The New York Times Sunday front-page article on a twenty-something young adult’s struggle with attention-deficit drugs that ended in his suicide was a tragic telling of a story involving questions of ADHD, stimulant medications and the failure of the system to help both the young man and his family.
Through the three-page account, I found parallels to the struggles parents have experienced in my own 30-year practice as a psychologist in Dearborn Michigan, and the
challenges of diagnosis and treatment. There are both clues and myths operating in this
area of ADHD – which has prompted my response.
Myth #1: Diagnosis can be made in one session with a licensed practitioner.
The Connors test cited in the article is not reliable as a stand-alone test.
The results can be misleading and it is a self-assessment. It does not show learning disabilities or personality issues which impact both diagnosis and treatment.
I never use a self-assessment test.
In my practice, the procedure I have used with transformative success is:
- 8 hours of data and impression gathering – which involves one session of history gathering, preferably involving the mother as well as the patient (mothers are usually more detailed than fathers, but if mother is not available
father or other parent figures are involved). Ninety-five percent (95%) of the
patients I see has someone who can give a history.
- Three (3) fifty-minute sessions of standardized testing on different days,
- A behavioral check list given to parents separately, spouse, or teachers when available,
- A personality test when judged important, and
- Approximately four hours of person-individualized analysis.
This process is completed before any diagnosis is made, or medication written by an in- formed physician or psychiatrist for stimulant or stratera trial at the physician’s discretion. Best case is a collaborative team comprised of a family physician, a psychologist and/or a psychiatrist.
Follow up is critical for both the prescribing physician and the talk doctor-psychologist-therapist. The follow up sessions are generally 50 minutes to determine effects and impact on behavior.
Myth #2: He doesn’t seem “hyper”.
It is not body activity that is the clue – it is brain activity. The ADHD features don’t happen at 14 or after high school, they happen from birth – and there are cues within the family. A student can get As and Bs in grade school and high school because you have structure and personnel who are concerned – providing attention to the student. In college, you rarely see that kind of attention, and the student has to make the structure for themselves.
Many times, there is more going on than just the appearance of being “hyper”, or grades. The students generally have problems socially, they don’t have many friends, and they tend to be impulsive and disorganized.
Myth #3: The medication doesn’t seem to help and needs to be increased.
The general dosage begins at the lowest level (10 to 18 mg) (not 50 mg or higher as the article states). If the patient has been diagnosed properly, it works immediately – within 15 minutes and lasts eight(8) hours. This is in contrast to anti-depressants that can take 3-6 weeks to have an impact.
However, if you put a non-ADD, or ADHD patient on stimulant medication, you will see more manic and grandiose behavior, more impulsive tendencies, and more sleeplessness.
In my 30 year practice, 85% of the desired effect for ADD and ADHD happens through proper diagnosis and medication. The medication is a bridge that teaches the patient what the state of calm feels like.
Most of the patients I see have gone on to lead productive successful lives and many
no longer need medication after two to three years. But it is essential to the patient and the family that proper diagnosis is made and a collaborative team in place to monitor the effects and the impact.
John A. George, Ph.D
Member, Michigan Psychological Association
Former Professor of Educational and Clinical Psychology, Wayne State University