually lasting 2-3 hours should a diagnosis be made and a 504 requested.
Thanks, Dr. Melini. Unfortunately, I don’t know too many professionals doing that… in fact, I only know one!!!!!! Keep up the great work.
Totally agree with the fact that in many cases kids are misdiagnosed by minimal assessments.
The criteria in the DSM V should be followed. So maybe this kid does not hve adhd. Or maybe he does and needs further eval. Data based on subjective opinion is not effective.
Great insight. Thanks