Shirah Vollmer MD

The Musings of Dr. Vollmer

The Second Opinion

Posted by Dr. Vollmer on March 3, 2011

Sharlene, seventeen, has been diagnosed with ADHD since she was eight years old. She has substance abuse issues, truancy issues, and she does not do her chores around the house. Her biological history is that she was the product of a sperm donor father and a single parent mother. She was raised by her grandmother, Sherry, who is now age sixty. Although Sharlene is on medication for her ADHD, my advice to Sherry is that Sharlene needs a strict behavioral program to help her have more socially appropriate behaviors. “You would need to be responsible for instituting this behavioral program, I tell Sherry directly. “Sharlene’s problems are from her ADHD and you seem to not understand that,” Sherry tells me with tears in her eyes. “I do understand that, ” I respond, but ADHD often requires a two-pronged approach: medication and a behavioral program. “Well, you don’t seem to see that if Sharlene just understood her situation better, then she would behave more responsibly,” Sherry tries to persuade me. “Well, of course, you can always seek a second opinion, but it is my opinion that Sharlene, at this time in her life, is not open to looking inward, and hence an external program, one that gives her strict consequences for her behavior, is needed,” I say with conviction. “I think someone who understands ADHD better will see things differently,” Sherry says. “I am curious what the second opinion will say, and I think that another professional could be helpful, but at the same time, I am worried that you might be giving Sharlene implicit permission to act irresponsibly by implying that she has a condition that she cannot change herself,” I say, trying to explain that personal responsibility is key, despite the fact that ADHD is a biological disorder which is not Sharlene’s fault. In other words, I explain “Sharlene should not use ADHD as an excuse for antisocial behavior,” I say. “Well, let’s see what the next doctor says,” Sherry says to me, continuing with her tears. It was a tough session.

2 Responses to “The Second Opinion”

  1. Shelly said

    Why is Sherry raising the grandaughter? Does she really not understand that ADHD cannot be fixed by medication alone? Given Sharlene’s history of substance abuse, truancy and oppositional defiance at home, won’t it be extremely difficult for Sherry to enforce a behavioral program at home?

    • Sherry is raising the granddaughter because Sherry’s daughter Jolie gave up parental rights. Sherry’s point of view is that if Sharlene had greater insight then she would no longer engage in uncooperative/illegal activities. Sherry is not so fixated on the medication as the cure, but rather “insight”. Normally, I think “insight” can be very valuable, but in this situation, there is no “buy in” on Sharlene’s part. Yes, a behavioral program might not work, but it is a good first step.

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