About once a month, a teacher, school counselor, or pediatrician refers a child to me for evaluation and treatment of attention deficit hyperactivity disorder (ADHD). Often someone has administered a Conners teacher or parent rating scale that presumably justifies the diagnosis, or the child has already been diagnosed with ADHD and has taken medication without symptom improvement. Such children commonly exhibit troublesome symptoms, including agitation, moodiness, hyperactivity, and distractibility, so I understand why they were referred to me. But what I can’t understand—and have become increasingly emphatic about pursuing—is why professionals diagnose and treat ADHD symptoms without first trying to understand the causes of those symptoms.

In my view, there’s an epidemic of misdiagnosis of ADHD in young children. Yes, school personnel are overwhelmed by the number of children whose poor concentration make it difficult for them to learn, and a number of likely explanations have been offered for the apparent increase in hyperactivity and inattention in children. Class sizes are bigger than they once were. Music, art, recess, and physical education—activities that used to provide a break from routine—have nearly been eliminated in many school systems. Children spend too many hours on video games to the exclusion of creative, unstructured play, and they don’t get the amount of physical exercise that contributes to healthy brain development. Lack of adequate sleep also…