ADHD and Medicine

That's comforting. I've got it bad. So far it's only been a huge problem (i.e. led to "bad" grades) when I've had to study REALLY boring stuff (plants, fungi.... stuff I don't care about). It's hard enough for me to concentrate on studying already.... it's near impossible for me to focus on studying that crap. And I'm pretty worthless in class.... I do 100% of my learning outside of class. Somehow I've made it by with a good GPA, but I think it'll be tough in med school. I'll be applying next year if all goes as planned. Good luck.

I have ADD, and I am in the top half of my class. You are going to have to learn how to study things that do not interest you if you want to be successful. With medication, I don't feel as if I am at any disadvantage. I don't know that I would broadcast it though. Even in medical school there are people who have negative views of ADHD. Not saying it would keep you from getting in, but you don't want to be known as "that guy with ADD".

Good luck.

I noticed the bit about having to learn things you are not interested in...and isn't that what everyone has to do, ADD/ADHD or not?

Food said:

I noticed the bit about having to learn things you are not interested in...and isn't that what everyone has to do, ADD/ADHD or not?

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Yep, you've gotta be disciplined in med school.

I agree about it being interesting material though. I constantly fall asleep or get up and play guitar when reading dull material...hard to stay focused for long periods of time.

The real question is "Residency and the Match". If you have ADD and use accomodations, and somehow get them on the USMLE there will be an astric on your USMLE scores indicating that you were non standard.

I want to know how that would effectapplying for competitive residencies? That is the real question.

I think med schools don't care if you have ADHD or not as long as you can get the job done. If you're able to maintain good GPA and MCAT, you're fine. Never use your ADHD as an excuse. They're merely obstacles you have to overcome to succeed.

A classmate of mine with ADHD is matching into the same residency program as myself (a competitive one). Not sure what his medical school stats were, but he did well enough to impress the faculty.

Not that it mattered in the whole process, but this student ended up choosing Emergency Medicine as a specialty, a specialty where everyone admittedly has some level of ADHD (subclinical to full-blown).

tremulousNeedle said:

A classmate of mine with ADHD is matching into the same residency program as myself (a competitive one). Not sure what his medical school stats were, but he did well enough to impress the faculty.

Not that it mattered in the whole process, but this student ended up choosing Emergency Medicine as a specialty, a specialty where everyone admittedly has some level of ADHD (subclinical to full-blown).

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But did he take the USMLE non-standard? I ask because the porgrams he applied to would know he had ADHD or some equivalent. Did he discuss that with residency directors.

This is the important question you should consider.

I have ADHD, can't take any of the meds due to my epilepsy and have had to find other ways of dealing with it. I've yet to get any accommodations much to the dismay of me and my PCP. I was told that since my grades are pretty darn good even battling ADHD that I shouldn't tell anyone that I have it.

Againstalloddz said:

Apparently medical schools think premeds with ADHD are awesome!

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I am not trying to be mean or anything, but why would an adcoms think that students with ADHD would be awesome? I feel like it shouldn't matter if you have ADHD or not, if you can't make the grades or focus on material (regardless of a disorder) then I don't think someone should be admitted just because they had a disadvantage. However, if you do have ADHD and you are stellar 4.0 student, I think THAT would look awesome.

Mandiblespeaks said:

But did he take the USMLE non-standard? I ask because the porgrams he applied to would know he had ADHD or some equivalent. Did he discuss that with residency directors.

This is the important question you should consider.

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I believe he took the standard USMLE and I am not sure if he discussed it with the residency directors. However, programs are not made aware of the reason accommodations were needed, just that they were given. For example, programs (result recipients) can request what the specific accommodations were, such as extended testing time, additional break time, audio rendition, etc, but they are not given the reason, such as ADHD. Granted they can presume or assume, but only the applicant can release this information.

Here is the link that discusses this information: http://www.usmle.org/Test_Accommodations/test_accommodations.html
See the bottom of the page.

Also, I doubt the program representative would bring this up during the interview because that would be treading on dangerous grounds with regards to Americans with Disabilities Act (many employers, including residency directors, avoid this topic during interviews; it can get them in trouble).

tremulousNeedle said:

I believe he took the standard USMLE and I am not sure if he discussed it with the residency directors. However, programs are not made aware of the reason accommodations were needed, just that they were given. For example, programs (result recipients) can request what the specific accommodations were, such as extended testing time, additional break time, audio rendition, etc, but they are not given the reason, such as ADHD. Granted they can presume or assume, but only the applicant can release this information.

Here is the link that discusses this information: http://www.usmle.org/Test_Accommodations/test_accommodations.html
See the bottom of the page.

Also, I doubt the program representative would bring this up during the interview because that would be treading on dangerous grounds with regards to Americans with Disabilities Act (many employers, including residency directors, avoid this topic during interviews; it can get them in trouble).

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I agree with you. Insightfull. But I think it would be simple human nature to "pre-judge" an astricted USMLE. Program directors, esp for competitive specialties, have so many fantastic applicants that, in my opinion, it would be easy to dismiss someone for a reason such as this.

Mandiblespeaks said:

I agree with you. Insightfull. But I think it would be simple human nature to "pre-judge" an astricted USMLE. Program directors, esp for competitive specialties, have so many fantastic applicants that, in my opinion, it would be easy to dismiss someone for a reason such as this.

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I agree, a USMLE score with accommodations will likely not go unnoticed. However, I think that what program directors do with this information varies greatly. For super competitive specialties that put a lot of weight on factors such as board scores (plastic surgery, neurosurgery), this annotation to a score may hurt the applicant (possibly also for the most competitive programs in any specialty). On the other hand, I doubt that a score annotation would have any affect for specialties like family medicine and psychiatry, where boards score are more of a formality than a determining factor. Obviously, these comments are made with everything else being equal.

Consider two scores, a 210 with no annotation and a 235 with the annotation of additional break time (average USMLE 220-ish). I still think that the 235 will be viewed in a better light because that individual was able to perform well above average despite having some concern that warranted additional break time. Especially if the student's clinical grades and evaluations are good, demonstrating that they have succeeded in previous clinical rotations.

tremulousNeedle said:

I agree, a USMLE score with accommodations will likely not go unnoticed. However, I think that what program directors do with this information varies greatly. For super competitive specialties that put a lot of weight on factors such as board scores (plastic surgery, neurosurgery), this annotation to a score may hurt the applicant (possibly also for the most competitive programs in any specialty). On the other hand, I doubt that a score annotation would have any affect for specialties like family medicine and psychiatry, where boards score are more of a formality than a determining factor. Obviously, these comments are made with everything else being equal.

Consider two scores, a 210 with no annotation and a 235 with the annotation of additional break time (average USMLE 220-ish). I still think that the 235 will be viewed in a better light because that individual was able to perform well above average despite having some concern that warranted additional break time. Especially if the student's clinical grades and evaluations are good, demonstrating that they have succeeded in previous clinical rotations.

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Yeah, competitive residencies. What I have been saying. It is a negative. No way around it. Which is a violation of people who have such dissabilities rights.

Decided that the post was a bit mean, so I edited. Sorry.

Stay far far away from psychiatry.

PCxX said:

In my view, if somebody can get be as competitive as non-ADHD applicants while having ADHD themselves (without any special accomodations), then they should not be treated any differently.

I do believe, however, that if the ADHD gets in the way of the person to perform as well as another (i.e. they required special accomodations to achieve a similar score), then that should be a cause for concern. Would you really want a neurosurgeon who had to receive special accomodations throughout school because of ADHD just in order to keep up? Should we give them special accomodations during surgery too?

I'd respect them for working hard, but at the same time if that hard work doesn't produce satisfactory results as good as other doctors, then I don't think I'd want that person as my doctor.

This is of course if the person needs special accomodations to keep up. If they don't and are able to be competitive without any special needs, then they by all means deserve to be treated like any other competitive applicant.

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PCxX said:

Decided that the post was a bit mean, so I edited. Sorry.

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Mean, yes. It was basically a slap in the face for any student with learning disabilities. The fact is ppl who have learning disabilities can't learn as you or I would. Maybe you will have a child who happens to have a learning disability and you will see the genuine struggle these kids have in a traditional school setting. You will most likely have a few med student colleagues with learning disabilities. These students work so hard, are intelligent (after all, they are in med school), and are dedicated to becoming a fantastic physician (just like you).

One thing to keep in mind when thinking about this topic is that a great/good USMLE score does NOT equal great/good doctor. I was fortunate to have a really good board score and get into my first choice for residency, but if there is anything that makes me think I will be a better doctor than anyone else in my residency class, it is not my board scores.

While a learning disability may alter how the student will take a test, this has no bearing on the quality of physician the student will become.

tremulousNeedle said:

One thing to keep in mind when thinking about this topic is that a great/good USMLE score does NOT equal great/good doctor. I was fortunate to have a really good board score and get into my first choice for residency, but if there is anything that makes me think I will be a better doctor than anyone else in my residency class, it is not my board scores.

While a learning disability may alter how the student will take a test, this has no bearing on the quality of physician the student will become.

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+2,000,000

^^^^^.


I also have ADHD. I have been medicated with adderal after concerta and straterra worked miserably. My doctor told me that he didn't think i had ADHD bc my "grades are too good" and he though I just wanted it to help me study (absolutely not true). My brother suffers from ADHD worse than me, and yes his grades suffer drastically from it and my doctor prescribed him with medication but not me, so I went and saw another physician. Getting medicated really helps; I can focus in class, I get all of my work done on time; I am more focused when I am driving....it's great. With that being said, I have heard that it is not good to announce it, especially infront of adcoms. They may think that you will have difficulty handling a tough med school cirriculum and that you may lead you to trouble later on down the road with your tests/studies. It sucks, but keep pushing on!!

tremulousNeedle said:

While a learning disability may alter how the student will take a test, this has no bearing on the quality of physician the student will become.

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False. There are no "accommodations" in the real world when the guy in front of you is circling the drain. I feel that the boards test the way a person thinks under pressure, which is a very important skill for physicians.

Nevertheless, I do agree that good board scores don't necessarily make good doctor.

Many people with ADHD end up doing well and getting to the top of the class. Still others flunk out.

There is no such thing as ADHD

Speculatrix said:

False. There are no "accommodations" in the real world when the guy in front of you is circling the drain. I feel that the boards test the way a person thinks under pressure, which is a very important skill for physicians.

Nevertheless, I do agree that good board scores don't necessarily make good doctor.

Many people with ADHD end up doing well and getting to the top of the class. Still others flunk out.

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Is it more dramatic if I respond false in all caps? Here I go... FALSE.

Requiring accommodations for a test has nothing to do with requiring accommodations for practicing medicine, not even a remote correlation.

Boards have nothing to do with thinking under pressure, they are about having enough facts in your head combined with the ability to pick the best response based on word association; all of the multiple choice USMLE exams test knowledge and word association, nothing about "thinking" (that's why they are called clinical knowledge exams). Even the MCAT tests critical thinking skills more than any of the USMLE exams.

Not to mention that I know many practitioners in competitive specialties (ortho, rads, plastics, rad onc - which means higher board scores) who were hopelessly unable to help patients who were circling the drain. Not to mention that physicians in EM, Anesthesia, and critical care (fellowship), who tend to be the best at resuscitation (circling the drain), also have average to slightly above average board scores.

I did very well on the step exams, but that success will have no bearing on how I care for a critical patient.

But I guess you are entitled to your feelings.

tremulousNeedle said:

Is it more dramatic if I respond false in all caps? Here I go... FALSE.

Requiring accommodations for a test has nothing to do with requiring accommodations for practicing medicine, not even a remote correlation.

Boards have nothing to do with thinking under pressure, they are about having enough facts in your head combined with the ability to pick the best response based on word association; all of the multiple choice USMLE exams test knowledge and word association, nothing about "thinking" (that's why they are called clinical knowledge exams). Even the MCAT tests critical thinking skills more than any of the USMLE exams.

Not to mention that I know many practitioners in competitive specialties (ortho, rads, plastics, rad onc - which means higher board scores) who were hopelessly unable to help patients who were circling the drain. Not to mention that physicians in EM, Anesthesia, and critical care (fellowship), who tend to be the best at resuscitation (circling the drain), also have average to slightly above average board scores.

I did very well on the step exams, but that success will have no bearing on how I care for a critical patient.

But I guess you are entitled to your feelings.

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I don't think I ever saw the word "strawberry tongue" or "strawberry cervix" or "sandpaper rash" on any part of the USMLE, but they appeared in textbooks and review books throughout my education. Word association was not part of my USMLE, perhaps you might have had a different experience. A good chunk of USMLE Step 2's question stems are "What is the next best step in the management of this patient?" -- these often did test critical thinking, and often for presentations that weren't classic. I am a terrible memorizer, but my scores were 266/270, because I reasoned out the answers in most cases. I feel I did well because I used common sense, and that is a skill I use in caring for patients. Nevertheless, I acknowledge that you could probably do well if you were an extraordinary memorizer. I do also think you could do even better if you had extra time to check your answers.

As for accommodations, I don't think you can say there is zero correlation with testing accommodations and real life accommodations. If it takes twice as long for someone to synthesize and process a bunch of information on a test, it follows that it will take them longer to do so in practice, perhaps even longer because life doesn't present itself in neatly organized vignettes. You take a whole bunch of data and lab values, maybe past admissions + H&P's, and figure out what you're going to do next for the person.

As for your example with the competitive specialties / high board scores, I know plenty of people in those specialties who are able to leap into action when push comes to shove. As for EM, it doesn't take high board scores to come up with creative and smarmy ways to consult medicine or the other specialties or order the kitchen sink of labs and studies for every patient. Most of the "critical thinking" is farmed out to other specialties.

Speculatrix said:

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Spoken like a true professional and a true MD/PhD student. Of all your qualities, I hope your condescending tone and contempt for other specialties is what really shines through in your future practice. Best of luck.

tremulousNeedle said:

Spoken like a true professional and a true MD/PhD student. Of all your qualities, I hope your condescending tone and contempt for other specialties is what really shines through in your future practice. Best of luck.

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And to you too! I'll be sure to look you up when I'm "hopelessly unable" to save someone's life because I did well on the USMLE.

GH253 said:

There is no such thing as ADHD

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Um.

Hey guys. I am also planning on med school soon. I have battled with adhd and have never done anything about it. Had the view that it was just an excuse. I can't prevent myself from becoming distracted in almost everything I do. I get lost in my own thoughts even talking with friends. Studying for the MCAT is really showing me the seriousness of the issue. Also normal readings for school classes take me a lot longer than they do my friends. I keep having to go back and reread things no matter how hard I try.

Anyone have experience with drugs like adderall? Seems like they work for a little while until a tolerance is built. Ive got an evaluation with a psychologist next week.

coyfish said:

Hey guys. I am also planning on med school soon. I have battled with adhd and have never done anything about it. Had the view that it was just an excuse. I can't prevent myself from becoming distracted in almost everything I do. I get lost in my own thoughts even talking with friends. Studying for the MCAT is really showing me the seriousness of the issue. Also normal readings for school classes take me a lot longer than they do my friends. I keep having to go back and reread things no matter how hard I try.

Anyone have experience with drugs like adderall? Seems like they work for a little while until a tolerance is built. Ive got an evaluation with a psychologist next week.

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Hey dude - I know exactly how you feel. This semester (undergrad), I'm taking a pretty science heavy course load, and I felt as though my brain was an iPod stuck on shuffle. My university offers free neurocognitive testing, and referred me to an amazing physician at the local hospital who diagnosed me with ADHD. I started concerta last week, and its made an extraordinary difference already in my study ability and my test taking ability. I'm not sure about the drug resistance question. It is logical though. Concerta (just because its the one I'm most familiar with) is chemically very similar to other stimulants such as cocaine, which have a very well documented history of tolerance with long term use. There is the possibility of cross-tolerance, but under the care of a doctor, you should be able to formulate a good long-term strategy.

Let me know how the doc visit turns out!

coyfish said:

Hey guys. I am also planning on med school soon. I have battled with adhd and have never done anything about it. Had the view that it was just an excuse. I can't prevent myself from becoming distracted in almost everything I do. I get lost in my own thoughts even talking with friends. Studying for the MCAT is really showing me the seriousness of the issue. Also normal readings for school classes take me a lot longer than they do my friends. I keep having to go back and reread things no matter how hard I try.

Anyone have experience with drugs like adderall? Seems like they work for a little while until a tolerance is built. Ive got an evaluation with a psychologist next week.

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If you are diagnosed with ADHD and medication is suggested it is unlikely that they will put you on Adderall from the get go. My psychiatrist put me on something different that has less side effects than Adderall.

About tolerance, she told me that this usually occurs when the drug is abused. My bf has been taking the same dose of Adderall for the past 7-8 years and it works the same for him.

Besides medication there are many things you cant do to help manage the ADHD. My school offers meetings with learning specialist which can help teach you the best way to learn with your ADHD.

Also, accommodations are usually given (extended test time, etc) but don't rely on this since it's pretty impossible to get accommodations for the MCAT especially since it's a late diagnosis.

Thanks for the responses guys. My appointment is on thursday. I have read about therapeutic management for ADHD and im not sure how it would help me. It seems like a lot of people have trouble organizing and "loosing things." I don't have trouble with that. I can to to the library and free myself from all distractions. I have the time devoted and the will to study. But still can't prevent myself from having my mind wander. I never received special treatment. I saw kids in my HS who "had add." They didn't so it gave me the impression that it was a load of crap. These kids would get extra time to take tests but had no problems doing other things. I always feel like i have tachycardia and my brain is wired. To the point where im always anxious and my BP is high. I love exercise because its one of the few things that actually calms me down. I can feel my heart / head relax.

Thanks for telling me about your experience with various drugs. I guess im getting ahead of myself. I have plenty to talk about with the psych.

Figured I would update for others in the future. I have been on 40mg of vyvanse for a week now. Side effects were worst for the first few days gradually improving. Got back to my place and started studying yesterday and I feel the medicine has helped. Still need to take breaks and get distracted but it calms me down which is what I wanted. Best way to describe it is being a bit drowsy without being tired . . . if that makes sense. Its still early but so far im pleased.

Biggest thing for me is the appetite suppression. Quite a pain. Good for those looking to loose weight though.

I wanted to say that I'm glad that this thread is here- there wasn't a lot of useful information on SDN before this for people in medical school/pre-med who are dealing with ADHD.

As someone who has been treated successfully for ADHD for 17+ years now and about to enter medical school, I like to help out people who are just diagnosed/just treated because there are a lot of misconceptions out there about what people with ADHD can and can't do, what treatments work and just a heck of a lot of skepticism and negative attitudes from people that don't understand.

So feel free to PM me.

RevivedPreMed said:

If you are diagnosed with ADHD and medication is suggested it is unlikely that they will put you on Adderall from the get go. My psychiatrist put me on something different that has less side effects than Adderall.

About tolerance, she told me that this usually occurs when the drug is abused. My bf has been taking the same dose of Adderall for the past 7-8 years and it works the same for him.

Besides medication there are many things you cant do to help manage the ADHD. My school offers meetings with learning specialist which can help teach you the best way to learn with your ADHD.

Also, accommodations are usually given (extended test time, etc) but don't rely on this since it's pretty impossible to get accommodations for the MCAT especially since it's a late diagnosis.

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Everyone ...develops tolerance - not only when the drug is "abused." The body does not know the difference when the chemical enters the system if it is being taken for "good" or "bad" reasons. Often, esp. with adderall patients will develop physiological tolerance but the benefits are also psychological as there is documented placebo effect even with amphetamines. There is no way a person can take the same dose for six years and not develop tolerance. If all is working fine, best to leave well enough alone!

Actually that isn't true about tolerance- my understanding from own personal experience and from talking to doctors who are ADHD experts is that once you titrate to the optimal dose, usually people can stay on that dose for years without problem unless it has to be adjusted because they gain or lose weight.

I myself have been on the same medications at the same doses for 7 years and the drugs work just as well as they did when I started them. I think tolerance effects for amphetamines and stimulants that you are referring to are most commonly seen when these drugs are recreationally used.

RevivedPreMed said:

If you are diagnosed with ADHD and medication is suggested it is unlikely that they will put you on Adderall from the get go. My psychiatrist put me on something different that has less side effects than Adderall.

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Almost every ADHD adult I know (and I know a lot) was put on Adderall from the get-go. I am apparently the exception, the only reason I was put on Ritalin originally is because I requested it due the stats that showed it was the most effective of all the meds. Then people were worried that I was falling asleep on the Ritalin. I was later transferred to Adderall which I hated and was ineffective for me. Then I was on Strattera which gave me seizures.

who the hell doesn't have ADHD these days?

familyaerospace said:

Almost every ADHD adult I know (and I know a lot) was put on Adderall from the get-go. I am apparently the exception, the only reason I was put on Ritalin originally is because I requested it due the stats that showed it was the most effective of all the meds. Then people were worried that I was falling asleep on the Ritalin. I was later transferred to Adderall which I hated and was ineffective for me. Then I was on Strattera which gave me seizures.

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I have been on ADD meds since I was 5 yrs old Ritalin, Medidate, Concerta, Stratera, some herbal stuff when I was in middle school, Darvocet, lexapro(crazy doc) and Adderall . I hate Adderall with a passion! Darvocet gives you the same cracked out feeling but actually goes away. I am now on Welbutrin(antidepressant but my doc said it works for some ADHD) and I actually like it!! I am not a crack addict twitchy antisocial anymore! I can still focus(not as much as on adderall but thats ok with me for now) Also I am hypo not hyper like normal ADHD and I also have dyslexia but I am ambidextrous. Also if you have taken adderall for 7 years straight like I did get ready for MAJOR withdrawls but you can get through it!!!

.

Speculatrix said:

False. There are no "accommodations" in the real world when the guy in front of you is circling the drain. I feel that the boards test the way a person thinks under pressure, which is a very important skill for physicians.

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Yes, because there will definitely be a proctor coming in to tell you to stop performing surgery on a dying patient because the time limit is up. Also, everyone knows about the patient months ahead of time and studies intensely with various courses and books.
Lord only knows what will happen to you if you cheat and take a few more minutes to save that man's life!

IonClaws said:

Yes, because there will definitely be a proctor coming in to tell you to stop performing surgery on a dying patient because the time limit is up. Also, everyone knows about the patient months ahead of time and studies intensely with various courses and books.
Lord only knows what will happen to you if you cheat and take a few more minutes to save that man's life!

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You're a year late to the party.

ps. ADHD is a cop out and you all know it

ADHD drugs are given out like candy on Halloween. Fact is unless you have clear interest in the topic you are studying, it will be difficult to pay attention. The smartest student in my highschool had ADHD and it makes you think if this student can't concentrate, how does she have a 100% average? Lesson to be learned here, even if you have a 3.8, why not try ritalin or adderal since all the cool kids are doing it? Maybe you'll go up to a 3.9.

For what it's worth, I have ADD and wasn't diagnosed until I was an adult, after undergrad and marrying someone with ADD (and realizing I was just like him). I had all the symptoms but was never diagnosed because I had good grades; I was able to get by studying as little as possible because I had no idea that "normal" people studied for more than 20 minutes at a time. I was on Ritalin and Adderall before going on Adderall XR for a year, and actually stopped taking it because I had started studying for the MCAT. I figured I wanted to get good study skills (for the first time) and didn't want to use medication as a crutch as I figured I wouldn't be able to use it during a 24 hour residency shift. What helped the most, for me, was staying away from sugar and red food coloring, and recognizing that, "Hey, my mind has strayed!" and having regular timed study breaks.

The judgement in here is sickening. Especially for a medical boards. People have no clue how others think yet so many of you pass judgement like you know it all. More stuck up physicians to be ...

Lucky me, I grew out of it. But it was a ****ing pain in middle school.

Jesus christ, no wonder ADHD is so over diagnosed if all you have to do is bitch and moan about not having fun (or having trouble staying with) studying something you're not really interested in. That's called being normal, by the way. I can't wait until I actually meet someone with ADHD rather than all these toolboxes looking for a scapegoat/study drug gravy train.

coyfish already did implied we'll be bad doctors, so you guys can relax

Food said:

I noticed the bit about having to learn things you are not interested in...and isn't that what everyone has to do, ADD/ADHD or not?

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I wanted to address this:

There's a gene associated with dopamine transporter proteins that is apparently mutated in people with ADHD, and differences in frontal lobe activity that show up on brain scans as well. Take that, brain-is-not-attached-to-the-body people!

On the qualia side... one of the (several) big differences between normal disinterest and ADHD attention problems is that with ADHD, disinterest can be a serious aversive response leading to severe frustration/anger, rather than simple boredom that people can push through.

biorenaissance said:

Darvocet

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Um, wha? That's a painkiller. A banned painkiller.

I think you probably mean something else.