Recent news has emerged regarding some huge concerns for patients and providers who have been dealing with ADHD diagnoses and prescription practices.

An investigation into unethical practices at the leadership of one of the major companies impacts patients’ access to such vital medications as Adderall.

This blog post intends to shed light on these issues and ensure that ethical standards are brought into diagnosing and treating ADHD.

Unethical Practices in the Diagnosis of ADHD

Understanding the Issue

ADHD is a neurodevelopmental disorder of a complex nature. Its diagnosis and management should hence be accurate and cautious.

However, current news reports have raised suspicions that some companies are involved in certain practices that undermine the integrity of ADHD diagnosis. These practices include the following:

• Diagnosing ADHD without thorough evaluation.
• Prescribing stimulant medicines without ascertaining demand.

Diagnosing ADHD Without Thorough Evaluation

An accurate diagnosis of ADHD involves detailed assessment. The assessments include the following:

1. Comprehensive Interviews: Detailed interviews with the patient alone, sometimes supplemented by informational input from family members, provide knowledge about his or her medical history and symptoms and help to assess his or her everyday functioning.
2. Standardized Questionnaires: The ADHD Rating Scale or the Conners’ Rating Scales are examples of tools that could give structured information about symptoms and behaviors in the patient.
3. Behavioral Observations: Direct observation of the patient in different situations to describe how symptoms manifest themselves in real life.
4. Collateral Information: This is derived from the teachers, employers, or anyone who frequently comes into contact with the patient to understand the behavior pattern of the patient fully.

Unfortunately, some companies skip these vitality phases and offer fleetingly quick diagnoses based on scarce information, such as filling up an online questionnaire or having a brief consultation.

This will undervalue the diagnostic process and can diagnose those patients who might not be suffering from ADHD; this will lead them to inappropriate treatments.

Prescribe Stimulant Medication Before Confirming Need

Stimulant medications, like Adderall and Ritalin, are the gold standard for medicating the symptoms of ADHD.

Such stimulant medications should be prescribed based on a professional and comprehensive assessment that establishes the existence of the condition being treated. These medications have side effects, risks of dependency, and other misuse.

Some companies are prescribing stimulant medications with less-than-adequate confirmation of ADHD diagnosis and even after minimal consultation. The problems that this approach can cause are many:

• Health Risks: Without proper medical supervision, patients may pave the way for such unwanted reactions as increased heart rate, sleeplessness, or anxiety.
• Dependency and Abuse: The availability of stimulants can facilitate drug abuse, dependency, and other illegal distributions.
• Medication Shortages: Over-prescription leads to medication shortages, and a diagnosed patient cannot obtain his or her needed medication easily.

Impact on Patients

The rapid growth of online health services, especially during this pandemic period, has changed the way most receive medical care.

However, there is always a significant downside to these practices that positively impacts the welfare of the patients.

Misdiagnosis

First, there is misdiagnosis. One of the most worrying issues is misdiagnosis. The risks of misdiagnosis are running high because patients are evaluated based on hasty virtual consultations.

For example, a patient might be misdiagnosed with ADHD and would be prescribed stimulants when he doesn’t have ADHD at all. This can result in taking unwanted medicines that bring along side effects and health risks.

In contrast to in-person visits where a doctor can observe and evaluate more comprehensively, most of these vital details are lacking in virtual consultations.

Medication Shortages

Another huge problem is the over-prescription of medicines. Too many prescriptions for particular drugs flood the market, creating an artificial supply and demand dilemma for medicine.

Then patients who are legitimately diagnosed have a harder time receiving the medications necessary for survival due to these artificial shortages. Picture a patient that has had ADHD all their life and depended on medication to now not be able to get it.

This disrupts their treatment and greatly affects their daily life. These shortages are not only inconvenient; they can be life-altering.

Ethical Diagnosis Practices

Ethical diagnosis of ADHD is essential to the well-being of the patients. The following are some key practices that healthcare providers should observe:

Conduct Comprehensive Assessments

A proper diagnosis of ADHD calls for comprehensive evaluation. It includes medical history, behavioral assessment, and consultation with other professionals in health. Every step in this procedure helps the provider understand the condition of the patient better.

Avoid Shortcuts

The majority of the misdiagnosis is due to rushed or superficial evaluations. Misdiagnosis will result in inappropriate treatment that is likely to harm the patient. Taking time to detail assessment assures proper diagnosis and appropriate treatment plans.

Thorough Assessments

Detailed evaluation considers the patient’s past and current medical conditions. It also encompasses his behavioral patterns, taking into account the views of other medical professionals. This ensures that such a case is viewed for its integrative approach to health.

Professional Consultations

It is also essential to consult other colleagues since it involves the consideration of all aspects of the patient’s condition. This allows a well-skilled diagnosis and thus proper treatment.

Accurate Diagnosis

Avoiding shortcuts and ensuring meticulous evaluations ensures accurate diagnosis. An accurate diagnosis is the key to effective and proficient treatment. This thus ensures proper management of the condition and a good quality of life for the patient.

These practices will guide healthcare providers in looking at an ethical and effective ADHD diagnosis. Such an approach not only benefits the patient but also upholds the integrity of the profession of a healthcare provider.

Overprescribing and Automatic Refills

The Problem with Overprescribing

Overprescribing stimulant medications not only depletes supplies but also raises concerns about dependency and misuse.

Automatic refills, without regular patient assessments, further exacerbate this issue by bypassing necessary medical oversight.

Consequences of Overprescribing

Medication Shortages

One significant consequence of overprescribing is medication shortages. When doctors prescribe stimulant medications excessively, it strains the supply.

This can make it hard for legitimate patients to get the medications they need. For those with genuine conditions, such as ADHD, regular access to these medications is crucial for managing symptoms and maintaining their quality of life.

Shortages lead to increased stress and anxiety for patients. They often have to visit multiple pharmacies or wait longer for refills. This situation disrupts their daily routines and overall well-being.

Increased Risk of Misuse

Another serious issue is the increased risk of misuse. When stimulant medications are overprescribed, they become more widely available.

This excess availability can lead to abuse and addiction, even among individuals who were not initially prescribed these medications.

Misuse of stimulant medications can have severe health consequences. It can lead to heart problems, mental health issues, and even overdose. Additionally, easy access to these drugs can encourage illegal sharing or selling, further spreading the risk of addiction in the community.

Addressing the Issue

It’s essential to address the problem of overprescribing to prevent these consequences. Providers need to follow strict guidelines for diagnosing conditions that require stimulant medications. They should also monitor patients regularly to ensure the medications are being used correctly.

Public awareness campaigns can help educate people about the dangers of medication misuse. By understanding the risks, individuals are more likely to use medications responsibly and avoid contributing to the problem.

Promoting Responsible Prescription Practices 

Healthcare providers must adhere to responsible prescription practices, which include:

• Regular patient evaluations: Continuous monitoring and assessment ensure that medications are used appropriately and effectively.
• Avoiding automatic refills: Prescriptions should be based on current patient needs, not convenience.

The Need for Industry-Wide Ethical Standards

Ensuring Patient Safety 

The recent issues underscore the importance of establishing and adhering to ethical standards across the healthcare industry. By prioritizing patient safety and responsible practices, healthcare providers can help maintain the integrity of ADHD treatment.

Advocating for Change 

Patients, healthcare providers, and policymakers must advocate for changes that promote ethical practices, including:

• Stricter regulations: Implementing and enforcing regulations that prevent unethical diagnosis and prescription practices.
• Increased awareness: Educating the public about the importance of accurate ADHD diagnosis and the risks of overprescribing.

What You Can Do:

If you’re considering telehealth for ADHD diagnosis or treatment, it’s vital to choose a provider with expertise in the disorder. Ask questions about the evaluation process and what type of assessments will be conducted.

Don’t hesitate to discuss your concerns with your provider. They can offer guidance and potentially offer telehealth services themselves.

Conclusion 

The recent events serve as a reminder of the critical need for ethical practices in diagnosing and treating ADHD.

By focusing on comprehensive assessments and responsible prescription practices, we can ensure that patients receive the care they need while maintaining the availability of essential medications.

It is essential to remain vigilant and advocate for standards that protect both patients and the integrity of the healthcare system.

Disclaimer 

This blog post is for informational purposes only and is not a substitute for professional medical advice. Always consult with a qualified healthcare professional for diagnosis and treatment of ADHD.

By following these guidelines, we can raise awareness about these important issues while avoiding legal trouble and maintaining a professional tone.

This approach provides valuable information to readers, emphasizing the need for ethical practices in ADHD diagnosis and treatment.

It’s been almost one year that Covid has changed things for everyone around the world. No one a year ago could have predicted how disruptive this pandemic has been in terms of lives changed, lives altered, and lives lost. We all have suffered in some fashion whether it was loss of freedom, loss of employment, loss of financial stability, loss of a family member, friend, mentor, partner etc. that will forever change us. And so it is with those folks who are struggling with maintaining some semblance of order in their lives but are finding it more difficult in these very trying times.
Know this, you are not alone. Since Covid has struck us all in different ways, my phone calls have gone up significantly. I hear folks asking for assistance like never before. I want you to know that this is not in your head, that just about everyone I speak with is reporting difficulties in their lives and if you have ADHD/ADD from a previous diagnosis, or think you may have ADHD/ADD because the things you use to do to cope with your ADHD/ADD like symptoms aren’t working like they did previously, I invite you to reach out and give me a call at (503) 492-2200.
I’m truly hopeful that we have turned a corner and people are starting to get vaccines. I encourage people to stay up with the latest news of where vaccines are being given in your area, and take them when eligible. If we have learned nothing else from this pandemic, it is that we are truly dependent on each other and together we are stronger than if we go it alone.
As always I welcome your thoughts, concerns, suggestions and feedback about ADHD/ADD in Portland OR. and thank you for your insights.

ADHD Medication Difficulties in Portland

I will start this posting by apologizing up front for the long delay in posting.

I will also apologize if any of this posting offends anyone because I am dismayed at the growing number of calls that I am receiving from ADHD/ADD folks here in Portland Oregon (OR) who are having problems with their new providers.

The scenario goes like this: Patient X is being seen by a provider who either leaves their clinic/office or is transferred to a new provider.

The new provider either doesn’t believe in ADHD or doesn’t want to continue the previous medication. Most of the time the previous medication was a stimulant and the new provider or their clinic’s policy is to avoid prescribing stimulant medication.

So the new provider attempts to convince the patient that their symptoms are really related to underlying depression issues and will want to switch the patient to an anti-depressant.

The new provider will attempt to convince the patient that their issues are related to underlying anxiety issues and want to prescribe something for anxiety.

While we can debate the intentions of the new provider, what is more, problematic is this growing trend to delegitimize ADHD as a true neurobiological disorder and reduce the prescribing of certain medications that oftentimes are most efficacious in treatment.

If this scenario is happening to you or a loved one, you have the right to speak to a supervisor or office manager and inquire about their medication policy.

You have the right if all else fails to find a new provider who will work with you in a collaborative effort and see you as part of the solution rather than part of the problem.

I understand that if you are limited in provider choices, you might inquire if your plan will allow you to see providers outside of your network on a single case agreement because you are unable to find one in the network that will work with you in a partnership basis.

Most of all, if you have been successfully treated with a medication for some time and the new provider can’t provide a reasonable medical reason for making a change, you might wish to find one that will accommodate you.

As always, if you have any questions, concerns, or suggestions about ADHD/ADD in the greater Portland Oregon (OR) area, I am an ADHD Specialist please feel free to contact me at (503)492-2200.

It never ceases to amaze me that here we are in 2016 and there are still people continuing to assert that ADHD does not exist here in Portland OR.

They contend that it can be explained away in several different ways and all one has to do is start doing some things or stop doing some things and their symptoms will disappear.

These could be start exercising,  take certain supplements or vitamins, do yoga, start biofeedback and other “remedies”.

While some of these may be tangentially helpful, for most they are only another setback in finding relief from symptoms that have plagued them for years.

Finally out of desperation I get the call and hear tale after tale of failed academic endeavors, failed relationships, employment issues, irritability, time issues and many other problems.

I understand their plight after hearing thousands of similar tales and I wonder how in this electronic age with information flashed around the world in seconds, we can have so many professionals and lay-people who continue to assert that ADHD is a fabricated disorder and is being over diagnosed leading to overprescribing of certain medications.

The reality here in Portland Oregon is that there aren’t enough ADHD specialists to satisfy the need. To make matters worse, Portland has seen an explosion of new residents that are attracted to the area for many different reasons.

This has only exacerbated the problem because many new transplants were diagnosed previously, are taking medications, and are needing to find a new ADHD specialist to take over their medication management and or therapy.

My recommendation is to be patient, be proactive in finding someone that understands the complexity of ADHD and is willing to work with you.

Too often when one goes to see a doctor or other health care provider, you feel as though you are invisible, simply just another number. If that happens, discuss it with your provider, ask for what you need, and if you still don’t feel heard or understood, that might be indicative of needing to find someone else that you feel understands you better.

As always, feel free to contact me at (503)492-2200 to discuss your needs. I welcome your thoughts, feedback, and questions.

Blame it on the media, I mean we tend to blame them for everything else so why not blame them for the influx of new residents to our fair city?

The media has been touting Portland Oregon as the number one city in attracting new residents. Almost daily I’m getting more calls from new residents who have moved here and can’t find anyone to either take over their medication management or that has openings to see them as a new undiagnosed person.

Oftentimes they want to find someone to see that week or the next week. When I inquire if they have contacted other providers they often say “yes, I’ve called 20+ people but you are the only one who has called me back”.

I let them know that, usually when they don’t get a return call it is because that provider is not taking new patients.

I explain that as a solo practitioner, it literally would take hours and hours to call everyone back. Most people know if they don’t get a return call it is not because the doctor or provider is rude or insensitive, rather between seeing patients, doing the required mounting paperwork, increasing numbers of prior medication authorizations, opening and closing patient files, handing requests for records etc., a solo practitioner spends more and more hours doing non face to face requirements. I tell callers that if you don’t get a return call, keep looking and find someone else.

Mental health specialists are similar to physical health specialists in the time required to see a new patient.

Usually, it can take months to see a new cardiologist, orthopedic doctor or urologist etc. and so it can be with ADHD specialists here in Portland Oregon (OR).

The key if you are moving here or to another city, is not to wait until you are down to your last weeks medication, rather do your search in advance and see if you can make an appointment that will coincide with your new arrival.

That will help to ensure a smooth transition of coverage. If you are undiagnosed the same applies; make an appointment in your new city before you arrive there, rather than waiting weeks/months.

Finally, if you have been diagnosed, make sure to have a treatment summary from your old provider listing the diagnosis, medications used, any therapeutic notes that would be helpful, old medication bottles, and current medications. Having this information with you helps to speed up the overall process.

I am hopeful this will assist new arrivals and current residents find an ADHD specialist in Portland. We welcome you and are glad you have decided to move here.

As always, I encourage your questions, suggestions, experiences and feedback. If you or a loved one is having problems with ADHD like symptoms, find a local ADHD specialist or if you are in the greater Portland OR area feel free to give me a call at (503) 492-2200.

Too frequently we hear the drone of the problem side of ADHD/ADD but are there any benefits to having ADHD/ADD?

I believe the answer to that question is an emphatic YES! Once diagnosed and treated, a person can move past the perceived drawbacks, learn to make adjustments, and move from deficit thinking to benefit thinking.

ADHD folks are incredible thinkers and oftentimes think outside the box from some of their “normie” counterparts. They can use the ADHD brain to approach the problem or situation and come up with novel answers. Look at Richard Branson who founded Virgin Airlines and the Virgin Group of over 400 different companies. Many ADHD’s can see beyond the surface and see things in greater detail and greater depth. Having said this, ADHD folk are not the kind that do well in highly repetitive tasks that could be mundane like widget maker on a conveyor belt eight hours a day. The ADHD brain is highly developed and needs change to stimulate it, which is why so many find it difficult to slow down and only do one thing at a time. Ever notice the desire to multi-task and do all of them well at the same time?

ADHD folk are also creative in writing, acting, music, film, sports and other endeavors. Some of the more famous ADHD folks in this realm include Adam Levine, Jim Carrey, Ryan Gosling, Katherine Ellison, Woody Harrelson, Mariette Hartley, Solange Knowles, Howie Mandell, and Michael Phelps. The list of famous people who have ADHD continues to grow as more come out and share their diagnosis. This is crucial as it shines a much needed light on the disorder as it cuts across all segments of society. It emboldens others to come forward and speak up against those who either minimize ADHD as non existent or feel that getting diagnosed and treated are unnecessary. It also puts a human face on those folks who while having good intentions, continue to feel that ADHD is over reported and over treated with unnecessary medications. If anything, the literature is replete with studies that indicate once diagnosed and treated, ADHD folks benefit most from a combination of medication and therapy/coaching.

In short ADHD folks can be highly intelligent, possess great sense of humor, are master generators of ideas, can think outside the box, are passionate, adaptive, compassionate and empathic. ADHD folk understand what it means to have others tell you that you aren’t working up to your potential or that all you have to do is “try” harder. They are highly resilient which is why I love working with this field so much. I do suggest that if any of these words applies to you, that you take action today to make changes in your life and start seeing the benefits in ADHD/ADD and what that might do to your overall functioning.

As always if you or someone you know or love thinks they may have ADHD/ ADD and lives in the greater Portland Oregon (OR) area, have them give me a call to discuss their situation. I welcome all you thoughts, suggestions and comments.