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Dr. Hallowell on CDC Report: 1/3 of Children w/ADHD Diagnosed by Age 6

Ned Hallowell, MD, is a nationally recognized child and adult psychiatrist who specializes in ADHD. He is based in Sudbury, Mass and New York City.

What do you make of the CDC data?

NH: I think it’s good news and bad news. There’s greater awareness in the general public and among mental health professionals of ADHD. But the not-so-good news is we don’t have enough clinicians, particularly primary care, who have enough training to make the diagnoses…they are on the front lines. It’s very understandable that some kids, a number of kids under age 6, may look like like they have ADHD and they don’t.

What’s the problem?

In my view it’s the combination of electronic overstimulation, too much screen time, with not enough family connection — family dinners, going for a picnic, it’s the human moment, compared to the electronic moment. And that can look like symptoms that look like ADHD.

The hallmarks of ADHD are distractibility, impulsivity, impatience, trouble with organizing and planning, getting your stuff together, those also can be caused by having too much time in front of the screen and not enough time with a human being.

We have a social problem masquerading as a medical one. So many primary care providers have neither the time or the training to do the job they’d like to do. Child psychiatrists are as rare as hen’s teeth, but we we have the most training in diagnosing this condition.

So what’s the takeaway here?

To me the big point is this modern paradox, the over-connection to electronics and under-connection to people — as you get younger, 5, 4, 3, it’s usually social problems that can look like ADHD, stress in the family, conflict in the family, poverty, violence.

What is the key to diagnosing this disorder in very young kids?

There are several several factors in diagnosing ADHD in these younger children. It’s intensity — how much more distractible are they, for example.

And the teacher observations are so important, parents don’t have a big cohort to compare to, you need several sources of information. Does this kid stand out? Another key thing is, does it occur in multiple settings, is it just at home, or daycare too?

You also want to be sure to rule out medical causes, lead poisoning, fetal alcohol syndrome, you want to make sure you check the medical causes.

Do you think the actual number of kids with ADHD is rising, or is it simply greater awareness of the condition?

I think two things: It’s increasing awareness and training, more accurate diagnosis and inaccurate diagnosis. The solution is to have people really trained and to have information from multiple sources.

My personal thing that I keep trying to stress is the need for human connection. I like to say it’s a vitamin C deficiency — a vitamin connect deficiency, connection to friends, neighborhoods, pets, nature, to heroes and dreams. I think it produces what can look like ADD or even failure to thrive, it’s a lack of sparkle, zest. The good news is that connection is free…that’s why I prescribe dogs all the time.

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