“Are We Overdiagnosing and Overtreating ADHD?” – Part Two— ADHD Tip O the Day 786

More from the recent ADHD article in Psychiatric Times

 (Jummani, MD, et al, in Psychiatric Times, May 2017, pp 26-28.)

To diagnose ADHD formally in children requires at least 6 of 9 inattentive symptoms and /or at least 6 of 9 symptoms of impulsivity and hyperactivity, present in two or more environments, evident before age 12, not accounted for by other conditions, and        “…clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning.”

Thus, there are tight rules for making the diagnosis and not just saying someone is a problem in the classroom.  The “let the children be children” advocates don’t know what they’re talking about.  Johnny is failing his classes, spending a lot of time in the principal’s office, shunned or teased or bullied by the other kids, losing his homework if he did it at all and at times his whole backpack, and is a source of extreme frustration to his parents.  Annie is daydreaming through class, barely passing, and largely ignored because she doesn’t cause any trouble.

To make the diagnosis in adults,  the criteria are the same, but only five symptoms are required.

Most adult ADHDers  have less dramatic hyperactivity and impulsivity.  But life is still hard. We need strategies.  And often medication.

In addition, before diagnosing, a good evaluation would include historical data, a rating scale, DSM criteria and additional information from at the least one other person who knows the patient well.  This often does not happen.

Most diagnoses are made by primary care physicians who do not have the training, and more importantly, do not have the time, for this.  They are more likely than psychiatrists to quickly start patients on medication without first starting psychosocial interventions.

I agree with the need for a good evaluation, but sometimes just getting the story and observing the patient in an interview are enough to make the diagnosis pretty clear.  I did also use a rating scale, usually more to help convince the patient more than myself, and got outside information when possible. The recommendations can be impracticable, given the limited time most physicians have and the lack of enough psychiatrists to meet the need.  One recommendation was that the physician go to observe the child in the classroom. Oh, my.

Many psychologists are better trained to make the diagnosis than many physicians, even many psychiatrists, but may lean too far away from recommending medication since most can’t prescribe. Many well trained ADHD coaches could make the diagnosis, although they are not supposed to.

I think most people with ADHD deserve at least a trial of medication to see how it works for them.

The rate of children being diagnosed with ADHD, and often treated with medication, is rising.  There are many possible explanations for this, which I will try to address next time.  Maybe.  This post is already longer than I’d intended. 

doug

News O the Day of Interest to No One But Me:

My iPhone arrived Monday morning.  I really missed it.

Links:

DSM V diagnostic criteria for ADHD,  David Rabiner, Ph.D.

Getting Diagnosed

Medications for ADHD?

 

   @addstrategies  #adhd  #add  @dougmkpdp    
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About doug with ADHD

I am a psychiatric physician. I learned I have ADHD at age 64, and then wrote two ADHD books for adults, focusing on strategies for making your life better. Your Life Can Be Better; strategies for adults with ADD/ADHD available at amazon.com, or smashwords.com (for e books) Living Daily With Adult ADD or ADHD: 365 Tips O the Day ( e-book). This is one tip at a time, one page at a time, at your own pace. It's meant to last a year. As a child, I was a bully. Then there was a transformation. Now I am committed to helping people instead abusing them. The Bully was published in January, 2016. It's in print or e book, on Amazon.
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9 Responses to “Are We Overdiagnosing and Overtreating ADHD?” – Part Two— ADHD Tip O the Day 786

  1. …had some technical difficulties.

    I was saying, thanks for the post, and I had two quick things.

    One, do you ever listen to Attention Talk Radio? I heard a podcast today in which the gentleman was saying that nicotine can benefit people with ADHD and that back before we cut out smoking everywhere, perhaps people were self-medicating. And now, my inference, is that since people are cutting back so drastically on their nicotine intake, ADHD symptoms may be more prevelant and people may be more diagnosed. Have you heard about this?

    Also, I had a quick question. You mentioned that ADHD coaches shouldn’t be making the diagnoses, but I thought only certain medical practitioners could. Are you saying that that they can’t, but understand the child well enough that they could make a diagnosis?

    Thanks again for the blog!

    Liked by 1 person

    • becket
      thanks for your good comments.
      no, i dont listen to radio but sounds like a good program. havent heard about the nicotine, tho it certainly helps people with schizoprenia. do you know if there have been any ADHD studies using the gum or the patches? no one should smoke, damage far outweighs any possible benefits.
      not sure what i said, but you are right about what i meant – ADHD coaches tell me they are not allowed to make a diagnosis, but I’m pretty sure they are capable of doing so. they might miss some other comorbid conditions or even some conditions that masquerade as ADHD, but so do MD’s
      thank you for commenting
      doug
      links
      http://www.webmd.com/add-adhd/news/19991202/nicotine-patch-help-concentration#1

      VOL 32, NO. 1, 1996
      67
      Nicotine and Attention in Aduit
      Attention Deficit Hyperactivity
      Disorder (ADHD
      )1
      C. Keith Conners, Ph.D., Edward D. Levin,
      Ph.D., Elizabeth Sparrow, B.S., Sean C.
      Hinton, M.S., Drew Erhardt, Ph.D., Warren
      H. Meek, Ph.D., Jed E. Rose, Ph.D. and
      John March, M.D.2
      Abstract
      Nicotine, like the psychostimulants methylphenidate
      and dextroamphetamine, acts as an indirect dopamine
      agonist and improves attention and arousal. Adults
      and adolescents with attention deficit hyperactivity
      disorder (ADHD) smoke much more frequently than
      normal individuals or those with other psychiatric con­
      ditions, perhaps as a form of self-medication for ADHD
      symptoms. Nicotine might therefore have some value
      as a treatment for ADHD. The present study is an acute
      double-blind crossover administration of nicotine and
      placebo with smokers (n=6) and nonsmokers
      [n=
      11)
      diagnosed with adult ADHD. The drug was delivered
      via a transdermal patch at a dosage of 7 mg/day for
      nonsmokers and 21 mg/day for smokers. Results indi­
      cate significant clinician-rated global improvement,
      self-rated vigor and concentration, and improved per­
      formance on chronometric measures of attention and
      timing accuracy. Side effects were minimal. These
      acute results indicate the need for a longer clinical trial
      and a comparison with other stimulants in adult ADHD
      treatment.
      Psychopharmacology Bulletin
      32(1 ):67-73,1996.
      Keywords:
      nicotine, ADHD, adult ADD, pharmacotherapy.

      Like

  2. Hey, thanks for the post!
    Two

    Liked by 1 person

  3. Pingback: Life With ADHD — ADHD Tip O the Day 787 | ADDadultstrategies

  4. rammkatze says:

    Diagnosing kids can be tricky, I see. I’m pretty sure my niece has adhd, but since even my sister doesn’t know I have ADHD (and our mother too, I’m pretty sure), I’m here the school will figure it out when she starts going. It is a delicate topic, and as you usually put it: it’s a booger.

    Liked by 1 person

    • Ram – well, there is a genetic component, especially fathers to sons. in the US, I wouldn’t be too hopeful that the school would figure it out. Sad.
      thank you for commenting. you add a lot.
      doug

      Like

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