Dilemma of Differential Diagnosis

I am a Licensed Professional Counselor in the state of Texas who is in private practice and also works with a large college. I also have an adult family member who has ADHD. I have specialized in the field of ADHD for 20+ years, but here is my concern:  I diligently try to find physicians who will spend at least an hour on the initial visit with the patients that I refer so that they have the opportunity to do a thorough differential diagnosis to determine a) if a psychiatrict "disorder" is indeed present, and b) if something is present, to carefully sift through all obtainable information to determine what it is and what it is not. I advise my clients that there are a number of other issues that can also exhibit many of the same symptoms -- anxiety, depression, bipolar, etc.  and that it is of paramount importance to go to a psychiatrist who is experienced in attention-related issues. But here is the dilemma:  due to insurance constraints, it is almost impossible to find a doctor who will spend that amount of time with a patient, even on the initial exam. Most doctors in this area seem to be utilizing Nurse Practitioners. The physician may very briefly meet the patient on the first visit and will "sign off" on the diagnosis, but the NP is the individual that patients see, who they follow-up with in future visits, and is the individual who prescribes or adjusts dosages of medications. Although I respect NPs, I am very uncomfortable with this practice and understand the vital importance of careful evaluation in diagnosis and treatment. The cost of paying cash for the visits is prohibitive for most of the individuals I see, and even though I make a conscious effort to locate psychiatrists who I believe to be experienced in the area of ADHD, I find myself increasingly uncomfortable with referring. Suggestions? Thank you, Anita Peters, LPC


ADHD diagnosis

I hate to say this, but so much of ADHD diagnosis seems completely subjective to me. I read, "Don't let teachers or school nurses diagnose your child! Only a physician can diagnose ADHD. And NEVER give meds on the basis of, "Well, we'll give them meds and if they work, he has ADHD." " So we went to son's pediatrician, filled out the questionnaires, had teachers fill out the questionnaires, and guess what the doctor said? "The questionaires were inconclusive. Well, we'll try Ritalin, and if it works, we'll know he has ADHD."

With all the counseling my ex and I had (both together and separately), NO ONE ever picked up on the ADHD aspect of his behavior, even though at the end of our relationship he freely admitted he had known all his life he had ADHD, as do many in his family. One therapist (whom we chose because she specialized in ADHD) thought he had Aspergers. But in the end, it came down to this: whatever HE and I thought he had, that's what they would treat him for, so his physican gave him several ADHD meds. And if I hadn't been there to tell his physician the symptoms he had, they would never have thought he had any problem at all. We were told by the physican that a psychiatrist would just oversee his meds -- maybe 15 minutes every few months to be sure all was going well. Not really necessary.

Sometimes all the hype about going to a therapist or physician is just hype -- many don't seem to know as much as you know, if you have been reading up on  the subject. Some will even admit it. You have to be well-informed.


It depends on the NP. I took

It depends on the NP. I took my son who is on the spectrum to our clinic NP when all the doctors couldn't give me the information I needed to help my child. We were incredibly lucky to have our son see this NP, she herself had many years volunteering at a ward with many adults on the spectrum, both on meds and without. She gave my son huge amounts of support for 5 years before she moved on (spending an hour+ each visit). She did not recommend drugs, which another doctor did, to disastrous effect. I think without her, we might not have gotten as far as we did with our child's healthcare.

If the parents do not feel comfortable with a NP prescribing, by all means they should get the opinion of a doctor consulting with the NP in the same medical group.