Medicating children for behaviors; the basics

(This entry is #4 in a series of posts regarding medicating children for behaviors)
What exactly makes up a "disorder" that needs to be treated with medication? ADD/ADHD is the most common psychiatric disorder that doctors treat in children. The symptoms that characterize ADD/ADHD are impulsiveness, easily distracted, inability to maintain attention, and often hyperactivity. If this sounds to you like the average preschooler or school-age child, you're not alone. It is my observation that every child comes with his or her own personality traits; some are calm, sensitive to others, stay on task, easily soothed, and accept change with rational behavior. Others are more reactive, easily frustrated, have difficulty accepting changes in schedule, strong-willed, give up easily if unsuccessful. These differences are really the fabric of our society; each person is different with skills and abilities that are unique to them.

So how does a physician identify ADD/ADHD? The DSM IV Handbook is the tool accepted by the American Psychiatric Association for diagnosing mental disorders. It's intent is to provide clear descriptions of behaviors in order to properly diagnose and effectively treat the disorder.

Please read the DSM IV diagnostic criteria for ADD:

http://edschool.csuhayward.edu/departments/ted/instruction/howe/5500/ADD-DSM-IV.html

Couldn't these criteria apply to any average 4-10 year-old? Some of my own children have displayed most, if not all, of these behaviors from age 4 until today! I think the difficulty here is in #1 and #2 :
"a degree that is maladaptive and inconsistent with developmental level."

With these descriptions in mind, could the following criteria not apply to any preschooler or teenager today:
Inattention
1. often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other 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)
6. often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
Hyperactivity
1. often fidgets with hands or feet or squirms in seat
6. often talks excessively
Impulsivity
7. often blurts out answers before questions have been completed
8. often has difficulty awaiting turn
9. often interrupts or intrudes on others (e.g., butts into conversations or games)

Do you understand where I am going with this? Treatment options are divided into two categories, family counseling and medication. Medication is not the accepted first line treatment for ADD; it is generally accepted as a treatment option after counseling has not been successful.
The question for you as parents would be: Is this a medication issue, one that has symptoms so unique that it must be classified as a disorder? If this is the case, I would suggest treatment by a very experienced physician to identify the medical component of the child's behavior difficulties.

Or is this a parenting issue, one that needs your full commitment to discipline and consistency, not just today and tomorrow, but for the long-haul; consistency even when you have corrected the child on the same behavior 10 times today, and 10 times per day for the last 5 years? Consistency when it would be much easier to look away "just this once" so you don't have to deal with it again when you are "burned out" for today. You and your doctor are the only ones who know the situation well enough to identify the difference. Many people may try to direct you one way or the other; since the choice to medicate or not is a very important one, only you and your doctor should decide what is best for your child.

Spend some time thinking these questions over until my next post. We will look at medication side effects in greater detail.