Dr is In - July 2012

The Doctor Is In

Gail Hacker MD
Gail Hacker, MD

July 2012

 Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder (ADD/ADHD)

health clinic graphic icon of stethoscope

 What it is, What it isn't, and Why the Health Clinic has a new policy regarding it.

First, what ADD is not.

ADD/ADHD is not "I study better and do better on tests when I take my friend's Ritalin."(Which, BTW, is a Class B felony, punishable by up to 10 years in prison.)  Nearly everyone focuses better and can pull all-nighters if they take an amphetamine. Does this mean we are having a pandemic of ADD/ADHD? No. Absolutely not. If I was to give you a shot of insulin your blood sugar would come down. Does that mean you have diabetes? No. All drugs have effects on our bodies. This does not a diagnosis make

ADD/ADHD is a clinical disorder with clear cut diagnostic criteria defined by the DSM IV, which is the manual of psychiatric diagnoses published by the American Psychiatric Association. A link to the CDC that lists the specific criteria for the diagnosis of ADD/ADHD is listed at the end of this article. A person must have more than one symptom and be affected in more than one arena (i.e. work and school) to meet the diagnostic criteria.

Diagnosis In order to do a complete and thorough evaluation for ADD a clinician needs to spend a great deal of time over multiple visits and should really interview not only the patient, but the patient's family members, bosses, and  teachers. For adults with a questionable diagnosis, records need to be reviewed as far back as elementary school, since we know that adults do not develop ADD or ADHD. For adults, this diagnosis is always a continuation of disease that began during early childhood. About 30-50% of children with true ADD or ADHD will continue to have symptoms during adulthood, but adults NEVER develop it de novo. When adults develop new symptoms of difficulty concentrating or sitting still, it always requires an extensive evaluation to rule out other disorders.

 The "Epidemic" Over the past five years, the number of prescriptions written for the treatment of ADD or ADHD has increased over 600% in this country. There has not been a sudden epidemic of ADD or ADHD. There has been an epidemic of overprescribing of ADD/ADHD medications. There has also been an epidemic of diversion of these substances (sales or distribution of controlled substances to those without a prescription). In the past, many health care providers were willing to provide diagnosis and treatment of ADD/ADHD with a less-thorough evaluation than is listed above, believing that it was the right thing to do. It turns out this was not in the best interest of patients. Because of this, many institutions, the University of Oregon and LCC included, have changed their policies on diagnosis and treatment of ADD.

The Problem So, what's the problem with prescribing a medication like Ritalin or Adderall without a clear-cut diagnosis of ADD or ADHD if it helps students perform better? Well, as noted above, these meds are frequently not used by the patient receiving the prescription, but are used for financial (and highly illegal) gain. Diversion of controlled substances is a Class B felony.  Also, most ADD medications are amphetamines.

The top 3 serious adverse effects listed are

  • dependency/abuse,
  • psychosis, and
  • mania

Other potentially serious effects include heart attack, heart arrhythmias, seizures, and stroke. Commonly reported side effects include nervousness, anorexia, high blood pressure, elevated heart rate, and chest pain.

Weighing Benefits and Risks As with all diseases, it is the job of your health care provider to weigh the benefits vs. the risks of treatment. Given the above-named risks, a clear-cut diagnosis of ADD/ADHD is mandatory before a prescription can or should be written.

All clinicians have limits on what they are trained and able to diagnose and treat.  Just as we refer patients to specialists for treatment of cancer, (or specialty surgery, or other health conditions requiring a specific medical specialist for diagnosis and intervention), we realize we need specialty consultation for the diagnosis and institution of treatment for ADD or ADHD.

LCC Clinic's New Policy on ADD/ADHD We no longer institute initial treatment of ADD or ADHD at the LCC Health Clinic.

What Your LCC Clinic Can Do for You

  • We are willing and able to meet with you to see if you may have symptoms of anxiety, depression, or a medical disorder that may mimic signs of ADD/ADHD.
  • We can provide you with a list of outside specialists that are available, at a cost, to do the initial evaluation.
  • After you have been evaluated by a specialist and we have a copy of their report, we will usually follow their guidelines for treatment. (We may ask for a release of records to accomplish this.)
  • All LCC students also have access to our excellent LCC counseling department, and we strongly encourage you to visit with them if you have questions regarding ADD/ADHD evaluation and non-medical treatment. Their services are free to all enrolled students.

Resources Below is a list of online resources you may find helpful or illuminating:

Adult ADHD: Evaluation and Treatment in Family Medicine, H. Russell Searight PhD, John M. Burke PHARM. D., and Fred Rottnek MD: http://www.aafp.org/afp/2000/1101/p2077.html

Attention-Deficit/Hyperactivity Disorder (ADHD), Centers for Disease Control and Prevention (CDC) http://www.cdc.gov/ncbddd/adhd/diagnosis.html

Testimony of William R. Bess JD, Virginia State Police, Richmond, Virginia, Testimony Before the Health, Education, Labor & Pensions Committee, United States Senate Hearing on OxyContin: Balancing Risk and Benefits, February 12, 2002 http://www.help.senate.gov/imo/media/doc/Bess.pdf

Controlled Substances in Oregon, Wikipedia, last modified on 29 May 2012 http://en.wikipedia.org/wiki/Controlled_substances_in_Oregon#Prescription_drugs

Attention Deficit Hyperactivity Disorder (ADHD), National Institute of Mental Health (NIMH) http://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml

 

woman in sunshineSupporting you in good health,
Gail Hacker, MD