Posted by noa on October 19, 2000, at 14:47:16
In reply to Re: Adderall, posted by JohnL on October 19, 2000, at 4:29:07
>There are normal growing-up behaviors and day to day distractions in the twenty first century that lead to millions of false diagnosis of ADD or ADHD.
This may be true, but there are also many kids with ADD that go undiagnosed and treated.
Not that it evens things out. Better training for pediatricians is needed, better protocols for referrals by insurance companies to competent mental health professionals and access to other forms of intervention (parent training, cog-beh. tx, etc. etc.) are needed both to avoid overdiagnosing and overlooking ADD/ADHD. I went to a consensus conference on ADHD a few years ago and one of the papers presented included the finding that most cases of ADHD are dxed and treated by a pediatrician or family doctor, the agerage amount of time evaluating the child was 15 minutes, the typical evaluation included data from parent report only. This is completely inconsistent with the accepted standards. The DSM criteria state that the symptoms need to cause marked problems in at least two settings and the standard for mental health professionals is to get observations from at least two sources, reflecting behavior in two settings. And, it is so important to do careful differential diagnosis because the symptoms of ADHD do overlap with those of other disorders.
In addition, this typical 15 minute limited "eval" often leads to medication without the doc ever contacting the school to find out if they have tried any other interventions, and without attempting any other strategies with the parents. Sometimes the problem is really a learning disability, unnoticed, or a poor fit with a particular school environment, for example. Sometimes teaching some behavior management skills is enough.
On the other hand, if ADHD related or non-ADHD related behavioral issues are left unaddressed, more entrenched patterns set in and by the time help is sought, it is much harder to make good use of non-medical interventions.
At the same time, lots of kids go undiagnosed and just shut down in some areas of their lives, esp. school, because of their sense of failure, and because of this, untreated ADHD often leads to the development of other problems and disorders: poor self-esteem, behavior problems, anxiety and mood disorders, social problems, oppositional behavior, antisocial behavior, self-medication with all kinds of substances, poor choices in activities and friends, lack of opportunity to develop intellectual abilities, school drop-out, etc. etc.
Another issue, I believe, is that stimulants (like many other meds) need to be started at low doses and titrated slowly, with close monitoring to see how the patient, especially a child, tolerates the medication.
So, essentially what I am saying is that the same sorts of problems that lead to overdiagnosis and overmedication, also lead to underdiagnosis and neglect of the needs of many with ADHD. AND, they lead to improper med management, which can increase the risk of negative reactions to the medications.
I don't know if your child's awful reaction could have been prevented by better or more thorough diagnostic procedures, or by more cautious initiation and more careful monitoring, but it is something to consider. But if you are like many parents in this situation, all you were offered was the standard "off the rack" approach, which is clearly inadequate.I am sorry this happened to your child and you. One thing is now certain. Your child is lucky to have a parent who took notice of the reaction and responded immediately.
I hope your daughter has recovered.
poster:noa
thread:46707
URL: http://www.dr-bob.org/babble/20001012/msgs/46775.html