Attention Deficit Disorder, unexplained, has repeatedly been in the sports section of the Tribune lately, and the start of school also brings questions about ADD meds into many family discussions as the first student grades come in. Hence, an explanation should be of interest to Trib readers.
What is ADD?
ADD is a problem with attention, concentration, focus, memory and distractibility that usually begins in childhood, often persists in adults, and interferes with quality of life. The symptom cluster often improves with controlled medications such as Adderall and Ritalin. Use of medication must be balanced with risks and requires an individualized and ongoing series of doctor visits.
It is controversial whether the response to medication indicates that an underlying neuro-psychiatric-behavioral trait is present, or the medication just enhances performance in certain stressful situations. Regardless, adult ADD is a real cluster of symptoms that can be altered with prescription medication, with a goal of improved quality of life.
How is it diagnosed? Although symptom checklists are sometimes used as screening tools, there are no blood tests, X-rays or brain scans that can diagnose ADD. The World Health Organization, the International Classification of Disease, and the Psychiatric Society’s DSM all use slightly different criteria. It is generally recognized that childhood ADD can persist in adults, when focus and concentration become the chief complaints. The hyperactivity component present in children becomes less of an issue in adults, who may like the excess energy of ADD and its associated increased work productivity and creativeness.
Diagnosis is established and medical treatment started only after a qualified medical doctor, such as a psychiatrist, has developed an opinion that the symptoms are present and significantly interfere with quality of life. A trial of medication such as Adderall or Ritalin in Florida must include an understanding of regulations, and the follow-up and refill policies of the prescribing physician. ADD meds are tightly controlled by federal and state laws. In Florida, this means face-to-face doctor visits and no phone-in prescriptions. Only one-month medication can be dispensed at a time, and visits to multiple doctors and pharmacies for the same medications are not allowed.
Each controlled prescription must be entered into the Florida Prescription Drug Monitoring Program (PDMP), an electronic database designed to prevent doctor-shopping and over-prescribing. For example, it is a violation to have two doctors prescribing the controlled medication for ADD.
The use of ADD medications by students trying to improve scores, athletes trying to improve performance, as well as use by the military when wakefulness is critical to accomplish a mission, are all rapidly changing and evolving standards of care.
William Cross Dudney is a medical doctor in Tampa.