Druggist Am I

There were many reasons why I didn't become a child psychiatrist, but one of them was this: I was not particularly interested in prescribing stimulants. (The other one was this: parents can be difficult. Now that I am one, I know I am difficult.)

Much of the work of a child psychiatrist these days involve prescribing stimulants for children with attention deficit spectrum disorders. While super important for those with this illness, this is a sticky issue. You see, EVERYONE does better on stimulants. You will focus better, stay awake longer, work on those problems sets more diligently, and DO better, whether you truly have the disorder or not. To meet the diagnostic criteria, there has to be a constellation of symptoms that are consistent in at least two settings- not just at home while under the supervision of a parent, which then might be oppositional defiant disorder. Mind you, having ADD/ADHD can bring on a host of comorbidities- often a very sad situation. For kids with ADD/ADHD, on stimulants, life is HARD: you have to take the medication at very specific times, you won't grow as fast, and life is just harder. Life is also hard without stimulants: harder to make friends (because you keep interrupting them) harder to do well in school (because you keep forgetting your homework at home), harder to get along with your parents (they are so disappointed).

In diagnosing children, there are sets of questionnaires for parents, for teachers, for coaches...etc, and these diagnostic tools are much more reliable than parents who show up and say, "My kid if flunking algebra, she must has ADD." (For starters, these symptoms must be present at a very young age, like before age SEVEN, probably way before people take algebra.) But to negotiate that discussion of "No, she doesn't have ADD, your expectations are just too high" can be very difficult. Besides, all people have some kind of inattention, that is NORMAL- or else our ancestors would have been so intent on working on those drawing in the caves that they didn't bother with the loud approaching thumping steps of a bear and the human race would not have survived. You are not suppose to be able to sit still for five hours straight, working on calculus, or addition. So anyway, I didn't become a child psychiatrist.

But I see a lot of adults who are concerned they have ADD/ADHD. And that is even stickier. You see, I can't send those questionnaires to their bosses, for starters. Typically, for a child with ADD, there is about 1/3 chance that s/he will grow out of it, 1/3 chance that s/he will find a career that allows for those tendencies (like being an ER physician) and 1/3 will remain very symptomatic and will need treatment.

When I worked at the Student Mental Health Services of a local prestigious university, I saw a lot of students that came in because they wanted to be diagnosed with ADD/ADHD to 1. get on stimulants and 2. get the special accommodations given for those people with ADD/ADHD (a huge deal when you are about to take qualifying exams for your doctorate program.) I encountered a few students who indeed suffer from ADD/ADHD (and usually, by the time they are at this level, they have ADD and they have been treated by stimulants previously- interestingly, a lot of them wanted to take drug holidays.) However, there were some students who only thought they had ADD when they needed to read Homer/Nietzsche/Boring-Guy-from-Long-Time-Ago, while they were valedictorians from their prestigious, private high schools, on no meds.

At my salaried job, I see a few people who want to either start or continue on their stimulants even though they have 1. history of psychosis (contraindication) and 2. history of substance dependence (also contraindication) and in a way, I become their legal drug dealer. It is a position I DO NOT want to be in!!! It is always SO hard to talk people out of this. So. Hard. (Perhaps it is because I haven't taken stimulants before, maybe if I knew the magical powers of amphetamines, I would want to take it ALL the time.)

In my private practice, I get people who think they might have ADD (often times because they keep forgetting to pick out their children at school, or are doing something that drives their spouses nutty), but they rather just work around it, and not take one more medication. Or, if they are interested in stimulants, I refer them to neuropsychiatric testing to collect data to evaluate their abilities in executive functioning and sort out their needs for stimulants. Actually, it is quite interesting to figure out people's level of executive functioning- I get to explore their day to day lives in gritty, gritty, details. (I LOVE getting the blow by blow of people's days! What can I say, I am a voyeur.)

Amazing how these populations are SO vastly different, isn't it?

Also, this is not meant to be any kind of useful mental health information for you AT ALL. This is just me, rambling about my life. If you want useful information, check out Mayo Clinic's website, or NAMI, or NIMH, or CDC. Finally, I do have patients on stimulants- when I get to use my special water marked prescription pad, which cost about 25 cents per prescription. Better suppress my inattention while I am writing that script, because if I mess up, I have to start over (for a controlled substance, you know, the DEA likes every script to be error free), and say good-bye to 25 cents.

And just so we are clear, I think child psychiatry is very important, and I admire my colleagues who work with children, and best wishes to those who suffer from ADD/ADHD. Just don't use your psychiatrist as a legal drug dealer is all I am saying.

Also, is it obvious that Hubby is out of town? I have all those words and no one to use them on!