"Child Diagnosed with both ADHD and Anxiety Disorder...HELP!" by Aletha Solter, Ph.D.

My four-year-old son was placed in a behavioral school three weeks ago for observation for ADHD. He was clinically diagnosed with this by the psychiatric doctor there. They decided to run some psychological tests to rule out anything else. They prescribed Ritalin. After a week the results came back and some other doctor decided our son had an Anxiety Disorder, which they said could have the same symptoms. Is this true? They took our son off Ritalin and put him on Zoloft.

My husband and I feel like puppets. We feel that these people have no idea what is going on. We feel just as lost as we did at the beginning. Our son is just as hyper and inattentive as ever. We don't know what to do for this problem now since the doctors have decided to treat him differently. Will Zoloft help the ADHD symptoms? We were told that they wanted to treat the anxiety first and see if the ADHD symptoms went away. If not, then they would reevaluate and treat the ADHD. This is very stressful for us to wait the eight weeks for the Zoloft to kick in while the ADHD symptoms are so prevalent. How could a whole psychiatric school misinform us on a diagnosis of ADHD and another doctor come say, "Oh no, it is anxiety" and everyone change their tune?

My husband and I are at the end of our rope. We hate putting our son on so many medications, and in a few months, maybe having to change again. We have considered stopping all meds and treating him with herbs and diet. Our doctor was against this, but they keep changing their mind on what the problem is, and we don't have the money or strength to just sit back while my son is used as a medical tool.

It is obvious from your question that you are a committed advocate for your son. He is lucky to have someone thinking about his needs and searching for ways to help him.

The decision about whether to give your son drugs is yours to make. However, I suggest that you inform yourself thoroughly about the effects of these drugs. Many of the drugs prescribed for behavioral disorders in children are addictive and have disagreeable side effects, and, very often, they only mask the problem without really solving it. Furthermore, the safety of long-term use of many psychiatric drugs has not been established for young children. See my article, The Drugging of Children: a National Disgrace.

It is important to realize that doctors are trained to consider the possible medical causes of behavioral symptoms in children, and to prescribe drugs. However, the underlying emotional and environmental causes are sometimes overlooked. The diagnosis of ADHD is made on the basis of behavioral observations. In the majority of cases, no neurobiological factor is ever found to be the cause, and there is no proof that the condition is hereditary. The same is true for anxiety disorder. For both ADHD and anxiety disorder, there are many other possible factors to consider.

In addition to possible dietary causes, there are three other factors to consider, which can contribute to symptoms of hyperactivity, distractibility, or anxiety. These are often overlooked by medical personnel, but are supported by research:

School setting. There is research indicating that many ADHD children function "normally" in less rigid, open classroom settings. These children show attention deficits or hyperactive symptoms only when they are being forced to do something that they are not interested in doing. When allowed to choose their own activities and to learn through movement, hands-on activities, games, and self-paced instruction, many of these children's symptoms disappear.
Television and videos. There is evidence that the rapid shift in images on a TV screen causes children to lose their ability for sustained focusing. Also, the activity, violence, and impulsive behavior of cartoon and live characters in children's programming serves as a role model for similar behavior. Many children are frightened by scenes of violence or danger on TV, and are in a state of chronic tension and anxiety because of this. Furthermore, children are forced into unnatural passivity while watching TV, and this is often followed by a rebound effect: a burst of pent-up energy as soon as the TV is turned off.
Stress and trauma: There is increasing evidence that ADHD can be caused by an overload of stress or from the effects of past trauma. In fact, the symptoms of post-traumatic stress disorder can look very much like ADHD. This would be especially likely in the case of your son, who is also showing symptoms of anxiety. This does not mean that you are to blame for your child's symptoms, but it is worth considering all the possible sources of stress in his life, both now and in the past.

Ask yourself the following questions: Is his life overly pressured or hurried? Does he experience harsh forms of discipline or unrealistically high expectations? Is there a tense home situation? Have there been medical, emotional, or financial problems in the family? Did he experience any major traumas in the past, such as prenatal stress, a difficult birth, hospitalization, separation, abuse, a death in the family, or other frightening event?

If you think that current stress is responsible for your son's symptoms, you can look for ways to make his life less stressful. Family therapy could also be helpful. If past traumas are a possible source of his problems, then individual psychotherapy for your son could be very beneficial. Look for a therapist who is knowledgeable about helping children resolve trauma. If his trauma was very early, look for a specialist trained in perinatal psychology.

You can help your son release tension at home by allowing him to cry and rage as needed. These are natural stress-release mechanisms that are often considered to be part of the problem for ADHD children, but are, in reality, important healing mechanisms. After a good cry, children are generally calmer and have a much longer attention span. Many parents feel it is their role to stop or distract these expressions of strong emotions. I recommend an accepting attitude towards tears and tantrums with all children, not only with those who are have emotional or behavioral problems. Many children with ADHD or anxiety symptoms have been completely cured when their parents implement this approach, as described in my three books. See also my article, Understanding Tears and Tantrums.

I encourage you to keep searching and questioning, and above all, don't give up. Get all the help and support you need. For more information about stress, hyperactivity, and the healing and calming effects of crying, please see my books, Helping Young Children Flourish, Tears and Tantrums, and Raising Drug-Free Kids..

This page was created on November 10, 2003. Lasat updated on April 14, 2009.