What to do about the low fliers; the ones who are clearly out of sync with their environment, at home and at school? They are unhappy, alternating between poor behaviors and upsetting everyone, then feeling badly and asking if they are still loved or are they still going to get the treat that was promised to them or are they okay. They are reactive emotionally, often intolerant of everyday situations; their behavior is impulsive and the first thing everyone thinks is ADHD and they certainly fit the characteristics of this disorder.
But here is the problem, you test them and they have symptoms of executive reasoning. Attention problems that seem to follow the pattern of ADHD inattentive type suggests a genetic disorder that has been exacerbated. So what is the problem of labeling ADHD when we see characteristics that are more related to executive processes? Because the label leaves them at risk for a lifetime of medication and no resolution; tired parents, low self esteem in the child and continuing unresolved problems. You refer them for a sleep study with all the symptoms of apnea and they come back okay and you ask the question, well, how close were they to sleep apnea? Or how well was this measured; or was the CAP scoring used or were other methods used to determine sleep disordered breathing? You can’t question the professional especially if they are a big deal in their field so what to do? You ask the treating physician about an EEG which comes back normal: But how normal? The pediatric neurologist is well known. How dare you question his read on things, but you can’t help but think there has to be some differentiating factor that creates this unmanageable kid who is so difficult for himself to deal with along with his parents and everyone else. So now you begin to treat and you do what you can with many of the causal factors remaining untouched. You are criticized for thinking critical thoughts about other professionals when your only concern is that something was missed that could be treated and could make a huge difference now: But all you can say to the parents is, “well there does not appear to be anything but lets do some treatment of the symptoms we know are clearly there and maybe discuss with your treating physician repeating these tests in a year”.