DOES YOUR PSYCHIATRIST UNDERSTAND ADD/ADHD?

[DANA]

After being diagnosed with ADHD over 12 years ago, I have continually educated myself about ADD/ADHD and stay on top of the newest information regarding this condition. I consider myself knowledgeable about ADD/ADHD, but I am not an expert.

What is the most mind boggling to me is that I have come across so many psychiatrists, psychologists, social workers and therapists in my local area that are NOT educated about ADD/ADHD. How could someone appropriately treat an ADDer patient WITHOUT expert knowledge, training and experience?

After all these years of struggling with ADHD, I am continually frustrated over uneducated "so called" professionals who look at me as if I am from Mars! What is the most astounding and totally frustrating is when I recently described to my psychiatrist my negative ADHD symptoms and she tried to minimize my symptoms by saying, "It is not ADHD, but it is simply STRESS." (Excuse me? Did I hear you correctly?)

My psychiatrist asked me to explain in detail my ADHD symptoms. I explained that my attention becomes worse, I am ALWAYS late for every appointment, I can't remember important information, I over react to little minor issues, I get frustrated easily, simple tasks become HUGE & TRAUMATIC ordeals for me and I can NOT concentrate. (Gee....From all that I have read and learned, this is the typical symptoms of ADHD.) Keep in mind, though, that I am taking Adderall. (Why do doctors insist on always blaming hormones or stress for every negative condition?)

Once again, the psychiatrist responded to me by stating, "This is just stress. You can not expect medication to fix everything. You need to go to therapy to cope with your stress." (Yeah, I have been going to a therapist for many months and it is not helping my ADHD. My therapist does not even understand ADHD!!!)

Feeling extremely frustrated with my psychiatrist, I said, "I agree that I am experiencing more stress than usual since my husband lost his job and medical insurance, but this is NOT causing me to be impulsive, forgetful, chronically late or unable to concentrate. I sincerely believe that my Adderall needs to be increased to find an appropriate dose."

For at least 10 minutes, I had to defend myself and persistently oppose the idea that my problem is stress-related, not ADHD related. My psychiatrist did not appear educated about ADHD. She looked at me as if I were CRAZY! She continued to rattle on & on about how she believed stress was my problem.

Nevertheless, after much debating about whether I do or I do not need my Adderall increased, finally, the psychiatrist decided to NOT change my dosage. I felt as if I was ignored, that my opinion did NOT matter, that my ADHD knowledge was criticized and that my symptoms were minimized.

In the meanwhile, I have been on the low dose of 20 mg Adderall for over 6 months and I do believe that I know exactly what I am talking about when I confidently express that I am NOT experiencing the positive results that I had expected. NOT once in the 6 months has my psychiatrist increased my dosage.

I am so frustrated, so sick and tired of "so called" professionals not understanding me, not understanding ADHD and not realizing that my medication may realistically need adjusted at some point to discover the "perfect" dose with the least negative side effects.

FOR CRYING OUT LOUD, AM I ASKING FOR TOO MUCH? OMG! (Can I please scream and shout because I am so ticked off!)

Is it too much to ask the psychiatrist to consider "trail & error" when administering stimulant medications? Why do doctors always have to assume the worst about us? Why are we always misjudged? Lastly, why on earth are ADDer's treated as if we know NOTHING about ADHD when the fact is that most of us are MORE experienced than the professionals?

I am exhausted from running in circles for doctors to simply ignore me.....

I am reaching the point in which "enough is enough!"

I have no medical insurance, I am not financially able to just switch psychiatrists and I personally believe that most doctors have lost all credibility.

No wonder so many ADDer's suffer on a daily basis, year after year, without ever receiving the proper time, attention, medical care or treatment......

[Ariane Benefit]

Dana, I so wish your story were uncommon, but sadly, many psychiatrists do not understand ADD, even ones who include it as a "specialty". I get asked for referrals all the time - but I still don't have even one name here in NJ that I can confidently recommend.

The other day I called 6 psychiatrists and asked them to briefly tell me how they diagnose ADD. I told them I was a coach and I wanted to refer people to them. One of them came right out and told that all they use is a checklist, and the DSM. They said that as a coach, I probably know a lot more than they do about it because they don't have time to keep up with the latest research.

One that "specializes" in it said that she doesn't see many adults with it because a lot kids outgrow it. ARE YOU KIDDING ME????

It is extremely frustrating. On the flip side I'm sure doctors are frustrated by having patients ask for meds...a lot of them are nervous about increasing dosages because the meds are so easily abused and they are held liable. So if they don't know what they are doing, I'm afraid they are probably right not to increase the dosage. Trial and error approaches to medication can be dangerous.

I would suggest visiting Dr. Charles Parker's website. http://www.corepsychblog.com/

I think they do phone consults too. Perhaps your doc would be open to consulting with him?

Good luck....I do feel your pain!

Ariane

[DANA]

Ariane, thank you so much for sharing your own experience with psychiatrists in New Jersey. (And all this time I thought it was ONLY Pittsburgh, PA!)

I do understand that most doctors simply do not have extra time to spend in keeping up with the latest ADD/ADHD research. However, as a patient, I am very concerned with professionals who are not actively seeking additional education to learn more about ADD/ADHD if they have numerous patients in which they are treating with ADD/ADHD.

What I do not understand is why professionals are not willing to attend educational workshops or conferences to gain more insight to children/adults diagnosed with ADD/ADHD? Many professions, especially in the medical field, have mandatory credits that they must pursue each year to stay up to date on the latest information within their specialty to keep their license or certification up to date.

It is not only in the best interest of the professionals, but also in the best interest of the patients for all ADD/ADHD professionals to thoroughly comprehend the full scope of ADD/ADHD. Can you imagine cardiologists, neurosurgeons or orthopedic specialists to never keep up with the latest research or information in their specific field? If that were the case, most patients would be very hesitant to go through with serious procedures or surgeries.

Mental health should not be any different than traditional medicine. If the regular doctors and specialists must continue their education, in my opinion, EVERYONE working with patients should have to continue their education. When you get right down to the nitty gritty of it all, this could be what is seriously needed for more ADDer's to receive quality care and treatment from a professional.

[Cathie]

I'm so sorry that you're having difficulties communicating with your Psychiatrist. I actually don't manage my meds with a pscyhiatrist...I manage them with my primary care doc (but did get diagnosed by a Psychiatrist).

Anyway, the point I wanted to make (and that might help him hear you a bit) is to acknowledge the possible role of stress. I know for me, the severity of my ADHD symptoms have a direct correlation to the amount of stress I'm under. I mean, I of course always have a baseline of symptoms, but when life gets very stressful, I go from scattered to fractured. Maybe approaching it this way with him might help? It turns the discussion away from being either the way you see it or the way he sees it and combines the two (which may likely be closer to the truth).

Just my .02 :-)

Peace,
Cathie

[Miss K]

I really don't like dealing with any doctors, not just psychiatrists, for the reason that I hate feeling like they are not hearing me, or like they just want to sit there and tell me I'm wrong. I'm like you Dana, I read a lot and really try to understand things, so when I have questions and a doctor gets annoyed with me for asking them it really upsets me.

As for them not understanding ADHD, I circumvented that problem by intentionally choosing a clinic that listed that as one of its primary specialties, and they REALLY are knowledgeable about it, so I feel lucky.

I don't know if this is the perfect solution for everyone, but here's what I have chosen to do in my medical/psychiatric life, because it's what I'm comfortable with, in relation to my personal experiences. In general, I prefer to see nurse practitioners instead of doctors...you just don't need a specialist doctor for everything. Nurse practitioners are very educated and perfectly able to deal with most run of the mill medical problems...and they are legally authorized to prescribe medications. They also seem to receive more training in bedside manner and communicating with patients, usually erring on the side of giving you lots of information, and being willing to answer questions (instead of interpreting your questions to mean that you are challenging them). Another rule that I have FOR MYSELF, is that I generally will only see female health care providers, which I hate to admit. I have several reasons for this though, and it's not a choice that everyone needs to make. I just feel that it's my health, and my body and I have had a few male providers who have really earned my distrust, so I don't generally go there.

That said, I have a therapist that I work with that is female, and...drumroll please, I have a MALE nurse practitioner that I really like working with and I feel that they "get" me, and they "get" ADHD.

From your story, it sounds like you and your doctor both have valid concerns. You have a right to health care that includes your provider actually having communication skills to let you know that she really understands you. It can also be true (don't know about YOUR case) that when we are stressed, it feels like "the meds aren't working", at least I have that problem. Sure as hell doesn't feel like mine are working today...but I got to work at 10am and it's midnight and I am still here, and can't seem to focus. Um...I also have enormous amounts of stress going on right now too, so even if I wanted to I wouldn't be able to focus. So...just food for thought. I'm not saying your doc is right...just that it can happen that stress will override even the awesomest medication.

Also...even if you do not have health insurance, in many areas there are community health centers which can give you a referral to mental health services, or community mental health centers (I got to one) where they have sliding scale fees. I honestly feel that the mental health care I'm receiving is just as good if not better than if I paid more to go to a regular doctor's office.