My Forum Comments

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  • in reply to: To Medicate or Not Medicate? #73473


    I’m a pediatrician. I have ADHD and use pharmacological treatment. I was diagnosed while in medical school, but in retrospect, had symptoms way before.

    Here is my approach when it comes to children & teenagers.

    1) Are the ADHD/ADD symptoms causing a dysfunction? At school, and/or in home life?

    By dysfunction I mean impairment. People think dysfunction = handicap. So if the child does well at school, but you can’t go out in public with the child out of fear he will slip away from you and get lost, there is a dysfunction, period.

    The standard tests (such as the Vanderbilt surveys) essentially measure what I call dysfunction. If he is doing well at school, gets along with teachers and peers, is not an overly anxious child – he likely doesn’t need medications.

    2) Let’s flip your question. How does the child/teenager feel about his life? These forums are mostly based on parent’s responses.

    The mother may think the child is OK, but when I ask the patient… the answers change. I ask the siblings too and obtain great responses!

    If these symptoms start earlier in life, I rather treat so the child can actually focus on learning some of these coping mechanisms and strategies. Teenagers that were previously well often feel overwhelmed when challenged with new skills (such as oral reports, more homework, etc) and that’s when a cycle of anxiety forms.

    Awareness, organization, repetition, and structure DOES help. As an adult, it is what gets me through the day!

    Some children, teenagers and even adults can cope quite well with the symptoms but ONLY when they’re AWARE of ADHD. Cope = deal with difficulties. ADHD is like jogging with a group, only you have a heavy backpack! Medication takes the load off initially and helps with the brunt of symptoms. But trust me, these symptoms won’t go away. Awareness, organization, repetition, and structure are needed to cope.

    Phrasing this as a child with “mild ADHD symptoms” is a misnomer, because what I look for is dysfunction. Everyone can be anxious, fidgety and forgetful, especially when stressed. That’s not ADHD. These symptoms have to persist AND cause a dysfunction in more than one setting. If you have people convincing you that your child doesn’t need ADHD medication – he likely needs it.

    Lastly, let a trained clinician (pediatrician, psychologist, psychiatrist) ask questions to the child directly, and you’ll be surprised at the responses.

    in reply to: Diagnosis #73600

    I’m a pediatrician and have ADHD. Here is my opinion… young adults are much closer to teenagers than people think, with the same societal pressures. However, the liability for your medical care, especially with ADHD, is much greater for “adult” physicians (family physicians, internists, psychiatrists).

    Why? Pharmacological treatment requires controlled substances and people look for them. Substance abuse is a BIG deal and preventing even one case is worth it. With a child or teenager, there is more control. As an adult, we literally have to take into account the following:

    1) Do you have an active criminal record? If so, for what?
    2) Do you have or have you ever had any substance abuse issues? Including things such as gambling and risk-seeking behavior.
    3) Do you have a history of mental health disease? It’s OK to say you have been depressed before. More on this below.
    4) Do you have stable housing and employment? Reality check: many youths are homeless and live from couch-to-couch.
    5) Lastly, can this adult be reliably trusted to follow-up with their physician? Not only the psychiatrist but also your general physician? Even more so if you are a female and get pregnant.

    Please excuse if the above (and below advice) seems patronizing. Some people really do need certain medicines (such as controlled substance) but drug-seeking behaviors are quite common. By definition, you fall into a category of people (masters’ student) that seek to use this drug. I could even make a case that others perceive you as attempting to seek the drug.

    My suggestions:

    1) Get yourself a reliable physician and become a reliable patient. Also, make sure you have seen an Ob/Gyn for your annual “female-care” checkup.

    Please explain to your physician that ADHD is a concern and you are actively exploring a formal evaluation by a psychiatrist.

    Ask for a urine drug screen so you can prove to the psychiatrist that you have not used illicit drugs before.

    I would also get your medical information organized. This is easy now with a patient portal.

    2) Get diagnosed by a healthcare professional. A psychologist can test for and treat ADHD (with various modalities) but does not have any prescribing power… because he is not a trained medical professional. It is a different knowledge set. Not better, not worse, just different.

    You need a psychiatrist for a more thoughtful diagnosis. If health insurance is an issue, I simply suggest asking the office how much does he/she charge per visit, and if they have experience treating adults. But don’t expect a diagnosis and a prescription just because you paid $300.

    3) Follow recommendations, including follow-up. Some adult doctors have a policy of not prescribing controlled substances to ANY new patient, regardless of appearances and sometimes request a urine drug screen as well.

    As for anxiety and depression. These are associated with ADHD, particularly anxiety. Many people with ADHD have co-existing anxiety, but some folks just have plain-old anxiety, and its the anxiety causing the symptoms. A psychiatrist can help you figure this out.

    Don’t be surprised if you are prescribed an antidepressant first and asked for follow-up in 1 month. Some antidepressants can help with anxiety as well. Think about this for a second: if you don’t get a stimulant medication by your physician, are you going to walk out and get another doctor? What happens next?

    As for you not being depressed now… I respectfully request that you let the psychiatrist make that decision.

    Two reasons:

    1) You are not a healthcare professional. Know yourself, but don’t ever diagnose yourself. Bipolar disease is in the differential diagnosis of ANY young adult with ADHD symptoms and prior depression. Which leads to…

    2) Depression is not always typical. Diseases don’t always “read the book”. Many adults with depression are incredibly functional, thus they don’t believe they’re depressed (e.g. “no one knew she was depressed, she seemed fine!”) Like I mentioned, the signs and symptoms of depression on a young adult are like those of teenagers: NOT typical. You may have comorbid depression as well.

    Give yourself that opportunity to heal and listen to someone else. It seems to me you’re trying to outsmart the world, and trust me, the only one who will not benefit is you. You don’t have all the answers. That’s why there are other people to help you.

    Best of luck!

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