I do not see how in person visits for diagnosis (which I like) make treatment harder once you have the diagnosis.
Without comment on the broader merits of the policy, Iāll just say a couple years ago I was prescribed adderall based on a 20-minute appointment with a telemed practice, no testing or really even rigorous questions, and I would not shed a tear if the docs at that particular practice got put out of business.
Relatedly, if your patientās main issue is anxiety with acute attacks, going straight to stimulants may be a very bad idea. Not that ADHD wasnāt part of the problem, but looking back, I donāt know how any doctor could have looked at me and thought the anxiety didnāt need to be addressed first.
They donāt, and I never claimed they did.
If the doctor decides, after a telemed appointment, that he needs to see the patient in person before landing on a diagnosis, then thatās his option. But removing the option of a telemed appointment for diagnosis is going to prevent some people from getting the diagnosis they need.
Bad practitioners are bad practitioners. Telemed is a tool that can be used for good or bad practice. The issue isnāt the tool.
FYI, Iām not defending your shitty doctor, but ADHD is almost always bundled with something else (that has been caused by the ADHD). So itāll be ADHD and depression, or ADHD and anxiety. The ADHD diagnosis is critical in such circumstances, because treating the other malady without addressing the underlying ADHD can be disastrous.
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Thatās how you like it, which is fine, but a lot of people (including doctors) prefer the flexibility of telemed visits.
Oh, good grief. I have done lots of video visits during the pandemic, and I have no clue what doctors prefer. The ones I see went back to in-person as soon as they thought it was safe. I was talking about ONE situation within my special education law practice area, and I will say or write nothing more about it.
This is an important point to make about ADHD. Itās not just attention regulation that is impaired, but memory function too. We have diminished capacity in our working memory, and it is a moment-to-moment problem that balloons out to create tension in every aspect of oneās life.
To paraphrase Donald Rumsfeld, itās the unknown unknowns that get you. If we donāt get to transfer something into long term memory (or to a note somehow), before something else comes along to push it out of working memory, itās gone. Poof. We will never know we once had that in our minds because there is no record of it. Think of it like Lucy at the conveyor belt; anything she doesnāt grab is gone.
This creates anxiety, because you are in constant fear of what you have forgotten. Every time the phone rings or the email chime sounds, I immediately think āWhat have I forgotten?ā, because an inordinate number of such communications are exactly what I fear - a question about something I havenāt done because I forgot.
This means there is also difficulty with functioning in large gatherings, because there are people there who you have met but forgotten, and people you will meet, forget and meet again some time down the line. This makes walking into a room full of people or getting onto a populated video/conference call a feat of will power. Itās stressful and exhausting. Society says that anything you donāt remember isnāt important to you. That is simply not true for ADHD brains, but people still get offended when you draw a complete blank on them.
Poor memory is one of the many ways that neurodivergent people struggle in a world designed around people with neurotypical traits. And living with constant anxiety like this is a major cause of depression, which is why so many ADHD brains also have both issues.
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This video was excellent!
Thank you, Ray!
The great thing about a video is that I can stop, rewind, take notes, realize I didnāt get it all, then keep washing and repeating - with CC - until I get it verbatim.
Like this quote near the end, on āwrite it downā.
Hey, I got something in my head right now that Iām trying to hold in my head.
If I write it down then I can get it out of my head and put my whole focus on you.
Absolutely love this!
Hate that I learning this so late in life, but at least Iām still able to benefit from it. (Iām learning w/ my daughter who is ahead of me on this quest.)
Much obliged!
Snuff
PS: Now, if I could just find my wedding in time for our anniversaryā¦ 
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I studied under very traditional and rigid schooling in the 70s/80s. Sit up straight, eyes front, ears open, mouth closed etc. etc. But this flyer is from today.
I can guarantee you that any kid with ADHD/Autism forced into this āgood listeningā pose isnāt hearing shit. So much attention is diverted to maintaining the performance of listening, that thereās little or nothing left for actually listening.
It is called āmaskingā and itās a drain on mental resources whether itās required, as above, or done as an instinctive defense mechanism.
I have posted this before, but itās well worth a revisit:
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My kid is the poster child for this sort of thing. Demand that he maintain the good listening position, man, forget about it. Let him just sort of be himself and buzz about while (whilst) the information is being delivered, well, you might think that heās not absorbing it, but you would be wrong.
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Preach it. And I totally get why people think Iām not listening to them, I probably make the same assumption about people who act exactly like I do. It pisses me off! Which makes me grateful to have mostly had teachers who let me do my own thing growing up. And particularly grateful to my wife for having the patience to learn how I operate and the grace to not have ripped my head off by now.
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One of my daughters had a 3rd grade teacher that, after asking the class if it was ok and not too distracting, allowed my daughter to pace around her desk. Even drew a circle around it with tape and said she could do whatever she liked as long as it was in that circle. Her grades immediately shot up to all Aās and all of her classmates immediately became less frustrated with her, reducing everyoneās anxiety.
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In music class I used to wrap one hand around my other wrist and watch my hand turn purple. The music teacher said, āHow about I do that around your neck?ā It was a different time, I guess.
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Yeah, thatās not messed up at all, and youāre not that old iirc.
Iām a man! Iām 40!
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Iām sorry but youāll always be in your 20s. Thatās not a bad thing.
My little guy is often able to remain seated for extended periods of time. Although just because he can, that doesnāt necessarily mean he will. In his case I think itās mainly that he will not sit there quietly with his eyes fixed on the instructor. Rather, heāll be staring off into space, humming, making other weird sounds, talking to himself, drawing something if he has some paper in front of him, most likely a fairly realistic depiction of an airline disaster or a music playing bug he created and calls Show Show (rhymes with wow). But, and, obviously, not everyone understands this, heās actually very likely to be taking in whatever is going on externally, whatever instruction thatās happening.
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A picture of Show Show, please.
Thanks, Mike Gundy.
Iāll see if I can find one that includes Show Show and a plane wreck.