Schools Diagnosing ADHD

A scarcity of physicians in America's inner cities sometimes causes school officials to diagnose attention deficit hyperactivity disorder (ADHD) themselves‹often improperly.

The problem of ADHD is growing so rapidly that the National Medical Association, which represents many of the nation's black doctors, held a teleconference recently to highlight the issues. Sharman W. Dennis, an early intervention child development expert, said:

"This is a diagnosis where there should be a complete and thorough medical workup and then an educational developmental evaluation of the child."

Diagnosing ADHD in youngsters can be challenging (there is no definitive lab test), but physicians and other professionals at the conference indicated that a new approach could minimize incidences of misdiagnosis, particularly in minority children. [Editor's note: What this new approach should be is not specified.]

Quentin T. Smith, a professor of clinical psychiatry at the Morehouse School of Medicine says, "If you look at elementary schools around the country, about three to five percent of all school age children carry the diagnosis." Smith believes there can be significant problems when a teacher mis-diagnoses a child.

Paul Organ, M.D., child and adolescent psychiatrist, believes, more often than not, hyperactive children, if nurtured in the right environment, need not be medicated. "Most of the times we are using medication to basically calm down a child who could be managed with the right type of adult giving the right type of supervision and discipline," he said.

He believes much can be learned from a comparison with children of earlier generations and children of today:

"A hundred years ago, if you were on a farm somewhere, if you had a boy who was up early in the morning, gave him a whole bunch of chores to do and then he could go play all day and run outside, come home at night, do more chores and get up the next morning, that would be the perfect kid to have. But in 1999, we want that same boy to get up, sit on a bus for twenty to forty minutes, go to school, sit at a desk...wanting to go outside but he has to sit inside for two hours Œtil recess, and listen to the teacher who is probably boring to him. My gut feeling is that these kids operate with a higher energy level and that we do not, as a society and in the schools in particular, provide the type of environment to channel their energy in a way that helps them learn."

"They just don't like class because the teacher is boring," he offered. "One of my favorite quotes is from a seven-year-old black kid who told me, ŒDoctor Organ, this isnıt my problem. this is the teacherıs problem.ı

"Many kids especially blacks are in single-mother households but I cannot think of more than ten cases in ten years where a boy with ADD is brought in to see me, and put on medication, who had a dad in the home. You almost never see it and, if it is, the kid has some brain damage, a head injury or something. Because part of it is if there are two parents in the home, the parents can take turns dealing with the kidıs hyperactivity. These boys do have a lot of energy and they'll burn out one parent."

The group concluded that school officials must defer to physicians, noting the government should help create more African-American physicians to handle the heavy case load.

(Tomlinson P. Schools are replacing physicians in diagnosing ADHD. Medical Herald 1999; 10(2):1, 28)

COMMENT: I've included this "unscientific" piece of journalism because it reflects an important perspective form the National Medical Association which represents the majority of African-American physicians. School nurses should be knowledgeable about this point of view when dealing with possible ADHD in minority students.