My child is inattentive, impulsive, and physically restless. Does that mean that he has Attention-Deficit/Hyperactivity Disorder (AD/HD)?

My child is irritable a good deal of time and often loses his temper. Does that mean he has Bipolar Disorder?

These days, it seems like lots of children have been labeled with one or more of these diagnoses, or perhaps with one or more of the many other diagnostic conditions that can occur in childhood. In addition to those already mentioned, children can have Conduct Disorder, Anxiety Disorders, Post Traumatic Stress Disorder, Eating Disorders, Autism and other Pervasive Developmental Disorders, as well as Learning Disabilities. If a child truly has significant behavioral, emotional, learning, or psychiatric difficulties, then it is very important for that child’s parents, teachers, and other caretakers to bring them to professional attention in order to determine:

1. Which problem or problems are present, and

2. How best to treat those difficulties both at home and school.

Although many of the things that children do can be bothersome to parents and teachers, most of these things are considered to be a normal expression of childhood and therefore not in need of professional attention. So how do you know when a child really does have a problem and therefore needs to be evaluated and receiving treatment? The answer to this question is by no means easy or simple. But there are some things that parents should keep in mind that can help them determine whether or not to seek out professional assistance for their child.

First of all, it is important for parents to understand that having one or more symptoms of a disorder does not necessarily mean that you have that disorder. As noted above, this is because many such symptoms can be found in just about any child. For example, all children at times can be inattentive, hyperactive, noncompliant, sad, anxious, or fearful. So it is not so much that a symptom is present or absent that determines whether a diagnosable condition is present. Instead, what determines this is:

• how many symptoms of the disorder are present,

• how often such symptoms are occurring,

• the degree to which these symptoms are different from what is expected of children of the same age and gender, and

• how much these symptoms interfere with the child’s daily life.

An example from the field of AD/HD is a useful way to illustrate each of these points. Let’s say, for example, that a 10-year-old boy has a hard time paying attention to his math teacher, but seems to pay attention just fine to his parents and to other teachers, and never shows any signs of being impulsive or overactive. Although being inattentive in that particular class may make it difficult for him to get a good math grade, that symptom alone would be insufficient for concluding that he has AD/HD.

Even if he displayed several symptoms of being inattentive - such as not listening, not finishing things, being easily distracted, and losing things - he would still not qualify for a diagnosis of AD/HD if such symptoms occurred only once or twice each week, or appeared for only a few months at a time.

If his problems were worse, such that he was displaying a number of inattention symptoms and these symptoms were occurring on a daily basis, a diagnosis of AD/HD might still be inappropriate. This is because it would remain necessary to determine if his symptoms were significantly deviant from what is expected of 10-year-old boys in general. As we have learned from the field of developmental psychology, young children are less capable of paying attention than are older children, and this needs to be taken into account when assessing a particular child for AD/HD.

Above and beyond addressing the child’s symptoms in these ways, it is also necessary to determine if these symptoms are significantly interfering with the child’s daily life. At a minimum there needs to be clear evidence of what is often termed functional impairment. For example, if the 10-year-old boy’s attention span difficulties seem to be contributing directly to his problems finishing homework or in-class assignments, and this in turn is making it difficult for him to do as well on assignments and tests as his classmates, then this would provide strong evidence pointing towards the presence of an AD/HD diagnosis being present. Among his peers, signs of functional impairment might be evident in terms of the boy experiencing far more difficulty making and keeping friends than do most children. Additional functional impairment might occur within the home, evidenced by extremely high levels of stress and strain that the boy’s parents experience in raising him.

Although a diagnosis of AD/HD was used in the above example, the same principles apply to determining the presence or absence of Major Depression, Bipolar Disorder, and other behavioral, emotional, psychiatric, and learning conditions that can affect children. Thus, to help parents decide whether or not to seek professional attention for their child, they should first ask themselves if they have reason to believe that their child is not functioning as well as most other children, whether it is in school, at home, or among peers. If the answer to this question is yes, there may be a diagnosable condition responsible for this situation. And if there is, then it is very important for parents, educators, and other caretakers to seek out professional advice in order to clarify what problem or problems are present and how they should be treated. With proper treatment, the child’s symptoms can be reduced and significant improvements in daily functioning can be made. When this occurs, this benefits not only the child, but also the child’s parents and everyone else who plays an important role in his/her life.

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