Zack is rambunctious, active and full of life. At 7 years old, he often is out of his seat in his second-grade classroom, is reminded by his teacher to focus on his work and fidgets with classmates disrupting their work. At recess Zack struggles. Kids tell the teacher Zack pushed during four-square, ran between their jump-rope game and stole their ball. Zack spends most recesses sitting on the bench frustrated and confused. When asked why he can't control himself and follow school rules, Zack shrugs and sadly answers, "I don't know."

At home Zack is active. He jumps off the porch with a towel tied around his neck imitating superman, chases Barney the dog around the yard until the dog is too tired to run and pesters his little sister until she cries. When asked by his mother to come in and wash for dinner, Zack screams "No," runs to the corner of the yard and cries while screaming, "I don't want to come in, I want to play!" Frustrated at repeating this dysfunctional dance every day; Zack's mom wonders if her child might have Attention-Deficit, Hyperactivity Disorder (ADHD).

In my career as a school counselor and private psychotherapist, I've seen less than 20 kids who truly have ADHD. Children who have this disorder try to sit still, focus, listen and behave but their body simply will not let them. This child hits often and emotionally explodes frequently. The child's parent is consistent disciplining the child and offers love and compassion openly but cannot control the child's behavior. The child knows he is loved and feels remorse when he disappoints but cannot control his impulsivity, pay attention and acts out emotionally and behaviorally everywhere he goes.

For a child to be diagnosed with ADHD the symptoms must be consistent in all domains of the child's life; at school, home, sports, grandparent's house, church, etc. If a child is overly active only at school or only at home, ADHD is probably not the culprit. When a kid displays ADHD behavior only at home or school, the result is likely due to inconsistent boundaries, too strict or too lax discipline or boredom.

Many children display impulsivity, hyperactivity and inattentiveness but not to the extreme required for a diagnosis. The children I work with who have the disorder are extremely impulsive, cannot sit still for more than a few minutes and find it difficult to follow a conversation without interrupting or becoming distracted. Children with the disorder have little control of their bodies and are unaware of the reason behind their negative behavior.

Is ADHD normal high energy or a genuine disorder? I believe most kids diagnosed with ADHD are healthy, active children who in a more natural outdoor environment seem perfectly normal. The required limitations and rigidity of many classrooms are difficult for an active child resulting in acting-out behavior.

The same proves true in homes that are unstructured or homes where parents are overly strict. Children need structure and discipline that is consistent, fair and based in love. Without this structure, children create their own rules for stability. If a parent can't provide stability for the child, the child will develop his own rules of life that seldom align to societal norms. These "life rules" often exhibit themselves like the symptoms of a child with ADHD.

Over stimulation can create the symptoms but not diagnosis of ADHD. Lights that are too bright, distracting noises, unstructured play, boredom and quickly changing environments exacerbates these symptoms in most children. Imagine a home, classroom, sporting event or computer game that is unstructured, noisy, ever changing and out of control then imagine a 7-year-old who is just beginning to learn how he fits in the world then placed in this situation. This child is not offered a chance to focus thus acting like a child with ADHD although he does not have the disorder.

Often children are overdiagnosed with the disability of ADHD when the child is simply being an active kid. I struggle with this. I believe diagnosing a child with a disability is a huge responsibility that should not be taken lightly. When I diagnose, I must believe the child is on the extreme end of the diagnosable criteria - a child cannot be a "little" ADHD. The 20 or so kids I know who have ADHD are desperately disordered. They cannot function effectively in the world I live in.

To over-diagnose is to disrespect the child and to medicate a child who is very active and mentally flighty but not disordered is dangerous and unethical. I suggest every child who is believed to have ADHD be fully assessed and accurately diagnosed by a verified professional. To offer Ritalin to a child to, "See if it will work," is playing Russian roulette with a child's brain and heart - a dangerous game to play.

Next week I will offer suggestions and ideas on how to talk with your child's school about ADHD, how to parent a child with ADHD and offer environmental changes to help all children focus and calm in most situations.

If you wish to comment or offer suggestions, please email me at [email protected].