Teachers often identify ADHD

Right about now", default", parents are attending fall teacher conferences. And many are squirming uncomfortably in little chairs, hearing something like: Johnny seems to have trouble paying attention.

By Kim Painter, USA TODAY

Hannah isn't finishing her assignments. Or more bluntly: I think your child has ADHD.

Most parents know attention-deficit hyperactivity disorder is common. The best estimate is that 5% to 8% of children are affected. Most parents also know increasing numbers of children are treated with medications for ADHD — a fact that makes many uneasy. Adding to that uneasiness: recent news that one attention drug, Strattera, is linked with increased suicidal thinking in a few children.

No wonder many parents respond to a teacher's concerns with alarm or denial. "They shoot the messenger, blame the teacher, blame the school. They think there's a conspiracy by the drug companies. They just don't want to hear it," says Edward Hallowell, a Sudbury, Mass., psychiatrist who is co-author of two popular books on ADHD.

Of course, teachers aren't always right. They know a lot about children but are not qualified diagnosticians. But they often are right. And experts say a teacher's concern should always prompt action.

But what exactly should parents do?

First step: Call your pediatrician's office. Say you want to talk to the doctor about problems your child is having in school — or specifically about ADHD, if that is what you suspect.

"In the best of practices, the receptionist hears that call and sends out a packet of questionnaires" for the parents and the teacher, says Martin Stein, a professor of pediatrics at the University of California, San Diego. In 2000, he helped write guidelines on ADHD diagnosis for the American Academy of Pediatrics.

Those guidelines gave front-line pediatricians a tool kit for diagnosing ADHD. The guidelines say doctors should carefully piece together a medical, developmental and educational history from information provided by parents, teachers and the child. The doctor should ask about the child's strengths as well as his weaknesses. This history, combined with a good physical exam, should allow him or her to reliably diagnose — or rule out — ADHD in most children, experts say.

Blood tests, brain scans and formal psychological testing usually aren't necessary, Stein says, unless the history makes a doctor suspect something other than garden-variety ADHD. Those other things can range from sleep deprivation to learning disabilities to seizures to a host of psychiatric conditions.

Getting an adequate history and physical exam takes time. Stein says doctors should take about an hour, often spread over two or three appointments. And a doctor should never prescribe medication on the basis of a quick chat during a routine 10-minute visit. But, he says, few doctors do that these days.

Hallowell isn't so sure. "What really ends up happening far too often is that the kid just gets a trial of medication" without a diagnostic work-up, he says.

Pediatricians who take the time can handle ADHD, he says. But many struggle, understandably, with their tight schedules. And many just don't like dealing with behavioral conditions. "Ask your pediatrician if he has a lot of experience with ADHD and whether he likes treating it. If he sort of grimaces and says, 'Well, I guess it's something I have to do,' you can ask him for a referral." The best job, he says, may be done by a child psychologist or psychiatrist — though the specialty matters less than the expertise and enthusiasm.

Pediatricians who follow the guidelines "are definitely qualified to do this," says Steven Pliszka, chief of child and adolescent psychiatry at the University of Texas Health Science Center, San Antonio. "But you still find doctors who 'don't believe in ADHD' or who just say, 'Oh, sure, sounds like ADHD, here's a prescription.' Luckily both are becoming less common."