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TRANSLATIONS: Untying ADHD’s Diagnostic Knots

News from the Johns Hopkins Department of Psychiatry and Behavioral Sciences 

Dr. Larson

Dr. Justine Larson

Maddie Tate* is 12, bright and kind. Her mother calls her Maddie-in-Space, however, because she leaves textbooks at school and her bedroom is a temple to unfinished projects. A pile of otherwise-empty notebooks, each with a snatch of a poem, gathers dust. The girl who came to Hopkins’ new ADHD and Behavior Disorders Program was distant after a row with her parents over a D in algebra.

“To us, children like Maddie aren’t unusual,” says child psychiatristJustine Larson. And treating them highlights the program’s strength in untying diagnostic knots. “People often think that children with counter-productive behaviors have a single problem,” she explains, “but we usually see otherwise. Our job is to parse the behaviors and find their causes.”

Maddie’s pediatrician suspected inattentive ADHD, a less common form more common in girls. “It’s a real problem in learning and staying tuned in,” says colleague Mark Riddle. Larson had that in mind during an initial several-hour interview with the girl and her parents. She took psychiatric, medical and social histories, including a screening for anxiety and depression. Maddie, her parents and her teachers also completed a behavior assessment. Program psychologist Rick Ostrander administered neuropsychological tests for learning disabilities, executive function and IQ.

“We collect a lot of collateral information,” Larson says. And Maddie, it was found, probably does not have ADHD, though she’ll be observed at follow-up visits. She does, however, have a learning disability that makes summarizing reading painful, partnered with an anxiety problem made acute by the prospect of high school and worries about grades. She scored high on a depression inventory.

What to do? Larson has prescribed anti-anxiety medication for Maddie and placed her in a cognitive behavioral therapy program that’s already improving her mood. Her parents are learning elements of be-havioral management to add structure at home and avoid disharmony. Other tactics sidestep her learning problem, though her focus is improving as her depression eases. 

* Maddie is a composite of patients.

For information, call 410-955-1925.

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