family practice issues and general life events

Posts tagged ‘ADHD’

Do we overmedicate?

I saw a child the other day, a patient.  He was brought in for routine medication, one he didn’t want and didn’t feel he needed.  His parents weren’t sure either but the school was demanding it.  This actually is not too terribly uncommon.

The diagnosis of ADHD has become so used and diagnosed, it makes me question whether all the diagnosis are valid.  I try to do the right thing, I make sure all my newly diagnosed patients are formally tested, but over the last 6 months to a year, I have found that all of the tests are coming back positive.  That makes me question, am I only sending those that I already know have ADHD, or is something else going on?  In fact, some that I sent more for developmental delay came back positive as ADHD.  This was not the case two years ago, and I was using the same people to do the test.

Is the problem becoming overly epidemic or all some of the tools becoming misused to put more children on stimulants so rather than having to engage the children in their work they are merely medicated so that their job is easier.  What if the decreased concentration has more to do with the children being bored because of lack of stimulation, than to do with true ADHD?  I can calm any child down with Ritalin/Adderall and other stimulants, but to what cost?  And now the American Psychiatric Association is discussing with their DSM -10 changing the lower age limit down to 4.  How many of you had a calm 4 year old?

I have grave concerns for this trend.  I thought it was improving briefly and there are definitely times when medication is needed to help the child succeed in school and life, and even some adults sometimes need it.  But are we trading in our children’s health and well being for well ordered classrooms?

One of parents greatest complaints is that sometimes their children seem like zombies on their medication.  That child is overmedicated, but when we decrease the dosage a little, there seems to be complaints from the school.  I don’t know about you, but I went into a local school about 2 years ago, and was horrified by what I saw.  In the time before classes began there were more children on the wall in time out than there were sitting at the tables in the cafeteria.  This was before classes had started. And I saw one teacher send another student that way for merely asking another student for a pencil.  So my question is, whether the ADHD epidemic is true, or is it manufactured from our one size fits all education system.  Are we forgetting that 5 year olds need to be stimulated?  Maybe we need to sit down and look a little closer at where the problem is coming from.

As for me, I am stuck between a rock and a hard place.  What do I do for that child?  Is medicine the best choice?  Maybe, maybe not.  But him getting kicked out of school definitely isn’t.  So I write the prescription, and we discuss things to help him function better in school, and I will see him again, in the next room, or tomorrow.  Unfortunately in some cases, I don’t have the answers, only the questions.

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