- To Change Your Mind - Details Matter
Understanding ADD/ADHD Medications: Pay Attention to the Details
Brain Talk and Web 2.0 – Tips on Connecting, And An Over-the-top Immunity Update
July 6, 2008The Power of Imaginative Mind: Sir Kenneth Robinson
July 28, 2008ADD/ADHD medications at first seems simple – if you have ADHD, “Here's the script for meds.” Yes, I am suggesting we modify our scripting process.
ADHD Worries
The truth is that ADD/ADHD medications do require specific, precise thinking with clear guidelines – or the entire process of medication management can become dangerous, frustrating, or disappointingly ineffective – with disastrous long term consequences. Problems arise much too often. And they are correctable!
Hey, this is not hype – we see these challenges everyday in my office and have for many years! I have seen literally several thousand second ADD/ADHD opinions, heard responses from dinner meetings with hundreds of medical folk, and find that some things just are not done in the offices they way they should be.
And the Paradox is Simple: We're treating Attention Deficit Disorder without Paying Attention!
Getting the meds right takes some forethought, careful planning and ongoing operational guidelines. I've been discussing this ADD/ADHD Medication subject since the first post here at CorePsychBlog back in '06, and really haven't changed my tune.
We should not find ourselves asking the patients what to do next, we should be teaching everyone what to look for, what the targets are, and evaluating progress by specific measurements – instead of simply “Is it working?” Duh…
And I am certainly not blaming anyone, any docs, any academics. We simply don't have a book, a reference, a set of guidelines currently available that provides a simple structure for medication management. My simple take on it: we are so research driven that too few are actually developing feedback loops with the patients in the offices.
Providers themselves are vertically challenged! Just see what my old friend Dr Edward de Bono says about the changes in management systems:
“TELESCOPE TO KALEIDOSCOPE: The management metaphor has moved from telescope to kaleidoscope. Where once top managers could focus on their own concerns, with little need for peripheral vision, they now view a constantly changing pattern of shapes, sizes and colours, from which they must try to make sense. It sounds like an awesome task. It would have been impossible save for the advances in IT, which animates and accelerates the agile corporation, setting it free to move from control to coordination of collaborative effort, from the status quo to the future.” From Thinking Managers.com
Sound familiar? Medicine for my entire [almost] 40 years in practice has been delivered vertically, from the top down – with a cross between a microscope and a telescope, both of which miss the ADD/ADHD kaleidoscope. It's now time to provide a more inclusive, more horizontal operational grid with specific measurement systems.
Your heard it first here: yes, feedback loops [Jack Welch on feedback here] with specific parameters.
I've been talking about these issues for months now, and to make this discussion more convenient for you, I will link some of my previous posts on some of the important ADHD medication management topics, and will tell you quickly about this new project in just a moment. Here are just few of the many topics I have been writing about:
- On metabolic problems with ADD: Specifically gluten sensitivity
- On internists using SPECT imaging for diagnostic evaluations showing PFC evidence
- On the controversy regarding the use of SPECT imaging for psychiatric diagnosis
- On immune testing as it relates to ADD symptoms and obvious immune dysregulation
- On using precise guidelines with the “Therapeutic Window”
- On the importance of breakfast multiple posts, with this one on school breakfasts
So what is the point?
Very simply, I am in the process of writing a book-map to help us out of this confusion – and I want you, my trusted readers, to be the first to know. The book I'm writing:
The Patient's Guide For ADHD Medications: What To Do When Nothing Is Working
- I have changed the audio here to tell folks about this new book, and have created a special gift
- I have added an opt-in box over there just below the email update box to go after that gift
- The deal is simply this: you sign up now, just to let me know you are interested in the book
- And on the Thank You Page for signing up you will find a 1200 word article/checklist: a pdf file outlining The 10 Biggest Problems with ADD/ADHD Medications with some brief notes on basic solutions.
- There is no obligation to buy the book when it is published, this simply gives you a big bonus benefit: a preliminary look at the contents, and a significant discount when the book comes out near the end of August
- Also, special savings/benefits on forthcoming teleconference training regarding *The Details* because you expressed that early interest
So sign up for the discount and goodies if you haven't already.
If you have and didn't get the bonus, just let me know, I will get you the checklist. Then think of two or three people who would like the checklist who are troubled by their progress [this will likely be easy] and send them the CorePsychBlog link so they can get into this offer. Time is short, so get it done now.
Hope you enjoy the checklist and this summary – please let me know what you think in the comments below-
Have a great week!
cp
19 Comments
This is a very serious issue that has been pointed out here. And one of the few that I can comment on, without any doubts about my opinion. I will use some of Gina’s and Betsy’s words in they’re comments..Gina said: “The truth is, far too many are reckless and detached when it comes to prescribing and listening to they’re patients.” Betsy said: ” The information they collect is taken to they’re Doctor.”
I am ironically fortunate to have been prescribed stimulant medications after all 4 of my Dr.s agreed on it (Neurosurgeon,M.S. Specialist,GP,and Psycho Neurologist). All copies of my medical records,results of tests,MRI presentations,etc.. are shared among them and myself. Without going into the reason for 4 Dr.s in my own story, I see a dilemma that occurs when a patient dose not have the resource’s available to do this. That goes into a politcal subject though. Thank You All!
Scott
I’m always happy to hear “good-doctor” stories, Scott, because I know they are out there. Thanks for sharing yours.
gina
You are very diplomatic and gracious towards your colleagues, Dr. Parker.
The truth is, far too many are reckless and detached when it comes to prescribing and listening to their patients. They fail to follow the most basic of protocols and, moreover, show not the least bit intellectual curiosity about the differences among the stimulant-medication choices. Nutrition? Allergies? Might as well be voodoo, as far as some docs are concerned.
Some have the excuse of limited time imposed upon them by managed care. But many practice “off the (insurance) grid” and still cavalierly approach treating their patients with ADHD.
The result: a HUGE medication backlash around ADHD in this country.
I, too, have heard thousands of stories over the years. If I hear one more horror story about Adderall (too often the first or only choice, and almost always at too high a dosage), I will flip.
The day that even 10% of prescribing docs actually use rating scales to titrate the dosage, we will have reached a major milestone!
Keep up the great work. We desperately need you and your work!
Gina
Gina,
I do agree that my perspective is likely somewhat distorted by the fact that the many who go to dinner meetings are working much harder to get the ADHD meds correctly adjusted at the outset – they are already interested in outcomes.
To take your remarks one step further: I do completely join in your serious medical concerns about those writing for psych meds, and especially ADHD meds, with no training, no interest, and a general disdain for psych patients in the first place. I don’t treat the common cold, I don’t write for antibiotics, as I just don’t keep up with that literature – why others write for meds they don’t understand is completely beyond me… except for the fact that many physicians have marginal feelings about the psych community in the first place. They want to do something, and try to protect the patients from odd experiences over in our offices based upon our mixed bag of psych interventions – many of which appear to have nothing to do with underlying biology or neurophysiology.
Thank goodness most of the psych community has embraced the new neuroscience findings – and become more biologic in focus, thus earning more respect from our medical colleagues. Yes, if we have the facts, let’s uniformly use them – interesting how the responsibility for good medicine evolves.
cp
[…] This post was mentioned on Twitter by Dr Charles Parker, Gina Pera. Gina Pera said: RT @drcharlesparker Understanding ADD/ADHD Medications: Pay Attention to the Details http://bit.ly/XjuWM […]
Dr Parker,
I live in NYC and I am surprised that the top psychiatrists here are so dismissive of any real comprehensive programs and new research. Mine sees us for less than 15 minutes and then writes scripts. So glad you are doing the work I believe should and could be done. I am ADD and my son is 11yrs old and ADHD. It is too late for me, I developed strange systems to succeed at things, I want my son to have an easier time in life. I am glad you are saying the obvious truth. I look forward to your book and anyway I can help to get you to speak in NYC on your book tour, please let me know.
Grateful for your contributions,
Sincerely,
Janet Rothstein
Janet,
Thanks for your kind remarks. Having spoken to medical audiences in NYC many times [at the Four Seasons, the Boathouse in Central Park, Ruth Chris in Midtown, and Spanish Harlem to hit the high spots] I can agree the audiences attendance has been quite mixed. Those that attend do get it, but too many simply don’t want to hear about any new medications – they absolutely won’t attend dinner meetings. As in other parts of the country, from Stanford in CA to U of Kentucky, to Boston, and even here in Norfolk at Eastern Virginia Medical School, they take the stand that pharmaceutical companies are only selling. – Very short sighted, and indeed reclusive. – Pervasive problem in metro areas, not a problem in the more rural areas like Bristol TN, or Minot ND, where they welcome new info.
Throughout the country it’s become a taint to talk to the pharma folks who bring new information, and it appears from a medical/sociological perspective, to underwrite the absolutely incorrect reductionistic thinking that pharmaceutical companies are pervasively misrepresenting the medications. Even some of our own psychiatrists rant about pharma companies teaching, and the money they spend on marketing, – and themselves make significant incomes ranting on that same boring topic.
Their take: no one is as smart and investigative as they are, and those dreaded drug companies are twisting docs to actually make problems for patients! Also implicit is the suggestion that docs are weak, actually almost moronic – and are easily seduced by sales reps with pens and sticky pads. The guys that write this trash haven’t attended the hundreds of dinner meetings I have, and probably have no idea how to present information well – and have absolutely no respect for their medical colleagues.
The more we don’t talk with each other, the more we don’t meet, the more patient care does suffer with outdated, outmoded, indeed paleolithic intervention systems. These are many docs that think Ritalin immediate release is the best stuff around for ADHD treatment! It’s the worst!
My experience for many years on the road emphatically argues against these short sighted and counterproductive points. I have not been told by pharma companies what to say, have always [with their support] presented fair and balanced info with the problems as well as the benefits of various medications, just as on these pages at CorePsych Blog. Most importantly, the hundreds of docs who have attended my meetings, including those in NYC, were interested, with good questions, and not trying to impress anyone. Sorry I don’t have a name up there, but I know they do exist.
If you are a NYC doc who reads this, don’t reply online ;-), but drop me a note and I will hook you up with Janet – no harm in that, and Janet et al may benefit! Good patient care, and evolved thinking, is all about constructive connections and constructive action.
BTW, my plan is to have pages here that do have the names of like minded docs – I don’t have the resources to make that happen in the near future, but it’s on my to-do list.
cp
Sharon, Paul and all of you on this page interested in the ADD book:
Now it is fixed! Please do go over and sign up. You can turn off the MP3 audio summary of the article at the bottom of the page – I just got into a Search Engine Optimization jag and had changed the url on that welcome page… ah well!
Thanks for your patience!
cp
Sharon and Paul,
Just went over again and corrected the links. For now: either please drop me an email available on my About page, or sign up again, no charge and I notice that the page is more navigable, the pdf file for the article is more visible and should work correctly.
Thanks,
cp
Hi Dr Parker
I’m another one who could not access the bonus; I got an “HTTP Error” when I clicked to get it.
Can you tell me how to access it?
Thanks much!
Sharon
Dr. Parker,
I signed up to be notified about your book and never received the bonus report.
Thanks!
Bryan-
Thanks again for your kind remarks, – I left a lengthy reply over at your site on the issues of immune dysregulation as related to ADD, and appreciate the note from the Norwegian study on gluten and casein allergies as related to ADD in Norway.
Thanks!
cp
Dr. Parker, you are way ahead of the issues!
Check out this posting I put up today and thank you for all of your advice along the way:
http://www.adderworld.com/blog1/2008/08/06/norwegian-study-links-milk-and-gluten-with-adhd/
Bryan
Martha,
Thanks for your kind remarks. So many folks are out there with incorrectly adjusted meds… I look forward to finishing the ADD Meds book ASAP to answer the abundant questions that arise with every attempt at treatment.
cp
Heidi,
I do hope my book will provide some additional clear answers for you-
cp
Betsy,
Thanks so much for your comments – always good to find a companion walking down the same ADD/ADHD treatment path!
Interestingly, I have been working away trying to decide my audience, and for some time kept coming up with a mix of professionals like yourself with an interest, and those who suffer with ADD personally or in other contexts…the patient crowd out there.
And, listening to myself write/talk I can see why I have been confused, because I have been speaking to my medical colleagues for so many years – they have been my main audience.
Writing does tell the tale – in the journaling you do come to find yourself in that new context –
And I have just discovered that my voice is predominantly directed to the patients… I have been speaking to them longer and more articulately about these matters than the medical folk – simply because they not only needed to hear it, they wanted to hear it!
I do try to set it up so that medical folk can use the material, but they have become a secondary objective.
The good news is that my writing is more readable, more fun, and more basic… and hopefully, thereby more universally useful.
Thanks again for your comments along the trail-
cp
You are singing my song. For years now, I have been helping patients in my office to provide their doctors with good information about their symptoms. They do this by tabulating their experiences at intervals, and the byproduct is that they learn to do this, the importance of doing it, and to generate more healthy self interest and efficacy.
I never found a ready-made checklist anywhere that suited my purpose, so I developed one myself. Actually, two of them.
One is to help someone to make observations about the severity of their cognitive “symptoms” at a given dosage of medication. The other is to help them notice when their medications are wearing off.
In both instances, the information they collect is taken to their doctor, so what comes in the door isn’t gazing at the ceiling and wondering what yesterday was like, and did the meds help, or did they even take them.
The question customarily asked by physicians of a patient is, “Are you feeling better?” These medications are not to do with feelings. They are to affect how a person experiences the world, functions in it, and more foundationally, they moderate cognitive function (of which the first two examples are but manifestations of the last).
Please know, patients are thirsting for something to go on. I know you are perhaps aiming your book at clinicians, but in my experience, it is more often the case that patients drive change in the field. No harm in being informed.
I’m interested in this topic. I have a husband on Stratera and a a daughter on Concerta but we arestill looking for the right med for our son…
Thank you for your knowlege of ADHD, especially on how to find the right kind of medications. This is a very important issue. So many doctors do not know how to prescribe and that leaves many pwADHD not properly medicated and possibly even making some things worse for them and all the pwople around them. It is refreshing to hear your perspecitve.