Sick, injured or merely different? Rising ADHD cases fuel running battle among mental health experts
Kollins says his clinic routinely spends four to five hours with a single patient, running them through a battery of tests and surveys, looking, for example, at family context and developmental history. He readily notes that he runs a “boutique specialty clinic” that uses the “gold standard,” and that such rigor is out of reach for most parents and medical professionals who are asked to diagnose on the run.
Kollins worries that popular overreaction against ADHD diagnoses presents a challenge, and that some recent treatments of the topic by journalists have been oversimplified and inflammatory. In particular, he pointed to a series of articles by Alan Schwarz at The New York Times.
Kollins reacted very strongly to that series, calling it a “disservice to medicine” that was “biased” and “reckless,” and arguing that it “polarized the issue to sell newspapers."
Kollins is as concerned about kids who never get diagnosed who actually have ADHD as much as he does about those who are mistakenly diagnosed who don’t have it. The false negatives are, he believes, probably about equal in number to the false positives. And failing to diagnose and treat can leave a bright child depressed and adrift, often leading to self-medication and substance abuse.
Overdiagnosis, misdiagnosis and underdiagnosis are all problems, as Kollins sees it. “You get well-intentioned clinicians who are doing the best they can in a broken system,” Kollins said.
Some people just skip the doctor and self-diagnose. Tom Metge, now 32, and his mom self-diagnosed his ADHD when he was quite young, but they chose not to seek formal diagnosis, partly because his mother was already reluctantly taking medication for a bipolar disorder, and both of them disliked the resulting dependency.
Today, Tom is a successful software engineer who recently accepted a nice job offer from Apple and is moving his family from Utah to Cupertino, Calif., this month.
Metge did it almost entirely without drugs, but he often has struggled. He dropped out of college during his junior year after a disastrous semester put him on academic probation. Family and financial pressures contributed to the fiasco, but ADHD was a major factor, he says.
A driven mass of good-humored nervous energy and a lifelong insomniac, Metge says he has a “black hole” in his head, a memory problem that makes him lose the thread of what he means to be doing.
After dropping out of college, Metge began working in technical support for a tech start-up, moving up to quality assurance and then to programming. In essence, he finished his college education on the job.
Metge keeps a notebook by his computer at work and takes notes on every step along the way, like Hansel trailing breadcrumbs. He took up Iron Man competitions because he felt the intense daily training regimen would translate to focus and control in other areas of his life. It did.
He does not see his ADHD as an illness, but rather just one part of his own genetic makeup. “I have compensating strengths,” he said. “ADHD is part of me, but it’s not me.”
Still, it remains a challenge. He recently went through a stressful career transition with another start-up company that intensified his “black hole” and left him depressed and struggling. For the first time in his life, he took an ADHD prescription, choosing Vyvanse because its controlled release makes it less addictive. Metge took it off and on for a year — using it to re-establish his own equilibrium before dropping it altogether and relying once again on his own coping strategies.
Though Paul has relied more on his “focus pills” to date, he and his family mirror Metge in blending determination to overcome with a realistic view of the challenges. At 13, Paul is already debating his career options. He loves to work with his hands. He loves working in the kitchen and he would like to be a chef, but he realizes that path might have a lower salary ceiling.
He says he wants to attend his parents’ alma mater, a prominent southern state university. His mom is not coddling him. Paul will start at a private high school this fall and is very aware that now his grades count. He knows it will not be easy.
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