Attention Deficit Disorder and Learning Disorders

Attention and learning disorders in children are very common
problems. Primary care pediatricians should be the ones to make the
diagnosis and do the treatment in the majority of children. You do not need a specialist in developmental/behavioral pediatrics to treat most kids or diagnose most kids with ADHD.
ADHD and the new DSM IV criteria. ADHD is defined as a persistent, that is more than 6 month cluster of behaviors. It's a behavioral cluster that has to have been going on for awhile - it can't just have started last week or last month. The behaviors are more frequent and more severe than most children at a comparable developmental level. This is very subjective, and part of the whole problem with diagnosing ADHD is there is no one way to make the diagnosis. There is no specific test. It is defined as behavior that is just more frequent and more severe than most children at a comparable level. It has to begin before seven years of age. It is not something that begins later on.
Most importantly, it has to be manifested in two or more settings: school or work and home. If you just have these behaviors occurring in one setting only, that is not ADHD. If it is only at home and not at school, it is not ADHD. If it is only at school and not at home, that is not ADHD. You should be thinking of other parts of your differential diagnosis. So, ADHD has to occur in at least two or more settings.
Finally to make the diagnosis, it has to cause clinically significant dysfunction in the social, academic, occupational, or family setting. There are some kids you'll see, that you will say to yourself, "this kid has ADHD. He's wild." But, he's doing great. He has friends. He's doing well in school. The school has adapted to him. The family has
adapted to him. You might not make the diagnosis in that child because there is not a clinically significant dysfunction. With the same
child in another setting who has a lot of problems in school and at home, you might make the diagnosis. So the diagnosis of ADHD is tough because there are these subjective features. And even among
experts, so-called experts, people will disagree with the diagnosis.
careless mistakes in school work, work outside the home, or in other activities. They often have difficulty sustaining attention in tasks or
play activities. What is important is sustaining attention when it is not easy to sustain attention, when it takes a little more effort, that is when ADHD shows up. The parents say, "He can play Nintendo for two
hours." and therefore he doesn't have ADHD. But that is not true.
The DSM IV criteria. For inattention, you have to have six or more of the following. One fails to give close attention to details or makes
careless mistakes in school work, work outside the home, or in other activities. They often have difficulty sustaining attention in tasks or
play activities. What is important is sustaining attention when it is not easy to sustain attention, when it takes a little more effort, that is when ADHD shows up. The parents say, "He can play Nintendo for two
hours." and therefore he doesn't have ADHD. But that is not true.
Because think of the kind of attention that it takes to play Nintendo. Whereas you have to pay attention to what's going on it is always changing. You are not sitting laboriously studying one thing or looking
at a number of things as you do in school. Does not seem to listen when spoken to directly.
Often does not follow through on instructions and fails to finish schoolwork, chores or duties in the workplace (not because of
oppositional behavior or inability to understand directions). He just can't get things done. Keeps trying a million projects, none of which get completed on time, if they get completed at all. Often has difficul-
ties organizing tasks and activities. And often avoids, dislikes or is
reluctant to engage in tasks that require sustained mental effort, such as schoolwork, homework.
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