Accurate Diagnosis vs. Subjective understanding

[PAPAMAU1]

I have lived with ADHD all my life (69 years). In my professional life as a clinician, I had the good fortune of working closely with psychiatrists and others skilled in the DSM. ADHD has historically taken various ups and downs based on my experience (not always consistent with science and statistics). For instance, during my experience working with children and families with a child living with ADHD, whether formally diagnosed or not. The family's journey and the child's separate yet critical journey that resulted in an authentic ADHD diagnosis led to both positive and negative outcomes depending on the services delivery system, including the primary support group. One issue that was near and dear to me was the child's acting-out behaviors that led to some third-grade non-readers. It also led to oppositional-defiant behavior, plus a diagnosis. And, at worst, the child grows and matures to evolve into increasingly bad behaviors leading to Anti-Social Personality Disorder. Ok, that is the worst case scenario. Then, another trajectory includes the child who begins with loving the whole world, and it is a great place to explore, enjoy the gift of curiosity, and wanting to do everything. They are the best in their class, attend a college of their choice, and succeed, looking at them from the outside. Often, they are very lonely and do well in crowds based on their animated and magnetic contributions; yet, when everyone goes home, that person has an empty sense of themselves. Other social experiences during the event offered most of the crowd a sense of satisfaction. Yet, the ADHD person could be exhausted as they gave everything to everyone. They experienced a sense of success in the moment while the action was happening. Then, at the end comes that void, and they often second-guess their identity compared to the others at the social event. Finally, and this is an issue mostly associated with a misdiagnosis. When using a checklist to diagnose ADHD, there are some incomplete determinants. For instance, the authentic diagnosis benefits from knowing whether the symptoms were present before they were seven. Even though it is not a qualifier, a small interview with the mother and asking questions about their pregnancy, many moms will emphasize that the baby was very active during the pregnancy. I have a hesitancy reaction when someone tells me that they have ADHD and can't offer any history of their younger years. In summary, the checklist first filled out as an adult is not definitive of the diagnosis. Far be it from me to diminish the symptoms that a person is living with and having to cope with some poor outcomes. There are some in our human population who are seeking out the stimulant medicine and count on a way and means for obtaining the diagnosis.

Pardon me, I am now on a roll. I am highly sensitive to the families who have a child who was referred to their family doctor or Psychiatrist and learn their child has been diagnosed with ADHD. Often, they don't know much about the generally accepted practices, nor does the school the child attends. One issue that often results in a bad outcome is when the parents are dictated to medicate their child. First, they had just left the doctor's office and learned about the diagnosis. Then, when the delivery approach comes from an authority figure, it dictates that the use of medicine is unethical and justifiably immoral. Yes, the stimulant medications are highly effective and often a conduit that promotes the learning process and makes life a lot easier for the entire family system. Living in the United States and other free countries, we are entitled to use our self-determination when medication choices are recommended, except for medicines such as insulin and other required life-sustaining medications.

Those with drug-seeking behaviors need to arrive at their own ends based on their choices. The service delivery system of care doesn't need to waste precious resources on that crowd.

I advocate for a strong educational element when discussing medication management and ADHD. I also encourage the family system to have access to any education that offers the various scenarios associated with ADHD.

[Lory_Y]

It's clear that understanding a person's full history, especially from childhood, is so important for a proper diagnosis. I also agree that educating families about treatment options, including medication, is key.