Saturday, December 22, 2012


I am a little tired of ADHD “numbers” articles. I mean the ones that list the “7 Secrets to Improve Your Child’s Attention”, “5 Ways to Eliminate Homework Problems”, and “32 Sure Fire Steps to Save Your Marriage” (that one seems to requires a little more work). Getting ADHD under control is just not that simple. What really is needed is a system, not a list.
            Of course, lists have a place when used to remind, prioritize, and teach us. For example, one for successful brain surgery might be:
1.    Get plenty of sleep the night before.
2.    Wear comfortable shoes.
3.    Make sure your scalpel is sharp.
They may be good rules, but we expect our neurosurgeon will also have the required knowledge, experience, skills, and clinical judgment to do the job correctly. Every professional from hairdresser to plumber to policeman has a reliable plan to deal with bad hair, clogged drains and criminals. Parents too need a problem-solving process to help their ADHD child consistently achieve their best potential in school, relationships, and self-esteem.
Years ago I was unexpectically given the responsibility to provide medical care for a large number of children who had ADHD and were in trouble at school. Although I had received excellent training in managing premature infants on ventilators and severely injured children in the Shock Trauma Unit, I had no idea what to do with this group. But what I discovered is that the medical problem-solving system I used to diagnosis and treat fever, pain, rash or whatever could work for ADHD as well. Although I realize this looks suspiciously like another list, I prefer to think of it as an algorithm or the sequence of steps that all doctors use to solve a problem.
1.    Describe the chief complaint (fever)
2.    Take a history (ask questions such as “Does your throat hurt?”)
3.    Do a physical exam (open your mouth and say “Ahh”)
4.    Perform a laboratory test (swab the throat and perform a rapid strep test)
5.    Make a working diagnosis (probable strep throat)
6.    Decide on best treatment ( usually penicillin)
7.    Evaluate the accuracy of your diagnosis and treatment (call the next day and ask about improvement or side effects)

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