ADHD Medication: Making the Right Diagnoses Part 2

Deciphering ADHD treatment and medication can be confusing. People with ADHD can receive different information from many different sources. For example, when patients, parents or teachers are asked to provide quantitative information using behavior-rating forms, the results can be confusing.

Often rating forms from two parents living in the same home with the child vary significantly in the number or frequency of symptoms reported. One parent may suggest significant problems with impairment while the other thinks the child is fine. This is only compounded for kids sharing time between two households. It may be harder for the non-custodial parent to see impairment while the parent supervising homework night after night is frustrated to the point of tears. For kids with multiple teachers, symptom rating form results can be variable and affected by many things such as:

  • personality conflict
  • teacher bias toward or against ADHD
  • time of day
  • a student’s interest or competence in a subject
  • the style of teaching, behavior of the peers in the classroom
  • bullying or multiple other extrinsic factors

Histories from parents, teachers and the patient may all vary. Some parents may exaggerate symptoms after hearing how much stimulants helped a friend’s child. Teens and young adults see improvement in their peer’s performance on stimulants and want to try them for themselves. The irony is that while some are seeking medication for performance enhancement, other parents may minimize true ADHD symptoms because they believe the behaviors to be age and gender appropriate or don’t fit the stereotypical (but erroneous) image of bad behavior. They make statements such as “He’s just a boy’ or ‘she’s just spacey’ or the most hurtful and damaging to the child with ADHD, ‘he’s lazy’.

Gray area indeed.

The irony doesn’t stop with diagnostic gray areas. While elsewhere more and more prescriptions are being written for neuroenhancement for patients that may not have ADHD, most patients that actually do have the disorder are being under treated according to Dr. Mark Wolraich, MD, FAAP, who helped write the ADHD guidelines for the American Academy of Pediatrics.

Patients taking stimulants have to be carefully monitored. There are no good or bad medications for ADHD. All work beautifully for some patients and lead to significant side effects in others. The key is to find the just right dose of the just right medication for the patient and this initially requires frequent follow up and thoughtful adjustment of medication dose.

Using an evidence-based plan of follow up and dose titration with both clinical evaluation and objective testing of symptom change and side effects usually allows Focus-MD clinicians to achieve dose optimization for patients in weeks to months not months to years.

Dr. Wiley is board certified in Pediatrics. He practiced general pediatrics at Dothan Pediatric Clinic in Dothan AL for almost 20 years before moving to Mobile in 2008 and founding Focus.

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