In over 13 years of clinical pediatric practice I saw many children brought to our office for ADD evaluations. Initially I was filled with the zeal and vigor of a freshly-trained pediatrician who was going to set the world straight and solve the problems of these kids who seemed to have so much trouble at home and school. I would dutifully perform an evaluation and send rating scales off for the teachers and parents to fill out. I would then pore over the scales with the intensity of a shaman looking at the entrails of a dead cat, deducing meaning from the various ratings. I would then huddle with the parent and come up with my pronouncement as to whether the child would benefit from stimulant medication of some sort or recommend other interventions. I felt I was doing a great service to mankind but soon came to realize that the parents almost uniformly came away very unhappy with my pronouncements unless they also came away with a prescription for Ritalin. I thought this strange; wasn’t I the trained professional practicing my craft to the best of my ability?
Then I took notice of my partner at the time. It seemed that he had very happy families after he met with them for their ADD concerns. I also noticed that over 99% of his patients came away from their encounter with a stimulant prescription. I was astounded at this statistic. What were the odds that nearly every patient that came to see my partner for ADD actually had ADD? His patient population must have had very astute parents to self-screen their children so well that almost every single one had ADD! Then slowly the realization came upon me that perhaps his patient’s parents weren’t that intuitive; maybe he just gave out Ritalin or the next ADD med du jour like they were candy. This seemed like a much more likely explanation and I became disillusioned with the entire industry.
The last 6 years of my foray into pediatric practice I stopped seeing patients for ADD. It just seemed like a racket that I didn’t want to get involved in. I know there is a subset of kids that really does benefit from this sort of pharmacological treatment, but not every single one. There are many other reasons for this behavioral pattern and I’m not sure pediatricians are putting in the time needed to tease out these various reasons. Not that the pressures of practice nowadays provides anyone time. I just believe that we owe our children something better…