COMMENTARY

ADD and Stimulant Use: An Epidemic of Modernity

Michael E. Ruff, MD, FAAP

Disclosures

February 06, 2007

Case Report

Jimmy, age 11, was brought to our office recently for a second opinion. His parents were divorced 4 years prior and their current relationship reportedly was adversarial. Jimmy had been on stimulant therapy for 3 years. His teachers reported that Jimmy had high-average general academic ability but was disorganized, performed inconsistently, had class work that was highlighted by impulsive and careless mistakes, frequently daydreamed, and, more recently, was noted to be confrontational and aggressive on the playground. His teachers noted that his problems were especially bad on Wednesdays and certain Fridays. Upon further questioning, Jimmy revealed that his father, to whom he felt close, had been through several live-in girl friends. Jimmy stated that his father didn't pay attention to him when both he and his dad's girlfriend were at the house. He added that, not long ago, his father's infatuous relationship was so consuming that he completely forgot to pick him up at the prearranged time. This hurt Jimmy deeply. What Jimmy wanted to say at this point but couldn't quite articulate was, "The emotional tension I'm feeling about my dad manifests as inattentiveness. My mind is consumed with these kinds of pressing concerns that render math and English relatively unimportant."

Not long after convincing Jimmy's parents to work together to better protect the positive feelings Jimmy had for both of them (no denigrating or criticizing the other parent in front of Jimmy), and persuading the father to spend some nights with Jimmy alone, his academic and behavioral performance improved significantly. Jimmy is currently off medication and doing well. Unfortunately, this is an exceptional case in that it is often very difficult to change parenting styles by giving advice in the office. It is also difficult for troubled families to take advantage of options such as behavior modification and parenting classes.[48,49] In many parts of the country, HMOs make it nearly impossible to even offer these therapeutic options. Thus, children are increasingly subjected to quick, inexpensive pharmacologic treatment as opposed to informed, multimodal therapy associated with optimal outcomes.[40]

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