ADHD research interview today

[Sheila]

I received a request for a research interview today. I'm short on time, so kinda did it on the fly.

What did I forget to say?

Short preference from researcher:

"I am researching children with ADHD and whether they are overdiagnosed."

1. You say ADHD is not overdiagnosed, yet millions of children are prescribed with drugs for having the mental disorder. How do you resolve this apparent contradiction?

It's not overdiagnosed, it's misdiagnosed in my opinion. ADHD mimicks many other disorders, and unfortunately, many children with ADHD are actually never diagnosed so they do not receive the help they need. Further, it is the rare case where ADHD exists alone, e.g., there is typically at least one co-existing condition.

Unfortunately in today's world, in too many cases, there are a lot of roadblocks a parent has to jump to get an accurate diagnosis.

Have you ever read the DSM on ADHD? The bottom line is that is says to rule out everything else before rendering an ADHD diagnosis. Yet how can that happen?

There are medical problems that can "look like" ADHD. Auditory Processing Disorder, Sensory Integration Disorder, Bipolar Disorder, learning disabilities (particularly speech or language problem), etc., can all "look like" ADHD. Even allergies can present as ADHD in children.

It requires a team of professionals to "get to the bottom line" -- the general physician, perhaps specialty physicians, an occupational therapist, an audiologist, psychologist, a diagnostician, perhaps a psychiatrist, maybe others. To my knowledge, there's not one professional with expertise in all these areas.

Is the insurance company going to pay for the various professionals and the team consulting meeting?

What about the parents that can&'t afford insurance?

Then there's the child with ADHD that doesn't fit the stereotype, doesn't act out, is not impulsive, is not hyperactive. There are a lot of girls and boys that have never been diagnosed.

And did you know that ADHD often looks very different in boys compared to girls?

More often than not, children are misdiagnosed or never diagnosed at all.

2. Some medical experts prefer a pharmacological treatment; others a behavioral and psychological methodology citing the dangers in Concerta, Adderall and Ritalin. Which do you prefer? Why?

I would prefer a cure, but to date there's not one.
In my opinion, there is always a need for a multimodal approach to treating ADHD. Medication is just one piece of the puzzle.
People tend to think that parents of ADHD children approach the problem in a lackadaisical fashion. I've interacted with literally thousands of them and I know this not to be true.
All medications have adverse side affects for some people & even asprin. When everything else fails, you're left with little or no choice but to trial a medication. . It's serious business and a parent must remain focused on the best interest of the child.

Do the potential risks outweigh the benefits? If my child had diabetes instead of ADHD, would I withhold treatment? If s/he had a heart condition requiring medication, would I withhold treatment? If my child needed a wheelchair, would I withhold it?

To medicate or not? It';s a hard decision -- particularly when there is so much controversy, misinformation and stigma attached to treatment.

But getting back to your question, I personally wouldn't medicate my child if I didn't have to. But the fact is that he responded favorably to medication and it is the primary treatment that allowed him to respond to the other treatments, attend school and absorb subject matter. I am grateful that the benefits have been enormous.

3. With all of the available literature on ADHD, how do we determine what to believe and what not to accept?

"We" is not defined.

If the "we" you're referring to is the general public, much work remains regarding educating the public about ADHD. The more people that really understand the disorder, the more the stigma dissipates.

If you're referring to those that just absolutely have their mind made up that ADHD is a myth or that ADHD medications is the easy way out for parents, I don't care what they believe. The treatment decided for my child is none of their business. It is a decision that is made by the doctor and me.

I will answer for any mistakes made in medical decisions related to my child in the same manner every parent has to answer for decisions they make regarding their own child&'s treatment and that includes deciding to withholding treatment. That's all they have to accept.

For professionals in the field and parents that suspect their child may have ADHD:
1)Feedback from those that live it day in and day out " parents of children with ADHD.
2) Research and more research -- acquired from a variety of sources. (Disregard 'sources' with hidden agendas " there are many.)
3) More discussion with experienced professionals and with parents of children that have been there, done that.

4. Do you feel students of college-age and above self report their own attention deficit hyperactivity disorders?

I don't know, but I know they are capable of it, e.g., parents self-educating and researching in order to help their kids often say, "When I read xyz, it described me."

5. The New York Times reported several stories on the abuses of ritalin and concerta on a college campus, especially around finals. What's your experience in this realm? Is this a problem that is going overlooked?

I primarily work and interact with parents of school-aged children so I can't address the question directly. There's so much recreational drug use in college and the workplace in general, however, that abuses of stimulants wouldn't surprise me. All types of prescribed and over-the-counter medications are abused for one reason or another.

What would surprise me is if Adderall, Ritlin and Concerta abuse by college students surpassed that of college students that abuse Tylenol, alcohol, marijuana or other street drugs.

Thank you for your interest. I regret that I don't have time to write this in a more eloquent fashion and check for typos, but I'm trying to meet an inflexible deadline.

Sheila

 

[Ropefree]

Interesting bit about abuse around finals. One of the cautionary guides I have
asked for in the IEP is that the completion of work be steady. I think the danger for ADHD and others is getting "hooked" on the adrenaline surge when the deadline is looming and the procrastination pattern is learned.
Having a sane and steady as she goes patern and not having intense battles over assignments, and having the expectation that after school there is some
pure down time to counteract the hyperhyper drive.
The 504 accomidations for college for the adhd learner, I wonder, how are those figured in?
It is good that their is some inquiry into this topic. Seems like their is plenty of room for all sorts of improvements.
Thanks for sharing that.

 

[justour2boys]

Shelia,

Thank you for addressing different "conditions" that can "look" like ADHD. I have one DS that does have ADHD and another DS that has Auditory Processing Disorders (APD) (Auditory Processing Disorder)... and while sometimes they can act out in the same manner... their issues are very different!

 

[klmno]

Thank you!! More people need to understand that MANY kids would fit the criteria for ADHD if they only go by that **** teacher and parent form. My son met it and I knew he wasn't ADHD and his pediatrician said he wasn't, as well. I think it was the common diagnosis for so long that any time a kid couldn't sit still or focus or got in trouble, and then people look at a form that says "has the kid EVER done abc", people just automatically jump to ADHD- even many pediatricians, tdocs and psychiatrists got to that point. I have reached a point that I don't have a lot of faith in diagnosis's of "ADHD and ODD".

Good job, Sheila!!

 

[crazymama30]

I think you did great. I also like the comparision to diabetes or a heart condition. People should realize that medications are not a cop out. I also think it is great how you spoke to all of the conditions that ADHD gets misdiagnosed as. I hope that your interview helps with awareness somehow.

 

[Sheila]

He was pretty intensive trying to get the info. Since I responded I haven't heard a word from him -- not even a "thanks." Maybe he hasn't had time, or maybe he didn't like what I had to say. lol

 

[klmno]

HA Ha!! Sheila- you might be right!! Oh, well, I wouldn't take it too personal!