View Full Version : Standard operating procedure with medication


rickymooston
03-22-15, 02:08 PM
Hi

My friend's kid was diagnosed with ADHD. I'm pretty sure he has
ADHD but I had major issues with the diagnosis process.

1) He was diagnosed without any testing at all based on parent and teacher info. I think testing should be
standard operating procedure for any competent doctor. I'm shocked.

2) His diagnosis didn't specify the subtype. Again, I expect this as part
of standard operating procedure.

3) His medication, Vyvesense, I think, "worked" in that it made him
clean etc, etc, etc. The problem was his face started to get flushed
and he complained of hardness of breath, chest pains etc, etc. I told my
friend to stop the medicatin right away. So, doesn't standard operating
include monitoring drug effectiveness and side effects?

Lunacie
03-22-15, 05:54 PM
There are no tests for ADHD.

Most diagnoses are based on patient descriptions of symptoms,
or having parents and teachers fill out evaluation forms.
Some doctors feel that tests like TOVA are helpful,
but there isn't any research that backs that up.

I don't know if Canada is concerned with sub-types.
I only know that in the US that is often part of the diagnosis.

You should have told your friend to call his son's doctor and report
the problems he was experiencing with Vyvanse. A different dose
might be all he needs. Or he may need a different medication.

A good doctor would certainly have told your friend to call if certain
side effects happened. But isn't that just common sense to do that?

bwalwayswins
03-22-15, 08:21 PM
One may feel better if a specific type of person does the testing - i.e. a psychiatrist...my son was diagnosed based on information from his teachers and (of course) myself- by his pediatrician. I don't know if he has a "sub type" I would most certainly affirm he is the Hyper variety and extremely intelligent (though i never had his IQ tested) his pediatrician has mentioned (again recently) that he believes my son is most likely gifted, but with that being said - i had him repeat Kindergarten and school is generally no fun for him and he can fail 5 tests and then get 100% just to show he can do it if he wants.

Anyway, i agree with you - it would be awesome if there was standardized - this is how we test (i realize there is no "test" - i mean observation over a set period of time) and every child is entitled to this much pre treatment (counseling, and and an IQ test and lets look for learning disabilities) i expected that would be the case when we ventured down this road...but unfortunately most of it is up to the parents to research, worry about and check up on :( thankfully we have a great pediatriician who takes my worries seriously and genuinely care about my son - we've been going to him since he was born and he knows him (and me) well. i speak my mind, lol.

Lunacie
03-22-15, 09:57 PM
- i had him repeat Kindergarten and school is generally no fun for him and he can fail 5 tests and then get 100% just to show he can do it if he wants.
.

It doesn't have anything to do with "wanting" to do things.

Some days you know what you need to do and just get it done,
and other days even though you're doing the same thing
you just can't do it right. Even though you really want to. :(
The computer of your brain just can't find the file it needs.

spunkysmum
03-22-15, 10:27 PM
It doesn't have anything to do with "wanting" to do things.

Some days you know what you need to do and just get it done,
and other days even though you're doing the same thing
you just can't do it right. Even though you really want to. :(
The computer of your brain just can't find the file it needs.

EXCELLENT point. It has nothing to do with being able to do it "when you want to." Odds are that the times you can't quite pull it off, the desire to do it is even stronger than it is at the times when you do manage to get it done.

bwalwayswins
03-22-15, 11:09 PM
It doesn't have anything to do with "wanting" to do things.

Some days you know what you need to do and just get it done,
and other days even though you're doing the same thing
you just can't do it right. Even though you really want to. :(
The computer of your brain just can't find the file it needs.

good point. when he wants to, isn't accurate. i didn't mean it the way it sounds... its better described as when he's "on task"....and thats hit or miss.
when he's on task, he does well.

spunkysmum
03-22-15, 11:21 PM
My general policy would probably not be to concern myself greatly with the processes by which my friends' children are diagnosed with ADHD - especially if the diagnosis appears to have been a correct one. I'm not a doctor or a medical review board and it's not really my business to have issues or not with somebody else's diagnosis if they are not my child or family member. My friends and their doctors are not answerable to me.

There's nothing particularly shocking about diagnosing without testing. Diagnoses are often made based on information gleaned from talking either to the patient if they are of age or the parent and possibly teacher reports if they are a child. I'm not sure what kind of tests you even have in mind. From what I understand medical testing for ADHD is not that common. Tests such as brain scans are costly and in most cases would probably just confirm what an oral history of the patient had already revealed, so they probably would not justify the cost and effort.

http://www.netdoctor.co.uk/adhd/howdodoctorsdiagnose.htm

It's also fairly common to have a diagnosis without a specified subtype, so I see no cause for alarm there.

Becoming flushed as a side effect to the medication is again, pretty common. I get flushed all the time from my meds. The chest pains and shortness of breath I would certainly mention to the doctor but there's no guarantee that even these are indicative of a serious problem.

I'm curious to know on what you have based your expectations of what standard diagnostic procedure should be. I hope I don't sound harsh in what I'm saying to you, but I do wonder why you seem to be taking your friend's family's medical matters so personally.

bwalwayswins
03-22-15, 11:24 PM
[QUOTE= and school is generally no fun for him and he can fail 5 tests and then get 100% just to show he can do it if he wants.
[/QUOTE]

since i feel like this sentence wasn't understood the way i meant it - let me clarify -there is times - he pulls off good grades when he *chooses* to put forth the extreme effort and get a good grade for the sake of pleasing his teacher. i have seen him do it. its not something he could do all the time - but he can occasionally. the teacher had him re-take a test last friday that he was going to fail because he lost track of the number he was on - and upon trying again he put forth the extra effort to tune out everything and got it done and got a 100%...the sentence i quoted -i was talking about the positive ability -that is sometimes under his control. Not the negative side - that i believe he has little control over without his meds. When given the opportunities to succeed - he can. Unfortunately in his classroom - when left to keep up with the standard running of a class with 33 kids in it - he gets lost and seems to fall through the cracks over and over. :(

sarahsweets
03-23-15, 05:02 AM
I dont think subtype is necessary for a diganosis.

Flory
03-23-15, 08:54 AM
There are also no tests for Adhd

The consult between school and parents is the best way of determining impairment which is the most important factor in any mental health diagnosis

Without impairment there is no disorder so seeing what his behaviour is like at school and home and how it impairs him is vital to a diagnosis

If started early enough medication can make the difference between high school graduate and high school drop out....believe me I'm the latter , I wish I had been medicated earlier
This is a very real disorder with very real and dangerous impairments for some of us
If the medicines cause adverse side effects there are certainly others that can be tried

sarahsweets
03-25-15, 04:18 AM
My friend's kid was diagnosed with ADHD. I'm pretty sure he has
ADHD but I had major issues with the diagnosis process.

1) He was diagnosed without any testing at all based on parent and teacher info. I think testing should be
standard operating procedure for any competent doctor. I'm shocked.
There are no tests for adhd.


2) His diagnosis didn't specify the subtype. Again, I expect this as part
of standard operating procedure.
I believe the dsm did away with subtypes, not that I agree with that but most doctors use the dsm in diagnosis.

3) His medication, Vyvesense, I think, "worked" in that it made him
clean etc, etc, etc. The problem was his face started to get flushed
and he complained of hardness of breath, chest pains etc, etc. I told my
friend to stop the medicatin right away. So, doesn't standard operating
include monitoring drug effectiveness and side effects?
Yes, it involves monitoring drugs but this is usually done by feedback from the patient and the caregivers. Any physical signs with regards to chest pains and blood pressure are usually monitotred by another doc such as a cardiologist or GP.

someothertime
03-25-15, 07:46 AM
when it comes to kids...... it's a fine line...... and one must ALWAYS stay within the realm of the childs benefit....... ( aka, barriers / experience / needs ).........

proper test, probably....... though....... with this there is also risks, in losing sight of the above......

steady, considered, and always with the best outcomes with the least disruption.....

i am pleased your are concerned for this individual and your friend.... this also needs to be kept in the foreground...

peace and well wishes.

Lunacie
03-25-15, 12:06 PM
There are no tests for adhd.


I believe the dsm did away with subtypes, not that I agree with that but most doctors use the dsm in diagnosis.

.

I believe the change between DSM IV and DSM V was in wording only.

Rather than saying Predominately Inattentive Type
it is now called Predominately inattentive presentation (etc.).
Also Combined presentation and Predominately hyperactive presentation.

http://www.helpforadd.com/2013/june.htm

zette93
03-27-15, 07:59 PM
Actually, there is a new EEG test for ADHD, but it has only been approved for a little over a year. Most doctors offices don't have it yet. It also must be used alongside the current standard practice, which is the questionnaires sent to parent and teacher, direct observation by the doctor, and taking a careful case history.

The first medical device to assist in the diagnosis of attention-deficit/hyperactivity disorder (ADHD) received US Food and Drug Administration (FDA) approval on July 15, 2013, and open comments on an American Academy of Neurology (AAN) Clinical Guideline for assessing the utility of this device recently closed.

The Neuropsychiatric EEG-Based Assessment Aid (NEBA) system measures the theta/beta ratio at Cz (vertex on the International 10-20 system) and was evaluated in two Class I clinical trials. It is not intended to diagnose ADHD independently but rather to "help clinicians more accurately diagnosis (sic) ADHD..." Patients are to be tested off medications. The device is manufactured by NEBA Health of Augusta, Georgia. The website advertises that clinics can rent the NEBA unit "starting at $79/month."

I agree with the other poster, though, that it is emphatically NOT your place to question the diagnosis of your friend's child.