The next time you visit the newsstand, take a look at a parenting magazine and you are likely to find an article about Attention Deficit Hyperactivity Disorder (ADHD) as well as at least one pharmaceutical advertisement for a drug to manage its symptoms. ADHD is diagnosed in 3% to 7% of American school-aged children, of which 15% of these children are currently taking medication to alleviate the symptoms of ADHD. It is the most commonly diagnosed neurobiological disorder in school-aged children. (CDC, 2011). Other studies suggest that rates of diagnosis are much higher.
In the case study of Gretchen, it is unclear at what age her symptoms initially presented, however, the DSM specifies the criteria that “symptoms that caused impairment were presented before age 7 years”. In Gretchen’s case, it is clear that the onset was before age 8 as this was the age at which she first reports forging her parents’ signatures on disciplinary notes from school to avoid punishment. The DSM also specifies diagnostic criteria of a minimum of six of the inattention symptoms, of which Gretchen demonstrated eight of the ten symptoms of inattention: inattention to tasks, lack of organization, loses things, distractibility and forgetfulness. Gretchen also had difficulty with fidgeting, talking out of turn and leaving her seat at school at inappropriate times, by her own report she was “always on the go”. The symptoms meet the DSM criteria for hyperactivity. These symptoms present themselves in two or more settings, at home, school and on the soccer field. Evidence for a significant impairment in an academic setting is seen in the frequent notes home and eventual expulsion from school. There is no evidence of a developmental disorder. For these reasons, paired with the results of the psychological testing Gretchen underwent, the diagnosis of ADHD is appropriate.
However, Gretchen also demonstrates many symptoms of Generalized Anxiety Disorder, of which there is some symptomatic similarity with ADHD. Gretchen’s inability to concentrate and her restlessness could be symptoms of either GAD or ADHD. The most compelling evidence for GAD can be found in the physical symptoms of anxiety Gretchen reports: her difficulty in controlling her apprehensive expectation about her parents’ reaction to the notes from school, the resulting upset stomach, headaches which are prevalent at home and school. As reported in Elia, GAD is concurrently co-morbidity in 18% of children with an ADHD diagnosis. (Elia, et al., 2008). ADHD does not preclude one from developing other disorders, including anxiety disorders. As also found in Elia, up to 21% of children with ADHD are also diagnosed with some form of depression. For this reason, I believe the possibility exists that Gretchen also has a generalized anxiety disorder along with attention deficit and by adolescence was also depressed.
The physical symptoms Gretchen describes: the frequency with which she reported...