Differential Diagnosis

One of the first steps in diagnosing a child or adolescent with AD/HD is to check for other medical and/or psychiatric illnesses so that a differential diagnosis can be reached.

This evaluation, which should be a comprehensive one, may include laboratory, physiologic, radiologic, and psychological testing. If the child is found to have a primary diagnosis of AD/HD and a comorbid medical or psychiatric disorder, her or his treatment plan should fully address both conditions. In this way, children have the opportunity to succeed at school, have satisfactory relationships with their peers and lead balanced lives as adults.

While these criteria seem straightforward enough, parents should be aware that during the diagnostic procedure, it can often happen that the secondary comorbid disorder may not be identified immediately, or the child may be diagnosed and treated for the secondary condition while the primary AD/HD diagnosis is not is overlooked.

A child who is diagnosed with AD/HD and Oppositional Defiant Disorder (ODD) for example, may be prescribed medication for his or her AD/HD symptoms, but the physician may not make any further recommendations, such as referring the child to a therapist specializing in Cognitive Behavioural Therapy (CBT) for the ODD symptoms. Should this happen, it is up to the parent to find the best CBT therapist for the child immediately so that an improvement is seen in this area too.

While stimulant medication, such as Rilatine and Concerta, the two types available in Belgium, bring significant results as regards improving the child’s ability to concentrate and stay on task, they do not bring about an improvement in the ODD symptoms, other than in a secondary way; when the child is able to fully concentrate, s/he will be less likely to be oppositional or aggressive with other students, with the teacher or with parents and siblings.

Another example of this would be as follows: if a child is diagnosed with Anxiety Disorder and is treated only for this condition, his or her concentration levels may improve somewhat, but if the primary disorder is AD/HD, s/he will still continue to present with symptoms that have not been properly addressed. In other words, treating a child for Anxiety Disorder when the primary condition is AD/HD will not bring about an improvement in the child’s situation, either for the Anxiety symptoms or the AD/HD symptoms.

It is best to make sure that the diagnosing physician you first seek out is knowledgeable about AD/HD and has a lot of experience diagnosing the condition, which includes being very familiar with co-morbid conditions that can co-exist with AD/HD, so that a differential diagnosis can be reached at the first point of medical contact. In this way, you will avoid difficult situations afterwards as you try out new physicians and treatment options to help your increasingly belligerent and frustrated child or adolescent. Children and adolescents become weary of trying out different physicians, therapists, medications and treatment options if they are not seeing any improvement in their symptoms – to the point of not wanting to be treated or “fixed” anymore. These are the adolescents who exhibit “at risk” behaviours and attitudes later on.


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