A Tricky Disorder

When Carol and Marc Pinard used to see bedraggled parents at the mall who were unable to control their running-around-like-crazy kids, or when they read newspaper reports about the "epidemic" of hyper boys on medications such as Ritalin, their automatic response was, "Those kids don't need drugs, they need better parents." But their view began to change when their youngest son, Jim, started to have problems in kindergarten.

He'd always been an active child, his mother says, who chose "preschool activities that involved running, jumping, shouting. He was never the kid in the corner quietly reading a book." But it's normal for 3- and 4-year-olds to go for active rather than sedentary play. It wasn't until kindergarten, when expectations changed but Jim's behavior didn't, that problems emerged. "He'd be distracted by kids walking in the hall or by a bug outside the window," says Carol. "He couldn't control his impulse to talk in class, not just to other kids, but to the teacher. He'd routinely shout out the first thing that entered his head, whether it was appropriate or not." And while his schoolwork didn't suffer  -- he kept up academically  -- his behavior disrupted the class and his ability to make and keep friends.

Things were difficult at home, too: "We'd send him upstairs to put on his pajamas, and he'd forget what he was doing before he left the room," Carol says. But it didn't occur to either parent that anything might be medically wrong until one day, a friend suggested that they find out whether Jim had ADHD. Then in first grade, Jim was increasingly disruptive in class. So the Pinards read a few books and discovered very quickly that his behavior closely matched the description of the disorder. Carol called several child psychiatrists "right out of the phone book," she says, and relatively quickly found Josephine Elia, M.D., an ADHD specialist at the Children's Hospital of Philadelphia. After testing Jim, she confirmed their suspicions of ADHD, and prescribed a stimulant called Adderol. It wasn't until the medication started to work that the Pinards shed their assumptions about the causes of behavioral problems in some children.

Although the Pinards ended up at a large hospital specialty practice, pediatricians or family doctors, who make the majority of the diagnoses of ADHD, should be capable of recognizing and treating it, says Dr. Elia. "They take care of most childhood ailments," she says. "Colds. Fevers. And attention deficit symptoms. I don't see that as a problem."

But many parents and doctors may be uncomfortable diagnosing a child whose symptoms seem simply to be that he can't sit still, follow directions, or color within the lines. ADHD is, after all, merely a collection of behaviors. There's no virus to look for, no blood test to administer. "It's just what people observe," Dr. Elia says.

This is why some view ADHD as a cultural disease more than an actual medical condition  -- and argue that boys are diagnosed with it three times more frequently than girls because society has become intolerant of behavior that used to be dismissed with a simple "boys will be boys." Other critics have suggested that diagnosing unruly children with a medical condition is merely an excuse for uninvolved parents who don't know how to discipline.

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