ADHD - Overprescription of dexamphetamines?
I've just started a new term this week - Women's and Children's Health. Pretty much it's just
the same stuff we did last year, with three weeks of Paediatrics followed by a single of week of O&G. Personally, I think it's a bit of a waste of time (although it's always good fun to play with the kids :D). I'm attached to a General Paeds/Resp team.
I spent this morning sitting in the outpatient clinic with the consultant, whilst we saw various cases. General paediatrics is pretty varied: we saw things like epilepsy, UTIs, asthma and Fanconi's anaemia, as well as things like ADHD (leading nicely into the point at hand).
At first, the consult started nicely enough with the patient's mother describing how her son was doing at school with respect to ADHD and his learning difficulties. Things were nice and civil, but then the mother asked the Paediatrician whether she could have a repeat prescription of dexamphetamines.
The Paediatrician had been writing in the notes, but suddenly stopped her writing and looked up, saying pointedly, "I've already given you a repeat prescription, last time you were here."
"Have you?"
"Yes, I'm pretty sure I have. Let me check." She checked.
"Yep, here it is. Two repeat prescriptions."
"Oh okay then. Must be my mistake."
"..."
"Um, when can we be seen by the GP? Can we not get the medication from the GP?"
At this point, the paediatrician lost it completely. This sudden look came over her and she started almost-shouting at the mother, telling her that she would not be allowed to be seen by the GP until it had been proven that the dexamphetamines were having an effect. And definitely not while the patient did not have a regular GP. And especially not when there are repeat prescritions outstanding. To be honest, it was a bit scary. I'd never seen anything like it before.
Seeing this ADHD patient brought up in my mind one of those controversial issues that seems to be plaguing Medicine, ie ADHD and the prescribing (or overprescribing) of stimulant medications. It's one of those things where everyone has an opinion, and depending on your training and area of expertise, you may have views one way or another.
It's a commonly held belief in the general community that ADHD is overdiagnosed, leading to overmedication of young children with stimulant medications. Unfortunately, there have been documented cases of young kids not taking their medications and instead selling them to their peers, or worse, drug dealers.
There are different schools of thoughts relating to this. One school of thought believes that ADHD is actually increasing in incidence, leading to an increased need for prescribing of medications. Another school of thought belives that the incident of ADHD has always remained steady, but we are starting to diagnose and treat it more. At the opposite end of the spectrum are people who believe that ADHD is a myth and that none of these medications are necessary. Between the extremes are people who believe that ADHD is overdiagnosed and that although there are patients who need medication, not all of them do.
The latter is probably the most likely of all the above scenarios, and various strategies have been implemented to counter this. Despite this, it doesn't look like the controversy is going to end, especially with the discovery of associated cardiovascular risk.
Tags: Medical
the same stuff we did last year, with three weeks of Paediatrics followed by a single of week of O&G. Personally, I think it's a bit of a waste of time (although it's always good fun to play with the kids :D). I'm attached to a General Paeds/Resp team.
I spent this morning sitting in the outpatient clinic with the consultant, whilst we saw various cases. General paediatrics is pretty varied: we saw things like epilepsy, UTIs, asthma and Fanconi's anaemia, as well as things like ADHD (leading nicely into the point at hand).
At first, the consult started nicely enough with the patient's mother describing how her son was doing at school with respect to ADHD and his learning difficulties. Things were nice and civil, but then the mother asked the Paediatrician whether she could have a repeat prescription of dexamphetamines.
The Paediatrician had been writing in the notes, but suddenly stopped her writing and looked up, saying pointedly, "I've already given you a repeat prescription, last time you were here."
"Have you?"
"Yes, I'm pretty sure I have. Let me check." She checked.
"Yep, here it is. Two repeat prescriptions."
"Oh okay then. Must be my mistake."
"..."
"Um, when can we be seen by the GP? Can we not get the medication from the GP?"
At this point, the paediatrician lost it completely. This sudden look came over her and she started almost-shouting at the mother, telling her that she would not be allowed to be seen by the GP until it had been proven that the dexamphetamines were having an effect. And definitely not while the patient did not have a regular GP. And especially not when there are repeat prescritions outstanding. To be honest, it was a bit scary. I'd never seen anything like it before.
Seeing this ADHD patient brought up in my mind one of those controversial issues that seems to be plaguing Medicine, ie ADHD and the prescribing (or overprescribing) of stimulant medications. It's one of those things where everyone has an opinion, and depending on your training and area of expertise, you may have views one way or another.
It's a commonly held belief in the general community that ADHD is overdiagnosed, leading to overmedication of young children with stimulant medications. Unfortunately, there have been documented cases of young kids not taking their medications and instead selling them to their peers, or worse, drug dealers.
There are different schools of thoughts relating to this. One school of thought believes that ADHD is actually increasing in incidence, leading to an increased need for prescribing of medications. Another school of thought belives that the incident of ADHD has always remained steady, but we are starting to diagnose and treat it more. At the opposite end of the spectrum are people who believe that ADHD is a myth and that none of these medications are necessary. Between the extremes are people who believe that ADHD is overdiagnosed and that although there are patients who need medication, not all of them do.
The latter is probably the most likely of all the above scenarios, and various strategies have been implemented to counter this. Despite this, it doesn't look like the controversy is going to end, especially with the discovery of associated cardiovascular risk.
Tags: Medical
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