How NOT to diagnose ADD

Got a call from a mom the other day. Concerned that her son might have ADD, she brought him to the family pediatrician. However, the doctor said he could not diagnose ADD with certainty. Instead, Mom told me the doctor said, "he would prescribe the ADD medication, and if it worked [?], then they would know for sure her son had ADD."

My jaw dropped into my lap. This is so wrong, that in my humble opinion, it borders on malpractice.

First, how on Earth can you prescribe a powerful, psychotropic drug to a child without having at least a reasonable certainty that the child suffers from the disorder which that drug is supposed to treat? These are serious drugs with serious known side-effects we're talking about!

Imagine fearing you had cancer, and you seek a diagnosis from your doctor. Your doctor says he can't tell for sure whether you have cancer, but, he'll start you on chemotherapy. If it works -- whatever that means -- then you'll know you had cancer.

Sound right to you?

Second, using drugs to diagnose ADD was rejected as an approach over a decade ago! The fact of the matter is, when given in prescription appropriate doses, these drugs have the SAME effect on "normal" folks as they do on those with ADD. Thus, the drugs "work" no matter to whom they are given.

Finally, has this mom's doctor not read anything about these drugs being abused on college campuses by students seeking an edge? If these students are using these drugs to enhance their attention and studying skills, how can you possibly use them as a diagnostic tool?

When did the prescription of these drugs become so commonplace, so automatic, so nonchalant, that we forget that there are dangers attached to the practice? That it is not "normal" to need these drugs? That we are doing no more than putting these poor children into a drug-induced state?

Again, I understand the use of medications. When you've tried everything else, and nothing is working, and you are desperate for your child to have a happy, successful life. I get it. I've been there. I've done that.

But, it is a last resort! One taken after very careful consideration. You would think a doctor would know that.