Symposium debates ADHD diagnosis, treatment

How does one diagnose a psychological condition that is, by its nature, practically impossible to define?

And once a doctor does diagnose a patient with this debilitating disorder, how does the doctor decide between treatment with a supposed wonder drug, or proven psychotherapy?

These were some of the many issues discussed by a panel of doctors concerned with identifying and treating children with attention deficit hyperactive disorder, or ADHD.

Penn School of Medicine Professor Tony Rostain -- a member of the three-person panel -- recommended thinking about the disorder as "impaired executive function" in the brain. This destroys an ADHD patient's ability to plan and execute goal-oriented activities that involve a succession of events to reach a final objective.

"ADHD is not a problem of attention per se, or a problem of hyperactivity per se, but of executive function" of the prefrontal cortex in the brain, Rostain said.

Speaking first and drawing on his knowledge as a child and adolescent psychologist and neurobiologist, Rostain discussed the difficulty involved in defining and diagnosing ADHD.

According to Rostain, the definition of the disorder "depends on who you ask." Though extreme cases can be clearly detected, children with moderate symptoms are difficult to assess since there exists "no definition of what age-appropriate behaviors are," according to Rostain. Therefore, it becomes difficult to diagnose a child solely based on immature behavior.

No doctor can "locate ADHD in any single part of the brain ... that's what's made it so hard to find an 'ADHD lesion,'" Rostain said.

Rostain used slides of brain scan images to note that while "people with ADHD don't have major brain problems," the disorder's impact is enormous.

Fred Fisher, a child psychologist who spends much of his time observing young children in school settings, loosely defined an ADHD child as "being unable to delay gratification."

He added that children diagnosed with ADHD often describe life as a "record where the volume suddenly turns off" at certain times, especially when they become bored.

Along with Rostain, Fisher agreed that ADHD has "very general symptoms," which makes it difficult to confidently diagnose.

Though arriving at a diagnosis may be challenging, both speakers seemed undeterred as they discussed the importance of treating what is a severely debilitating disorder.

However, treating the disorder is also not without difficulty.

In a question-and-answer session following the speeches, the doctors expressed their concern over society's push for what many assume is the easy solution in a bottle: Ritalin pills.

Assuming Ritalin solves all ADHD problems is "magical thinking," Rostain said. Fisher agreed, noting every treatment "has to be based on the needs of the child," which may not include Ritalin or other medications.

However difficult ADHD is to diagnose and treat, both speakers found gratification in helping their patients.

Since "ADHD does not exonerate you from learning to function in the world," therapy becomes self-fulfilling in its ability to "help people cope," Rostain said.

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