Focus Problems in Children: An Integrative Approach
It is common practice in medicine to lump people into a group. All elderly people with memory problems do not have dementia. Every depressed person doesn’t need an antidepressant. Likewise, there are many reasons why a child would seem to have problems maintaining his or her focus.
For the provider, getting a full history and evaluation is the most important way to figure out the cause or causes of a clinical issue. Often the first step in evaluating a child who seems to have focus issues is by have their hearing checked. Even with normal audiology testing, however, there are many children who do not process sound normally. Those children are at risk of a misdiagnosis.
I was out at lunch recently and heard a mother at the next table going on and on about how her son just doesn’t listen. She has to say the same thing over and over but he still doesn’t respond. “His hearing test was normal,” she continued, “so the doctor thinks he must have ADD.” ADD = the clinical diagnosis of attention deficit disorder.
Whoa. Slow down. The next step for this woman’s son is probably a check for an auditory processing disorder. It is estimated that 90% of adults and children with this condition are undiagnosed. The person with this issue will seem like they don’t hear well, but have normal hearing testing. If this issue is correctly diagnosed, therapy with a specialized occupational therapist can correct the problem.
For those children who have focus problems, the next step is often to do a series of ADD/ADHD questionnaires. This may also be premature, however, because there are a number of other factors that can contribute to poor concentration.
Does the child have underlying anxiety or depression? Is the child getting an adequate amount of deep, restorative sleep? Do they have a relatively poor diet with excessive sugar and processed foods? Does the child have some form of a learning disability like dyslexia that challenges their academic success?
There are other areas that can be explored as well. William Shaw, PhD, is the driving force behind Great Plains Laboratory. He lists a number of tests that can help clarify some of the many reasons why a child has focus problems. These include an organic acids test (for intestinal yeast and bacterial overgrowth), hair testing for heavy metals, tests of copper/zinc imbalance and food allergy testing. He contends on the website that “two-thirds of children diagnosed with AD(H)D have un-recognized food allergies that generate most, if not all, of their symptoms.”
If all of these angles have been explored, then it is reasonable to clarify where the child is on the ADD/ADHD spectrum. The standard mainstream treatment is a prescription stimulant like Ritalin or Adderall. Many people feel these medications are being used inappropriately to keep child with behavioral issues in check.
The medications, however, can be life changing. There are millions of children that have had their status in school completely turned around because of stimulants. I have seen it over and over. The child goes from Cs and Ds to As and Bs. They are the teacher’s most difficult student and then, in a short time, are well mannered and easy going.
For those that are anti-pharmaceutical, this can be hard to accept.
The key is to avoid the quick diagnosis of ADD or ADHD. Each child deserves a complete evaluation before they are lumped into a group for convenience. As always, it is better to figure out the underlying cause(s) of an issue than to do an incomplete assessment and medicate someone for life.
Andrew Lendhardt MD