FAIRMONT - Where does "all boy" end and ADHD begin?
It is a challenging question, according to psychologist Mark Anderson of Mayo Clinic Health System-Fairmont, and it's one those involved in diagnosing childhood behavior and emotional disorders need to carefully weigh.
Anderson spoke to parents and professionals Tuesday at Southern Plains Education Cooperative, addressing the most common diagnoses, how medical personnel arrive at them, and when parents should consider getting help for their children.
Two major behavioral disorders - attention deficit/hyperactivity disorder and oppositional defiant disorder - and two emotional disorders - clinical depression and anxiety disorders - were addressed.
Children with attention deficit/hyperactivity disorder suffer from inattention, sometimes combined with hyperactivity and/or impulsivity.
A common misconception is that a child with ADHD has to be hyper. Anderson said that is not true.
"There is no such thing as ADD," he said, referring to the diagnosis "attention deficit disorder," which is no longer used.
Oppositional defiant disorder describes a child who simply won't follow the rules and argues much of the time.
"It is a strong-willed child taken up a notch or two," Anderson said.
ODD causes trouble at school if a child refuses to obey his teacher.
"You aren't going to do well in school if you don't do what you are told," Anderson said.
Depression and anxiety are also problems for some children.
"Depression in children - does it exist? Yes it does," Anderson said.
Diagnosing a child with depression can be complicated because the term refers both to a mood and a medical illness. A person can feel depressed without being depressed.
Diagnosing a child with an emotional or behavior disorder is a matter of meeting criteria laid out in the Diagnostic and Statistical Manual of Mental Disorders, with evidence provided by teachers, parents and doctors.
The challenge is that those criteria can be somewhat subjective, according to Anderson.
For example, ADHD criteria, according to the manual for mental disorders, include: "often does not seem to listen when spoken to directly and often loses things necessary for tasks or activities."
Determining how "often" is often is not specified. The disturbance also needs to cause impairment in social, academic or occupational functioning.
Anderson said it is time for parents to seek a medical opinion when they believe symptoms are occurring often and causing impairment.
Schools are often involved in a child's diagnosis, both because teachers have experience identifying students outside of the norm and because they are often able to give concrete examples of how certain behaviors interfere with educational goals.
According to Lisa Ellingson, special education coordinator with Blue Earth Area Schools, district staff are not able to diagnose a student, and often cannot offer certain services without a diagnosis.
If someone suspects their child is struggling with an emotional disorder, the first step is to talk to a medical professional.
"Generally speaking," Anderson said. "I would go to a psychologist or psychiatrist, or a pediatrician who has seen a lot of this."