About 2.8 million children received a prescription for an ADHD medication in 2008, according to a study published by the American Journal of Psychiatry, September 28, 2011.

A diagnosis of attention deficit hyperactivity disorder (ADHD) is important, but the use of supplements without proper monitoring can also worsen ADHD. For instance, using the dietary supplement SAM-E can increase anxiety and cause mania in a child that also has bipolar disorder. SAM-E is easily oxidized and should come from a reputable company. However, because the U.S. Food and Drug Administration does not monitor dietary supplements and herbs, the sources of these products may have many infiltrates or may not contain the proportion of the product stated on the bottle. Caution should be used.

ADHD is diagnosed using an array of symptoms. However, these symptoms, which include problems focusing, daydreaming, being easily distracted, hyperactivity and impulsivity, can be attributed to many different conditions. So before starting a regimen of medications or supplements based on such indications, it is important to rule out other problems that may be causing the symptoms or making them worse. Here are some other conditions that can confused with ADHD.

Even children with high IQ can suffer from learning disorders involving processing speed, auditory processing and a working memory problem. Further testing is required to uncover these deficits. Temporal lobe epilepsy is usually seen as unresponsive staring spells, and a sleep-deprived EEG is needed. For chronic sleep problems, a clinical sleep study may be required.

Blood testing is needed to determine zinc and iron deficiencies, while low-protein breakfasts and food sensitivities also need to be addressed. Sometimes there is an inability to break down pesticides in the environment, but a blood test for specific liver enzymes can detect this condition. There are also tests for different indications of inflammation that can be done, and any history of asthma, ear infections, eczema or allergies should be explored. Omega-3 fatty acid levels can also play a role.

Hashimoto’s thyroiditis may look like ADD as long as two years before thyroid tests become abnormal, thus a blood test for antibodies must be done. A thorough history must be taken and further neurological testing may be required in cases of head injury, concussion or suspected lead toxicity.

Alcohol-related neurodevelopmental disorder and fetal alcohol syndrome both require a history, physical exam and possibly neuropsychological testing. Fragile X, a chromosome abnormality, can also demonstrate symptoms similar to ADHD and requires a chromosome analysis. Conditions such as post-traumatic stress disorder, depression, autism, anxiety, bipolar disorder, tics, substance abuse and Tourette’s syndrome cannot be overlooked. Family conflict, parenting inconsistency, lack of exercise or an overly stimulating environment all have possible roles to play.

ADHD can be due to or made worse by an assortment of problems. Recent evidence also has shown that ADHD may be due to a developmental delay. Nonetheless, one intervention does not fit all, and a thorough evaluation is encouraged before attempting to intervene.

Deborah R. Simkin, M.D., DFAACAP, Dipl. ABIHM, BCN, is board certified in adult, child and adolescent psychiatry, a diplomate of the American Board of Integrative and Holistic Medicine and board certified in neurofeedback by BCIA. She practices integrative psychiatry and her interests also include sports psychiatry. Simkin is a clinical assistant professor at Emory School of Medicine, where she teaches integrative psychiatry. Her office is located at 4641 Gulfstarr Dr., Ste. 106, in Destin. For more information, call 850-243 9788.