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Q: Am I in denial, or this behavior is not an ADHD?

I hesitate to take our son to a doctor specializing in ADHD for fear that he may fit the mold and be diagnosed with something he may not have. He is fidgety at home, and we do have to remind him to do something we've asked him to do...but we have to do that with our other children also. He is not at all defiant; he is a very loving, sweet, considerate little boy. At school they say he won't stay seated and that he has difficulty staying on task. We don't see that at home. He sits through 3 hours of church on Sunday without a problem. We have observed that all three children get overly hyper around new people and that they all tend to see what they can get away with when they are babysat, etc. His reading teacher at school says he climbs all over the chair and is constantly in a hurry. When we sit down to read to him, we see nothing like this. He loves to read and is very excited when he is able to read a difficult word and often grabs me and hugs me and kisses me on the cheek when he gets one right, but other than that we have no climbing or off-task behavior. Again, we don't deny he has some traits...but we feel they developed from his earlier childhood. And he is still emotionally younger than his age, as well as the fact that he had no discipline or structure up until we adopted him a month shy of his 6th birthday. The school is pressing for us to have him professionally evaluated and put on medication. We are leery about the medication part of it. He has progressed in his behavior to being sent to the vice-principal. I'm told that with the next occurrence, he will be suspended for 1 day. Now, this is not defiant behavior, bullying, stealing, hitting or hurting someone at school. His behavior issues are strictly that he gets out of his seat and talks out of turn. I'm going to sit in on class this week and see what really happens. Although this would be annoying behavior...I can't imagine suspending a child for a day because of it. I know the school thinks we're in denial but they have had no experience with IA children and I just could not seem to make them understand there may be other issues involved.

A: You are concerned about school's personnel jumping to the conclusion that your son has ADHD and will be put on medication unnecessarily. It is certainly a valid concern. Your son's behavioral problems in school may be caused by a variety of factors that might or might not include an attention deficit or hyperactivity. I think that it is important to have an evaluation done by a developmental psychologist or pediatrician. They will provide questionnaires both for the parents and the teacher, which will be part of the input for the evaluation. Before the diagnosis of ADHD can be properly made, there needs to be evidence that some of the behaviors occur in at least two different environments (e.g., school and home). There are also computer-assisted tests that can help compare the child's attention span and impulsivity against established norms. If your son's issues in school stem from some other source, such as learning disabilities or difficulties with social adjustment, they also need to be identified as soon as possible.
My experience is that many of the hyperactive and disorganized behaviors that we see in post-orphanage children have been developing differently than they do in general population. One thing that most internationally adopted children have in common is a total lack of experience with emotions regulation. In normal development, caregivers respond to infants' distress and assist them in the management of negative emotions. Language also plays critical role in development of self-regulation, because it allows children to gain control over their feelings and helps them inhibit impulsive responding and behave in a more organized way. I would recommend including a social-emotional learning component and language treatment into the remedial plan for your child.



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Last update on May 8, 2018