Brian, a pensioner now, has one leg clearly shorter than the other, the result of childhood tuberculosis. He wears a special shoe that makes his legs the same length as they hit the ground -- which facilitates a fully mobile life. Without it, he would be unable to enjoy life to the fullest. People may notice the raised shoe, but they are less likely to notice his disability.
What has this to do with ADHD?
We know that ADHD is a disorder (probably) caused by differences in two genes, one that supports the uptake of important chemicals in the synaptic gap, and one that creates those chemicals. Deficits in one alone lead to ADHD; deficits in both lead to ADHD with more severe symptoms.
We don't yet have a straightforward biological test for ADHD. No blood test, urine test or saliva swab, yet. Fortunately, diagnostic criteria, such as DSM V, can provide a set of defining statements for clinical staff to evaluate behavior. From there, they can diagnose ADHD when appropriate. But the diagnosis is subjective; frankly, too often, it is worryingly poorly administered.
Back to Brian. It's a clinical fact that his left leg is dramatically shorter than his right. His doctors didn't assess the difference from a far, looking at him without science. They measured, and measured again. When accurate measurements were taken, they made recommendations for the height and nature of the foot riser he needed to adopt a full, normalized life.
Perhaps now you can see the emerging parallel?
There is Science to Evaluate Treatment Effectiveness
As our understanding of ADHD has grown, clinical practice has similarly expanded, though not as consistently or completely as we could hope. In a recent conference I asked the audience, 100+ clinicians, how many of them diagnose ADHD by looking at a combination of behavioral questionnaires (from school, parents or direct observation) and brief analysis? Most raised a hand.
Then I asked how many of them diagnose ADHD by using an approved rating scale to assess behavior? Hardly any raised a hand. Some hadn't even heard of rating scales. In effect, less than one third of the clinicians in the room use a tool to decide the nature, prevalence and severity of the ADHD they were diagnosing. If that is the case, are they providing the best ADHD treatment for kids?
Goal: Remission from Symptoms of ADHD
Once a program for treatment of ADHD is determined, a high number of clinicians I work with appear content to see improvement in an ADHD sufferer's behavior as the goal for treatment. Let me be clear, and encourage parents to be clear: improvement isn't enough. Remission from symptoms has to be the goal in ADHD treatment.
The World Health Organization has taken the time to test, re-test and approve the ADHD Rating Scale (version 4). This easy to use tool gives clinicians a way to identify when a patient reaches a diagnostic behaviour level that can be determined as ADHD. This gives a benchmark ‘score' for the patient, from which improvement can be tracked by re-testing, using the same tool. This gives a more objective set of data for clinical teams to determine improvement.
But, and this is an important but, this tool also has a defined level. A score of 18 defines ADHD: ‘yes' or ‘no'. Therefore, the goal could be, I would suggest should be, to get the patient legitimately below that score, and thus in behavioral remission from ADHD.
If your clinician isn't using a rating scale for assessment and diagnosis, I believe we should be asking ‘why not'? After all, parents and guardians, friends and family members work hard to support the person with ADHD symptoms; the sufferers themselves deal with the stigma, the difficulties and the solitude the disorder can bring.
Thankfully Brian is in a position where both of his legs now function as if they were the same length. One leg is shorter than the other, that's a fact. With accurate treatment, he walks, laughs and enjoys mobility.
Three Questions to Ask to Get the Best ADHD Treatment for Kids
Your children may well always have ADHD. Let's not settle for their legs being nearly the same length. Lets strive for both legs functioning at the same length. Let's push clinicians for remission in ADHD.
There are three simple questions to politely ask the clinical staff:
- ‘Which rating scale do you use to assess ADHD?'
- ‘How will you know when (my child) is in remission clinically?'
- ‘What confidence can you give me that you are taking all possible measures to make sure that (my child) is as well as possible?'