Suzy McNulty, MD ☮️

Growing trend of #perfectionism as a risk factor for #teen #suicide. #perfectionismhurts facebook.com/permalink.php?…

@29arista1 Overdiagnosis isn’t a “specialty problem”—it’s a systems problem. ADHD requires clear, impairing symptoms across settings and over time. When those standards are applied, the issue isn’t overdiagnosis—it’s inconsistent evaluation and lack of access to appropriate care.

@socrdoc Maybe not in pediatrics, but pediatrics is very focused on the finer points of neurodevelopmental abnormalities in kids. This is your wheelhouse. Family medicine and NP/PA territory is more where you will see overdiagnosis or misdiagnosis.

I respectfully disagree. As a general pediatrician caring for a large neurodiverse population (ASD, ADHD, dyslexia, CAPD, concussion, anxiety), I’m seeing a very different reality over the last 5 years. 🧵1/14

@tymmesalab @mirwijn Happy to speak for myself. Clinical experience and evidence-based medicine are not mutually exclusive—and neither involves dismissing patients or oversimplifying complex conditions. If the goal is discussion, let’s keep it grounded in data, not assumptions.

@mirwijn @socrdoc As, I am sure, she can speak for herself. Yes?

@tymmesalab Personal attacks don’t strengthen your argument—they undermine it. If you’re going to present a theory as science, it needs to be grounded in evidence, not jargon. Critique of non–evidence-based claims is part of practicing good medicine, not a lack of it.

Intriguing, you perceive this way. More so, given, you clearly have not taken the time to either read through it with care, respect, or otherwise, sound mind. You should be careful to consider whether or not, you are fit to practise as an MD with such an attitude, personally and professionally, Suzy.

@tymmesalab This is not a recognized or evidence-based model—it’s a word salad of scientific terms presented as theory. ADHD is a well-characterized neurodevelopmental condition with established diagnostic criteria. We should be careful not to spread misinformation dressed up as science.

You may find this of intrigue... The Algorithmic Phenotype: Reframing the Attention-Deficit Epidemic Through Biological Spacetime, Cognitive Offloading, and Visceral-Cognitive Integration Abstract The escalating crisis of Attention-Deficit/Hyperactivity Disorder (ADHD) diagnoses has overwhelmed contemporary clinical infrastructures and exposed the limitations of traditional, purely neurogenetic and dopaminergic paradigms. This paper presents a radical theoretical reframing of ADHD, synthesizing the physics of Biological Spacetime with predictive coding models of active inference and visceral-cognitive integration. We propose that the modern digital environment—characterized by hyper-predictive algorithms and generative artificial intelligence—induces severe cognitive offloading. This phenomenon deprives the developing brain of the essential prediction errors required to metabolically maintain a coherent internal cognitive architecture, leading to a state of manifold decoherence and executive dysfunction. Concurrently, we fundamentally redefine ADHD as a neurointestinal syndrome by modeling the electrophysiology of the Enteric Nervous System as an analogue gravity metric tuned by autonomic vagal tone. In this integrated framework, external digital overstimulation and internal physiological dysregulation precipitate gastrointestinal conduction blocks—characterized mathematically as analogue event horizons. This visceral collapse holographically projects into the central nervous system as the profound cognitive fragmentation clinically observed as ADHD. By reconceptualizing the attention-deficit phenotype as a systemic biomechanical adaptation to environmental and visceral collapse rather than an intrinsic biological failure, this analysis advocates for a paradigm shift toward topological diagnostics. We propose the integration of high-resolution electrogastrography and microstructural neuroimaging to accurately diagnose, differentiate, and therapeutically anchor the disrupted neuro-visceral axis.

@29arista1 No one is diagnosing ADHD in “perfectly normal” 3-year-olds. We’ve cared for active, neurotypical toddlers for decades—we know what typical looks like. ADHD diagnosis requires clear, impairing symptoms across settings over time, not just high energy or boredom.

@socrdoc I feel skeptical when I repeatedly see diagnosis of perfectly normal three year-olds with ADHD because they can't sit still for very long. Or adults who have trouble sitting for 8 hrs a day indoors in front of a screen under fluorescent lighting and feel unmotivated. Absurd.

We should be holding ourselves to a higher standard: Do the work. Ask better questions. Actually listen. Reducing complex medical & neurodevelopmental conditions to “enabling” is not insight, it’s a misinformed take that dismisses real pathology and causes real patient harm. End

What actually harms patients is being told their symptoms reflect weakness, dramatization, or poor character. That doesn’t build resilience. It builds shame—and delays care. 6/x

This is exactly the kind of thinking that worsens anxiety and perfectionism in kids. Framing legitimate symptoms as “softness” or lack of resilience is not honesty—it’s dismissive and harmful. 1/x

Saddle up 🤠 it’s RODEO NIGHT! ⏰4 PM | 📍Allan Saxe | 🆚Baylor UTA Straw hats ON US (while supplies last)‼️ #BuckEm🐎

As a #pediatrician as well as a proud parent of a App State alum, I applaud @appstate and @VayaHealth for their collaboration and vision in reaching this high risk #pediatric population. 👏👏👏

Dear parents, Your child does not need to be the smartest in the class, the best on the field, or the most talented in the room. But they do need to be teachable. We are raising a generation that can Google anything, yet too many are forgetting how to listen, how to respect, and how to learn. Being teachable is not about grades or intelligence. It is about humility. It is about knowing you do not have all the answers. It is about being open when someone is trying to help you grow. Our job is not to raise kids who always get it right. It is to raise kids who can take feedback without shutting down. Who can admit when they are wrong. Who can disagree without being disrespectful. Who can be corrected without becoming defensive. Because in the long run, teachability will take them further than talent alone.

The answers are there—but they won’t be found in a 10-minute visit model. We can do better. We have to work together. End/14 @AmerAcadPeds @OCAAP @AAPDelMonte @AAPCADocs @TheAMSSM

Fragmentation isn’t just about referrals—it’s about loss of pattern recognition when no one owns the whole patient. 13/14

Chest tightness/air hunger gets siloed: Pulm → “not asthma” ENT → Exercise-Induced Laryngeal Obstruction Cards → “not cardiac” Meanwhile symptoms persist—even at rest. 7/14