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Attention Deficit Hyperactivity Disorder

Diagnosing ADD

06/11/2001

Question:

Very helpful information. Trying to determine if a teen has ADD and/or depression. Teen also has a chronic illness. How is ADD diagnosed? At suggestion of therapist, probably going to go to a adsolescent psychiatrist.

Answer:

ADD has specific criteria for `official` diagnosis although, like many disorders, there is more to it than that since the diagnosis includes excluding other causes of the symptoms. Since some ADD symptoms can also be seen with depression, one must first ask the appropriate history questions to determine if depression is present. In addition, in my experience, depression may be able to be diagnosed by `official` criteria but may be a reaction to the ADD and, therefore, lift when the ADD is properly treated. This differentiation is particularly important because the main ADD medications (stimulants) can worsen depression if it is not the kind that will lift with ADD therapy. Sometimes it is a question of a trial of medication (and, perhaps, therapy) with close follow up to see the response. We know a lot about psychoactive meds but often need to reassess and change our approach if the diagnosis is unclear. If it is ADD plus depression that is unresponsive to ADD therapy, suggested medication will likely include both a stimulant and an antidepressant. One may be started first and another weeks down the road or both may be started at about the same time. WORTH NOTING: 1. Stimulants alone may mask depression for a few weeks that later needs more specific therapy. Their initial effect can be a little different than a few weeks later. 2. Anti-depressants alone may be so helpful that it seems like the ADD diagnosis is wrong yet the person with both diagnoses will likely benefit most from treating both. An adolescent psychiatrist is a good place to start when the ADD diagnosis may be complicated with other disorders. Best of luck to you!

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Response by:

Susan Louisa Montauk, MD
Formerly Professor of Family Medicine
University of Cincinnati