Behaviours are messages – not a diagnosis
Many children with attention deficit hyperactivity disorder (ADHD) also have a learning disability, depression or an anxiety disorder. When a child can’t sit still to read a book or can’t complete a task, he or she is often labelled ADHD. If the child worries excessively, the label is anxiety disorder. The problem is that we sometimes see the smoke and miss the fire; or we see the smoke and incorrectly conclude what the cause of the fire is. Stress and anxiety are part of children’s lives. Moderate anxiety helps children push themselves to succeed at home and school. When the level of anxiety is greater than expected, we suspect that there is an anxiety disorder and pure anxiety may cause restlessness that can be interpreted as hyperactivity.
An accurate diagnosis is critical to the development of an appropriate treatment plan. Distinguishing between primary or secondary anxiety requires a full evaluation by a professional who is willing to seek for clues. A thorough consultation with an educational psychologist is essential before starting any treatment. Parents need to understand that the diagnostic process can be complicated during the treatment phase – patience is the key, there is no quick fix!
When a child with ADHD also have an anxiety disorder or another co-morbid condition, the disorder might be so minimal that there are no symptoms. Taking a stimulant, however, may exacerbate a low-level condition. When this happens, it is important to deal with the anxiety disorder first. Once that is treated, it is generally safe to reintroduce the stimulant without causing a flare-up of anxiety.
Case 1: The patient has ADHD with anxiety secondary to frustrations, failures, and negative feedback experiences. The ADHD must be treated, whilst addressing the social, emotional, and family problems associated with the anxiety disorder.
Case 2: The patient has ADHD and anxiety disorder. Both disorders must be treated to maximise success. Children are under tremendous pressure to perform. Parents should constantly reassure their children that they are good enough. Only when a child feels safe and secure, can the next steps in diagnosis and treatment be taken.
Dr Desere Ferreira, General Practitioner, Intercare Irene