The front page of the New York Times featured “Drowned in a Stream of Prescriptions” (Feb 3) exposing the ease with which a person can obtain a diagnosis and medication for ADHD. The tragic outcome of this story is not common but the unreliable diagnosis and abuse of meds by those without ADHD is common in my observation.
The sloppy diagnosis and current culture shown in this article reminds me of Alice in Wonderland.
“But I don’t want to go among mad people," Alice remarked.
"Oh, you can’t help that," said the Cat: "we’re all mad here. I’m mad. You’re mad."
"How do you know I’m mad?" said Alice.
"You must be," said the Cat, or you wouldn’t have come here.”
I have a clear recommendation that may have prevented the tragedy of Richard Fee that until this article, many saw as unreasonable. That recommendation is that before an evaluation of ADHD a person should receive 12 sessions of psychotherapy. While this will prevent drug seekers from getting a diagnosis by making it an arduous process not a simple one, it will also prevent a life-long diagnosis and medication regimen for those who are not drug seeking but do not have ADHD. Many people have difficulty concentrating and believe they have ADHD. An egregious example is a 14 year old boy who suddenly can’t concentrate on his studies. In this case, it is more likely a well-documented developmental phenomenon called puberty. He can’t concentrate because he has become more interested in 14 year old girls rather than his studies.
More commonly, depression, anxiety, addictions, learning disorders, sleep disruption and high levels of stress impair concentration. For a child or adult 12 session of therapy can separate the signal (ADHD) from the noise (100s of reasons for difficulty concentrating). It is possible that a course of therapy that increases emotional intelligence would improve behavior and attention so that by the end of treatment a person wouldn’t even need an evaluation. And the “side effects” of increased emotional intelligence include improved social and emotional functioning for the rest of one’s life! If symptoms persist after the 12 sessions of therapy, a gold standard diagnosis should be sought.
While this may seem like a lot, it may prevent tragedies of misdiagnosis which prevent underlying issues from being treated and a life- long regimen of medication. In principle, looking to a brain disorder to explain attention deficits should be the LAST possible explanation. Especially for children, developmentally you would expect rowdy behavior and difficulty with attention. Almost all kids have SOME of the symptoms of ADHD -- SOME of the time. The key point of diagnosis is to rule out alternative explanations and to determine that a “clinically significant impairment in functioning” exists.
WebMD features the Gift of ADHD http://www.webmd.com/add-adhd/features/is-there-gift-in-adhd
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