Not Attention-Deficit Hyperactivity Disorder (ADHD)

Family therapy involves meeting with the family to meet a goal. I am Sam Schaperow, MSMFT, LMFT, a counselor and Licensed Marriage and Family Therapist practicing at the Waterford branch of the “Schaperow Psychology Center of CT”. This column will deal with child and adolescent behavior problems that often fall into common categories such as ADHD or Bipolar. But going beyond a one-hour assessment can find something else. Understanding everyone in the family can provide a far more thorough analysis than just seeing meeting with a child in isolation. A thorough assessment, such as one conducted by me and my team, can give an accurate understanding, to be followed by effective treatment. Subsequent columns will deal with the topics of “Psychotherapy for Work Stress”, then “Successful Marriage Therapy”.

I saw children and families at a clinic with a variety of complex problems. Often I could utilize my training and experience to diagnose and successfully treat even the toughest kids. Many mental illness diagnoses from the DSM-IV-TR, an American Medical Association “Diagnostic and Statistical Manual” were not helpful to treat children who went home to the same non-supportive family environment; it was a family-wide problem. Yet at other times accurate diagnoses were helpful in implementing effective treatment. I found that the more hours I spent evaluating, the more accurate my diagnoses were.

Sometimes before seeing me, the child saw the clinic’s psychiatrist (a psychiatrist is typically an M.D. specializing in psychotropic medication). A pattern was formed. While the children who saw me had a wide variety of diagnoses, ~85% who saw the psychiatrist were given ADHD or Bi-Polar. I remember one child who clearly met the criteria in the DSM-IV for Oppositional Defiant Disorder (ODD), such as “often loses temper”, “often argues with adults”, “is often angry and resentful”, and “often actively defies or refuses to comply with adults’ requests or rules”. And yet the psychiatrist gave the diagnosis of ADHD, citing the temper loss as related to an attention deficit. Hours of evaluating did not support ADHD, but the psychiatrist prescribed medication. The family reported a modest increase in focus, but little more. They decided to take their child off the medicine and become fully involved in the treatment process that could potentially remedy the situation once and for all.

Children are often diagnosed with whatever is in vogue. Many insurers/HMOs only reimburse for brief evaluations. This makes a thorough assessment difficult, especially when only certain diagnoses are reimbursable.

Occasionally harm can be done to the child when giving medicine and side effects occur for a time. Hopefully other options will be explored, but all too often another medicine is tried. When the family is finally ready to invest in a thorough evaluation, they can discover what is really going on. Appropriate treatment options can now be offered, particularly when the entire family is involved in the process.

If the diagnosis is ODD, family therapy combined with parental coaching can create a solution within a matter of weeks or months. When the whole family works together toward creating change, that change can happen. For ODD as the sole diagnosis, I find it most important to help the family become more consistent, predictable, and respectful of each other. Appropriate rewards for responsible behavior are also taught, while immediate losses of privileges occur for most ODD behaviors. Losses are all temporary depending on the age and temperament of the child. All of the above should produce fast results that last as long as the parents are willing to follow the plan.

Thorough evaluations typically cost ~$750, which is a relatively small additional cost relative to the benefits that can be seen for years to come. For more information, please visit


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