Dr Puhalla’s - 12 Areas to explore before you make the diagnosis of ADHD
What it isn’t! It is not the core symptoms of ADHD , Hyperactivity, Impulsivity, and Distractibility [HID] caused by other problems or disorders. If you say yes to the following questions or problem areas, it is likely you are not dealing with ADHD but with another problem or disorder, or perhaps two disorders. When the primary problem is addressed or treated the HID gets better or goes away, and if not there may also be ADHD that needs its own separate treatment.
1.Unstable Mood? Is there excessive violence, destructiveness, aggression or persistent irritability, anger , rage, with mood shifts? Think of an unstable mood problem, in the Bipolar Spectrum
2.Too much worry? Is there excessive worry, fear, avoidance , or psychosomatic symptoms like headaches, irritable bowel, in a keyed up, on edge, restless fearful person? Think of an anxiety or “worry” disorder.
3.Twitches and sounds? Are there extra motor movements like muscle twitches called tics, or involuntary sounds like coughing, throat clearing, or repeating the last thing said or done? Think of a tic like disorder like Tourette’s.
4.Unusual relatedness? Poor emotional give and take, oddness, peculiarities, with a history of gaining and losing developmental milestones such language and mastered fears? Think of something in the Asperser’s-Autistic Spectrum.
5.Illogicalness? Unusual, illogical, strange thinking or behavior, problems knowing what is real or not, too suspicious? Think of a thinking problem in Schizophrenic Spectrum , which could be very mild, yet extremely significant.
6.Sad moods? Or not caring attitude, less and less pleasure out of life in a restless, pre occupied agitated person? Then think stable but agitated Unipolar depression?
7.Medications, drugs or alcohol, physical toxins? Is the person in treatment for anything or “using” ? Anything being put into or on your body may cause HID ? Exposed to physical toxins like lead, gasoline, inhalants or anything else?
8.Medical-surgical problems? Like diabetes, thyroid illness, sleep apnea, seizures, infections or fevers?
9.“ Environmental Toxic exposures”? From environmental stress or other “toxins”, being neglected, abused, in a war like zone in the community or at home, environment overly structured or under structured, or un-thought of “every day toxins” like too much stimulation from electronic media, like video games, caffeine, energy drinks and lack of sleep, too much “stimulating” wake time? Any short or long term Adjustment stresses and issues, including Bereavement?
10.Other Non brain chemistry, hard wired “ brain ” problems? Like a learning problem, intelligence too high or low, “mind-brain sensitivities” to things like noise, lights, pain, other perceptions, where there may be a “mis-match” or brain function to the environment or situation.
11. Mind-Psychology problems? “Mind over Chemistry” problems like Personality issues [ disturbed conduct, defiance, willfulness, cultural factors, the “non-compliant” person?], or powerful mind states, or mental mechanisms or temperament causing HID? Think therapy, counseling, education and behavior treatments before medications.
12. No psychiatric-medical-“mind” diagnosis or problem? “Faking it”, malingering, feigning, other secondary gain?
In summary: What ADHD is! The person that has only uncomplicated classical ADHD should have none of the above. It is relatively free of any serious disturbance or mood, behavior or thinking, the anger tends to be short lived, not going on for more than 15 minutes, they are fearless not fearful or worried, they relate normally, and there is nothing odd or strange about their behavior, speech or thinking, they care about and enjoy life, don’t seem unhappy or depressed, and there are no abnormal physical movements or sounds. Medical problems, medications, drugs-alcohol, environmental factors, non brain chemistry mind problems have been ruled in or out, and have been treated or addressed.