Attention Deficit/Hyperactivity Disorder

The Jewish Star Times, June 5, 2002, p. 21

Some months ago, I humorously addressed the Attention Deficit Disorder problem in this paper. A reader responded (correctly) that it is "no laughing matter." I revisited it last week by suggesting that the first step after diagnosis must be to address the big questions such as "Why am I stuck with this disorder" and "Is it a disorder?" When that groundwork is laid, it seems almost too obvious that the next responsible step should be Medication for it. Indeed, we started our third grader on Medication, and now, in high school, he still takes it, appreciating its benefits while all the while applauding his own maturity in grappling with this challenge on a daily basis. But getting those meds is not without risks.

Harvey Spigler of the Military Entrance Processing Station Public Affairs Office told me point blank, "Ritalin is one of the Medication they will not let people into the armed services for." One needs to be off Medication for one year in order to qualify to apply; however, with a past diagnosis, they will look more closely at grades and present functioning, not to mention the doctor's report. We took that risk-and others-because we weighed our options and decided that, for our son, success in school was worth it. For adults with Attention Deficit Disorder the risks may not be worth it.

My husband's situation illustrates this. When we were married twenty-five years ago, no one ever talked about adult Attention Deficit Disorder. I just thought he was a cute combination of an absent-minded, somewhat rumpled, professor and quite disorganized, but hey, lots of people are all that, and luckily he married me, so I could straighten him out. Okay, okay, I wasn't such a smart kid. I learned. In fact, it wasn't until my son got to high school and he started resembling my husband so much that the truth hit me with incredible force. Luckily, we were insured at the time, but we quickly discovered that the probability would be high that he/we could never be insured again if he got a diagnosis and then lost our insurance.

Last year, the Kaiser Family Foundation and Harvard School of Public Health National Survey on Consumer Experiences With and Attitudes Toward Health Plans, canvassing a random sample of over 1200 adults with over 700 on private plans, reported that 48% of Americans had problems with their health insurance. Of these, 13% of privately insured adults under 65 experienced delays or denials of coverage or care. This is not surprising. According to Georgetown University's Karen Pollitz, a co-author of the Kaiser research, and reported on the website www.insure.com, you can be denied coverage if your medical history includes the use of psychotropic Medication to treat anxiety, depression, or a physical condition.

Pollitz remarks, "People who've always had group health insurance are completely unprepared when they're forced to seek [individual] coverage." In fact, the denial of coverage is not limited to the obvious, like AIDS. "Mental/nervous disorders" head the list, and whether I personally am willing to label my son, my husband or my clients as suffering from "disorders," the fact is that every time you see a therapist and wish to have the session covered by insurance, you must receive a diagnosis-and that diagnosis comes out of a handy little book called "The Diagnostic and Statistical Manual of Mental Disorders" put out by the American Psychiatric Association. I'm sure that many therapists share my non-pathologizing philosophy, but insurance companies have no idea what that term means. In short, ADHD is considered a mental disorder for insurance purposes.

For the lucky souls who are not denied, the prices are astronomical. I submitted my family health data to an instant quotes website only to learn that, if accepted, I would be paying $500/month more than I pay now for individual insurance-for the cheapest plan on a list of 20!

Lying is not an option, either. Once you have ever had health insurance, your personal information is registered with the Medical Information Bureau which keeps files on 16 million Americans and is available to insurance companies. When you see a doctor, whether you make a claim on a visit or not, that visit is recorded for posterity.

Basically, we must choose between the continued treatment of other medical conditions versus starting treatment for adult Attention Deficit Disorder. That's why we have developed a sense of humor in this house.