In Part I, we discussed the advantages to front-line physicians of using the 10 Patient Profiles as developed by Dr. Timothy Bilkey. I asked Dr. Bilkey, wouldn’t it just be easier to have a symptom checklist?
Dr. Bilkey said:
“The checklist is a mechanistic way that anybody could identify with ADD. Because these symptoms are very non-specific, and they’re cross-sectional, they’re very skeletal. The problem with it is that, anybody could say, “Well, I’m forgetful.” And the checklist of symptoms doesn’t give a context in a context-driven condition.”
Dr. Bilkey, Storyteller
When Bilkey explained this innovative approach to me, it sounded like a storytelling approach. It places the patient squarely inside their life story, and allows us to look at how they operate in certain situations. Dr. Bilkey explains:
“These are profiles for quick, snapshot views of how somebody looks. It’s in the picture, or the story that they tell a physician, which physicians are trained on. Like the story of diabetes: they’re getting up at night, they’re losing some weight, they’re going to the bathroom a lot, they’re very thirsty.
As opposed to going through [the big reference book], and saying, ‘Well, I’ve got 22 out of 29 symptoms, so I must have it.’ Yeah, but what does it look like? What do you look like?”
The 10 patient profiles
For each profile, there’s a shortlist of typical symptoms and behaviors. After the symptom/behavior list follows one question that the family doctor asks the potential ADHDer, in relation to that profile.
For example, there is a Distractable Daydreamer profile. So, for a Distractable Daydreamer, the doctor asks the patient if she’s internally or externally distracted, bored, spacey, forgetful, disorganized, chronically late, a procrastinator, and can’t manage paperwork. After establishing these parameters, the physician will ask: “Are you distractable in everyday activities?”
A similar framework is provided for the remaining 9 profiles.
Do you make the Top 10?
The 10 ADHD Patient Profiles are:
1 ) The Person with Previous Diagnosis and/or Family History [of ADHD]
2 ) The Struggling Student
3 ) The Person with Addictions
4 ) The Irritable/Moody Person
5 ) The Distractible Daydreamer
6 ) Married with Children
7 ) The Person with Comorbidities
8 ) The Person with Antisocial History
9 ) The Hyperactive/Restless Person
10 ) The Stuck Person
As another example, Dr. Bilkey describes The Person with Comorbidities profile as follows:
“This is where somebody, often female, has been diagnosed with another condition, a mood or anxiety condition, and that’s been treated. That’s fine. She’s great. But underlying it, she’s still forgetting paperwork, is quite chaotic, can’t manage the cluttered home, and underneath it then, the clinician looks and says, ‘Oh, wait a minute. You may have this other thing called ADD. You’ve always had it, so it doesn’t stick out as much as something very graphic like a panic attack or addiction.’
And often treating that comorbidity, the symptoms of the distractibility will come out more clearly.”
The different profiles aren’t mutually exclusive, says Bilkey.
“Somebody, historically, could have been the struggling student, now married with children. Somebody could have been an addiction profile, while now they’re antisocial, so they’re intersecting profiles.”
For family doctors, learning how to identify the classic stories of ADHDers might help more of us to get a diagnosis and treatment. And, maybe, a happy ending!
NOTE: These profiles will be discussed in Dr. Bilkey’s upcoming book, for which he recently signed a contract with Penguin Books. Bilkey is co-authoring his book with Dr. Craig Surman from Massachusetts General Harvard University. Look for my review of their book, once the book is available.
DID YOU MISS PART I? CLICK HERE.
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Last reviewed: 23 Nov 2010