ADHD or Something Else?
Is It Really ADHD?
Each year, thousands of children are unnecessarily medicated for ADHD, as symptoms are commonly confused with other disorders. Three types of disorders are frequently misdiagnosed as ADD/ADHD: sensory processing disorder, visual disorders, and auditory processing disorder.
Below is specific information related to these disorders.
Sensory Processing Disorder
Children with sensory processing disorder (especially sensory cravers, a sub-type of sensory modulation disorder) are often misdiagnosed with ADHD due to their constant hyperactivity, difficulty sustaining attention, and impulsive behavior. Dr. Lucy J. Miller’s research has indicated that ADHD and SPD can either co-exist or occur independently in children (Miller 2014). Dr. Miller’s research suggests that 40% of children with SPD also have ADHD. Research shows that these children may benefit from any combination of diet intervention, supplementation with high EFA fish oil, less screen time, more aerobic exercise, occupational therapy, and at last resort medications.
Whereas the symptoms of these two disorders are very similar, the brain features associated with the disorders are significantly different.
A sensory craving child’s symptoms reflect an under-registering vestibular and proprioceptive system with an overall high arousal level in the brain. In other words, the child’s nervous system is missing some vital sensory information that results in an over-aroused brain craving sensations. In the case of children with ADHD, studies have shown that their brains may be less active than typical children reflecting under-arousal. (Cortese 2012).
Children with vision impairments often demonstrate the same symptoms as children with ADHD as evidenced by recent studies (DeCarlo, Bowman, Monroe, Kline, McGwin, Owsley 2014, Granet 2005). Often, children with eye movement, focusing, and eye-teaming dysfunctions are unfairly accused of “not paying attention” or “being lazy learners.” These children will be highly distractible with short attention spans, as their attention is diverted to their surroundings instead of on a book or other target. One eye-teaming disorder called Convergence Insufficiency is frequently misdiagnosed as ADD/ADHD. In order for the eyes to work in tandem, they must be able to turn inward to focus on close images as during coloring, reading printed text, using computer screens, playing handheld video games, or writing. The inward focusing ability of the eyes is called convergence. Convergence Insufficiency results when the eyes do not turn inward enough to focus on close images. The inability of the two eyes to turn toward each other, or converge, causes reduced near point (close-up) visual attention. Because the child must expend considerable effort to compensate for her Convergence Insufficiency, she will experience a shortened visual attention span, exhibit avoidance behaviors, or pay less attention to visual processing (Margolis 2009). The reduced attention span is what causes a misdiagnosis of ADD/ADHD so often.
The connection between eye-teaming problems and attention-deficit disorder has been documented by Dr. David B. Granet, a pediatric ophthalmologist and director of the Ratner Children’s Eye Center of the University of California in San Diego. Dr. Granet’s research found that children diagnosed with ADHD were three times more likely to have Convergence Insufficiency than children in the rest of the population (Granet 2005).
Auditory Processing Disorder
Children with auditory processing disorder will pass a standard hearing test easily, and parents are left to categorize their problems as “behavioral.” Hearing is more complicated than what can be detected by a simple hearing test administered by your child’s school. The school auditory screening confirms whether a child is able to detect the presence of pure tones of sound, which is called peripheral hearing. Individuals with peripheral hearing loss sustain damage to the organs or nerve responsible for transmitting auditory information to the brain, as is the case with deaf people. Children with auditory processing disorder do not have damage to auditory organs or the auditory nerve. Instead, these children cannot process auditory information efficiently in the brain which leads to difficulty recognizing and interpreting sounds, especially those of speech. The diagnosis with which children with auditory processing disorder are most frequently mislabeled is ADHD. Individuals’ with ADHD may well be poor listeners and have difficulty understanding or remembering verbal information; however, their neural processing of auditory input in the central nervous system is intact. Instead, it is the attention deficit that is impeding their ability to access or use the auditory information that is coming in (Bellis).
Treatment appropriate for an ADHD child will not be effective for a child suffering from auditory processing issues, who needs to develop specific auditory skills.
Given the high risk of misdiagnosis, it would be prudent for parents to have their child screened by an occupational therapist for sensory processing disorder, a developmental optometrist for vision disorders, and an audiologist for auditory processing disorder should the child receive a diagnosis of ADHD. Then, and only then, can parents be certain that it really is ADHD.
References: 1. Miller, Lucy J. Sensational Kids: Hope and Help for Children with Sensory Processing Disorder. 2nd ed. New York: Penguin Group, 2014.
2. Cortese, Samuele. “The Neurobiology and Genetics of Attention-Deficit/Hyperactivity Disorder (ADHD): What Every Clinician Should Know.” European Journal of Paediatric Neurology 16 no.5 (September 2012): 422-33.
3. DeCarlo, Dawn K., Ellen Bowman, Cara Monroe, Robert Kline, Gerald McGwin, Jr., and Cynthia Owsley. “Prevalence of attention-deficit/hyperactivity disorder among children with vision impairment.” Journal of American Association for Pediatric Opthalmology and Strabismus 18 no. 1 (2014): 10-4.
4. Margolis, Neil. (Developmental Optometrist and Owner of Lederer and Margolis), in discussion, September, 2009.
5. Granet, David B. “The Relationship between Convergence Insufficiency and ADHD.” Strabismus 13 no.4 (December 2005): 163-68.
Written by the author of The Sensory Processing Anthology: A Comprehensive Guide for Parents and Caregivers of Sensational Kids available on Amazon.com, BarnesandNoble.com, and in select bookstores.
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