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Schools are Replacing Physicians in Diagnosing ADHD, the NMA Implied

By Phillip Tomlinson

WASHINGTON - An absence of physicians in America's inner cities causes school officials to often act as doctors in improperly diagnosing attention deficit hyperactivity disorder.

The problem of attention deficit hyperactivity disorder (ADHD) is growing so rapidly that the National Medical Association, which represent many of the nation's black doctors, held a teleconference recently to illuminate the problem.

"If you're talking about a child who doesn't have regular access to a doctor, healthcare or health insurance, then it's all going to be dependent on what the school system says, but unfortunately, the school system does not do that kind of workup," asserted Gary Dennis, president of the NMA.

Sharman W. Dennis, an early intervention child development expert, agreed and said: "This is a diagnosis where there should be a complete workup and than there should be an educational development evaluation of the child."

Diagnosing attention deficit hyperactivity disorder (ADHD) in youngsters can be challenging, but physicians and other professionals at the conference theorized that a new approach could minimize incidences of misdiagnosis, particularly in minority children.

Diagnosing ADHD is already a challenge for physicians and other health care professionals. "There is no definitive lab test, and there is no definitive brain wave test or anything that identifies ADHD," stressed Paul Organ, M.D.; a child and adolescent psychiatrist.

"It's really a diagnosis that you come at from observing behavior. It's in the eyes of the beholder."

Quentin T. Smith, a professor of clinical psychiatry at the Morehouse School of Medicine says the instances of ADHD diagnoses are quite frequent and, in many cases fifty percent of the children psychiatrists see fall into this category.

"If you look at all of the school children-maybe in elementary schools around the country-about three to five percent of all school age children carry the diagnosis," he said.

"The cause of it is really not known. It seems to run in some families. There is some indication that there might be some structural and biological dysfunction. going on, but the cause of it really is not known."

Studies show that approximately five million children, annually, are diagnosed with the illness.

Smith believes there are other dangers when a teacher mis-diagnoses a child. "One of the other things that could happen is that the teacher could suggest that the child has another problem rather than attention deficit disorder. She might think the child has some kind of more serious problem."

Paul Organ, M.D., child and adolescent psychiatrist, believes, more often than not, hyperactive children, if nurtured in the right environment, need not be medicated. "Most of the times we are using medication to basically calm down and sedate a child who could be managed with the right type of adult giving the right type of supervision and discipline," he said.

Gut Feelings

He believes much can be learned from a comparison with children of earlier generations and children of today:

"A hundred years ago, if you were on a farm somewhere, if you had a boy who was up early in the morning, gave him a whole bunch of chores to do and then he could go play all day and run outside, come home at night, do a whole bunch of chores and get up the next morning, that would be the perfect kid to have.

"But in 1999, we want that same boy to get up, sit on a bus for twenty to forty minutes, go to school, sit at a desk.. wanting to go outside, but he has to sit inside for two hours 'til recess, and listen to the teacher who is probably boring to him.

"My gut feeling is that I believe that these kids operate with a higher energy level than other kids their age, but my bottom line feeling is that we do not, as a society in general, in the schools in particular, provide the type of environment to channel their [children] energy in addition to helping them learn."

Organ believes a positive result-without the use of drugs-can be achieved if schools begin to recognize that many of these children have advanced beyond their years.

"They just don't like it [class] because the teacher is boring," he offered. "One of my favorite quotes is a seven-year-old, black kid told me, 'Doctor Organ, this isn't my problem. This is the teacher's problem.'

"I said, 'Oh, really? What's the problem?' He says she is too old, and he goes, 'You know, Organ, my whole life is rap music and Nintendo. My brain moves too fast. I cannot slow my brain down to listen to the teachers.'

"The other thing he told me which I thought really gave me an insight was he said, 'You know, when I come home at night after school, my mom only lets me watch the nature shows. I've seen every nature special there is.'

Two-Parent Households

"He goes, 'You know, what? I can tell you anything you want to know about whales. How many types of whales there are, where they breed, how they eat, whatever. The teacher wants me to read this stupid book about Timmy the whale. It doesn't even have all the pages in it. I'm not reading the book. I know more about whales than the teacher does.' "

Organ also believes hyperactive children can normally be calmed if they are from two-parent households.

"Many kids especially black kids are in single-mother households, but I cannot think of more than ten cases in ten years where a boy with ADHD is brought in to see me, and put on medication who had a dad in the home.

"You almost never see it and if it is, the kid has some brain damage, a head injury or some thing. Because part of it is if there are two parents in the home, the parents can take turns dealing with the kid's hyperactivity

Those boys do have a lot of energy and they'll burn out one parent. So, part of it is just having one parent. But they don't have a male in their lives who can say 'Don't worry. Let me take him out to the park and wrestle with him.' "

Smith believes that some doctors because they are stretched beyond their resources are often forced to make quick decisions which can have unintended results

"For example if you're a busy pediatrician or a busy general practitioner or internist and you see children and you see forty patients a day, you're not going to have the time generally to sit down and do all the assessments that a child psychiatrist should do before he makes a diagnosis and develops a treatment plan."

Even so, Dennis warned, school officials must defer to physicians, noting the government should help create more African-American physicians to handle the heavy case load.

Published in and copyrighted by The Medical Herald, March 1999, pgs. 1, 28.

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