Evaluation of the Child or Adolescent Who is Not Paying Attention


Jason isn’t paying attention in class.  Does he have ADHD?  Maybe he does; maybe he doesn’t.  Maybe he’s bored.  Maybe he’s gifted.  Maybe he is depressed. Maybe he is sleep-deprived, perhaps because he stays up past midnight playing his video games.  All these conditions can mimic ADHD.  Jason certainly has a deficit of attention; but many deficits of attention are due to conditions other than ADHD.  In particular, sleep deprivation can mimic the symptoms of ADHD almost perfectly. And the medications most commonly prescribed for ADHD – medications such as Adderall, Concerta, Metadate, and Vyvanse – are powerful stimulants. They will compensate for the sleep deprivation. They may “work” very well. Many parents, indeed many practitioners, will misinterpret the response to medication.

The Adderall which was prescribed for Justin’s ADHD has really helped. Therefore Justin must have ADHD, right?

Not so. An “empiric trial of medication” may be misleading, because the medications most often prescribed may benefit normal children as much or more than they benefit kids with ADHD, especially if the “normal” kid is sleep-deprived.  (See my scholarly paper for Annals of Family Medicine on the diagnosis of ADHD, my interview on CNN on the over-diagnosis of ADHD,  my invited comment for the New York Times on this topic, my essay for Psychology Today on this topic, and chapter 4 from my book Boys Adrift.) We also separately consider how to identify the teenager who is pretending to have ADHD but who is seeking a prescription for stimulant medications to use for reasons which the practitioner would not approve, e.g. as an aid to personal weight loss, or to sell to peers.

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