Being a physician can be very rewarding. I have to admit that the rewards have not come as often as I dreamed as a young medical student, and they frequently come from unlikely places. I never imagined that one of the most rewarding things I could do as a physician would be to treat a child with ADHD. Surprised? Did you think I would say delivering a baby? Saving a life?
These are the romanticized aspects of medicine that rarely live up to their billing as presented on TV. Babies come into the world in an extremely messy and painful fashion, not to mention that as the attending physician, it can be incredibly stressful. Unfortunately, we know that things could go awry and a normal, healthy delivery can go south at any moment. I know I have been involved with life-saving treatments for many patients over the years, particularly during residency. On many occasions, I didn’t personally know the patients and never got to see them through to recovery. I rarely saw the real fruits of these efforts. If any of these patients or their families wanted to thank me, I would not have been aware.
I’ve learned that the best rewards come from the little things I do in my practice every day, and the relationships I’ve built with patients over the years. There is nothing seemingly exciting about ADHD (attention deficit hyperactivity disorder), but treating these kids is one of my favorite things to do as a physician.
Before my medical training, I had a very common misconception about ADHD. I believed that kids with “ADD” were just really hyper and poorly disciplined children who took medicine to sedate them because their parents and teachers didn’t know how to control them. I quickly learned as I worked with these children and their parents that I couldn’t have been more wrong. The parents often bring their children in with an incredible sense of reluctance after trying every parenting trick they could think of, read about, or was suggested by family and friends. Children with ADHD often don’t respond well to the same types of parenting, discipline and educating that other children do. Most parents don’t want to believe that their child has a problem that requires medication. They don’t want to put their child on “a drug.” They usually come in as a last resort. Their child is not doing well and they are desperate.
I also have not found teachers pushing parents to get these drugs to make their classrooms easier to handle. Not once. On the few occasions in which a teacher disagreed with my recommendation to hold on medication for a child with some symptoms of ADHD (but not a clear diagnosis), the teacher graciously accepted my decision. Usually after some time, and I’ll admit, more intense struggling by parents and the child, the teacher’s instincts were confirmed. A diagnosis of ADHD was made and medication was successfully prescribed.
Which brings me to why this is so rewarding. With the stroke of a pen, I can transform a difficult, academically challenged, and sometimes aggressive child into a bright, confident, happy child who is learning and enjoying school. I get to flip a switch and see a failing student get straight As. Obviously, not all cases are like this. Sometimes the medication doesn’t work or there are intolerable side effects. Sometimes we go through a long process of trial and error before finding the right drug at the right dose. But, when it works, it’s awesome!
So, what is ADHD? Attention-deficit hyperactivity disorder is the name of a constellation of behaviors found in many children and adults. People with this disorder have trouble focusing at work and school, are often disorganized, and cannot complete tasks that require sustained attention. They have trouble paying attention to details, are easily distracted, and often lose things. Some are more impulsive and have a higher level of activity than their peers. These problems create difficulty in learning and relationships. Children with ADHD often seem to be difficult, defiant, “spaced-out,” and/or the result of lack of discipline or good parenting.
We don’t know exactly what causes ADHD, but we do know that people with ADHD have lower levels of certain brain chemicals in areas of the brain that are responsible for organizing thought. There does seem to be a genetic component as ADHD is more common in children with family members that have ADHD. There is also limited evidence that smoking or using alcohol or drugs during pregnancy can be a contributing factor.
Things that don’t cause ADHD include bad parenting, sugar, aspartame, food allergies, TV and/or video games. A disorganized home life can exacerbate symptoms, but certainly is not the cause.
The medications we use do not turn the children into “zombies,” as many parents fear. In fact, if a parent feels that the medication is making their child sedated, slow, or have an unusual personality, I tell them to stop it immediately. This is not an acceptable side effect in my opinion. Thankfully, this rarely happens. Most children with ADHD will only seem different on the drug in that they can suddenly focus and complete schoolwork. Their true potential will finally shine through. I don’t mean to imply that there aren’t potential side effects. There are. I have just found that the benefits outweigh the negatives for most children. And this is very rewarding.