Opinion: ADHD children face challenges

The Norwalk Board of Education on Oct. 3 voted to recognize October as National ADHD Awareness Month. This is the Board’s statement.

The Norwalk Board of Education recognizes October as National ADHD Awareness Month to bring awareness to the issues surrounding Attention Deficit and Hyperactivity Disorder.

ADHD is one of the most common neurodevelopmental disorders of childhood. It is usually first diagnosed in childhood and often lasts into adult hood. The terms ADHD and ADD both refer to the same disorder, with the only difference being that some people have attention deficit and hyperactivity, while others do not.

ADHD affects people of every age, gender, IQ, and social-economic background. In 2011, the Centers for Disease Control and Prevention reported that the percentage of children in the United States who have ever been diagnosed with ADHD is now 9.5 percent, with boys being diagnosed two to three times as often as girls.

Diagnosing ADHD is a Complex Process as many of the symptoms look like extreme forms of normal behavior. Additionally, a number of other conditions resemble ADHD. What makes ADHD different from other conditions is that the symptoms are excessive, pervasive, and persistent. That is, behaviors are more extreme, show up in multiple settings, and continue showing up throughout life.

We know ADHD can create problems for students in school, at home, and with friends, and can impact the chances of a student succeeding. Children with ADHD may have trouble paying attention, controlling impulsive behaviors or be overly active. Children with ADHD are often faced with a number of simultaneous challenges, including anxiety, depression, sleep disorders and more.

The good news is that when children, teens, and adults are diagnosed early and receive treatment, they can lead more fulfilling lives.

By declaring this ADHD Awareness Month, the Board of Education encourages the community to reflect on this disorder and to seek out information that will help them to understand and appreciate the challenges that their fellow students are facing day in and day out.


An Observor October 15, 2017 at 8:52 am

So why has there NEVER been any Professional Development for NPS educators on ADHD, especially since girls are so often un- or misdiagnosed?

Donna Smirniotopoulos October 15, 2017 at 9:06 am

I wonder what kind of pressure the BOE was under that they felt forced to announce yet another thing people need to be aware of. For the record, October is also Breast Cancer Awareness month. I promise we are ALL aware of Breast Cancer. The NFL sells millions in pink apparel each October, and 1% of the proceeds go to breast cancer research.

In European countries, you do not see a diagnosis rate of 9% for ADD. There is a disease. It’s called childhood. Being a boy increases the risk of this “disease”. ADD has been overdiagnosed and overtreated. An ADD diagnosis can lead to ADA protections under section 504, translating to a lifetime of extra time on standardized tests. Also there is a brisk college market for the sale of Adderall to enhance academic performance. Adderall is an amphetamine. So it’s okay to put children on amphetamines but it’s not okay for 10 year old boys to talk out of turn in class. Adderall carries a risk of long term heart damage. I know a man diagnosed at 38 with congestive heart failure attributable to adderall use. ADHD Awareness Month should include time to reflect on the risks of overtreatement of a “disease” closely associated with boys behaving badly in the classroom.

An Observor October 15, 2017 at 4:48 pm

Actually, many European countripples are )much further along in their understanding of ADHD. For example, while in the United States there is still resistance to the idea that there are differences in ADHD between the genders, and Europe there are already guidelines on differential diagnosis. The idea that ADHD is a “American” disorder is simply inaccurate. There is research being done worldwide. If you look at the professional literature there are studies from Japan, India, in Korea and of course many European countries. There is also a great deal of work being done in Latin America. I suggest that you might want to do some research in the professional literature in scholarly, peer-reviewed journals before you make sweeping statements.

Donna Smirniotopoulos October 15, 2017 at 6:13 pm

I made a sweeping statement about over diagnosis and over treatment in the US relative to other countries which is anchored in meta data as there is no global consensus on ADHD. However the prevalence is greater in the US. I did not make a sweeping statement about where the research is being performed.

Kevin Kane October 15, 2017 at 8:49 pm

Going through the alphabet soup of “diagnosis” for ADD, ADHD, BPD..you name it, our experience is that in many cases anxiety is at the root of these “diagnosis”. Parents, educators and doctors can be a bit too quick to head for the medicine cabinet without taking time to truly help the child AND the parents work through the challenges.
As with any mental health issue, it is unbelievable how much good and bad information that is out there. With that in mind, I think that simply floating this out there, it gets lost in the shuffle. Specifically, did you know there are 117 National Month of ______ for October which is also National Toilet Tank Repair Month…https://nationaldaycalendar.com/october-monthly-observations/ ?
A better step would be for the school district or town to start a support group that meets regularly because I think this is both a serious issue but also, the kid growing up and needing to learn to follow rules and also, mom and dad not checking out and giving up their role as parents. A true tangled web of issues – some real, some bogus. Kevin Kane

An Observor October 15, 2017 at 9:04 pm

Actually, there is a global consensus, just as there is on climate change. There is also more or less the same level of discord in the scientific community, as opposed to the lay press.
Much of the misunderstanding stems from the words “hyperactivity” and “deficit,” which tend to lead to misunderstanding, with particularly devastating results for girls. ADHD is a best understood as a disregulation of attention, not a deficit. Since girls are far more likely to have the Inattentive type, and (for biological reasons) the onset comes later in life, many girls and women were undiagnosed, or misdiagnosed with a disorder brought on by living with undiagnosed ADHD. Don’t take my word for it, take a look at the studies in brain differences in the studies cited in “More brain differences seen between girls, boys with ADHD” in Science News, or “A Review of Attention-Deficit/Hyperactivity Disorder in Women and Girls: Uncovering This Hidden Diagnosis” in The Primary Care Companion for CNS Disorders, or the studies published by Babinski, et al and Hinshaw, et al. You might also be interested in the study by Veadrigo, et al,, “Gender Influence in Attention-deficit/hyperactivity Disorder Treatment: a Systematic Review” published in 2015 in the peer-reviewed journal European Psychiatry.
There are dozens, if not hundreds, of studies published in scholarly journals on every continent on ADHD; to my knowledge there are none disputing its existence except in the popular press. That’s why the best analogy is the climate change discussion. In the scientific community there is indeed a consensus.

Bob Welsh October 16, 2017 at 1:33 am

The conversations appearing under NON stories are often quite interesting, ranging from the profane to the profound. This discussion around ADHD is an example. A prior conversation in which several regular commenters displayed an impressive understanding of George Kennan felt like a Graduate-Level History Seminar.

Thank you to the commenters who make this digital town square more interesting!

Jeffry Spahr October 16, 2017 at 3:27 pm

The Board of Education was not pressured to make an announcement re: ADHD. They were asked to do so and they cooperated. I am not sure what Breast Cancer Awareness and the NFL has to do with recognizing ADHD in our schools. I do know that some quibble over the numbers — saying that “only” 7% of our children have ADHD instead of 11%.That still presents us with statistics that place a child with ADHD in everyone of our classrooms. ADHD is real. It is a fact. It can have devastating consequences. I have an adult sibling who has ADHD and a child with ADHD. They are real. They face real challenges. I would suggest that those who seek more information go to the CHADD website or to this link for more information: http://www.chadd.org/training-events/adhd-awareness-month.aspx The inappropriate transfer of medication is called ‘diversion’ and yes that happens. However, this fact does not take away from that fact that some kids need to take the medication. One of the hardest decisions that a parent has to make is to decide whether or not to place their child on medication. A good book on this is ‘Your Child in the Balance’ by Dr. Kalikow. There are many articles on this. A good source for information is also ADDitude magazine. I would strongly suggest checking in with CHADD as well.

Finally, thank you Nancy for running that article.

M. Jeffry Spahr
Member CHADD, Public Policy Committee, Editorial Advisory Board, and former National Secretary for CHADD.

Donna Smirniotopoulos October 16, 2017 at 8:23 pm

The are global variantions in rates of ADHD disagnosis. In addition there has been recently published research suggesting that ADHD is grossly overdiagnosed and many children are needlessly medicated. Certainly there are some children who benefit from medication and other treatment modalities. But the suggestion that there is broad consensus in the medical community or even in the neuroscience community is incorrect.

Take for example an editorial in the Journal of the American Medical Association Pediatrics, linked below (via an NPR article).


We arrive at a differential “diagnosis” of ADHD by asking 9 questions. If you answer YES to six of the 9, your child has ADHD. Dr. Dimitri Christakis, who wrote the editorial, suggests that there is a continuum of attentional behaviors and that some of the overdiagnosis in the US is attributable to the desire to qualify for services under section 504 of the ADA. Another factor affecting diagnosis is the diagnostic manual favored in the US (DSM IV) is not the one favored by the WHO, which uses the ICD 10, where the threshold for an ADHD diagnosis is higher.

If the BOE is declaring October ADHD awareness month, I hope the conversation is open to differing opinions, including some of the latest thinking and research in neuroscience.

An Observor October 17, 2017 at 7:42 pm

There’s a lot to unpack in your response, but none of it speaks to my previous points. Let’s start with the fact that, as much as we may love NPR, they are journalists, not trained clinicians, and their work is not peer-reviewed. The popular press often gets science wrong (NPR did a story following the intentional publication of a “junk science” study that was reported as proving that eating chocolate helps weight loss). The editorial (not a study that passed peer review) is authored by a pediatrician. He may be a wonderful, skilled, experienced pediatrician, but he has no credentials in psychiatry, psychology, or neurology.

There reason to question any physician’s expertise if they make statements such as, “But the current process of diagnosis amounts to giving a questionnaire to parents and doctors. If they identify six out of nine specific behaviors, then the child officially has ADHD.” In fact, that statement is not in quotes, which gives me cause to hope the doctor did not say that. Any doctor making a diagnosis on that basis is ignorant, sloppy, or lazy, and possibly guilty of malpractice. Notice, for example, this purported questionnaire is not named – because it probably exists in some lay self-rating scale.

1) The DSM criteria for a diagnosis are not a “six out of nine” checklist. There are nine indicators for Inattentive type, and there are nine for Hyperactive/Impulsive but there’s more required:
In addition, the following conditions must be met:
“Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
Several symptoms are present in two or more setting, (such as at home, school or work; with friends or relatives; in other activities).
There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.
The symptoms are not better explained by another mental disorder (such as a mood disorder, anxiety disorder, dissociative disorder, or a personality disorder). The symptoms do not happen only during the course of schizophrenia or another psychotic disorder.”
Therefore, a diagnosis may not be made without a thorough history.

2) The actual questionnaires used are extensive, and a qualified clinician usually has parent, teacher, and the patient each fill out a rating scale. If you know a teacher, ask them whether they have had to fill one out.The Connor rating scales are widely used, and each version is several pages long. The adolescent self-report has more than a hundred questions.

3) Even the article you cite contains the statement that “Neuroscientists, too, are finding brain wiring patterns characteristic of the disorder.”

4) A great deal of opposition to the diagnosis is based on the idea that “Every child — every person — struggles with this sometimes.” True enough; but the DSM criteria distinguish between “sometimes” and persistent over a period of time; between “sometimes” and across different settings; and that they impair the patient in more than one environment. Everyone coughs sometimes – does that mean that a cough is never a symptom of something more significant?

The wisest observation made is that there is a continuum (in this context, spectrum is a loaded word). There’s a continuum in people’s hearing, too – and sometimes there’s an impairment.

Of course there are those that “game the system,” whether it’s parents angling for accommodations on high stakes tests, or adolescents after access to drugs. And, although this may sound surprising, I agree this disorder is overdiagnosed (see my previous comments), but more seriously, it is also underdiagnosed, especially in girls.

Children have many challenges, and unfortunately, they can’t all be overcome. Our challenge is to be knowledgeable, and to use our knowledge appropriately.

So I ask again – why has there never been PD for educators?

Donna Smirniotopoulos October 17, 2017 at 10:27 pm

The article appeared in JAMA Pediatrics. Christakis is an associate editor. He is also a Pediatrician and lead researcher at the Seattle children’s research Institute. NPR covered Dr. Christakis’s article about ADHD, as did the New York Times. He’s no slouch.

An Observor October 18, 2017 at 5:47 am

Of course he’s no slouch, nor did i suggest he is. He gave his opinion, as a pediatrician/editor, in an wditorial. This is not a peer-rwviwed paper, his credentials (impressive as rhey are) do not include any indication of his rxpertise in psychology, psychiatry, or neurology – or gerontology (ADHD persists through the lifespan.

I take that you do not disagree wth the substance of my observations, and your defense of the good doctor is unnecessary.

BTW, the DSM-4 (as well as the DSM-4R) is obsolete.

An Observor October 18, 2017 at 6:58 am

Apologies for the many typos in my previous post (I’m not young enough to be good with my thumbs).

And – just to get the medication issue out of the way –

Pharmaceuticals (even antibiotics), like any other tool, can be harmful, if not dangerous if not used appropriately and judiciously. When utilized appropriately, medication can literally save lives. The best analogy may be corrective lenses. Many people are fortunate enought to be able to forego their use. Some people need them some of the time, some people need them all of the time, and some even need supplemental lenses (think reading glasses over contact lenses). And some people like the look of eyeglasses so they wear them with plain glass lenses.
Nobody would suggest any person should wear corrective lenses if they were not needed, and nobody would deny their use when needed. The difference is the lack of an “eyechart test” to perform the complex assessment required to determine the need for medication to manage ADHD (and that individual response to any medication varies).

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