Shirah Vollmer MD

The Musings of Dr. Vollmer

Archive for September 19th, 2011

ADHD:Who Should Treat It?

Posted by Dr. Vollmer on September 19, 2011

   Child psychiatrists, behavioral pediatricians, family physicians, child neurologists are all physicians who feel comfortable and confident in treating ADHD kids. Where should a family turn when their child begins to have behavioral problems at school? The path is not clear. Often, the family begins in primary care, either at a pediatrician’s office or a Family Medicine doctor. Then, depending on the comfort level of the provider, either they receive treatment in primary care, or they get referred. This referral can be to any of the above-named specialists, all of whom have a different idea about how to treat ADHD. The family is often unaware of the landscape, and hence they are blindly following the recommendations of their Primary Care Physician. Usually, the child ends up on stimulants, but the difference lies in the details. For example, child psychiatrists, as a group, are usually the only ones who insist on a two-parent consent process, whereas the other providers are satisfied with getting the history and the consent from one source. The other disparity is in how much attention is paid to the family dynamics. ADHD poses a severe risk to marriages, and neglect of other siblings. I contend that child psychiatrists are more attuned to those very important issues. ADHD kids often need an advocate at their school to make sure that their educational system is maximized given their disability. A child psychiatrist is more likely to emphasize the importance of altering a child’s education, given the diagnosis of ADHD.

  I am biased, I hear my readers saying. Of course. I speak from my point of view. Still, the medicalization of ADHD seems to narrow the scope of this large issue which occurs in a developing child, and hence impacts a family. Child psychiatrists are uniquely suited to understanding the need for medication, while at the same time, appreciate the need for multiple psychosocial interventions as well. Child neurologists tend to treat ADHD like seizures; they try to “get it under control” as if this is not a life-long struggle with many potential hazards downstream. Behavioral Pediatricians are well trained in the area of ADHD, but they hit their limits when the behavior becomes very aggressive and is unresponsive to psychotropic medication. I do not mean to disparage my medical colleagues. I would rather that we pool our expertise so that we can figure out how to refer to one another. I am not sure how to make that happen. My second wish is for the consumer (or the patient’s family, in these cases) to know the difference so that they can seek consultation in a place that makes sense to them. Medical care is in such high demand. It is too bad there is redundancy in our system, especially when healthcare workforce issues are coming to light. Clearing the road for consumers, such that there is greater clarity on who should treat ADHD,  might help patients streamline their efforts to help their child. I can hope.


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