Today’s column by Valerie Strauss “If you can pay attention, you do not have ADHD”–and 9 other misconceptions about the disorder” was a great read.  Ms. Strauss highlights the Top 10 Myths of ADHD by Dr. Ned Hallowell, a child and adult psychiatrist. This list is a good for families of newly diagnosed children or in situations where parents are concerned about the possibility of ADHD and have yet to get confirmation.

I have been in the position of talking to parents, to grandparents, to schools about what ADHD is and what it is not. There are a lot of myths and misconceptions about the diagnosis and treatment options.

Let’s get that out of the way now. “Treatment” does not necessarily imply medication.  However, I know many parents cannot stop thoughts of: “if this is ADHD, then it must mean they will want to medicate my child…” First, as a behavioral pediatrician, I want to say that having the diagnosis of ADHD does not automatically mean your child will need to be on medication. In fact, the first line “treatment” for ADHD is parent training and education.

RELATED: Treatment & Target Outcomes for Children with ADHD (from healthychildren.org)

Yes, sometimes medications are used in the treatment but educational supports, behavioral therapy and parent training or also part of the plan. These components can be started at any time, may be combined with other treatments. Sometimes treatments are dropped and added on again at later times.

These decisions are made with the family and the team (for example: doctors, teachers, therapists)–and always with the goal of asking, “What else is needed to ensure that the child is learning and doing what he/she needs to be doing every day and doing it as well as can be?”

If you are a parent with a child with ADHD or a parent who is worried that your child may have ADHD, make sure you come prepared to ask questions at each and every appointment. It can be challenging and hard to remember who is doing what since much of the time behavioral conditions require many team players. Your child’s doctor wants you to feel comfortable with every decision that has to be made along the way. They are happy to have you ask questions, no matter how many times or different iterations.

Another thing to remember is that at the time when the diagnosis is uncertain or is new, it can feel like you are all alone and overwhelming. The first step is to take a breath and write down any and all questions. Organize all paperwork and relevant schoolwork in a binder/folder and keep them together. It helps keep things handy when you have to meet yet another new team player. It also ensures that everyone is on the same page. There is nothing more stressful than not knowing which team member to call when things go awry or after a particularly challenging day. See my post “A new handout for ADHD” that I developed and use with families that can help explain some concepts I think is important to think about when a child is newly diagnosed.

The key is to remember to reach out to your child’s doctor if you have ongoing questions. Yes, they can prescribe medications for ADHD, but they can and always will be there to coordinate care and make referrals. They are interested in talking through all treatment options and linking you to great community resources and organizations. This is what the “medical home” is all about.

RELATED: Your child’s medical home: What you need to know

Helpful Resources to Learn More:

1. http://www.healthychildren.org
2. http://www.understood. org
3. http://www.chadd.org

A colleague of mine published an op-ed in the New York Times on February 1, 2016 “Diagnosis is Key to Helping Kids with ADHD.”  As Dr. Froelich states, even though there is strong scientific evidence that ADHD has a biologic basis, there is always concern whether a child truly has ADHD and if it is misdiagnosed or over diagnosed. The issue is that there are currently no medical or laboratory tests that is inexpensive, non-invasive and has good test characteristics to reliably be used as part of every day practice.  We must rely upon a careful behavioral history that includes asking about the home, family and school, collect parent- or teacher-report on behaviors and functioning and think through this while taking into account behavioral observations.

We still have a long way to go to improve upon the decision making process regarding behavioral conditions. There is not the equivalent of a “swab” or laboratory test to tell the pediatrician, parent or teacher that a child definitely has ADHD.  This is, in part, because behaviors are the equivalent of symptoms of any medical condition. Behaviors are what the parents or teachers see and observe. However, not being able to sit still, daydreaming or being forgetful can represent other things about the child (like chronic untreated allergies, anxiety, learning disabilities, poor sleep, or just plain having an “off” day) or may be a reflection of something else going on in the home environment. This is why it is important to explore the the context around the child and understand how the behaviors impact the child’s functioning in the home and school. It takes understanding the patterns and paying attention to the environment in which the child is in to truly begin to understand the “why” of a behavior.

This is why general pediatricians or family practitioners find behavioral conditions so challenging. However, having only 15-20 minutes to address these complex issues and still cover other topics, do a physical exam and give vaccinations is less than optimal. That is why it is important to examine innovative ways to automate some of the screening processes and use health information technology to remind pediatricians of key information. This is also why we have been working towards developing a new model to improve care in busy pediatric clinics. By restructuring the typical brief visit for individuals into an hour long group visit for up to 6 families, pediatric providers not only get to educate and explore these issues with families, but also observe children with others.

There is so much work to do to improve upon diagnosis and ongoing management of pediatric behavioral conditions. Over the next several posts I will be sharing materials we have developed for our group visits (curriculum, handouts and just lessons learned). The group visit is one option that at our institution has led to increased satisfaction for providers and families, despite the systems-level challenges this model requires. Yet, the group visit model may not be for everyone and is not always feasible.  Explaining this to families is important and acknowledging the imperfect methods we have to identify behavioral conditions. It requires being flexible and re-evaluating if a child’s behavior or functioning does not improve. Also, being open to going back to the drawing board and thinking about other conditions that can mimic ADHD. It means partnering with teachers and educators, and other family members to get their impressions on how a child is doing.  Primary care providers are able to develop long-standing relationships over time and build a working partnership with each and every one of their families. This is also why primary care providers are still best equipped to make the initial diagnosis.

I cannot discount the importance of reaching out to the schools and talking to teachers and daycare providers about their concerns. This step is so important, but can be overlooked at times. Input from schools (whether it be through asking educators to complete screening forms or picking up the phone to ask for their opinions) is a vital part of the process, not just to make the diagnosis but also as part of ongoing management.  We are all part of the family’s team: doctors, teachers, behavioral therapists, tutors, with the family at the center.

There is still so much work to be done. Together we can share solutions, brainstorm additional methods or ways that may help decrease the time to diagnosis or ensure the diagnosis a child receives is correct.