Why Physicians Should Pay Attention to ADHD

by James Wiley, MD, FAAP — @adddoc

In recent years, our understanding of ADHD has overwhelmingly improved. We know that this chronic medical condition has been proven to cause serious problems with learning, destroys self-esteem, significantly increases the risk of accidents, and can lead to substance abuse, depression, anxiety, divorce, and even incarceration. A recent study suggested that those with ADHD have an increased risk of suicide, especially completed suicide, even without depression.

Now that we know so much about ADHD, isn’t it ironic that so few physicians are paying attention to it? Why are so many ignoring a serious condition that is diagnosed in five to ten percent of our patients?

Here’s who is not ignoring ADHD: The Media. The media gives ADHD plenty of attention, but it’s the wrong kind of attention. We know that ADHD teens are more likely to smoke, but did you hear about the recent study that revealed treating ADHD in childhood cuts the risk of teen tobacco use in half? No, of course not. The media would rather focus on the message of over-diagnosis and over-medication. While both are true scenarios, they are only part of the story.

Another group focused on ADHD is the self-proclaimed “ADHD experts”. You¹ll find them online selling all kinds of interventions for ADHD, most of which have no evidence base whatsoever, and some of which are actually harmful. Many parents spend thousands of dollars on these interventions before realizing that their kids haven’t made any progress at all. What makes this scenario worse is that these “experts” are selling ADHD as mostly a gift. This approach can lull individuals into denial about the significant risks that ADHD brings into our lives.

The five to ten percent of the population living with ADHD and all of the parents wondering if their children have it need more physicians paying more attention to ADHD. They need physicians to provide thoughtful diagnostic evaluations that consider co-occurring conditions like dyslexia, anxiety, and depression. And if an ADHD diagnosis is confirmed, parents and patients need to hear the scientific facts about ADHD and the truth about treatment.

Here’s the truth about ADHD: despite the popular notion that ADHD is a gift, it’s not. It’s a disorder. (Re-read paragraph one if you don’t believe that). Also, ADHD is frequently accompanied by some not-so-great stuff (See paragraph four). However, we cannot overlook the fact that ADHD may provide some abilities. Impulsivity can make a person fun and spontaneous. Hyperactivity makes a high-energy friend. Distractibility can even be vigilance in the right situation. I explain it this way to my patients, “You have an awesome brain, but it¹s not the pay attention kind. Its the notice everything kind.”

While ADHD patients and their parents deserve to know the truth about ADHD, they also should know the truth about medication. For at least 85 percent of ADHD patients, stimulant medication is the treatment of choice. No other treatment has even been close to having the same effect in improving ADHD. And in addition to being effective, stimulant medication is safe and has very few side effects if managed correctly. Perhaps best of all, the medication doesn’t require patients to trade in their gifts. When I asked a young composer patient of mine if his ADHD medication was dampening his creativity, he replied, “Oh, no, Dr. Wiley, I still hear the music. I just get more notes on paper.” Hearing about this precisely-treated, well-controlled ADHD and how it allows my patient to live his life more fully was music to my ears.

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