Of all the people worrying in print lately about overdiagnosis of ADHD, I think Daniela Drake, writing on Salon, has the most important thing to say. A doctor and the mother of a son who was wrongly diagnosed with ADHD, she admits to being credulous when she was told that her son had the disorder, and, frankly, seeing a lot of other kids who looked like they had it, too. “I’d see students bouncing off the walls,” she writes, “and think, ‘They should medicate that kid.’ ”

But the medication didn’t help her son, and more testing eventually revealed that he had an auditory processing disorder and a severe milk allergy that left him fatigued and unfocused. And she was wrong about the other kids, too. “That child I saw bouncing off the walls had something called a sensory processing disorder. Another had visual developmental problems. Yet another had celiac disease. And all of them were at one point wrongly diagnosed with ADHD.”

What concerns Dr. Drake the most is that kids who are being quickly and sloppily diagnosed with ADHD may have other very real problems that are causing their inattention or acting out in school. She mentions learning disorders, sensory processing issues, visual challenges, food allergies. I would add trauma, problems at home, and anxiety—a common cause of inattention and disruptive behavior.

Dr. Drake’s point is that while ADHD has been widely publicized by the pharma companies, many pediatricians, social workers, teachers, and parents don’t know enough about other possible problems that could be causing their children’s behaviors. “The only thing we’ve all ever heard of is ADHD, so these other disorders aren’t even considered.”

I would also add that it’s in school that the majority kids are flagged for having problems with inattention and hyperactivity, by teachers who are under growing pressure to keep kids from falling behind. Many are diagnosed by overworked pediatricians who see ADHD meds as the only thing they have to offer struggling students whose families don’t have the resources for more costly diagnosis and treatment.

When we see those shocking numbers of kids being diagnosed with ADHD, I think we need to look at why so may kids are having trouble meeting expectations for them in school. ADHD medications help a lot of kids who really have the disorder to live up to their potential, but in other cases they may just forestall recognizing why a child is struggling, and what we need to do about it.