This is one of the more exciting areas we are diving into at Care Practice over the last several months.
In 2010 I would freely admit that Care Practice and myself were part of the problem in medicine with regard to ADD and ADHD. We found ourselves increasingly managing patients previously diagnosed with ADD and put on stimulant medications by their doctors in other cities. Part of the reason for this increase in our patients has been the huge growth of tech jobs in the Bay Area and the high incidence of ADD amongst software developers. So as more and more of these people moved to the Bay Area on stimulant medication they were finding their way to our office to continue their treatments. We were not doing evaluations or making any new diagnosis of ADD, but managing more and more of these patients on their current regimens as primary care physicians continuing established treatment plans. Since there is such a huge lack of access to care for uninsured patients we felt stuck trying to meet a need outside of our practice focus. Where were all these patients going to go when the costs of getting treatment with a Psychiatrist was often out of reach and they genuinely depended on these medications for stability in their lives? We felt like we were stuck in a bit of a box.
Our problem began with a description and criteria used to diagnose ADD that seemed extremely vague and in many cases hard for us to understand. We were not dismissing the disorder, but like many health care professionals had some very negative preconceived notions about the diagnostic criteria and the treatment used to manage it. For example some of the criteria in the DSM IV for diagnosis include; fails to give close attention to detail, makes careless mistakes in schoolwork, difficult sustaining attention in tasks, does not seem to listen when spoken to, fails to finish schoolwork or chores, difficulty organizing tasks, easily distracted by external stimuli, and forgetful to name a few. These just seemed like vague criteria to explain a pattern of dysfunction in the population and a set of criteria originally established for a population of teenage boys struggling in school. I certainly didn’t understand how to extrapolate it into an adult population and didn’t understand the pattern of behavior or its true origins. The treatment also was hard for me to understand, although I knew that there were clear benefits to treatment in numerous studies I didn’t understand patients taking amphetamines inorder to crank out code or power through large projects at work. It just didn’t make sense the way many were using the medication, especially not short acting amphetamines like Adderall that only lasted for short periods. I later realized that our patient population was slanted toward people on the short acting low cost generics and people being treated on newer more expensive drugs had access to insurance and were seeing other doctors. This really meant we were attracting people who couldn’t afford optimal treatment and were on less than valuable treatments by inexperienced doctors across the country.
In an attempt to gain more awareness and knowledge on my part I sat down to watch a PBS documentary by Patrick McKenna called “ADD and Loving It.” In this 90 minute documentary he talks to researchers, specialists, and doctors about ADD and ADHD. He speaks with ordinary people who are directly dealing with the challenges of the problem. Throughout it he shares his own life story and his struggle with undiagnosed ADD and his success in tackling the disorder. But much of the underlying messages was that everything you have been told about ADD is completely wrong and it really tried to dissect many of the misconceptions out there. It had a profound impact on me personally and I had numerous epiphanies throughout the film about the true outlines and experiences related to this neurochemical pattern. I immediately began doing more research on finding the top people in the country and San Francisco that were working on treatment and management of ADD and ADHD. People like Gina Pera, the author of “Is It You Me or Adult ADD?” and Dr Charles Parker of Virginia Beach, VA who are helping to lead a grass roots revolution in our understanding and treatment of this common problem. We connected with a company
called Neuroscience doing testing of neurochemicals and advancing our understanding of the imbalances of the brain in this and other disorders.
Currently we are dedicating ourselves to working on this neurochemical pattern and its manifestations in our patient population. We want to advance our understanding by taking a deeper look at this disorder that is particularly heavily concentrated at Care Practice. We are doing testing on dozens of patients looking at their neuroscience and beginning to dive into this grass roots movement to transform the way ADD is understood and treated. We are accepting new patients for testing and evaluations, but not diagnosing people with ADHD or starting stimulant medications. We are looking at these patterns and helping people to advance their understandings of how their brain works. Largely we are working with entrepreneurs and artists that want to explore alternative therapies to help manage their ADD symptoms. Our concentration is on exploring root causes of ADD and behavioral manifestations of brain neurochemical patterns. This does not mean we don’t support traditional approaches to ADD management, we just feel we are not prepared to evaluate and manage stimulates in these patients. Many of our patients are also reluctant to be fully evaluated and don’t want to use stimulants meds even if we would recommend them. We want to explore the root causes and reach for a deeper understanding of what is happening neurologically. If someone is looking to be evaluated and diagnosed officially by a medical professional that concentrates on ADHD then we recommend Dr Joshua Israel here in San Francisco. We are referring several patients a week to his office for evaluations. People seeking a diagnoses and treatment plans involving stimulant medications should call his office for an appointment before coming to Care Practice.
We are accepting new patients that wish to gain insight into their brain through a comprehensive evaluation and neurochemical testing. Some of the tests we are doing are not cheap, but finally are within reach of regular patients wanting to achieve a new level of awareness and optimization of how their brain works. We eventually may do neuropsych testing and ADHD evaluations, but currently are not offering them at Care Practice.
Aaron Blackledge M.D.
