The hand that was dealt you- ADHD undiagnosed and untreated
Updated: Aug 11, 2022
Few doctors keep up with ADHD. Is the diagnosis nebulous and challenging, requiring one to see a specialist? According to Dr. Bill Dodson, a renowned psychiatrist with expertise in ADHD, diagnosis is not problematic. Pediatricians, internists, and family practice doctors can make it when they understand it better. Asking the appropriate questions is essential, and that starts with proper education.
Someone with ADHD doesn't know any difference; that is all they understand to be how their brain works. I have treated multiple generations with ADHD. If I see a child with ADHD, part of the education is to build awareness that ADHD is genetic and likely one of the parents has ADHD. They likely have never been diagnosed.
Teachers may be uncertain or insecure about broaching the topic of possible ADHD. Although many don't feel comfortable, Dr. Dobson says teachers must bring it up. There is also a stigma among patients with the diagnosis on themselves. The acceptance of the diagnosis, like fibromyalgia, is not always firmly embraced initially.
Making the diagnosis requires taking a careful history and rating scales. Neuropsychiatric testing doesn't help in making the diagnosis. ADHD is common in those with ADHD. A study in 2018 in the Journal of Pain showed 46% of those with fibromyalgia had ADHD. This likely underestimates as most people with ADHD underestimate their impairment.
Patients with fibro who think they have ADHD require a physician to make the diagnosis. The medications work very well for the treatment of ADHD, but the system's clog is that doctors don't feel comfortable diagnosing and treating ADHD. Over seven years, the average adult with ADHD has seen 3.3 physicians and 6.7 SSRI(Serotonin Selective Reuptake Inhibitor) trials. The delay in diagnosis is seven years and leads to many years of frustration. Most people stop trying anymore to get help.
You may come to the realization that you have ADHD, but then finding the doctor to manage it is probably the biggest problem. Dr. Dobson says "it wasn't part of their training. Ninety-three percent of adult psychiatrists have not had ADHD as part of their residency training." Finding a physician can be facilitated by attending the ADDA, the National Association of ADHD in adults association, or CHAD. Children and adults with ADHD, ADD.org, and CHADD.org.
Once diagnosed and treated, most doctors are willing to continue the medication once the medication has been fine-tuned, and ADHD medication dosages shouldn't change. There is rare tolerance. You need to find someone who knows what they are doing or will become frustrated.
How concerned should we be about stimulant medications and their risk of addiction? Dr. Dobson shares the history of stimulant medications. They had been over the counter as nasal and chest decongestants for asthma and became a controlled substance after 1958, when a lot of stimulants were on the market. They had been used to help keep soldiers awake during World War 2. There was some minor problem in Sweden, and then everyone around the country said, let's monitor them and make them schedule 4. 20 years later, drug abuse like cocaine, heroine, and methamphetamine. They were worried amphetamine could be made into methamphetamine. They never evaluated to see if you could make methamphetamine out of amphetamine. It turns out you can't, but you can make it out of Sudafed, which they kept over the counter for another 30 years. It is primarily incompetence by the federal government, according to Dr. Dobson.
What are the features of drugs that are abused? They make the person feel good. There is a ready market for them. People think about it all the time and crave it and have to fight to get someone off of it. In contrast, the stimulants for ADHD, if the dose is too low, you don't feel anything, and it is too high, people complain about how they think. They also forget to take the medication, and parents have to remind their children to take them. 50% of people don't fill their 3rd prescription. At the end of the year, only 13% are taking them. "Does that sound like addiction to you?", Dr. Dobson says. He says that people may try to abuse them, but they do not continue to do so. They are typically white, male, fraternity members, alcoholics and use them to stay awake to drink more. You have to be more vigilant in those situations, which doesn't mean that you shouldn't get prescribed in a fraternity.
90% of adults got to Dr. Dobson because they have a family member who had a marked improvement with ADHD treatment. They try their cousin's medication and do very well. They come to see Dr. Dobson and share the story. He doesn't condone it and is understanding. He says, "Every teacher failed you. Every doctor failed you. You figured it out on your own to get your own prescription. Congratulations. You played the hand that was given you." You have played the hand given to many of you with fibro and ADHD. You have had to struggle through life. Proper treatment can be life-changing.