Neurologists Treating ADHD

Neurogeneral

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Apr 22, 2020
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  1. Attending Physician
    I just wanted to find out if you guys treat adult ADHD patients in your outpatient neuro clinics?

    I get referrals for this. Thus far, I have declined these referrals. My practice partner is a Peds neuro guy who treats lots of ADHD in kids and adults. He has a very big panel of patients and routinely is able to see at least 30 patients in clinic in less than one full day. We have a slew of ADHD medication pharmaceutical reps coming by our office - often touting to me about the increasing need for providers to treat adult ADHD patients.

    Due to my own emerging growth interests in this, I am now seriously considering accepting these ADHD referrals. I just wanted input into what other adult neurologists experiences are with caring for this patient population and routinely prescribing controlled substances such as stimulants?
     

    liquidshadow22

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      i mean technically you can do it. Do you have the training to do it as an adult neurologist? You likely do not. It's not exactly complicated management, but from a liability perspective if you don't have experience treating patients who easily become addicted to these medications, divert/sell these meds, and potentially develop psychosis or exacerbation of pre-existing mood/psychotic illness, you could at some point find yourself in a precarious position. Most of the time you will do fine treating these patients, it's just the difficult cases here and there that could bite you in the behind.
       
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      Neurogeneral

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      Apr 22, 2020
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      1. Attending Physician
        I feel that treating ADHD is not overly complicated and can be completely within the scope of practice of neurology. I have had some exposure to it in peds neuro clinic in residency, but more importantly, I feel that I already have a good mentor in our clinic to help me get started with this properly. As far as liability and safety, he has a very strict no nonsense control substance policy, consisting of required follow ups every 2-3 months and urine drug screens. Anyone who is not compliant with the requirements is immediately discharged from his clinic. I would hope to emulate the same type of protocol.
         
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        Telamir

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          Candidate2017

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            Of course the drug reps are shilling their stimulants. Primary care is cracking down on passing out candy.

            In my psych resident clinic, I find only 1 out of 5 adults who come in for a chief complaint of attention issues will meet ADHD criteria. Of those 4 out of 5 who do not meet criteria, a portion will also have significant past or current substance/diversion issue, especially those that have been "referred."
             

            Neurogeneral

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            Apr 22, 2020
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            1. Attending Physician
              Is it common for a child neurologist to see adults? I thought that was a no-no.

              coming out of residency/fellowship, that’s what I thought. But peds neuro can see adult patients. My practice partner is peds neuro and he sees adult patients in clinic and inpatient consults. He is even the stroke director for our hospital!

              So it is possible so long as the hospital and/or system is okay with it.
               

              Appellatelove

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                coming out of residency/fellowship, that’s what I thought. But peds neuro can see adult patients. My practice partner is peds neuro and he sees adult patients in clinic and inpatient consults. He is even the stroke director for our hospital!

                So it is possible so long as the hospital and/or system is okay with it.

                Interesting! I guess peds neuro does have a year of adult neuro training.
                 

                deathmerchant

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                  Is it common for a child neurologist to see adults? I thought that was a no-no.

                  Few old school adult neurologists do see pediatric and even neonatal neurology patients. Esp small towns. I personally work with one who is like 70 years old but does everything- Pediatric, EEGs, EMGs, sleep studies and even reads his own imaging.
                   

                  neglect

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                    I feel that treating ADHD is not overly complicated and can be completely within the scope of practice of neurology. I have had some exposure to it in peds neuro clinic in residency, but more importantly, I feel that I already have a good mentor in our clinic to help me get started with this properly. As far as liability and safety, he has a very strict no nonsense control substance policy, consisting of required follow ups every 2-3 months and urine drug screens. Anyone who is not compliant with the requirements is immediately discharged from his clinic. I would hope to emulate the same type of protocol.

                    Kids with ADHD/ADD become adults, they need care. Many adults have undiagnosed ADHD and the medications can be life changing. There's a ton of anti-psychiatry bias and anti-pharma/anti-medication out there, which your expertise can help cut through.

                    Just beware. Not all ADHD responds to the meds. Not all people with attention disorders have ADD (poor habits, low intelligence, bad sleep or sleep DO, anxiety/depression, early Alzheimer's and other dementias). Expertise is needed and as a neurologist you're well positioned to help them.

                    Best luck.
                     
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