Scott H. Kollins: ADHD story not the norm

February 16, 2013 

ADHD story not the norm

The story of Richard Fee, carried Feb. 3 in The News & Observer, tells a sad story of addiction and the failure of our mental health system to adequately care for a young man who fell into a downward spiral that led him to take his life.

The story, however, does not depict recommended routine care for people with Attention Deficit Hyperactivity Disorder, and it’s important to put the tragedy in context.

Fee’s dangerous cycle was likely fueled in part by mental health providers who could not afford to spend adequate time with patients and consequently made snap judgments without all the relevant data.

The majority of providers diagnosing ADHD and prescribing medication are primary care practitioners, including pediatricians and family doctors. Such providers are routinely pressed for time and resources that make it difficult to access corroborating sources of information, primarily because of inadequate reimbursement for mental health services.

Although the Mental Health Parity and Addiction Equity Act passed in 2008 to address some of those issues, the law has yet to be implemented, leaving mental health care financially challenging for providers and patients.

The manner in which some of Fee’s providers managed his care is also not the norm for assessing or treating ADHD. In fact, a substantial proportion of people with ADHD who are truly in need of help go untreated as a result of clinician reluctance to diagnose ADHD.

Additionally, the story raised issues about the safety of stimulant medications used to treat ADHD. People diagnosed with ADHD are at increased risk for substance use and abuse, but this risk is believed to be related to poor impulse control and deficient reward processing that are core features of the disorder.

When patients with an accurate diagnosis use the stimulant medication for ADHD properly, the drugs do not substantially increase the risk for drug abuse.

Cases like Fee’s are heartbreaking and leave families and the public searching for answers. While there are lessons to be learned in evaluating the ways his care was managed, we must be cautious about drawing broad conclusions that may limit access to proper care for people with ADHD. Appropriate and thorough diagnostic procedures and a carefully monitored treatment regimen, including medication and behavioral therapy, are the best.

Scott H. Kollins, Ph.D.

Director, Duke ADHD Program, Duke University School of Medicine, Durham

The length limit was waived to permit a fuller response to the story.

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