Dear Director,
Our 8-year-old adopted daughter is doing a terrible job of following directions and staying on task at school. Her pediatrician is convinced it must be ADHD and wants to put her on meds for that, but I am
concerned because what if that’s not the problem? We adopted her when she was 2 and she unfortunately did experience physical abuse and severe neglect before she came to live with us. I have heard that trauma can look like ADHD, and I want to make sure this is what’s going on before we give her any medicine. Please advise.
Very truly yours, Confused
Dear Confused,
You are right to be concerned about getting the best diagnosis, so that the treatment of choice is clear. I mean, I love pediatricians, but they have to keep track of all those childhood diseases, all the developmental stuff, all the preventative parenting stuff, and the mental health-that’s a lot of pressure to do a really good mental health diagnosis.
And I am glad you are aware that many diagnosis have a symptom checklist that overlaps with lots of other diagnosis. Depression is often seen as irritability and poor focus, anxiety looks like oppositional behaviors-not following directions-and poor focus, PTSD looks like irritability, poor focus on schoolwork but hyper-focus on other things and sadness, Disruptive Mood Dysregulation Disorder has the irritability, the hyper-vigilance, and these long tantrums, and ADHD looks like all of that.
The real question is what else is going on that might help you, the pediatrician, and a psychiatrist, when you see one, to tease out the proper diagnosis and therefore the proper plan of treatment. What else are you, the parent, seeing, and when? And I mean the basics, like patterns of sleeping, eating, when is her mood good and when does she struggle? Is she off task all the time or in the morning or the afternoon or when she has to do math? Does she follow directions for people she knows well and feels safe with and not others-the substitute or the teacher she sees once a cycle?
That might help you separate out ADHD from a learning issue or anxiety related to new situations when she doesn’t feel safe, and so on. I knew a kid, four, got kicked out of three preschools for punching other kids before someone figured out he couldn’t cut with scissors, so instead he just punched his neighbor. Not ADHD, he needed OT to help him strengthen those arm muscles. I knew another kid who ran around the classroom disrupting other kids whenever he had desk work to do. He was two grades ahead in reading, and once he finished his work, he got bored. He got the go-ahead to have a book at all times at his desk and permission to read it as soon as he was done with assignments. Scary and adventure books worked best, he would rather read than anything else.
So knowing when the problem arises, what happened before and what else was going on might help you help the pediatrician properly diagnose the issue. Trust me, a child with PTSD or anxiety will not do well on typical ADHD meds, but why put your daughter through that? Get a notebook and start tracking things, and then share the evidence with people who can help guide all of you to her best self.
Best, The Director
