Autism, ADHD, Medication, and Bedside Manner
This is a revised version of a letter I wrote to a parent who is considering a specific doctor to consult on medications to help her child's problem behaviors.
We had (in hindsight) a negative experience with Dr. X. While he is extremely knowledgeable, genial, and responsive, he did not give us the evaluation we had asked for. We came in for a meds/ADHD evaluation; he gave us an autism evaluation (which we already had from Stanford/GGRC/UC Davis), told us our son was probably mentally retarded, told us that if we didn't potty train him by the time he was six it was unlikely to happen, and that, despite my son's obvious hyperactivity, he didn't recommend medicating him. I spent a long time feeling hopeless after seeing Dr. X.
Thankfully my son's amazing, wonderful home therapy program supervisor had practical rather than clinical experience and helped me regain my optimism -- now my newly seven-year-old son is almost fully potty trained (we flew to Las Vegas and back for Thanksgiving; not one accident during the entire week, even on the plane, even at night), and is learning to read via the Edmark system with a ferocity that is surprising even his veteran therapists.
The one thing I would laud Dr. X for is his caution regarding medications. He recommended that we explore every possible other cause of my son's hyperactivity before medicating him. We thought we had done that and eventually ended up going to see pediatric neurologist Dr. Y. She did think our son might have ADHD, and helped us explore a variety of medications: Adderall, Adderall XR, Focalin, Focalin XR. Each time he tried a new medication, we would have a two- to three-week honeymoon period of wonderful behavior, then he would plunge into a prolonged dark awful period of intense aggression. Our home life was horrible.
Then I talked with his regular pediatrician, Dr. Z. She said that children who present with ADHD symptoms often have undiagnosed seasonal allergies that make them miserable and lead to behaviors that mimic ADHD. We started my son on a daily dose of Claritin, and he has been a completely different child ever since.
What worked for my son won't necessarily work for every child, but I always feel that by sharing our experiences we special needs parents can help each other avoid reinventing the wheel.