Case Study


Rush to Judgment: Beware of the ADHD diagnosis

May/June 2014


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…

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1 Comment

Wednesday, June 11, 2014 2:38:49 PM | posted by Jessica M. Newland, Psy.D.
Thank you for publishing Dr. Pernicano's case study and discussion of issues relevant to the differential diagnosis of ADHD and trauma in young children. I know Dr. Pernicano from my years at Spalding (she was on my dissertation committee) and from the awesome reputation she has in the KYANA area. It is articles like this that continue to inspire and help my own practice of psychology in working with young children. I will likely use this article as an introduction to assessment and therapy for parents who suspect their child has ADHD. I think it might be useful for the pediatricians and school counselors I receive referrals from to read as well.

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