Interview with Dr. Steven Dassel

Pediatrician at Virginia Mason Medical Center, Seattle, Washington

 

NHFL (New Horizons for Learning) : Dr. Dassel, what is AD/HD?

Dr. Dassel: AD/HD refers to a spectrum of disorders that have four elements: difficulty in concentrating, difficulty in organizing, hyperactivity (restlessness and fidgetiness), and impulsivity. Those with attention deficit and poor organizational skills (ADD) are more likely to be seen in girls and older boys. Hyperactivity along with attention deficit (AD/HD) is more likely seen in younger boys.

NHFL: What are the usual treatments for these disorders?

Dr. Dassel: Usual treatments are stimulant medication or behavioral therapy. I would like to point out that here is a scenario that happens too often: patient goes to doctor and says his or her child is having a hard time concentrating or may be too active. The doctor may say something like, "Let's try some medication and see if it helps." Then a low dose may be prescribed and if that doesn't help, the doctor may prescribe a higher dose and so on. If even a higher dose is not helping, another medication may be prescribed. If the patient does not have AD/HD, he or she has been needlessly on medication for a long time. In most cases side effects are more uncomfortable and inconvenient than damaging.

NHFL: What is another approach?

Dr. Dassel: The American Academy of Pediatrics suggests the following approach recommending the use of the Vanderbilt Assessment Scale, developed at Vanderbilt University. There are no blood tests or other physical tests to diagnose AD/HD, so patients may be evaluated through this questionnaire, history-taking, and interviews. These must then be evaluated by a knowledgeable health care professional.

NHFL: If the patient is not diagnosed as having AD/HD, what happens then?

Dr. Dassel.: If AD/HD is not the diagnosis, one might consider a learning disability,or a behavioral problem, such as depression or oppositional defiant disorder.(ODD). On occasion, obstructive sleep apnea may masquerade as AD/HD. Other possibilities include low I.Q. boredom, not seeing themselves as academically oriented, low self-esteem, or environmental problems in the home or classroom, So, rather than stimulant medication, the therapeutic approach might involve a clinical psychologist, an educational psychologist, or even rarely an ear nose and throat doctor in the case of sleep apnea.

NHFL: Further thoughts about your work in this area?

Dr. Dassel: Children and adolescents with learning problems or behavioral problems are a real challenge in problem solving, and I enjoy problem solving and being able to help.

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Further information is available on the following website: http://www.medicalhome.org/diagnoses/AD/HD.cfm

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About the author

Dr. Steven W. Dassel, is a pediatrician at Virginia Mason Sand Point Pediatrics in Seattle, Washington. He is a graduate of the University of Washington School of Medicine (1965) and did his residency at the University of Washington Medical Center (1968) and his internship at Strong Memorial Hospital, Rochester New York, 1966. He was certified by the American Board of Pediatrics in 1971, and Joined Virginia Mason Medical Center in 1995. Dr. Dassel specializes in Behavioral Pediatrics only: ADD/AD/HD, parenting concerns, and adolescent depression. Virginia Mason Sand Point Pediatrics, 4575 42nd NE, Seattle WA 98105. 206-525-0969.

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©September 2005 New Horizons for Learning
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