Changes In Diagnosing ADD/ADHD

Preposterous But True

During the first decade of my martial arts business in a western suburb of Central OH, the teachers in grades K-5 were permitted to label students with a diagnosis of ADD or ADHD (the attention deficit conditions) and adjust medication levels on their own. They had neither licensing nor degrees in psychology, psychiatry or medical social work. Perhaps elsewhere in the USA, teachers are equipped today to diagnose and adjust medications for ADD/ADHD, but not in Ohio to my knowledge.

The school system in this suburb I mentioned contracted with a counseling services company in the Greater Columbus Metro Area, with one contract stipulation - or at the very least a byproduct - teachers were able to diagnose from a checklist of behaviors and adjust related medications. One teacher, however, diagnosed her entire class, which is against all that is reasonable in statistics or reality. That is, unless her class had been stacked with students showing checklist behaviors or unless an unusual percentage of children in her class's age cohort had shown these behaviors in other district K-5 schoolrooms (they had not). Can a teacher "make" an entire class of thirty 9-year-olds show ADHD symptoms? Doubtful. The class may simply have been too large!

Unfortunately, some individuals without relevant training believe that they understand more than they actually understand. For instance, a professor at my college failed almost an entire class one quarter and was proud for doing it - until the administration pointed out that with such a large percentage of failures, it was he, the professor, who was doing something wrong. The same thing occurred with another professor that produced far too many students with "A" grades. Yes, he was an excellent professor who, along with his teaching assistants, spent much one-on-one time with students -- but the entire class should not have received an "A" grade, considering that a few students did not do well on the exams (or even show up for them).

The teacher that diagnosed her entire class stated that children in elementary grades should not exercise nor have breaks*, but should work straight through the school day, except for lunch. She felt that they should not be in after-school exercise programs or sports, either, because they were all a distraction. Interestingly, a few children in her class attended my martial arts classes and within three months, were removed from all ADD/ADHD related medications by their family physicians and/or psychiatrists.

*In the Healthy People 1990 and 2000 large surveys of the national Institutes of Health, the majority of people responded that women should never exercise and that men should stop exercise after high school. Incredible but true. Unfortunately, these beliefs are held in the 2010s by a sizable number of people in America. In addition, we have too ineffective a large number of children and youth either in no exercise or physical education activities at all or in sports 4-7 days per week.

`You are old, Father William,' the young man said, `And your hair has become very white; And yet you incessantly stand on your head-- Do you think, at your age, it is right?' `

In my youth,' Father William replied to his son, `I feared it might injure the brain; But, now that I'm perfectly sure I have none, Why, I do it again and again.'

Why We Have Required Professional Qualifications

The above fiasco hurt a lot of children and families. A few children needed psychiatric in-patient treatment to withdraw them safely from prescribed drugs. One in my class narrowly missed committing suicide from his gallery of prescriptions and their side actions. I was doubly appalled, since I was working in health psychology and counseling at the time.

Since the 2000s, in order to diagnose a mental health condition of any sort or magnitude in Ohio and, by the way, in order to perform hypnosis in this state, one must possess clear qualifications and licenses. A person providing a diagnosis or a suggestion of a diagnosis must be a Psychologist, Psychiatrist or other Physician; a Licensed Nurse, Social Worker, or Counselor; a Certified Physical or Occupational Therapist, a licensed Dentist, or similar. The positions of Physician Assistant and Medical Assistant are on the cusp and likely have been approved. Alternative Practitioners are also now included in the list. Students and Supervisees registered with the relevant governing boards of the related licensed practitioners mentioned above may suggest diagnoses to their Supervisors and perform hypnosis if the Supervisor is on the premises.

Diagnosing a medical or mental health condition without the required provable qualifications is a Misdemeanor here, the third such misdemeanor becoming a 4th degree Felony at this time.

In 2013, the diagnostic manual DSM-V is published, with many changes to the various diagnoses contained therein and the addition of new diagnoses. At the same time, perhaps too many are writing on the Internet about mental health disorders, particularly SMD (Severe Mental Disorders), without the proper training or experience, and offering diagnoses and treatments. It is also against copyright laws and the wishes of the American Psychiatric Association to cut and paste from the DSM-series, but it is done.

Exceptions

Writing about your own experiences with any SMD and even about diagnosing yourself and having your doctor listen to you and check it out are all good ideas, however, and can help others on a large scale, but writing as an uncredentialed person giving advice or diagnoses for others is often seem smug or controlling, as in some cases of codependents of persons with substance abuse and other conditions, and always dangerous.

The exceptions I can see clearly are the Autism Spectrum Disorders, and ADD/ADHD, which parents have researched better and farther than scientists, in my opinion (and they work with the professionals for better treatments as well); and anyone can still go online until after May 2012 and state your opinions about the changes in diagnosis criteria for 2013.

Teachers without proper training and credentials in Ohio are not to diagnose ADD/ADHD at this time to my knowledge, but they may suggest to their school principals that some testing is in order and they should work with parents. Since teachers may not teach longer in Ohio than 10 years now without earning a relevant Masters Degree, some of these advanced teachers may be able to provide a larger amount of input to a possible ADD/ADHD diagnosis; but that remains to be seen.

A lot of Personality Tests are on the market, including career decision making tools that require fewer or no credentials to administer or take (Multiple Intelligences Test) than those requiring a Masters or PhD or MD to administer (MMPI, for instance). They are a fine starting point, but not the end picture of WHO YOU ARE. for instance, none of the professional or fun personality tests has been more than 50% correct in results for me except the MMPI (625 questions, the last time I took it).

A summer program arts instructor here gave the Multiple Intelligences instrument, without reading the instructions, to disadvantaged youth and instead of telling them their Top Three areas of most natural talent as instructed, told each student that he/she had only One Talent. The kids had to wear a big poster board sign with their one and only talent written on it in a citywide presentation. The kids went to school that fall and refused to study anything else. How many dropped out or flunked out of school? Many.

SO! -- I can't imagine offering a diagnosis of a mental health condition online, over a phone connection, or in a Hub, although I may point to some of my experiences with diagnosis and treatment in practice under supervision and even say that a set of symptoms sounds like a certain diagnosis (but more probably several diagnoses). I don't see how online diagnosis can really be accurate, in any event. And, of course, I'm still appalled with the local teachers scenario of the 1990s. In martial classes or private lessons - and in work related assessments - I don't deal with diagnoses or "illnesses" at all. I deal only with the person, making sure they understand what I expect and what they can expect from me.

A lot of overlap exists in mental health types of symptoms and many criteria are changing for 2013. A symptom could reflect one of many personality disorders or a brain tumor or lack of nutrition or something else.

A physical link has been suggested medically between OCD, Tourettes, ADD/ADHD, Autism Spectrum Disorders and more. It's pretty complex and teachers cannot diagnose within this matrix. There will be more complications before there is smooth sailing. Increasing numbers of mental health conditions are being connected to genetic sources by scientists and the American Psychiatrist Association. Twenty years into the future, we may need to be Biochemists in order to diagnose one of them!

Not revealing the gender of one's child until school age has become a conundrum to those outside the family in the 2012s. People are stunned! I see that it is an obstacle of sorts to outsiders, but I see that many people do not know how to deal without that label and set of expectations.

My stance is that I don't like psychological diagnosis very much, nor labeling, because both can be used as excuses for unwanted behaviors and refusal to fulfill one's potential. I don't even like zodiac personality types or the Myers Briggs (it assigns me two 4-letter types); but how many people will take the the more accurate, the expensive MMPI? The favorite Star Trek or Star Wars Personality and other shorter tests can be a start, though, in career planning.

Psych conditions? - well, don't ask your 5th grade teacher in Ohio.