ADHD: Questions to Ask during Physical Examinations [Interview][Transcript]

Dr_Michael_Feld_ADHD_diagnosisGuest: Dr. Michael Feld
Presenter: Neal Howard
Guest Bio: Michael Feld, M.D. is a Child, Adolescent and General Psychiatrist with a private practice focusing on psychopharmacology, psychotherapy and parent training in Northbrook, Illinois. He has a subspecialty in treating ADHD of all ages and consults at Misericordia North Residential Facility for developmentally disabled clients, The Bridge Youth and Family Services, and Barrington Youth Services. Dr. Feld also holds a Clinical Director position at Alexian Brothers Behavioral Health Hospital. As Clinical Director, Dr. Feld speaks throughout the Chicagoland area on various Child and Adolescent Psychiatry topics for conferences, professionals and/or parents.

Segment overview: Dr. Michael Feld, a Child and Adolescent Psychiatrist talks about the questions to ask during health examinations and school physicals.

Transcription
Health Professional Radio – ADHD: Questions to Ask

Neal Howard: Hello and welcome to Health Professional Radio. I’m your host Neal Howard, thank you for joining us today. Our guest in studio is Dr. Michael Feld, Child, Adolescent and General Psychiatrist with a private practice focusing on psychopharmacology, Psychotherapy and parent training. And he’s here with us in studio today to discuss questions that you need to ask when you’re having a health exam especially if you suspect that yourself or maybe someone else maybe suffering from ADHD, well there’s some questions that you might want to ask just to be on the safe side. Welcome to the program Dr. Feld.

Dr. Michael Feld: Thank you.

N: Thank you. Talk a little bit about your background, have you always been interested in psychiatry from everything from children to adults? Or did you specialize in adults in one time and kind of branched out?

F: No, actually before I went to med school I was always interested in working with kids but to become a psychiatrist you have to go through general psychiatry training program which obviously makes you an adult psychiatrist first and then you proceed to do a child and adolescent fellowship.

N: Now you’re in private practice in Illinois. Do you see the bulk of your patients being in one age group or another?

F: I think I treat patients of all ages, I obviously work a lot with adolescents and young adults but I treat young children and I also work with adults but the bulk of my patients are school aged and high school and college.

N: Now briefly let’s just describe what ADHD is.

F: Okay, well ADHD is a neuro-biologic disorder that presents with core symptoms of inattention and distractibility along with possibly hyperactivity and impulsivity and these symptoms are pervasive enough that they call those impairment and functioning in different areas of life like school and then other areas of life. The symptoms to make it ADHD, these core symptoms have to be due to their neuro-biologic origin and not caused by other medical issues or other issues.

N: Does it depend on what the causes or what you determine the cause to be whether or not drugs are always the case? Are drugs always the case when treating ADHD or are there instances where drugs don’t necessarily have to be introduced?

F: Well to use medication for ADHD you’d only want to use it if the person had proper diagnosis of ADHD. So the use of medication like the psychostimulants are indicated for our people who have ADHD not for people that have these symptoms due to other reasons. So the other issue is we know through ADHD and there’s constantly new research in treatment of ailments and tons of information but what we know about in psychiatry is that in ADHD that psychostimulants are clearly indicated as the first line treatment to help manage and reduce the symptoms of ADHD. There are some people that can manage the symptoms without medication or some people that may not respond as in meds who as we like so they don’t use medication but in general psychostimulants are first line treatment of ADHD.

N: Is the process of diagnosis something that can indicate whether a person will be someone that can manage without medication or is that something that is strictly ‘wait and see trial and error?’

F: Well while you’re working… the nice thing about the new research and treatment development is that we’re now recognizing that ADHD has a spectrum of mild, moderate to severe. Some people present with mild symptoms and some of those people are able to manage with behavioral and environmental and other strategies techniques that help them to manage their symptoms of ADHD but in general if somebody has the diagnosis of ADHD and certain things are put into place organizationally and environmentally and not working, we tend to look at psychostimulants as the first line treatment.

N: Are there any genetic factors that contribute to whether or not a person is a better candidate for one type of treatment drug-wise or another?

F: Well we do know that there is genetically ADHD is clearly a heritable disorder so we do, diagnosing ADHD we do look for genetics as part of our aid and help in diagnosing ADHD. There are now some genetic testing techniques that we can use for it, what the genetic testing does is to help focus on metabolic pathways. So it’s possible that you can learn that let’s say a person is a slow metabolizer of a pathway that metabolizes psychostimulants that we know that we’re gonna have to start with lower doses because they’re gonna have trouble metabolizing the meds and the meds gonna build up quicker, if they’re a rapid metabolizer it lead to the idea that you might have to work towards using higher doses or understand why they might not respond and what we use, study doses that are approved by the FDA.

N: When you’re treating someone that has ADHD, are some of these genetic factors identifiable before the diagnosis of ADHD?

F: Yes. So there are some physicians that may use the genetic testing earlier than others. In my practice I tend to not use it right up because I feel confident in my understanding in the use of medications and what I’m looking for. There are people that can use it that might help guide their choice like I’ve been working with as we’ll talk about… therapeutics to talk about parents to see potentially using some of the newer medications like… ODT and this is a new extended release oral disintegrating tablet and my comfort level using the medicine would allow me to know what I’m looking for clinically to decide if I need to use it before I would do any genetic testing.

N: In another segment when you’re here with us before, you talked about high levels of skill and confidence being required in order to make a proper diagnosis. What types of questions should a person ask of a professional concerning ADHD to give them peace of mind that this doctor is skillful and has the confidence to actually treat my disease effectively?

F: I think that’s great question. One, I think people should ask the professional what their experience is in diagnosing and treating ADHD. Another, I think that is really important is that we know that there’s constantly new research in treatment development and information available about ADHD and we know that science and medicine is always evolving and changing. So I think it would be really fair to ask the doctor what they’re aware of, what’s going on and latest with the field of ADHD and see their comfort level and their understanding of the evolution and what’s the new treatments and what’s the new research is showing. But most importantly I think the parents should ask doctors what their experience is and their comfort level is in diagnosing and treating ADHD.

N: In your experience, is there one treatment that seems to have the highest level of success as opposed to others?

F: Well I mean research shows it and my clinical practice shows it that the use of psychostimulants are first line treatment to help minimize the symptoms of ADHD.

N: Okay, that’s pretty much across the board. Veering from that means that there’s something unique about that patient or that patient’s situation, yeah?

F: Well everybody we’re gonna work with on behavioral and environmental issues to help them manage their ADHD symptoms and hopefully we work with them on exercise and nutrition and sleep then light exposure but we know that properly used and tolerated psychostimulants help them reduce the symptoms most effectively.

N: You’ve been listening to Health Professional Radio, I’m your host Neal Howard in studio with Dr. Michael Feld, Child and Adolescent Psychiatrist talking about some of the questions that need to be asked when you’re getting a health examination, whether it’s a school examination or just a general physical in order to determine whether or not you could be suffering from ADHD. Transcripts and audio of this program are available at healthprofessionalradio.com.au and also at hpr.fm and you can subscribe to this podcast on iTunes.

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