When Physicians Have “ADHD Denial”

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Speaking of ADHD and denial (as we were, with the previous post on baseball anti-doping doc Gary Wadler), Dr. Charles Parker wrote to say that treating physicians often compound the problem. I’ve personally witnessed this more times than I can count: An adult with ADHD is perfectly willing, even eager, to seek medical treatment—only to become so beset with side effects that medication is foresworn forever. This is a preventable tragedy.

Dr. Parker explains:

Denial and misrepresentation of ADHD difficulties remain pervasive in spite of remarkable new science.

One of the most important reasons, other than some simply not wanting to have a problem or take medications, is this:  Basic new science is often overlooked. Most importantly, psychiatric labels have not kept up with functional brain science. The current labels are too superficial, too descriptive, and lack functional biological significance.

The unhappy result of these circumstances? Medical targets are imprecise, miss significant symptom objectives, and often are simply used capriciously. If docs don’t have a precise target, it’s almost impossible to hit the mark. Missing the mark directly correlates with encouraging denial.

Seven Factors of “Physician ADHD Denial”

These seven brief observations underlie some of the most challenging public perceptions regarding the use of medications used to treat ADHD.

1. Right Diagnosis

If the ADHD diagnosis is made with shallow observations, descriptively and not functionally, the treatment targets appear vague, unconvincing, and somewhat imaginary.  Indeed they are with description alone. Regrettably, medical practitioners struggle daily with these vagaries.

2. Right Medication

While many understand the pharmacology of stimulant medications, many others simply do not take the time. If the doc does not know the differences, how can the doc address them? And, if not addressed with the patient, inevitable adverse effects will be blamed on the diagnosis and the specific medication. The client simply does not want to do that again.

3. Right Dosage

All ADHD medications require titration strategies to dial them in specifically. If titration strategies are not used—and many do not practice specific titration—the course of treatment is confounded by ups, downs and inside outs. The treatment regimen itself becomes a disincentive for the long term medical relationship necessary to adjust medications.

4. Belief Systems

Some docs simply do not believe in ADHD, and they challenge the care given by other more informed docs. Science does not count for these docs; instead, ADHD is a character or personality disorder, based on will.

5. Antidepressant Thinking Applied to Stimulants

Some docs treating ADHD apply 24-hour half-life thinking, such as is seen with antidepressants, to these shorter half-life stimulant medications ( which often last less 12-14 hours). Stimulants must be adjusted quite specifically.

6. Noncompliance

Patients take the stimulant care into their own hands, using medications irresponsibly, and then have side effects. They blame the doc, the diagnosis, or the medications. Capricious dosing results in capricious outcomes, and ultimate dissatisfaction. The new longer-acting medications offer significant improvements on this process.

7. Previous Bad Experience

Older medications just did not work as well, proved too cumbersome and subject to abuse. These problems turned the public against all ADHD intervention possibilities.

Some of the most profound denials come from those identified with ADHD as children who were improperly dosed with what are now antique medications.

Even today, with better options available, managed-care companies regularly favor outdated drugs that provide less predictable outcomes.

Precise dosing, careful selection of medications, knowledge of drug interactions, and appreciation of multiple possible comorbid conditions will significantly improve outcomes.