Shirah Vollmer MD

The Musings of Dr. Vollmer

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.

 

See also…https://shirahvollmermd.wordpress.com/2010/04/25/is-it-severe-adhd-or-is-it-aspergers-the-case-for-a-good-assessment/

7 Responses to “ADHD:Who Should Treat It?”

  1. Shelly said

    Great piece, thanks. The pediatrician treating my children never prescribe medication alone but simply take the advise of neurologists or psychiatrists who have seen my kids–i.e. refill meds that are prescribed by others. Aren’t Behavior Pediatricians less inclined towards using medication and more into using behavior modification? Where does therapy and family dynamics enter into the picture? How can you “pool your expertise” when all you professionals have different approaches to treating the patient?

    • Behavioral pediatricians are probably a mixed bunch. The ones I am familiar with are happy to prescribe stimulants. Yes, therapy and family dynamics are a very important part of treating ADHD. ADHD kids bring a lot of stress to the family, and as such, the families need a lot of support in managing their marriage and their family life. Ideally, we could pool our expertise by going to the same conferences and sharing information. Sadly, this is rarely done. We usually stay in our own worlds. Thanks, as always.

  2. mimi said

    And don’t forget all of the misdiagnosed kids!

  3. Jackie said

    My kids were diagnosed with ADHD and ODD . They do not like the affect of medications ( we tried several ) and what makes the whole situation even harder is the fact that their father doesn’t believe there is such a thing as ADHD ( he was diagnosed with ADHD also) . He sees me as too strict with my rules and routines and sabotages my efforts to build a structure. We tried family therapy and now we are facing divorce which makes the kids even more confused and defiant.
    I would like to meet with you.

  4. Shay said

    We have a 6 year old daughter who was diagnosed with ADHD at the age of 4. At the age of 5, she was diagnosed with PDD-NOS. We have been on a medication roller coaster ever since. On top of that, we have seen an expensive therapist that after a month of weekly visits said he just couldn’t get a connection with her. While she does portray some behaviors that fall into the PPD category, we are starting to believe more and more that her issue may just be severe ADHD. From what we have gathered after much reading, the PDD and severe ADHD have a lot of the same quarks and behaviors, such as impulse control. We are at a loss as to what to do. I have read several of your articles and they are some of the best that I have seen on ADHD. Everything else that we have seen just tells us to “stick with it” and to “work through it” as we work through this puzzle. This is true, but when you feel as if nothing seems to work, you start to question just what is being treated and if it is being treated properly. If you are available, I would like to talk with you more in depth. Thank you for your time!

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