There is a whole lot of rumble going on about ADD in adults. The NY Times made the APA a little upset with this one last week. Now here are the issues.
1. ADD is usually proceeded by ADHD or ADD in childhood.
2. This brain disease usually presents somewhere in childhood.
3. Many of the drugs that we use to treat this disorder are termed “controlled.”
4. Many of the drugs that we use to treat this disorder can also be used for “Cognitive Enhancement in students and or professionals.”
5. Many providers have been accused of “failing to provide” an adequate work-up before prescribing stimulants which can be abused if not prescribed and monitored properly.
Now what about me and my practice. I require a very thorough psychiatric evaluation and some form of testing before prescribing a stimulant to anyone who is post-secondary in their educational pursuit. If this is your first time presenting and you are a Sophomore in college, I certainly require a more intensive and rigorous work-up. Now, if a patient is NOT looking for medications, but merely organizational skill training, I am less suspect. I am very concerned about the college engineering student who presents for the first time, after he or she has failed Physics II. Now there is a quick test, the ADHD-RS-IV that I can do at the bedside, in my office. This is a quick test that just might validate a need for any further testing or evaluation. However, I can assure you that I ain’t giving out no medications after the first session without good and solid objective, not subjective data for the new-comer who has already completed high school.
Dr.O is there anythings that might make you a little suspect that ADD is low on the differential? Yes, let me just list a few out for you.
A. A successful student with a GPA 3.0 or above.
B. A high-powered executive in a new competitive position with new job requirements.
C. Lack of any pre-existing documented mental illness.
D. A competitive work-place and or recent bad performance evaluation.
E. Scanty oral presentation of signs and symptoms (Reciting the DSM-IV criteria to me).
A good psychiatrist only treats brain disease after an appropriate work-up. He/She is NOT afraid of the “pushy” or “hyper-verbal” patient who may know how to manipulate a system.Most patients will say, “I am not sure I have this disorder or something else but I simply need to be evaluated. If I, as a physician become a little uncomfortable with what I am being told, I will certainly probe a little more with my diagnostic stethoscope. Physicians are now under fire by insurers and others for some of their prescribing practices. Therefore, we must exercise our due-diligence before “passing any medications” to the patient.
I hope this article has been helpful. I did not go into a lot of the specific diagnostic criteria because I don’t want to be misleading to any of my readers. However, any good textbook should be descriptive enough for you to understand your possibilities of having this disorder.
Once again thank you for visiting this blog. Have you checked out my website @www.AskDrO.com there are some interesting articles on mental health and hot topics just for your pleasure.