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Heather and Steven have just left a meeting with their son Daniel’s first-grade teacher, and they are worried. They have been told that Daniel fidgets constantly in class and has a hard time staying in his seat. He usually has trouble following instructions, and doesn’t complete his work. Daniel also talks excessively and at inappropriate times, often interrupting others. Heather and Steven have always thought of Daniel as energetic and rambunctious, but they’ve brushed it off—after all, “boys will be boys.” Steven even reminds Heather that his parents claim Daniel acts exactly like he did at that age. However, at the meeting Heather and Steven just attended, the teacher recommended that Daniel be evaluated for ADHD (Attention Deficit Hyperactivity Disorder).

Heather and Steven have heard a lot about ADHD. News stories about the abuse of ADHD medications and the increasing incidence of ADHD diagnosis are common. Many of their friends and family claim that ADHD is just a fad—or that it could easily be prevented by stricter parenting, a better diet, less television, and so on. However, Daniel’s teacher told them that there is increasing scientific support for the reality of ADHD.

The teacher said that ADHD appears to have a biological basis. Scientists have found physical differences in the brains of children with ADHD that are detectable through noninvasive procedures such as MRI (magnetic resonance imaging). More work is necessary before brain scans can be used as a reliable basis for diagnosis, but the areas of the brain most affected in ADHD appear to be those where the neurotransmitter dopamine is particularly important. Some of the genes involved in these dopamine-using pathways may be at least partly responsible for ADHD. This is no surprise, since family studies have shown ADHD to be highly heritable. Someday, a genetic test may be used to assist in the diagnosis of ADHD.

Since brain scans and genetic tests are not yet available for ADHD, diagnosis is based on an assessment of the child’s symptoms. Daniel’s teacher recommended that Heather and Steven first take Daniel to his pediatrician for a full physical examination. This will allow them to rule out other conditions that lead to ADHD-like behavior. The pediatrician may then focus on evaluating Daniel’s behavior, or perhaps refer him to a mental health professional with expertise in treating ADHD. At this time, diagnosis of ADHD is based on whether or not a child regularly exhibits specific behaviors from a standard list as described in the Diagnostic and Statistical Manual of Mental Disorders (DSM). If it is concluded that Daniel does have ADHD, he may be treated with medication, behavioral therapy, or a combination of both approaches.

Questions

1. Do you think Heather and Steven might have come away from their meeting with somewhat different feelings if the teacher had suggested that Daniel needed to have his vision or hearing tested, rather than be evaluated for ADHD? Why or why not?
2. Some people feel that the evaluation of ADHD symptoms is too subjective, making accurate diagnosis difficult. Does the need to help children who may have ADHD outweigh the possibility of an incorrect diagnosis? Explain your response.
3. Objective means of evaluating children for ADHD, such as brain scans and genetic tests, may become available in the near future. Such developments would be expected to increase the accuracy of ADHD diagnosis. Some people are likely to call for routine screening of school children to see if they have or are at risk for ADHD. Do you think such ADHD screening should be mandatory? If so, should it be required only for children exhibiting symptoms of ADHD, or for everyone? Explain your answer.
4. What advice would you give Heather and Steven about having Daniel evaluated for ADHD?