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“What if it’s not ADHD after all?"

Published on Jan. 31, 2023

I’m a doctor. I’m also a mom. While I am trained to get everything right as a doctor when it comes to my patients, I was ill-prepared to get everything right when it came to diagnosing my adopted daughter’s mental illness. In medical school, I was taught to consider every possible cause for my patients’ ailments. One must consider everything so as not to miss anything. Unfortunately, that’s not what I did. When her second-grade teacher told me he suspected ADHD was the cause of her extreme impulsivity and constant need for redirection, I took her to a psychologist who confirmed the teacher’s suspicions. Because they were the experts, I didn’t question the diagnosis.

The only problem was she didn’t have ADHD. She had an attachment disorder. It would take eight years of the wrong medications, ineffective teaching techniques, misguided parenting strategies and ultimately, admission to a residential treatment center that specialized in children with attachment disorders before she was correctly diagnosed and given appropriate treatment. Eight long years filled with academic failure, familial strife and heartache for everyone involved, especially my daughter.

So how did we get it wrong for so long?

The main reason is that we never considered attachment disorder as a possibility. In theory, children are only at risk for attachment disorders if they are adopted later in life or have suffered severe trauma or neglect. My daughter was adopted at birth, so we thought we’d avoided that possibility. It wasn’t even on our radar.

Another problem is that ADHD and Attachment Disorders share a lot of the same behaviors, but—and this is a BIG but—the reason for the behaviors is different. At the most basic level, children with attachment disorders NEVER feel safe. In fact, they feel a sense of threat under normal circumstances—such as in a classroom—and live in a constant state of Flight, Fight or Freeze. Everything they do is an attempt to escape that perceived threat. What the school saw as “impulsivity” when she ran from the classroom was her Flight response. What the school saw as “defiance” was her Fight response. What the school saw as an “unwillingness to engage” was her Freeze response. What seems illogical at first glance makes perfect sense when viewed through the eyes of a constantly anxious child living in what they perceive as enemy territory.

“At the most basic level, children with attachment disorders NEVER feel safe. In fact, they feel a sense of threat under normal circumstances—such as in a classroom—and live in a constant state of Flight, Fight or Freeze.”

But here’s the biggest reason I think we missed the right diagnosis: We had a presumptive diagnosis in our heads and went looking for confirmation of that diagnosis instead of looking at the entire constellation of her behaviors. In so doing, we ignored a lot of other behaviors that didn’t fit the diagnosis, chalking them up to “just the way she is,” even though the behaviors were more problematic, especially at home. Lying, stealing, destruction of property, lack of remorse, refusal to change her behavior when punished, self-harm…none of them “fit” the diagnosis of ADHD.

In the end, my daughter got the correct diagnosis and received appropriate care. Did she suffer because we operated under the wrong diagnosis for so long? Undoubtedly. Could we have made the diagnosis earlier? Maybe, although many of her behaviors took years to develop. Would the trajectory of her life be any different if diagnosed sooner? There’s no way to know, but my mother-heart suspects that it would.

So why tell my story? Because if you’re a teacher, I want you to put attachment disorders on your radar when you have children in your classroom who look like my daughter. If you are a therapist to a child with behaviors like my daughter, consider the possibility that not all attachment disorders require trauma or neglect and, in fact, may have a genetic component. And finally, if you are a parent of a child who sounds like mine, remember that YOU are your child’s best advocate. YOU are the expert when it comes to your child. If the medications that are prescribed and the interventions that are recommended don’t seem to be working, question the diagnosis. I wish I had questioned it earlier. Be relentless. But also, be gentle with yourself. Mental illness in children can be difficult to diagnose, with many of the behaviors blossoming slowly over time. Finally, I hope that my story eases the journey for both you and your child—it’s a hard road, but you can do it. You are not alone.

About the Author

Dr. Michelle Grua joined the anesthesiology team at Valley Children’s in November 2021. Her research has been published in peer-reviewed journals such as European Journal of Anesthesiology and Anesthesia and Analgesia. In her spare time. Dr. Grua enjoys spending time with her three adult children, mountain biking, camping in National Parks, hiking, rowing a boat on white water, weightlifting, quilting, welding, creative writing and paddle boarding.