According to researcher Allison S. Bell[1], ADHD is the most pervasive psychological disorder among children in their schooling years (Woo & Keatinge, 2008)[2], affecting many aspects of their functioning and development. If ADHD or ADD is one of the fastest growing diagnoses in children, it seems surrounded by a wave of controversy over increase diagnosis of young children. The sheer volumes of books contradicting themselves on the subject can leave a parent spinning in confusion. Let’s have a look at how ADHD is defined.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5), published by the American Psychiatric Association, is the guide that lays out the criteria to be used by doctors, mental health professionals, and other qualified clinicians when making a diagnosis of ADHD. In the DSM-5, ADHD is defined as a neurodevelopment disorder affecting both children and adults. It is described as a “persistent” or on-going pattern of inattention and/or hyperactivity-impulsivity that gets in the way of daily life or typical development Individuals with ADHD may also have difficulties with maintaining attention, executive function (or the brain’s ability to begin an activity, organize itself and manage tasks) and working memory.
According to DSM V[3], there are three presentations of ADHD: 1) Inattentive, 2) Hyperactive –Impulsive, 3) Combined inattentive & hyperactive – impulsive[4].
While these types of ADHD are the most often used by medical professionals for diagnosis, there are other definitions. For instance, in the book Healing ADD-The Breakthrough Program That Allows You to See and Heal the 7 Types of ADHD, psychiatrist Daniel Amen, outlines seven different types of ADHD. Through his practice, Dr Amen began using SPECT imaging and realized that different areas of the brain can trigger ADHD behaviors. Dr. Amen views ADHD not as one disorder but as a “cluster of symptoms”[5] associated with different causes. Another professional correlates this position.
In the professional experience of Dr. Lawrence Wilson, MD, ADD and ADHD are not a single disorder, but rather are symptoms with many possible causes:
“The causes can be divided into those from outside a person, and those from within. Outside influences include factors such as the family, home and school environments.
Internal causes include structural, biochemical, congenital, genetic or other bodily imbalances. Factors such as nutrition and brain chemistry are often overlooked. In addition to vital nutrient deficiencies, toxic metal excesses, hypoglycemia, chronic yeast infection, central nervous system allergies, this article discusses the effects of stimulants in the diet, congenital imbalances, the effects of medications, and a faster-than-normal metabolic rate. “[6]
Interestingly, these medical professionals consider that treatments must be based on lifestyle changes, nutrition and food supplements. Amen recommends ADHD medication only as a last resort, believing medication “can help some people, but can also make some people worse. “[7]. Dr Wilson believes nutrition and lifestyle changes should replace medication treatment.
If these approaches are not embraced by the medical community, they are enough to suggest that other roots can be causing attention issues in children. The overarching umbrella of ADHD may indeed cover too many symptoms that could be caused by other issues such as sensory processing abilities. Interestingly, the same controversy is appearing in the autism epidemic.
According to the website autismspeaks.com[8], autism spectrum disorder (ASD) and autism are both general terms for a group of complex disorders of brain development. With the May 2013 publication of the DSM-5 diagnostic manual, all autism disorders were merged into one umbrella diagnosis of ASD. Previously, they were recognized as distinct subtypes, including autistic disorder, childhood disintegrative disorder, pervasive developmental disorder-not otherwise specified (PDD-NOS) and Asperger syndrome.
Slowly, an increased number of symptoms, including sensory processing differences, are being combined into the same diagnosis. This can lead to a misdiagnosis trap. As Dr Enrico Gnaulati explains in this book “Back to Normal: Why Ordinary Childhood Behavior Is Mistaken for ADHD, Bipolar Disorder, and Autism Spectrum Disorder”, defining autism as a “spectrum disorder,” means that Autism now incorporates mild and severe cases of problematic social communication and interaction, as well as restricted interests and behavior. In its milder form, it can be difficult to distinguish between early signs of autism spectrum disorder and other causes. [9]
While there is no doubt that autism does exist, Michael Goldberg, in his book, “The Myth of Autism: How a Misunderstood Epidemic is Destroying Our Children”, asserts that thousands of children are being mislabeled when what is actually affecting them is a compromised immune system due to a viral infection-often caused by receiving too many inoculations at the same time or while the child already had an overextended immune system due to illness as well as allergy induced diets.[10]Goldberg considers these conditions to be physical conditions that can be treated through proper medication and diet, and not genetic or psychosemantic ailments.
For a parent with a child who has sensory processing sensitivities, the broad spectrum of sensory processing symptoms incorporated into the ADHD and autism diagnoses pose a serious problem.
In order to help these children thrive by avoiding damaging misdiagnoses, parents, educators and caregivers must learn to listen to them and to be aware of what sensory integration sensitivity means. This is essential as sensory processing sensitivity takes different form in every person. Listening is not the simple act of hearing their words, but also to learn to observe these children and understand what motivates their actions. The first step in this deep listening is to understand what sensory processing means.
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Bibliography
[1]Bell, A.S (2010). A Critical Review of ADHD Diagnostic Criteria: What to Address in the DSM-V. Journal of Attention Disorders OnlineFirst, published on April 23, 2010. XX(X) 1–8. SAGE Publications
[2]Woo, S. M., & Keatinge, C. (2008). Diagnosis and treatment of mental disorders across the lifespan. Hoboken, NJ: John Wiley & Sons
[3]American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (DSM-5), Washington, D.C.: American Psychiatric Association
[4] ADHD, Combined Type (combined inattentive, hyperactive, and impulsive). People with combined ADHD show characteristics of all three symptoms. This is the most common type of ADHD. Criteria include the inability to pay attention to activities and instructions, difficulty listening and staying organized, and being forgetful and often losing things. Other criteria are impulsive behaviors like speaking out inappropriately, interrupting others, talking excessively, the inability to sit still, and fidgeting.
ADHD, Predominantly Hyperactive-Impulsive Type. People with this type of ADHD show only symptoms of hyperactivity and impulsivity, but do not have problems with inattention. This is the least common type of ADHD. Criteria include hyperactive behaviors like being overly active physically (can’t sit still, always running around), talking excessively, frequent fidgeting, and impulsive behaviors like the inability to wait their turn, speaking out inappropriately, and interrupting others’ conversations or activities.
ADHD, Predominantly Inattentive Type (formerly called ADD or attention deficit disorder). People with this type of ADHD don’t have any symptoms of impulsive or hyperactive behaviors, but have difficulty paying attention. This is the most common type of ADHD in girls. Criteria are limited to symptoms of inattention, like carelessness and forgetfulness in daily activities, disorganization, not listening, and difficulty following instructions or completing activities.
[5] Types of ADHD: Amen’s Types:
Type 1 – Classic ADD. This type includes symptoms of inattention, impulsivity, hyperactivity, and restlessness.
Type 2 – Inattentive ADD. Characteristics include inattention, acting “spacey,” laziness, seeming lack of intelligence, lack of motivation, and unenergetic. This type tends to be diagnosed in older children or adults, and most often in girls.
Type 3 – Overfocused ADD. Symptoms include inattention, frequent worrying, difficulty changing attention to another task, obsession with negative behaviors and thinking, resistance to change, and frequent arguing.
Type 4 – Temporal Lobe ADD. People with this type are often quick tempered, have anxiety, show physical symptoms like stomach pain or headaches, and have difficulty remembering things. People with type 4 also tend to experience trouble reading.
Type 5 – Limbic ADD. Includes symptoms of inattention, as well as signs of depression like insomnia, lack of appetite, problems with self-esteem, lack of energy, and frequent sadness. People with type 5 also tend to be socially isolated.
Type 6 – Ring of Fire ADD. Characteristics include symptoms of inattention, anger and temper problems, talking a lot, sensitivity to lights and sounds, and being resistant to change.
Type 7 – Anxious ADD. Characteristics include inattentiveness, distractability, disorganization, anxiety, tension, nervousness, a tendency to predict the worst, freezing in test taking situations, and a tendency toward social anxiety. People with this type are prone to experience the physical symptoms of stress, such as headaches and gastrointestinal problems.
[6]Wilson, Laurence (2009).Attention Deficit and Hyperactivity Disorders. Retrieved from: http://drlwilson.com/articles/attention_deficit.htm
[7]http://www.healthcentral.com/adhd/c/1443/135240/dr-amen-types-adhd/#sthash.Sy5nFkZu.dpuf
[8] http://www.autismspeaks.org/what-autism
[9] Gnaulati, Enrico (2013). Back to Normal: Why Ordinary Childhood Behavior Is Mistaken for ADHD, Bipolar Disorder, and Autism Spectrum Disorder.Beacon Press.
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