Is ADHD over-diagnosed? Under-diagnosed? Probably both -- and certainly real. ADHD affects children's school performance and their relationships with others. Parents who are wondering if their children have ADHD are often exhausted and frustrated.

ADHD is often genetic. Whatever the specific cause may be, it seems to be set in motion very early in life as the brain is developing. Other problems, such as depression, sleep deprivation, specific learning disabilities, tic disorders, and oppositional/aggressive behavior problems, may be confused with or appear along with ADHD. Every child suspected of having ADHD deserves a careful evaluation to sort out exactly what is contributing to his concerning behaviors.

Most children with ADHD also have at least one other developmental or behavioral problem. Every evaluation should include a search for possible additional conditions, including conduct disorder, oppositional defiant disorder, mood disorders, depression, anxiety, and learning disabilities.

To be diagnosed with ADHD, children should have at least 6 attention symptoms or 6 activity/impulsivity symptoms -- to a degree beyond what would be expected for children their age.

The symptoms must be present for at least 6 months, observable in 2 or more settings, and not caused by another problem. The symptoms must be severe enough to cause significant difficulties. Some symptoms must be present before age 7.

Inattention symptoms:

1. Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
2. Often has difficulty sustaining attention in tasks or play activities
3. Often does not seem to listen when spoken to directly
4. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
5. Often has difficulty organizing tasks and activities
6. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
7. Often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
8. Is often easily distracted by extraneous stimuli
9. Is often forgetful in daily activities

Hyperactivity symptoms:

1. Often fidgets with hands or feet or squirms in seat
2. Often leaves seat in classroom or in other situations in which remaining seated is expected
3. Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
4. Often has difficulty playing or engaging in leisure activities quietly
5. Is often "on the go" or often acts as if "driven by a motor". Often talks excessively.

Impulsivity symptoms:

1. Often blurts out answers before questions have been completed
2. Often has difficulty awaiting turn
3. Often interrupts or intrudes on others (e.g., butts into conversations or games)

Too often, difficult children are incorrectly labeled with ADHD. On the other hand, many children who do have ADHD remain undiagnosed. In either case, related learning disabilities or mood problems are often missed. The American Academy of Pediatrics (AAP) has issued guidelines to bring more clarity to this issue.

The diagnosis is based on very specific symptoms, which must be present in more than one setting. The child should have a clinical evaluation if ADHD is suspected.

Evaluation may include:

• Parent and teacher questionnaires (Connors, Burks)
• Psychological evaluation of the child AND family including IQ testing and psychological testing
• Complete developmental, mental, nutritional, physical, and psychosocial examination

The American Academy of Pediatrics (AAP) has developed evidence-based guidelines for treating ADHD:

• Set specific, appropriate target goals to guide therapy.
• Medication and/or behavior therapy should be started.
• When treatment has not met the target goals, evaluate the original diagnosis, the possible presence of other conditions, how well the treatment plan has been implemented, and the use of all appropriate treatments.
• Systematic follow-up is important to regularly reassess target goals, results, and any adverse effects of medications. Information should be gathered from parents, teachers, and the child.

ADHD is a frustrating problem. A number of alternative remedies have become quite popular, including herbs and supplements, chiropractic manipulation, and dietary changes. While there is evidence suggesting the value of a healthy, varied diet, with plenty of fiber and other basic nutrients (the diet that would be best for most children), there is little or no solid evidence for many remedies that are marketed to parents. Adequate sleep has been proven to help ADHD symptoms.

Children who receive both behavioral treatment and medication often do the best. Medications should not be used just to make life easier for the parents or the school. There are now several different classes of ADHD medications that may be used alone or in combination. Other helpful techniques may include:

• Modifying the environment to limit distracting factors
• Providing one-on-one instruction with teacher

ADHD is a long-term, chronic condition. About half of the children with ADHD will continue to have troublesome symptoms of inattention or impulsivity as adults. However, adults are often more capable of controlling behavior and masking difficulties.

Statistics show that there is an increased incidence in juvenile delinquency and adult encounters with the law among individuals who had ADHD as a child.

Every effort should be made to manage symptoms and direct the child's energy to constructive and educational paths.

There are a high number of adults with ADHD who are in successful jobs. Possible complications, if ADHD is not adequately treated, could include failure in school or other similar problems.