Getting tested for ADD - HPSP

[st008]

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To preface, I am a first year medical student who is a current HPSP student. I have done moderately well my first semester of school, and I am in no danger of failing out of school.

My preceptor has indicated that he believes I should get tested for attention problems. I have long suspected the same, but I have never pursued it because I did not want it to jeopardize my application for HPSP. I have read the other SDN threads about ADD not being a huge problem and only affecting your career if you want to go into things like flight medicine.

My reason for posting a question here is to figure out the best way to go about getting tested / (and possibly diagnosed) in regards to being a current HPSP student. I am unsure whether I would go through regular civilian channels, then notify the Navy, or whether there was a more proper pathway to undertake. Thanks for any advice or insight you can provide.

 

[Kingfisher]

Unless you are a tricare prime kid near a military installation willing to do the w/u, you will most likely have to set that evaluation up in the civ community.

I have known mult docs on meds in the medical corps for ADD/ADHD. On this side, no one cares (certain communities like flight excluded of course). The front end can be different. I'm not involved in those decisions but it might affect your eligibility.

 

[jabreal00]

I don't buy ADD diagnosis in adults. Many PCP or Psychiatrists are quick to prescribe stimulants to young adults or even those in their 20s/30s for supposed ADD. I guess in an age of patient satisfaction scores no one wants an angry patient who comes in knowing their diagnosis and what therapy they need because the Googled it. Many young adults or students think that these stimulants can help with improve their stamina to study or give a boost to concentration so they go seeking this diagnosis and therapy to make the difference between passing and honors. Folks who need it are those who are having impairment and are not able to properly function, which are generally identified in childhood.

 

[Kingfisher]

IKR

Thats why strattera is formulary. 🙂

 

[notdeadyet]

I don't buy ADD diagnosis in adults. .... Folks who need it are those who are having impairment and are not able to properly function, which are generally identified in childhood.

You might want to broaden your view a bit.

ADDD should be identified in childhood, and probably would be for most folks in good schools. But lots of folks graduate from schools that aren't good and ADD and all sorts of other learning disabilities aren't discovered. These are often the folks who often don't get diagnosed. Since physicians tended to go to decent schools, they don't always recognize how easy it is to fly under the radar at lost of schools in this country.

9/10 high functioning adults looking for an ADD diagnosis are bogus (we all have trouble concentrating, okay?), but I'd caution docs to keep in mind that many folks did not go to the sorts of schools they did. I've treated more than a few folks who made it through high school without a whiff of a diagnosis when they might have had things turn out very differently if they had. We can't toss them under the bus because of a $hitty school system.

 

[Gastrapathy]

How many were in medical school?

 

[Maverick87]

To preface, I am a first year medical student who is a current HPSP student. I have done moderately well my first semester of school, and I am in no danger of failing out of school.

My preceptor has indicated that he believes I should get tested for attention problems. I have long suspected the same, but I have never pursued it because I did not want it to jeopardize my application for HPSP. I have read the other SDN threads about ADD not being a huge problem and only affecting your career if you want to go into things like flight medicine.

My reason for posting a question here is to figure out the best way to go about getting tested / (and possibly diagnosed) in regards to being a current HPSP student. I am unsure whether I would go through regular civilian channels, then notify the Navy, or whether there was a more proper pathway to undertake. Thanks for any advice or insight you can provide.

My situation was similar to yours. I received the HPSP. Shortly after, while on rotations, one of my preceptors (unofficially) diagnosed me with ADHD. This was after MEPS. I never followed up on it and I'm currently an active duty Air Force PCP.

I was never officially diagnosed with it so I never reported it. To be honest, I had trouble adjusting to the military lifestyle, but 2.5 years in, my degree of concentration is better than ever. I would say that, if I actually do have ADHD, being in the military has improved my symptoms exponentially.

 

[jabreal00]

You might want to broaden your view a bit.

ADDD should be identified in childhood, and probably would be for most folks in good schools. But lots of folks graduate from schools that aren't good and ADD and all sorts of other learning disabilities aren't discovered. These are often the folks who often don't get diagnosed. Since physicians tended to go to decent schools, they don't always recognize how easy it is to fly under the radar at lost of schools in this country.

9/10 high functioning adults looking for an ADD diagnosis are bogus (we all have trouble concentrating, okay?), but I'd caution docs to keep in mind that many folks did not go to the sorts of schools they did. I've treated more than a few folks who made it through high school without a whiff of a diagnosis when they might have had things turn out very differently if they had. We can't toss them under the bus because of a $hitty school system.

Anyone who has made it to medical, graduate or professional school without a previous diagnosis likely has a good academic record from high school and undergrad. I would assume that a medical or professional (law, dental, pharmacy) student either went to a "good" high school and/or undergrad and if they have ADD it would have been picked up prior to getting into professional school. I would be very suspicious of a medical student (as this OP) who is an average student (without failing grades) in his class coming to me seeking a diagnosis of ADD.

I graduated suma cum laude from undergrad. I was always had one of the highest scores in my courses in undergrad. However in medical school I was decidedly slightly above average because I was competing with other studs. It was a new feeling for me being just above average rather than creme of the crop.

I can maybe see some folks on the enlisted side who maybe barely finished high school or got a GED and joined the military. Now they're in a MOS that requires them to do clerical or administrative work and their disability manifests or becomes problematic. These are the types who probably went to marginal schools and the diagnosis and treatment should be entertained.

 

[bustbones26]

Anyone who has made it to medical, graduate or professional school without a previous diagnosis likely has a good academic record from high school and undergrad. I would assume that a medical or professional (law, dental, pharmacy) student either went to a "good" high school and/or undergrad and if they have ADD it would have been picked up prior to getting into professional school. I would be very suspicious of a medical student (as this OP) who is an average student (without failing grades) in his class coming to me seeking a diagnosis of ADD.

I graduated suma cum laude from undergrad. I was always had one of the highest scores in my courses in undergrad. However in medical school I was decidedly slightly above average because I was competing with other studs. It was a new feeling for me being just above average rather than creme of the crop.

I can maybe see some folks on the enlisted side who maybe barely finished high school or got a GED and joined the military. Now they're in a MOS that requires them to do clerical or administrative work and their disability manifests or becomes problematic. These are the types who probably went to marginal schools and the diagnosis and treatment should be entertained.

You are championing the notion that ADD = stupid. Hence, why individuals such as the OP are hesitate to seek treatment. Also since there is always at least one pompous jerk as an attending per residency program, that particular indivual just tends to label ADD residents as axis II and never gives them a fair shake.

My wife and mother in law are the eptiome of ADHD. Whenver my wife finally met with a neuropsychologist, and went through extensive testing, they told her that her IQ was easily over 180. Anybody here ever see a "true" complex figure test. The recalled it two months later to detail!!! Unfortunately, she has the attention span of a bullfrog and thus, this hinders her capabilities. It's like owning a high performance ferrari whenever you are surrounded by dirt roads!

I myself grew up in an old fashioned household where my parents, and all of their blue collar friends, also did not believe in ADHD and every kid just needed a good A$$ whooping and that would solve everything? Hence, my many are NOT diagnosed as children, because they are too scarred to even admit it to their parents. I can think of many friends as a kid who were told by a teacher or school counselor to go get tested, and of course, it was their parents that were the barrier. Again, back to the "my kids just needs a good a$$ kicking" style of parenting.

Think of it this way, in college, you have to take 12 credits per semester to be full time. Most average about 15. That is childs play for a "brilliant ADHD" kid. I can recall back in my day, the guy down the hall from me spent more time on his computer and at the pool hall than focusing on studies, yet he always managed at ace tests? Medical school is a collection of individuals that all performed well in college, yet somebody still has to finish last. That is a harsh reality. It is the first time that you are "drinking from the fire hose". It's more than high volume studying, but also multitasking. I can see where an ADHD individual would break down. Again, if I use my wife as an example, in her undergrad, she was in honors classes, 3.8GPA, but in medical school, she was introduced to her first round of C's and even failed a course.

On the other hand, I will agree with you that ADD/ADHD should not be over diagnosed and we should not be handing out stimulants to every person "having a hard time". They really do need to be formally tested, and not by some computer, something these softward companies prey upon (you can just have your patient sit in front of a computer and bill for it!). Unfortunately, insurances may not pay for full face to face evaluations. But that is a different battle.

 

[j4pac]

I believe the mass majority of med school "ADHD" diagnoses are sleep deprivation and anxiety. Anxiety is significantly underdiagnosed because it is a perceived well adjusted anxiety...anxiety is the daily norm.

The others are primarily drug abusers...essentially cheaters trying to get an edge.

I suppose there are a handful of genius true ADHDers but I would bet that is an incredibly small subset of the med school "ADHD" population.

If I was in the OPs shoes (notice that this isn't advice)...I would get counseling for anxiety or phase of life.

 

[jabreal00]

You are championing the notion that ADD = stupid. Hence, why individuals such as the OP are hesitate to seek treatment. Also since there is always at least one pompous jerk as an attending per residency program, that particular indivual just tends to label ADD residents as axis II and never gives them a fair shake.

My wife and mother in law are the eptiome of ADHD. Whenver my wife finally met with a neuropsychologist, and went through extensive testing, they told her that her IQ was easily over 180. Anybody here ever see a "true" complex figure test. The recalled it two months later to detail!!! Unfortunately, she has the attention span of a bullfrog and thus, this hinders her capabilities. It's like owning a high performance ferrari whenever you are surrounded by dirt roads!

I myself grew up in an old fashioned household where my parents, and all of their blue collar friends, also did not believe in ADHD and every kid just needed a good A$$ whooping and that would solve everything? Hence, my many are NOT diagnosed as children, because they are too scarred to even admit it to their parents. I can think of many friends as a kid who were told by a teacher or school counselor to go get tested, and of course, it was their parents that were the barrier. Again, back to the "my kids just needs a good a$$ kicking" style of parenting.

Think of it this way, in college, you have to take 12 credits per semester to be full time. Most average about 15. That is childs play for a "brilliant ADHD" kid. I can recall back in my day, the guy down the hall from me spent more time on his computer and at the pool hall than focusing on studies, yet he always managed at ace tests? Medical school is a collection of individuals that all performed well in college, yet somebody still has to finish last. That is a harsh reality. It is the first time that you are "drinking from the fire hose". It's more than high volume studying, but also multitasking. I can see where an ADHD individual would break down. Again, if I use my wife as an example, in her undergrad, she was in honors classes, 3.8GPA, but in medical school, she was introduced to her first round of C's and even failed a course.

On the other hand, I will agree with you that ADD/ADHD should not be over diagnosed and we should not be handing out stimulants to every person "having a hard time". They really do need to be formally tested, and not by some computer, something these softward companies prey upon (you can just have your patient sit in front of a computer and bill for it!). Unfortunately, insurances may not pay for full face to face evaluations. But that is a different battle.

Are there the rare cases that a 20 something or 30 something year old who have undiagnosed ADHD but makes it all the way through into medical school because of innate brilliance overcoming a deficit to executive function, sure. However this scenario is not the norm to very improbable. Those truly with ADHD have difficulty with executive functioning that impairs a lot of different aspects of their lives. I am not a psychiatrist but I do remember from medical school and psychiatric rotations as a resident that one most likely doesn't have ADHD if it is isolated to one setting (ie school or home). If a child is an angel at home but a terror in school (vice-versa) it likely not ADHD but some other behavioral related issue. Although I am not in behavioral health, I am a internal medicine based subspecialist who still is fond of internal medicine and keep up with my primary skills. Someone with ADHD should have symptoms that not only is evident in school but also at work, at home or any other place where executive function is utilized. They will be known for being forgetful or someone who fails to follow through with plans, forgets to pick up little Johnny from soccer practice or little Sally from ballet lessons. Adults with ADHD will often report that tasks are finished only at deadlines, late or even not at all. There will be problems related to driving, including increases in driving errors, tickets, and speeding may be related to attention deficits.

Now if some young adult who got honors in high school and undergrad and was in multiple social and sports organizations without any problems who all of a sudden realized that they have ADHD in medical school because they're not AOA or honoring all of their coursework or even failing some classes but they seem highly functional in other parts of their lives, ADHD will be very low on my differential. There were plenty of good students who got failing grades in medical school for one reason or another (family issues, poor stress coping, poor time management, seasonal affective disorder, depression, psychotic breakdowns etc). I would think of maybe depression, adjustment disorder/anxiety first before jumping to ADHD.

Now I can't speak much about ass whoopings as a child or the suck it up type mentality that some may have experienced growing up regarding perceived stigma of behavioral health issues. I also don't know the specifics of your wife and this is probably not the appropriate forum to get into the nitty-gritty but to the OP if there is concern that there is some sort of functional impairment because of some undiagnosed disorder, get tested. Atypical depression is more likely to be diagnosed.

 

[DrMetal]

Are there the rare cases that a 20 something or 30 something year old who have

I totally agree with this post, jabreal hits the nail right on the head.

Interesting: at my medical school, there were a couple preceptors who also told many of us that we should get "evaluated for ADD". I think this was code for, "go tell your PCM that you'd like some help in concentrating, maybe he/she will give you a rx for methylphenidate (even if you don't necessarily need it), you can still use it and probably do better in school". Some took the advice, got their rx..I can't really say if this resulted in any improved performance.

I hope this isn't a growing trend among medical school preceptors. I'm sure most have good intentions and want to help out their students, but planting the seed in their minds of some unsubstantiated diagnosis is no help at all.

 

[Beargryllz]

I don't buy ADD diagnosis in adults. Many PCP or Psychiatrists are quick to prescribe stimulants to young adults or even those in their 20s/30s for supposed ADD. I guess in an age of patient satisfaction scores no one wants an angry patient who comes in knowing their diagnosis and what therapy they need because the Googled it. Many young adults or students think that these stimulants can help with improve their stamina to study or give a boost to concentration so they go seeking this diagnosis and therapy to make the difference between passing and honors. Folks who need it are those who are having impairment and are not able to properly function, which are generally identified in childhood.

You're describing particularly serious cases. You can miss a meal and feel crappy from influenza or you can die from it.

It is very possible to treat a mild case of ADD and see good outcomes.

 

[Gastrapathy]

It's possible that "the clear" can help Barry Bonds. Doesn't mean he had a testosterone deficiency.

 

[DeadCactus]

The way a profession that readily prescribes medications and invasive procedures of questionable merit for "medical diseases" gets so worked up about people trying to "cheat" using "unnecessary" ADHD medications says more about the sad state of our culture's views on mental health than it does about current prescribing habits. No one bitches about lazy people using statins instead of living a healthy lifestyle...

 

[Kingfisher]

The way a profession that readily prescribes medications and invasive procedures of questionable merit for "medical diseases" gets so worked up about people trying to "cheat" using "unnecessary" ADHD medications says more about the sad state of our culture's views on mental health than it does about current prescribing habits. No one bitches about lazy people using statins instead of living a healthy lifestyle...

I do.

Of course, there can be considerably worse outcomes if you don't use your statin when you need it....

 

[DrMetal]

invasive procedures of questionable merit for "medical diseases"

What are you talking about? Is a PCI to clear coronary lesions or endoscopy to repair a GI bleed a procedure of "questionable merit for medical disease"?

culture's views on mental health than it does about current prescribing habits.

Here's the fundamental problem about ADD and all things mental health: we don't have any good objective tools to assess who's for real, who's malingering, who's somatoform, etc etc. We have "diagnostic criteria" that are based mostly on subjective history. A sailor on my ship right now can read up on said criteria for ADD (or MDD, or BPDO), learn it better than I, come into sick call tomorrow morning and rehearse said criteria in Academy award winning fashion. I'd have no choice but to treat/workup for ADD (or MDD, or BPDO). I can't get labwork or imaging to tell me who's truly ADD or not . . . and if the PCM has 30 patients to see, it's easier just to give him what he wants.

So, because of the lack of any good objective scientific evidence of a disease--and this is no fault of the MH profession, it's just the way it is---we tend to be skeptical about some diagnostic criteria, or for that matter even the existence of the disease (ADD, Fibromyalgia, etc etc). Forgive us for our skepticism.

No one bitches about lazy people using statins instead of living a healthy lifestyle...

Do you not have physician friends in other specialties? Talk to them sometime. We bitch to high-heaven about all sorts of these things.

 

[notdeadyet]

Here's the fundamental problem about ADD and all things mental health: we don't have any good objective tools to assess who's for real, who's malingering, who's somatoform, etc etc. We have "diagnostic criteria" that are based mostly on subjective history. A sailor on my ship right now can read up on said criteria for ADD (or MDD, or BPDO), learn it better than I, come into sick call tomorrow morning and rehearse said criteria in Academy award winning fashion. I'd have no choice but to treat/workup for ADD (or MDD, or BPDO). I can't get labwork or imaging to tell me who's truly ADD or not . . . and if the PCM has 30 patients to see, it's easier just to give him what he wants.

Yeah, this accounts for many of the train wrecks we end up getting referred in psychiatry. There's a whole subset of folks getting what they want or think they need from busy PCPs.

I'd imagine it's hard to deal with deployed or on a cruise. But it's amazing how late folks are to send them our way domestically. Mental health isn't something you can order a lab for and get a yay/nay result, but much of the subjectivity and confusion goes away when you've had good training and experience. It's like how impossible it was to hear murmurs the first time you picked up a stethoscope.

 

[DeadCactus]

What are you talking about? Is a PCI to clear coronary lesions or endoscopy to repair a GI bleed a procedure of "questionable merit for medical disease"?.

PCI outside of active ACS has questionable evidence. Tamiflu, TPA, statins, mammography, appendectomies, PSA screening, spine surgery for chronic back pain, etc. Debate what topics you want, but it's not a short list. If you're really going to pretend we don't do all sorts of medical and surgical therapies with weak and conflicting evidence then you're frankly out of touch with medicine.

Yet stimulants are such a hot button for so many. Not because anyone debates whether those taking it experience some sort of benefit, but because there is some asinine debate on who really "needs" that benefit. Every other part of medicine has free reign to do things that might help unless there is strong evidence that it harms but psychiatry has to justify delivering benefit because it might be some sort of unfair advantage...

 

[st008]

Thank you all for your replies. I appreciate the insight as a first year medical student. I was more trying to inquire if being diagnosed would somehow disqualify me even though I am already commissioned.

 

[BigNavyPedsGuy]

Thank you all for your replies. I appreciate the insight as a first year medical student. I was more trying to inquire if being diagnosed would somehow disqualify me even though I am already commissioned.

They won't let you off the hook that easily.

 

[st008]

Thanks. I do not want to be let off the hook haha.

 

[PikminOC]

Can you be on medications and be in the Navy?

 

[DrMetal]

Can you be on medications and be in the Navy?

Pre-existing conditions (and the medications that come with them) might prohibit you from joining, or at least you'd have to get a medical waiver. If diagnosed after you join, you certainly can be on meds and continue serving (provided you're stable). Prior to entry, the "recruit" sees a doctor (history, take vitals, do a basic physical). For some of the harder jobs (dive, aviation), we do an EKG and a CXR. If somethings comes up abnormal, that might keep him/her from joining.

The problem with mental health issues, is that the recruit can lie through his/her teeth (claiming never any MDD, never dysthymia, never on any meds), and we have no way of verifying this. (I often wonder why we don't ask recruits for a copy of their civilian medical record?). Of course, their physical is square normal. They join the Navy, 2 years later their MDD manifests again, and we have to separate them for "Adjustment Disorder". It's an incredibly taxing process that wastes the time of many commands and the providers (especially mental health ones) that are involved.

 

[Gastrapathy]

Are you all sure that an rx for a stimulant wouldn't end a career before it starts? You are recommissioned as an O3, not promoted. I'm not sure this is accurate advice.

 

[NavyFP]

Are you all sure that an rx for a stimulant wouldn't end a career before it starts? You are recommissioned as an O3, not promoted. I'm not sure this is accurate advice.

And I would agree. The simple fact is that when you graduate and a REcomissioned as an O3 you must meet ACCESSION standards. Being on a stimulant for ADHD is disqualifying. You would need a waiver. It is likely you would get one, but not guaranteed. Depending on force needs when you graduate, it could be an issue. Tread warily. Remember the ultimate enemy of good is better.

 

[DrMetal]

Are you all sure that an rx for a stimulant wouldn't end a career before it starts? You are recommissioned as an O3, not promoted. I'm not sure this is accurate advice.

I dunno, that's a good question. If you're commissioned into the military--either AD at USUHS or IR as HPSP--techanically you are now in the military (any conditions that manifest during that time can be deemed as "new conditions"). FWIW, at USUHS, you could probably find a dozen or so students in each class that were started on stimulants for the first time. None of them had a problem in graduating/commissioning. I dont even think they even got waivers, kinda shady. There were kids there with other (more severe mental health issues) who were not allowed to graduate/commission.

In any case: I'm not so worried about the medical corps, we do a reasonably good job of policing ourselves. The greater concerns are in the line military, their screenings are a joke, we get a lot BS from Nowehere, America then spend a lot of time/effort trying to get them out of the military.

 

[BigNavyPedsGuy]

And I would agree. The simple fact is that when you graduate and a REcomissioned as an O3 you must meet ACCESSION standards. Being on a stimulant for ADHD is disqualifying. You would need a waiver. It is likely you would get one, but not guaranteed. Depending on force needs when you graduate, it could be an issue. Tread warily. Remember the ultimate enemy of good is better.

So you're telling me that I could've gone to the student mental health office like many of my classmates and end up on stimulants and I could've gotten out of my HPSP commitment!?!? Man, I wish somebody would've told me about that back then....just imagine....

 

[asdf123g]

So you're telling me that I could've gone to the student mental health office like many of my classmates and end up on stimulants and I could've gotten out of my HPSP commitment!?!? Man, I wish somebody would've told me about that back then....just imagine....

What would be the point of 'geting out' of your committment? Wouldnt that just put u right back in debt along with all the people who chose not to go with the scholarship?

 

[BigNavyPedsGuy]

By the time I hit my 3rd year, I would've traded debt for freedom. And you hear over and over, the Navy isn't a lending institution. If one were medically disqualified, I don't know how they'd punish you for that and make you pay it back. But who knows. They have no soul.