Shirah Vollmer MD

The Musings of Dr. Vollmer

ADHD, In Context: Give Me A Break

Posted by Dr. Vollmer on June 8, 2016


ADHD can look like PTSD, or in the new language,  a result of ACEs (adverse childhood events), in that the lack of focus could be a result of traumatic experiences interfering with the ability to concentrate. Understanding the child in context can help discern the various factors which contribute to difficult or disruptive behaviors. I am just not sure why this needs to be said, as it is inherently obvious. Yet, in lecture after lecture, that I go to, given by people with impressive degrees, I hear this as a take-away point, as if the audience does not know this. Without understanding the child’s environment, the speaker said, you can make the wrong diagnosis. Duh, was my private thought, while I was  stuck on whether the speaker thought she was being profound or if she thought that her audience was so clueless that she had to state the obvious. Every child, every patient needs to be seen in the broader context of their family, social and academic environments. In today’s day of assembly-line medicine, perhaps this does need to be said. I close with a common refrain of mine. Sad, sad, sad.

2 Responses to “ADHD, In Context: Give Me A Break”

  1. Shelly said

    Indeed. Wasn’t it just last week that I read an article which said that there is no, or at least far less, ADHD in other countries such as France? That being said, does that mean that ACEs don’t happen in other countries? No. Does it mean that overactive children’s behavior disrupt the classroom more in the US than elsewhere? No. I think that ADHD definitions vary widely worldwide. Where I live, I often receive phone calls (and since I work in an open workspace hear other parents receiving similar phone calls) from my child’s’ teacher telling me that my child had a hard day. I’m sure that is teacher-speak for how much of a hard time she had with his behavior (on medication, no less!). So tell me again why other countries don’t have ADHD?

    • Indeed, the regional variation of diagnoses is very “interesting” to be dispassionate about it, and certainly noteworthy. There is always a cultural context to psychiatric diagnosis, such that how a society understands behavioral issues has a lot to do with who gets diagnosed and treated. Drug companies too, play a role in the diagnosis and treatment of disorders. The first step is for us, as professionals, to try to understand the context, and to me, this is an obvious point, but maybe, since I am seasoned, I forget that the training has changed, and so perhaps this is not as obvious to others. In essence, perhaps the pendulum is swinging back towards getting a good history and understanding the patient on multiple levels, and we are swinging away from a narrow look at behavioral issues. I sure hope so.

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