Diagnosis Question from a Parent

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I recently received this letter from a parent which touches on all of the issues involved in the diagnosis of childhood behavior disorders such as ADHD. Look at all of the issues involved: divorced parents, lifestyle of one of the parents, mood swings, inattention, tics, meds that don't work, and more. My heart goes out to this dad and his child:

I have a 9 yr old son who was diagnosed with ADHD about 4-5 years ago, and ever sense then I'm not sure where my son has gone. He's lost weight, doesn't eat and has a pretty bad mood swing once in a while and the only action by his care provider is to change his medication time after time after time. He's been on countless combination's of drugs and none seem to work. My son's school told us they ranked him in 9th percentile in terms on attention span, I would hope after being on drugs for more than 4 years that are suppose to help his attention span that number would at least be 70-80%.

My questions are simple...

Could a hectic home life with his mother (lots of boyfriends, being moved from place to place, moms constant fights with b/f, not getting the attention he needs basically) be confused with a child having ADHD?

He is currently on Vyvanse..Is it normal that he has constant ticks?

And is there an age at which doctors take a wait and see approach before giving meds, because the child may just be young and unruly?

Here was my response to this father:

Dear Dad,

It sounds like a difficult situation, as the school is involved, a doc is involved, custody is involved, boyfriends, and etc. It can be very difficult to figure out what is ADHD, depression, anxiety, tourette syndrome, a head injury, fetal alcohol syndrome, chaos at home, or what... There are lots of things that can cause the attention problems in school.

Certainly "mood swings" can be from ADHD, or early on-set bipolar disorder, or childhood depression, or anxiety disorders, or OCD, or just being "fed up" with things. Weight loss is likely from the medications, as stimulants reduce appetite.

The tics are most likely from tourettes syndrome (the genetics of ADHD and TS are very close, and they are often confused diagnostically, as are ADHD and early onset bipolar disorder). Some experts think that the medications can cause the tics, and there is some evidence for this, but it is just as likely to see a child diagosed as ADHD, and treated for ADHD, but has TS instead.

Fetal Alcohol Syndrome or Drug Exposure in utero can cause little head injuries during development that can look like more extreme cases of ADHD (mood, temper, inattention, etc) but they don't respond to meds as well as "true" genetic ADHD kids do.

You might just consider going back to get a new diagnosis from someone who can differentiate between the possibilities listed above. This diagnosis might include using a Tova test or similar, both without medication, and then a challenge test with medication. But without a diagnosis that you can be confident in it is hard to 100% support treatment, especially if it doesn't seem to be working.

I guess you should also rule out food allergies, which would set him off whether on the meds or not, or "environmental" allergies that would do the same to him.

You probably know that I like Attend and Extress for ADHD treatment, but when several medications have already failed to get desired results it makes me suspicious of the diagnosis. But you might try some Extress in addition to the Vyvanse, just to calm the mood. It can be taken with the Vyvanse. Here's a link with more information on Extress from the manufacturer's site: http://www.vaxa.com/26462/index.cfm?page=631.cfm

Here are some links that might help:

Things that look like ADHD but are not -
http://newideas.net/adhd/differential-diagnosis

ADHD Tests and Diagnosis -
http://newideas.net/adhd/diagnosis

ADHD Diet Recommendations -
http://newideas.net/adhd/adhd-diet

Hope this helps at least a little.

Doug Cowan

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