At this time of year when students start streaming back from college for break, I usually have a few who come in to ask for medication for their newly (self-) diagnosed ADHD. What has usually happened is that they have just gone through reading week and final exams and have discovered that the ten bucks they shelled out for their roommate's Adderal did a lot to help them focus and stay up all night to write the final paper in Sociology. Usually these are students who were never prescribed medication before,performed well enough in high school to go to college, often are risk takers or adventure seekers and get insufficient sleep. And rarely do they have ADHD. Frankly, this group is not the one that makes me worry about missing a diagnosis.
A recent article in the New York Times by Dr Perri Klass highlighted the over-use of the ADHD diagnosis and the current trend toward blaming difficulties in focussing on our fast-paced, internet-based culture. She makes passing mention in the article of the "inattentive-type" ADHD student who often passes right under the radar. This is the group of patients and students that concerns me most. These students are more likely to be girls than boys, more likely to have been missed for a long time because they do not cause trouble. They are the "quiet daydreamers, slow, distracted, and forgetful," as described in a recent article in Pediatric News by Dr. Barbara Howard of Johns Hopkins University. The concern with these inattentive-type ADHD patients is that they need a careful evaluation to rule out other causes of their dysfunction. As Dr Howard states, "far and away, the most common missed diagnosis and frequent bedfellow of inattentive-type ADHD is anxiety."
And this is the story that I most frequently uncover in practice when a student approaches me with a request for stimulant medication. There is usually an underlying problem of anxiety, drug use, sleep deprivation, or real life concerns over family matters. Only a careful assessment can uncover whether a student has these issues going on which need sorting through or whether indeed there is a diagnosis of ADHD that has been overlooked. In any case they deserve our attention!
image from newyorkdailynews.com