The Dark Side Of ADHD Part 3

The Dark Side of ADHD

Hello, people, welcome back to the blog! This week, we’re continuing our discussion on the dark side of ADHD, with a look at gender differences within the disorder. 

Before we get to that, I want you to imagine this: Little Janie sits quietly at her desk in second grade. She isn’t talking and she isn’t acting out. That’s great, but she also isn’t learning… anything. Her inattention and inability to focus are obvious every time her teacher asks her a question, which isn’t very often. Teachers like Miss Jones like interaction; they tend to shy away from vacant stares like the one that usually occupies Janie’s face. So Miss Jones’ gaze moves to Barbara, who’s listening attentively- she’s not a “space cadet”- she’s clearly keeping up with what’s going on. So once again, Janie is overlooked, passed over…

Janie’s fraternal twin brother, Johnny, on the other hand, gets lots of attention… though not always for the best reasons. Diagnosed with ADHD last year, he has a reputation for being a bright kid, even if he’s usually hyperactive. Treatment for his ADHD has helped him; he’s a better student than he was, and he gets along better with the other kids. He has some behavior problems, but his natural charm keeps him from getting into too much trouble. But Miss Jones can tell immediately if he’s missed his medication, because it makes all the difference in the world for Johnny. It’s been a total lifesaver. Good for Johnny. But meanwhile, Janie is in her own little world, drowning in inattention. And no one is any the wiser… especially Janie.

Unfortunately, scenarios like this play out day in, day out, all across the globe. Why? Because the vast majority of people diagnosed with ADHD are male. In fact, according to the CDC, boys are three times more likely to receive an ADHD diagnosis than girls, but I’ve seen that number quoted as double that. Statistics say that during their lifetimes, an average of 13 percent of men will be diagnosed with ADHD, while just 5 percent of women will be diagnosed. Girls aren’t any less less susceptible to the disorder than boys, so why are boys three times more likely to receive a diagnosis? That’s what we’ll talk about today.

In a nutshell, it’s because ADHD symptoms present differently in girls and boys. Boys tend to show more obvious externalized symptoms, such as hyperactivity and impulsivity, while girls’ often display the inattentive aspects of the disorder, with symptoms that are more internalized and much more subtle. In general, boys’ symptoms are typically simply more pronounced and extreme as compared to girls. Captain Obvious says that hyperactive characteristics are obviously much easier to spot than more subtle symptoms like inattention. Some ADHD signs in girls can be very difficult to identify. When girls have primarily inattentive type ADHD, without hyperactivity, research indicates that up to 75 percent are undiagnosed. Ultimately, it takes a higher burden of risk factors for symptoms to be recognized in girls- the threshold for referral and diagnosis seems to be much higher than for boys- so girls are less often referred to behavior specialists for evaluation, and this leads to fewer girls being diagnosed. 

There are other theories as to why it’s more commonly diagnosed in boys. One is that there may be actual neurobiological differences. Some researchers think that girls may have a protective effect at the genetic level, that they are in some way “protected” from developing ADHD, though the jury’s still out on that. 

Another reason why boys are much more commonly diagnosed with ADHD than girls is because boys with ADHD have been found to have more obvious co-existing disorders, like conduct disorder and oppositional defiant disorder, whereas girls do not. The girls’ internalized symptoms are less disruptive in the classroom than the aggression and rule breaking typically exhibited by boys, so this results in fewer referrals, diagnoses, and treatment in girls. The ole “squeaky wheel gets the grease” kind of thing. 

Why else? Well, yes, girls are less likely to exhibit hyperactivity, but even when they do, they’re more likely to “just” be over-talkative, or maybe a little rebellious, more of a “wild child,” so the symptoms aren’t recognized for what they are, as being caused by ADHD. Also, girls with ADHD might get noticed in school for being overly chatty, but we expect girls to be more sociable than boys, so teachers might chalk this up to the girls being immature, rather than possibly having ADHD. And girls with primarily inattentive type ADHD, who don’t have hyperactivity, might just be described as distracted or “daydreamy” or overly emotional or “sensitive.” For some reason, we just seem to attribute these behaviors in girls to other things first, whereas with boys, if they’re running around, the first thought is usually ADHD. It’s nearly automatic, and that’s a problem for both the boys and the girls. 

Another contributing factor to why so many more boys get diagnosed is that girls are better at compensating for their ADHD symptoms than boys are. Girls develop better coping strategies to make up for their ADHD-related difficulties than boys, such as working harder to maintain classroom performance. As a result, they can better mitigate or mask the impact of their diagnosis. This is similar to how girls with autism “mask” their symptoms. At one time, it was theorized that autism was strictly a “boy disorder,” but of course that’s not the case. It’s a similar situation. Girls simply tend to adapt better. Even if they are hyperactive, girls are less likely to blurt things out in class or shove the kid next to them. This is where the social or societal aspect comes in. A girl that runs around and acts aggressively would be criticized more harshly by her peers. It’s much harder for girls to behave that way, to get away with it, so they tend not to. 

All of these behaviors I’ve mentioned are signs of ADHD, but people react to them in different ways, for lots of reasons. Ultimately, not only are teachers and families less likely to notice signs of ADHD in girls, but they may even be more accepting of the signs girls often show. Parents and teachers either don’t notice girls’ inattentive behaviors and/ or seem to down play girls’ hyperactive and impulsive symptoms, while playing up those same types of behaviors in boys. Seems to be a much bigger issue when it’s a boy. 

Since girls with ADHD often display fewer behavioral problems and have less noticeable symptoms, their difficulties are often overlooked and/ or mislabeled. Many times, the behaviors are wrongly attributed to anxiety or depression. Even when girls are properly diagnosed, it happens an average of five years later than boys. This can lead to serious problems in the future, as girls with undiagnosed and late diagnosed ADHD are more likely to have problems in school, social settings, and personal relationships than other girls. Research indicates that this can have a very negative impact on girls’ self-esteem, and can even affect their long term mental health. Boys with ADHD typically externalize their frustrations, but girls with ADHD usually turn their pain and anger inward- they tend to blame themselves- and this puts them at an increased risk for depression, anxiety, panic disorders, eating disorders, chronic sleep deprivation, and substance abuse. This doesn’t just impact them long term, as adults, these things can affect them even as they enter their teenage years. 

Many late diagnosed adult women with ADHD show symptoms similar to those found in post-traumatic stress disorder, PTSD, where the coexisting panic and anxiety are the result of the classroom trauma they experienced during childhood from the undiagnosed ADHD. For example, if the woman dealt with low self-esteem from attention problems back in grade school, returning to school later in life may trigger those same emotions. Some women aren’t diagnosed until much later in life, around their 30s and 40s, when one of their children is diagnosed with ADHD. This happens more than you’d imagine… when undergoing the process with their children, they recognize the symptoms in themselves. Being diagnosed much later in life can lead to problems, such as the woman blaming herself for things going wrong, or believing that she cannot achieve higher goals, especially if her symptoms interfered in her school or work performance. Studies have indicated that these women are prone to financial problems, underemployment, divorce, and/ or lack of education. It’s a sad situation, and they blame themselves, as though at age seven they should’ve known they had ADHD. That’s why it’s important that everyone recognize the signs in girls and boys.

Recognizing ADHD in Girls

As I mentioned above, girls with ADHD often display the inattentive aspects of the disorder, whereas boys usually show the hyperactive characteristics. These hyperactive behaviors are easy to identify at home and in the classroom, as the child usually can’t sit still and behaves in an impulsive or dangerous manner. The inattentive behaviors are generally more subtle and can be difficult to spot. That child is unlikely to be disruptive in class, but they will miss assignments, will be forgetful, or just seem “spacey,” and this can be mistaken for laziness or even a learning disability. It’s important to know about the different ways kids can act out, and which behaviors tend to get overlooked. That awareness can help girls with ADHD get the help they need sooner, and that definitely makes for a better long term outcome.

Girls’ symptoms typically include:

-Inattentiveness or a tendency to “daydream”

-Trouble focusing

-Appearing not to listen

-Verbal aggression, such as teasing, taunting, or name calling

-Being withdrawn

-Low self-esteem

-Anxiety

-Intellectual impairment

-Difficulty with academic achievement

Recognizing ADHD in Boys

Though ADHD is often underdiagnosed in girls, it can be missed in boys as well. Traditionally, boys are seen as energetic, so if they run around and act out, it may be dismissed as simply “boys being boys.” But it’s a mistake to assume that all boys with ADHD are hyperactive or impulsive; some boys display the inattentive aspects of the disorder, and they may not be diagnosed because they aren’t physically disruptive.

Boys with ADHD tend to display the symptoms that most people think of when they imagine ADHD behavior. These include:

-Impulsivity or “acting out”

-Hyperactivity, such as running and hitting

-Lack of focus, including inattentiveness

-Inability to sit still

-Physical aggression

-Talking excessively

-Frequently interrupting other peoples’ conversations and activities

While the symptoms of ADHD may present differently in boys and girls, it’s critical for them to be treated. While the symptoms of ADHD usually lessen with age, they still tend to have adverse effects. People with ADHD often struggle with school, work, and relationships- even as adults- and they’re also more likely to develop other conditions, including anxiety, depression, and learning disabilities. If you suspect your child has ADHD, take them to a doctor for an evaluation as soon as possible. Getting a prompt diagnosis and treatment will not only improve symptoms, but it can also help prevent other disorders from developing in the future.

I hope you enjoyed this blog and found it to be interesting and educational. Please feel free to share it with family and friends. Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, leave comments, and share those vids! As always, my book Tales from the Couch has more educational topics and patient stories, and is available in office and on Amazon. 

Thank you and be well people!

MGA

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The dark side of ADHD Part deuce

The Dark Side of ADHD, part deux

Hello, people, welcome back to the blog! Hope everyone had a great weekend. Last week, we started a series on the dark side of ADHD. Squirrel!! If you don’t get that, check out last week’s blog. This week, we’re going to continue the discussion, but we’re going to focus on what it’s like to have ADHD, from that person’s perspective. I’ve made a little list of things patients have told me, and I want to share that, because they tell it best; far better than I can. 

First, I just want to bust a couple more myths. Someone asked me about sugar causing ADHD, and that really put a bug in my bonnet about myths and misconceptions. There’s still so much misinformation out there, so I want to stamp it out.

“ADHD is a learning disability.”

Wrong. ADHD symptoms can definitely get in the way of learning, but they don’t cause difficulty in specific skills like reading, writing, and math, as a true learning disability does. That said, some people can have ADHD and a learning disability, but it is not one itself. Now, just because ADHD isn’t a learning disability doesn’t mean that kids can’t get help in school. And for that matter, adults with ADHD can often get support at work as well. 

“People with ADHD can’t ever focus.”

Wrong. While it’s true that people with ADHD can have trouble focusing, they can actually experience hyperfocus. If they’re very interested in something, they may focus on it very intensely, to the exclusion of everything else, even to the point that they cannot pull themselves away. That’s hyperfocus. Some kids with ADHD are very easily distracted in class but a bomb could go off when they’re playing a video game, and it wouldn’t faze them. Adults might have trouble focusing on the parts of work they find boring, but they totally pour themselves into the aspects they really enjoy.

“People with ADHD would be more successful if they tried harder.”

Wrong. ADHD isn’t an issue of laziness or lack of motivation. A person is considered lazy if they have the ability or capacity to do something, but they just don’t want to exert the effort to do it. People with ADHD are often trying as hard as they can to focus and pay attention, and they exert as much effort to get things done as those without it- and often more- but their condition keeps them from getting to the finish line because they’re so easily distracted along the way. They’ll eventually get there, it just may take a little longer. And btw, telling someone with ADHD to “just focus” is like asking someone who’s nearsighted to just see farther. It doesn’t fly. If they could, they would. The reason they struggle with attention has nothing to do with attitude… it’s due to differences in the way their brain is structured and how it functions.

“People with ADHD aren’t smart.”

Wrong. ADHD isn’t related to lower IQ. People with ADHD may be perceived to have lower intelligence because they work differently than everyone else. But the truth is, most people with ADHD are highly intelligent and creative… even more creative than their non-ADHD counterparts. They’re also more intuitive thinkers and better at managing crises. Tell Albert Einstein (yes, the theoretical physicist) that people with ADHD aren’t smart. Or Sir Richard Branson, the billionaire business mogul. Or John F. Kennedy, the 35th president of the United States. Or actor/producer/rapper Will Smith. Or actor/comedian/producer Jim Carrey. Or Michael Jordan, the greatest basketball player of all time. They all seem to do just fine. People with ADHD aren’t dumb, and kids with ADHD can grow up and be just as successful as anyone else. The factors that contribute to the success of a child with ADHD are mostly related to how their parents and teachers react. If they take the time to understand what’s going on, embrace the learning process, and help the child find ways to manage it, they greatly increase that child’s chances of success.

So what’s it like to have ADHD? Here’s what I’ve been told…

It’s rarely feeling like you really enjoy anything, because you’re always so distracted by something else.

It’s constantly coming up with great ideas, but failing to focus or work efficiently on any one of them long enough to make it a reality.

It’s knowing how long it takes to get ready in the morning, but not being able to tell how quickly time is passing until you’re already late. 

It’s being able to note every single detail of a classroom, but being unable to pay attention to the one thing you’re supposed to be looking at.

It’s struggling in every aspect of your life, but feeling that other people don’t recognize your suffering as a legitimate disorder.

It’s feeling exhausted at the end of a hectic day, but too overwhelmed with thoughts to actually fall asleep.

It’s having a conversation in a public place and hearing every noise around you… except for the voice you’re supposed to listen to.

It’s being barely focused on everything around you, or so hyperfocused on one thing that the world around you ceases to exist.

It’s hearing all the instructions, but not being able to hold them in your brain long enough to actually use them.

It’s remembering that you always need your phone, keys, and wallet before you leave the house, but still having to play hide and seek for them every single time.

It’s knowing you need to switch to another task on your to-do list, but being too hyperfocused on what you’re doing to disengage from it.

It’s being completely bored with what’s in front of you, but totally restless and jittery with excitement about all the abstract thoughts circling in your head.

It’s always trying to do too many things at once, and not multitasking efficiently enough to finish any one of them.

It’s believing you can succeed in your career, while also fearing that your ADHD will cause you to fail.

It’s knowing you need to reach a long-term goal, but lacking the planning strategies to take the right short-term steps to get there.

It’s wanting to control your intense emotions, but not realizing you need to until after you’ve had the uncontrollable outburst.

It’s having a brilliant answer to a question in the back of your head, but taking too long to communicate it, so someone else answers.

It’s knowing you’re smart, but feeling stupid all the time, because you have trouble putting your thoughts into words.

It’s knowing that you shouldn’t interrupt someone, but not being able to stop yourself from speaking out loud.

It’s working twice as hard for twice as long as everyone else, but to get just half as much done.

It’s knowing that you need a particular environment to be productive, but not wanting to ask for special accommodations.

It’s being excited to make plans with someone you love, but forgetting about them because you didn’t write them down.

It’s being focused on everything and nothing at all, which makes it feel like you’ll never get anything done.

It’s wanting to take control of your life and achieve your dreams, but feeling like ADHD will always have control over you.

As you can imagine, ADHD can cause a great deal of frustration. People can feel hopeless at times, and feeling misunderstood makes it that much worse. Misconceptions propagate in silence, and ultimately can prevent people from seeking help. By taking the time to learn more about ADHD, you’re already making an effort to beat that, so be sure to share what you’ve learned. 

That’s a good place to stop for this week. Next week, we’ll talk about gender differences in ADHD. I hope you enjoyed this blog and found it to be interesting and educational. Please feel free to share it with family and friends. Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, leave comments, and share those vids! As always, my book Tales from the Couch has more educational topics and patient stories, and is available in office and on Amazon. 

Thank you and be well people!

MGA

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The Dark Side Of ADHD

The Dark Side of ADHD

Hello, people, welcome back to the blog! Last week, I told you all about SAD, seasonal affective disorder, a depressive disorder that exhibits a seasonal pattern, usually late fall through spring, though it can have a spring/ summer pattern. I thought it was timely, since we were approaching its usual start point; symptoms seem to begin shortly after we “fall back” and winter arrives. Speaking of which, we had our first hint of winter this weekend- or at least what passes for winter here in SoFla- as temps dipped below 60 late Saturday night…. brrrrr! Sunday was kind of gray outside, but temps were really nice. Anyhoo, this week, I’m starting a new series on the dark side of ADHD, attention deficit hyperactivity disorder.  

When you think about ADHD, you probably think of a 9 year old boy running around in circles, laughing his head off, totally out of control. While that certainly can be the case, the real faces of ADHD may surprise you. Think of your boss, your mail carrier, or your kid’s teacher… anyone has the potential to have ADHD, even if you don’t see what you think of as the classic symptoms. What most people know about ADHD comes from pop culture… they hear ADHD and think of that 9 year old boy, or maybe Dug the talking dog from the movie Up. Remember him? He couldn’t even complete a sentence without being distracted by an imaginary squirrel. Squirrel!! It was funny, right? Squirrel!! Maybe you’ve made a joke about being ‘sooo totally ADHD’ after you’ve gotten distracted and lost your train of thought? Hey, you’ve got to have a sense of humor to get through this life, and psych disorders sometimes make easy punchlines. But ADHD is a real disorder, and it affects real people in real ways, so it’s important that you’re informed about it, that you understand it, as that’s the basis of empathy. Empathy is where it’s at, and that’s the true point of this blog, to understand what people with ADHD experience on the daily. That’s not to say we can’t laugh about it, because sometimes it’s funny. Squirrel!! But if you understand it, you’re much more likely to laugh with, and not at, and that’s the ultimate point here.

So, what is it? ADHD is a neurological disorder, typically characterized by difficulty in sustaining attention, a lack of impulse control, and impaired working memory. There are three forms of ADHD: inattentive, hyperactive-impulsive, and combined types. By the way, ADHD is the official, medical term for the condition, regardless of whether a patient demonstrates symptoms of hyperactivity. We used to call that condition, having an attention deficit but without hyperactivity, ADD- actually some people still do- but that’s now technically considered to be an outdated term for describing inattentive type ADHD. So they’re all called ADHD now, no more ADD, and just the type or form varies. Inattentive type ADHD is characterized by a lack of attention to details, an inability to follow or remember instructions, and getting distracted easily. Hyperactive-impulsive type is marked by the stereotypical symptoms, things like fidgeting, running around, and talking too much. And shockingly, combined type is a combination of inattentive and hyperactive-impulsive ADHD types, and people with this type can exhibit both types of symptoms. Regardless of type, ADHD symptoms impact every aspect of a person’s life, and can seriously limit a person’s ability to study or work, and this can lead to stress, anxiety, and depression.

Prevalence statistics for ADHD vary widely, but it’s considered the most common childhood neurodevelopmental disorder. The symptoms of ADHD typically first appear between the ages of 3 and 6, and the average age of diagnosis is 7 years old. Squirrel!! According to the American Psychiatric Association, 5 percent of American children (ages 4 to 17) have ADHD, but the Centers for Disease Control and Prevention puts the number at more than double that, stating that 11 percent of American children carry the diagnosis. In my opinion, the actual number is closer to the CDC’s statistic, but may actually be higher still. And contrary to what some people believe, ADHD isn’t just a childhood disorder. Today, about 4 percent of American adults over the age of 18 deal with ADHD on a daily basis. 

ADHD Features

People with ADHD experience hyperactivity, impulsivity, and inattention in varying degrees. Not everyone with ADHD is noisy and disruptive. A child may be quiet in class, for example, while facing severe challenges that they do not express. The effects of ADHD features vary widely from person to person and even within a person, as they may find that their experience of ADHD changes over time. Squirrel!! Features and behaviors also seem to vary by gender; females with ADHD tend to have more difficulty paying attention, while males tend to have more hyperactivity and impulsivity. Depending on the type a person has, ADHD will have a predominantly inattentive presentation, a predominantly hyperactive and impulsive presentation, or a combined presentation that includes both types of behaviors.

Inattention

This can manifest in innumerable ways, many you might not even realize unless you experience them. Some behaviors related to inattention might include daydreaming, being easily distracted, squirrel!, having difficulty focusing on tasks, making “careless” mistakes, appearing to not listen while others are talking, being late, having difficulty with time management and organization, difficulty completing projects, frequently losing everyday items, avoiding tasks that need prolonged focus and thought, and difficulty following instructions. 

Hyperactivity and Impulsivity

Hyperactivity presents in any number of ways, and can vary widely, especially depending on the person’s age. In children, impulsivity often presents as conduct issues, so we think of a child “running amok” around a classroom. With age, overt behavioral symptoms usually become less conspicuous, as adults have generally learned to restrain themselves from these telltale behaviors. But they may manifest conduct issues in other ways, like blurting out things they didn’t mean to say. Some other behaviors related to hyperactivity and impulsivity include restlessness, the person seeming to be unable to sit still, being constantly “on-the-go,” running or climbing at inappropriate times, having difficulty taking turns in conversations and activities, constantly fidgeting or tapping the hands or feet, excessive talking and/or noise making, workaholism, and taking unnecessary risks.

Causes and Risk Factors

We don’t know exactly what causes ADHD, but we do know that a large component is genetic. About 85% of people diagnosed with ADHD have someone in their family who also has it. We have identified some risk factors, and these include brain injury, fetal exposure to stress, alcohol, or tobacco during pregnancy, fetal exposure to environmental toxins during pregnancy, or from a young age, low birth weight, and preterm birth. Diet may play a role, and some factors are random, just down to an individual brain’s wiring.

One question that’s asked a lot is if kids can outgrow ADHD. The answer is yes, but it rarely happens. That said, at one time, it was suggested that up to 40 percent of children outgrow their diagnosis, but recent research has proven this is wrong. Unfortunately, fewer than 10 percent actually outgrow it; the rest still meet the clinical definition of the disorder. Generally, what actually happens is that the presentation of symptoms changes as the person ages, but the underlying disorder remains. As the person matures and enters adulthood, overt behavioral symptoms usually become less conspicuous, and excessive motor activity becomes less common. Squirrel!! Hyperactivity is usually changed from being an external behavior to an internal state, so it can appear to others that the person’s ADHD has gone away, along with its most obvious symptom. But in reality, only the presentation has changed. 

In other words, a 35 year old can’t get away with the same behavior that a 9 year old can, so instead of being a 9 year old running around willy nilly, laughing maniacally, the now 35 year old has an inner restlessness, and channels that into something else, like becoming a workaholic or an adrenaline junkie. Many adults with ADHD become workaholics, they like to keep their brains in overdrive. ADHD symptoms can also change for the better depending on stress levels, environment, and the amount of support a person receives. For example, establishing a routine and having understanding family members, friends, co-workers, and colleagues that can assist or help compensate for certain issues as needed are two ways to make symptoms seemingly decrease or disappear. In addition, the person may develop coping skills that address their symptoms well enough to prevent ADHD from interfering with their daily lives. Some do it so well that it appears as though they’ve outgrown it, but in reality, they’ve found working solutions. It’s sort of like watching a duck on a pond. Or maybe a squirrel! The duck looks still and serene on the surface, everything under control, but beneath the water, its little feet are paddling furiously. 

I’ve seen many patients create their own little systems and methods to cope and compensate for their symptoms, to varying levels of success. I remember an ADHD patient that was very forgetful and terrible with time management especially. She had alarm clocks set to go off to remind her to set other alarm clocks, and her life was all color coded post its in strategic places to remind her to do whichever thing. I couldn’t understand it to save my life, much less keep up with it, but it worked for her. Pretty darn well, actually. But if the batteries in one alarm clock died- this was years ago, when people used alarm clocks, and they were radios too, imagine that- her entire life unraveled. She would get behind and it was like dominoes. But if her alarm clocks went off properly and her post its didn’tblow away, you’d be hard pressed to know she had ADHD. On the surface, she looked like she had it all under control, no problem, but below, her feet were constantly paddling, she was working overtime to keep it all together.  

The term “attention deficit hyperactivity disorder” wasn’t used in medicine until the 1980s, although symptoms of the disorder were discussed in the early 1900’s. Back then, the diagnosis was typically thought to relate to the child having family members with psychiatric disorders, or the result of poor parenting. Squirrel! Strangely enough, some of these myths and stereotypes persist even today. We’ve busted some of those today, and next week, we’ll talk about what it’s really like to have ADHD, how it affects someone’s day to day life. 

I hope you enjoyed this blog and found it to be interesting and educational. Please feel free to share it with family and friends. Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, leave comments, and share those vids! As always, my book Tales from the Couch has more educational topics and patient stories, and is available in office and on Amazon. 

Thank you and be well people!

MGA

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The Skinny on Psychostimulants,Part 2:Methylphenidate Stimulants

The Skinny on Psychostimulants, Part 2: Methylphenidate Stimulants

Last week I introduced a class of drugs called psychostimulants, or central nervous system (CNS) stimulants. As the name states, psychostimulants are “uppers” that stimulate the central nervous system when consumed in varying ways. This class includes the illicit drugs cocaine, ecstasy, and crystal meth, nicotine found in tobacco, and the most commonly consumed drug in the world, caffeine, which is a highly addictive compound that occurs naturally in more than 60 plant species, including the various beans brewed to make the most widely consumed beverage in the world, coffee. Other recognizable sources of caffeine include cocoa beans, tea leaves, and kola nuts. Caffeine is also chemically synthesized for handy inclusion in energy drinks, sodas, and various medications. This class also includes two types of stimulant medications, amphetamines and methylphenidate, which can be found as the bases in a myriad of pharmaceutical products.

In last week’s blog I introduced amphetamines; this week I’ll discuss methylphenidate stimulants. Like amphetamines, methylphenidate stimulants are tightly controlled Schedule II central nervous system (CNS) stimulants that work by stimulating the chemical messengers dopamine and norepinephrine, the neurotransmitters associated with control, attention, fight or flight response, and the pleasure/ reward system in the brain.

While these two types of drugs induce similar effects when taken, the way that they induce those responses, their mechanisms of action, are actually different. Both work to increase levels of dopamine and norepinephrine in the synapses between neurons, which helps messages move from one neuron to the next. Recall from last week that amphetamines have three mechanisms for increasing these levels: 1) they reverse the direction of the transporter pumps that would normally divert dopamine and norepinephrine away from the synaptic cleft, 2) they disrupt cellular vesicles, thereby preventing the storage of excess dopamine and norepinephrine, which frees them up for use in the cleft, and 3) they also promote the release of dopamine and norepinephrine at nerve cell terminals, making them more readily available in the synaptic cleft. Amphetamines’ three mechanisms combined ensure that there are very high concentrations of dopamine and norepinephrine in the synapses of the central nervous system and result in the very strong psychostimulant effects that amphetamines produce. 

In contrast, methylphenidate affects the levels of dopamine and norepinephrine in the synaptic cleft through a single mechanism: by shutting down the transporter pumps that would usually take up excess neurotransmitters. It does not reverse these pumps to cause a flood of neurotransmitters to be released, and does not work to increase neurotransmitter levels through any other actions the way that amphetamines do. As a result, amphetamines are slightly more stimulating than methylphenidate-based stimulants. For this reason, I typically use methylphenidate-based stimulants for children and adolescents and generally reserve amphetamines for use in adults. 

Both amphetamines and methylphenidate are used to treat and control symptoms of narcolepsy, obesity, binge eating disorders, and most commonly, attention deficit hyperactivity disorder (ADHD). Off-label indications, meaning potential uses that are not strictly approved by the FDA, include using either to treat major depressive disorder and in cancer patients to treat weakness, fatigue, and depression. There are also some relatively recent studies that indicate success in using psychostimulants off-label to decrease pain levels as part of a regimen in treating chronic pain patients. 

All stimulants can be prone to misuse, and may be used recreationally in certain populations via oral route, smoking, injecting, or snorting, to get high and/ or to stay awake for long periods of time. And their ability to improve concentration means some people use them to boost cognitive ability, to improve focus, and to study for and/ or take exams. This is a relatively common practice among some college students. 

The two types of medications are available as short-acting medications and in longer acting preparations. Both are essentially equally effective, and have the same benefits, risk(s), and side effect profiles, only varying mainly in their severity, with the profiles associated with amphetamines sometimes being slightly stronger than with methylphenidate. And while I’ve found that most patients respond equally well to either medication, adults to amphetamines and children to methylphenidate, some may respond better to one versus the other. But that’s certainly not a unique feature; that’s always the case with medications, as different bodies respond differently to varying formulations. 

Methylphenidate is most commonly used for treating ADHD, and is FDA approved first line therapy for ADHD patients age 6 and up. While it may seem counterintuitive to treat hyperactivity with a stimulant, this class of drugs have been shown to be the most effective treatment for reducing the symptoms of ADHD. This is because CNS neurotransmitter concentrations are lower in the ADHD brain, sometimes markedly so, and the addition of a stimulant raises the neurotransmitter levels to equal those comparable to the “normal” levels found in the non-ADHD brain. 

Attention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in childhood, and is associated with impaired functioning and negative developmental outcomes. Children with ADHD find it unusually difficult to concentrate on tasks, to pay attention, to sit still, and to control impulsive behavior. They generally have more difficulty focusing, controlling actions, and remaining still or quiet, as compared to classmates or other people the same age. The American Academy of Pediatrics (AAP) recommends behavior therapy and medication for children 6 years of age and older, preferably both together. The end result in up to 90 percent of cases is that methylphenidate-based stimulant medication helps children with ADHD become more focused, improve their approach to schoolwork, get better organized, think before acting, get along better with others, conform better to societal norms, and break fewer rules. They do better socially, academically, and in terms of self esteem. As a result, they, and their other family members, are happier. In my experience, as the chaos in the patient’s mind is decreased, the chaos that usually follows and surrounds them is also decreased, and that makes for better harmony in the home as well. To put the success of methylphenidate in treating ADHD into perspective, there is no other medication for a psychiatric condition that has such a high response rate. 

In contrast, children with untreated ADHD don’t do as well comparatively speaking. Generally, if the symptoms of ADHD are negatively impacting any area of their life, they are impacting every area of their life, because ADHD is not just an academic problem, it’s a neurobehavioral problem that permeates every aspect of life and affects them academically, emotionally, and socially. Studies have shown that unchecked ADHD symptoms hinder childhood progress, causing a tendency to suffer in school and in social relationships. This negatively affects self-esteem, which causes feelings of anxiety and depression, not only at the time, but as lifelong consequences. The long term implications of low self esteem are well documented and extensive, and nearly always include fairly pervasive anxiety and depression. Low self esteem and all of its many consequences is common in adults with undiagnosed childhood ADHD, as well as from other sources, and it’s a common source of issues that I treat on a daily basis. 

So the lesson is that when weighing risks of treating ADHD with methylphenidate stimulants, recognize that making the decision not to medicate a child with notable ADHD symptoms has its own risks that must be considered. When you take into account that childhood is meant to be a building block and a time to learn, not just math and grammar, but how to make friends and function in the world, what the decision encompasses is a whole person and a whole life, and all that entails. As a psychiatrist, my opinion might be biased, but I might never understand why the decision to treat disorders affecting mental health are made so differently from ones that affect physical health, as if good mental health isn’t as important, or as necessary, as good physical health. I wonder, if a child had diabetes that was negatively impacting their life, would you suggest that child be treated for it, or would you withhold medication from them? Why is mental health treated so differently?

While it has been used safely and effectively for decades, there’s still a great deal of angst and controversy surrounding using stimulants in children with ADHD, one that begs further discussion. I’ll start with some fast facts on ADHD.

ADHD: By the Numbers

Incidence and prevalence statistics always vary according to sources and sampling methods, but the following are the 2020 numbers quoted by the Centers for Disease Control and Prevention.

The number of children ever diagnosed with ADHD is 6.1 million, or 9.4 percent. 

This includes: 

388,000 (2.4 percent) young children, aged 2 to 5 

2.4 million (9.6 percent) of school-age children, aged 6 to 11

3.3 million (13.6 percent) of adolescents, aged 12 to 17

Symptoms of ADHD typically first appear between the ages of 3 and 6.

The average age of ADHD diagnosis is 7 years old.

Males are more than twice as likely to be diagnosed with ADHD than females (12.9% compared to 5.6%).

Despite that fact, the incidence of ADHD diagnosis in girls has increased in recent years. Historically, diagnosis and incidence reporting had been low in girls, but new research indicates how ADHD symptoms manifest differently in boys and girls, leading to better recognition in girls.

ADHD isn’t just a childhood disorder. About 60 percent of children with ADHD in the United States become adults with ADHD, which is about 4 percent of the adult population. 

ADHD severity is generally based on the age at diagnosis:

Mild: Average age of diagnosis is 8

Moderate: Average age of diagnosis is 7

Severe: Average age of diagnosis is 5

Roughly two-thirds of children with ADHD diagnosis have/ have had/ will have at least one other mental, emotional, or learning disorder: most common are depression and/ or anxiety and other behavioral or conduct disorders, but other conditions such as autism spectrum disorder and Tourette syndrome/ tic disorder may also affect children with ADHD.

ADHD On the Rise

Cases and diagnoses of ADHD have been increasing dramatically in the past few years. The American Psychiatric Association (APA) says that roughly 8.4 percent of American children have ADHD, which differs significantly from the statistic quoted by the Centers for Disease Control and Prevention. The numbers vary depending on sampling methods and reference, but they all do indicate one thing: that ADHD diagnoses are on the rise. 

To account for the differences in statistics, there may be an implication that ADHD is being commonly mis-diagnosed, that children are being diagnosed with ADHD when they don’t actually have it. In reality, while ADHD isn’t a fast, easy diagnosis to make, there are strict and clear cut guidelines for diagnosis that make mis-diagnosis fairly rare. There must be a comprehensive evaluation using multiple collaborative sources (including interviews with the child, the parent(s), and typically the teacher), established symptom rating scales, observation by a physician, and cognitive and/ or academic assessments. A valid diagnostic appraisal takes time, so while mis-diagnosis certainly occurs in a very small percentage, it is certainly not responsible for the rise in numbers. 

What is responsible? The answer is multi-faceted, and includes: the increase in research and development in making the diagnosis, the decrease in the stigma associated with seeking help and/ or being evaluated for and/ or potentially having the diagnosis, and the increase in public awareness of ADHD. Many of today’s ADHD patients would have been yesterday’s “problem children.” In other words, we simply know better now, so we do better. Physicians are better trained in how ADHD manifests itself, especially in girls, since it’s stereotypically been a “boy disorder,” and everyone involved, including physicians, parents, and teachers, are more alert and pay closer attention to the disruption that behavioral issues cause in the classroom to everyone, not just the student with ADHD. 

The question then may be asked if more kids are actually experiencing ADHD today than they were before, and if so, why? We now know that ADHD is caused by a mix of genetic and environmental factors, and current best estimates indicate that about 70 to 80 percent of the risk for ADHD is genetic. But it’s not very clear cut or simple, where you either have an “ADHD gene” or you don’t, and there’s no single marker to look for or confirm a diagnosis. Instead, each gene involved in the condition contributes a certain amount of risk for developing it. The genetic component is complicated, but we really know even less about the environmental component, which makes up the other 20 to 30 percent of the risk of developing ADHD. The environmental risk factors we are fairly sure of- the ones we have the strongest and clearest evidence for- appear to be preterm birth and low birth weight. We also know that it is likely that if in fact we are seeing a true rise in ADHD cases over the last 20 years or so, as we believe we are, environmental factors must play an important role in it, simply because genetics don’t change that quickly. Some studies have suggested that exposure to toxins (ie lead exposure, smoking during pregnancy) may play a role, and that traumatic brain injuries may also play a role in increasing risk of developing ADHD. In the end, the rise in the number of cases is most likely to be a combination or interaction of all of the above factors, and that some environmental factors interact with certain genetics to increase a child’s risk of developing ADHD. What else do we know about increasing numbers of ADHD cases? That we always need and want to know more. 

Methylphenidate Medications

There are several methylphenidate product formulations, including oral tablets and capsules in immediate release/ short-acting, extended release/ long acting, chewables, liquid, and patches to be applied to the skin. There’s even a formulation called Jornay PM, which is taken at night, but only becomes active in the morning. All are derived from essentially the same basic methylphenidate compound. Immediate release or short-acting formulations typically begin to work about 30-45 minutes after ingestion and last about 3-4 hours, while extended release generally last about 6-8 hours, though there are of course exceptions that may release even more slowly and last longer.

Ritalin is a short-acting formulation of methylphenidate that lasts about 3-4 hours. Focalin is another form of methylphenidate that also lasts about 4 hours. Both of these medications begin to work about 30-45 minutes after taking them. For children who have trouble swallowing pills, this medication can be crushed and mixed with foods. There is also a liquid and a chewable tablet form of the short-acting methylphenidate.

Other preparations of methylphenidate have been created to release the medication over a greater period of time, extending the duration of the effect of the medication. This is of great benefit when trying to provide a response that lasts through a school day, typically 6-8 hours. Some of these compounds take effect as quickly as the short-acting forms of these medications. 

Concerta is one of the longest-acting methylphenidate medications on the market, lasting 8-12 hours. Concerta can’t be chewed or opened. It has to be swallowed whole in order for it to work the way it was designed. This can be a problem for some kids.

Ritalin-LA and Metadate CD are capsules that are filled with medication. These medications are very similar in that they both last about 6-8 hours. These are better for kids who can’t swallow pills, because you can open up the capsule and sprinkle it on foods like yogurt, applesauce, peanut butter, etc.

Aptensio XR and Focalin XR are also capsules filled with medication that can be opened and mixed with food. They typically work longer than Ritalin LA or Metadate CD.

Quillivant XR is a long-acting formulation of methylphenidate in liquid form, which makes it a good alternative for kids who have trouble swallowing capsules and can’t tolerate beads on food items either.

Quillichew ER is a chewable long–acting formulation of methylphenidate that can last up to 8 hours.

Daytrana is a methylphenidate patch. It’s another good option for kids who can’t swallow pills. You can wear the patch for up to 9 hours, and often get another hour’s worth of response after the patch is removed. But if using the patch, understand that it can often take 1-2 hours from application to the skin to start working.

Potential Benefits of Methylphenidate

In truth, the benefits of treating ADHD with stimulants are too vast to really list when you consider long term implications, but for our purposes, I’m only dealing with direct observed benefits when treating ADHD with methylphenidate stimulants here. 

Methylphenidate based medications have been proven to reduce the disruptive and troublesome symptoms of ADHD, making kids less hyperactive, less impulsive, more focused, and less distractible, with few side effects, if any, when the medications work properly. However, it’s important to note that these medications cannot treat or correct learned behaviors or other types of learning disorders.

The Benefits of Methylphenidate on ADHD Brains: What Science Says

Much of the controversy that surrounds treating childhood ADHD with  methylphenidate stimulants has to do with concerns about long term implications, mainly regarding brain development. Recent research on the neurobiological and anatomical underpinnings of ADHD has shed some light on this subject. 

Several years ago, neuroimaging work confirmed that there are neuroanatomic, or structural differences, in the brains of people with ADHD versus those without ADHD, especially in the frontal cortex, which is involved with attention, organization, abstract thinking, and keeping track of things. It was also confirmed that total brain volume, made up of gray and white matter, also differs.

Regarding anatomical brain differences, specifically, children with ADHD had overall smaller brain volumes, by about 3 percent, than children without ADHD, though it is important to note that intelligence is not linked to or affected by brain size. In addition, five of the regional areas in the deep brain that pertain to regulating emotion, motivation, and emotional problems- the caudate nucleus, putamen, nucleus accumbens, amygdala, and hippocampus- were smaller in people with ADHD; and some showed structural deformations as well. The brains of children with ADHD showed decreased cortical thickness in the prefrontal cortex, and less white and gray matter. 

White matter affects learning and brain functions, and acts as a relay to coordinate communication between different brain regions. White matter consists of axons, or nerve fibers, which have a myelin sheath whose color gives the area its name. Think of these myelinated nerve fibers of the white matter as the wiring of the brain- where information is carried from one point to the next- and these are insulated, so that the information is conserved, ie doesn’t “leak out” as it’s carried. Grey matter is the more outward layer of the brain that serves to process information in the brain and directs sensory stimuli to nerve cells in the central nervous system where the synapses induce the response to that stimuli. The grey matter has more connections than white matter, but isn’t as insulated as myelinated white matter; so this area relates more to memories and facts which are used every day to help a person function optimally.

In fact, further studies have shown that the structural differences in ADHD brains tended to be most observed in the brains of children with ADHD and not as much in ADHD adult brains. This is likely an indication that childhood is an important time to treat ADHD, which seems to be confirmed by further research. All in all, the findings led researchers to state that ADHD is a function of atypical brain structure and atypical chemical development. A few years ago, a research group took these findings a step further. Given the success of methylphenidate in treating the symptoms of ADHD, which is basically correcting the atypical chemical differences in neurotransmitter levels, they looked at the effects of methylphenidate on brain structure. 

The study found that childhood psychostimulant medication (methylphenidate) led to volume normalizations in several areas where volume levels were known to be reduced in the ADHD brain. Normalization means that where they were previously reduced prior to treatment with methylphenidate psychostimulant medication, they were increased to the point of reaching levels found in “normal” non-ADHD brains after being treated with the psychostimulant methylphenidate.

These studies found that specifically, overall white matter volume and grey matter volume normalized, or “resolved” after childhood treatment with psychostimulant, as did anterior cingulate cortex (ACC) volume, which is implicated in several complex cognitive functions, such as empathy, impulse control, emotion, and decision-making. When they looked at the largest part of the brain, the cerebral cortex, which is the ultimate control and information processing center, responsible for higher-order brain functions of sensation, perception, memory, association, thought, and voluntary physical action, they found that the ADHD-related thinning that had been present, was moderated by childhood psychostimulant treatment. The ADHD-related size reduction of the deep brain structures, which are key to learning, memory, reward, motivation, and emotion, normalized after psychostimulant treatment, as did deformations of the caudate nuclei, when present. 

One hypothesis that they had looked to prove or disprove was that methylphenidate treatment of ADHD during childhood and adolescence, but not during adulthood, would stimulate white matter, striatal, and frontal cortical development, resulting in more adult-like values. And in fact, their findings did prove this. This is important, because it is an age-related treatment response. It essentially means that when you treat childhood ADHD with methylphenidate in childhood, the methylphenidate stimulates a response that normalizes most of the abnormalities found in the brain of the child with ADHD such that they are comparable to normal adult values later. That’s a good thing.

Another study looked at behavioral changes associated with using methylphenidate, and found that, relative to periods off medication, ADHD patients on medication have fewer motor vehicle accidents, have a lower risk of traumatic brain injury, are less likely to engage in criminal activity, have lower rates of suicidal behavior, and have lower rates of substance abuse. Why? Because it seems that when neurotransmitter levels are normalized, behavior is normalized as well, which makes behavior when on medication safer, more risk averse, ie less risky. The authors end the report of their findings with this: “Thus the answer to the question ‘Is there long-term benefit from stimulant treatment for ADHD” is a definite “Yes!'”

Potential Negative Side Effects of ADHD Stimulant Medications/ Methylphenidate

Most side effects associated with methylphenidate are very mild and temporary, but if they exist, are likely to be dose or formulation related, as it can take some time to find the appropriate medication and dose. If you find that any side effects are intolerable or persist, it’s important that you inform the prescribing physician. In addition, the dose should be re-evaluated each year, even if there are no issues, as the medication needs can change over time, especially in growing children. 

Decreased Appetite

This is the most common side effect of stimulant medications. The loss of appetite may happen just while the medication is effective, and then wear off, as the benefits of the medication do. Children may be very hungry once the medication wears off, and if they haven’t eaten, they may also be irritable, aka hangry. This is typically a manageable problem, but the issue should be discussed with the physician who prescribes the medication if it persists or is intolerable.

Insomnia/ Sleep Problems

There may be issues with falling asleep associated with methylphenidate. This is usually fairly mild, and it tends to occur more in younger children who might have already had issues with falling asleep before they started the medication. There are many things that can interfere with falling asleep or manifest as sleep issues, so it’s important to determine if any external causes (other than medication) may be present. These can include poor or irregular sleep schedule, excess screen time/ blue light exposure right before bed, academic concerns/ worrying about school tests, or social issues with friends. Again, problems falling asleep are likely to improve over time, but may also be overcome by changing either the time or type of the medication that is given. For example, if a second or third dose of a short-acting formula is taken too late in the day, it may not have worn off by bedtime, which could cause the issue. This can be addressed by the physician with formula or dosing changes.

Mood Changes

There is a small subset of children with ADHD who may seem moody and irritable when they take stimulant medications, even if they are taking the best possible dose. If this is going to happen, it usually happens right away, as soon as they start taking the medication, and goes away immediately when they stop taking it. If this happens, it may help to switch to a different formulation or dose, so inform the prescribing physician right away to discuss potential alterations. Sometimes when a stimulant dose is too high, especially in children, they may begin to look tired or experience irritation. If this happens, the prescribing physician may opt to adjust the dose until the right dose is found: one in which the child gets the most benefit from the medication with the least possible side effects.

“Wear-Off” Effects

While this isn’t technically a side effect, a very small minority of children experience behavioral changes as their ADHD medication wears off, which typically occurs at the end of the school day. Some parents call it “rebound” but that term can be a bit misleading. They can seem more irritable or emotional, but it is usually a mild transient finding. Sometimes it’s related to being hangry or overtired, but it can be connected to the medication level dropping, and strategies that create a more gradual decrease in the medication level may help relieve it. Obviously, discuss with the prescribing physician if you notice it and believe it’s due to the medication levels. 

Tics

About 10% of kids with ADHD will have concomitant tics, whether or not they take methylphenidate, so that translates to a fair number of children. Tics usually start between 6 and 8 years of age, which is often when kids also first start taking a medication for ADHD. Tics may also be transient, and may come and go over time. The best we know from a series of studies, is that stimulants don’t cause tics, but if tics are present, sometimes methylphenidate can aggravate them. Despite this, methylphenidate may possibly still be used, but treatment should be more closely monitored if this is the case. If tics increase significantly during treatment, there may be an option to use a non-stimulant medication that affects the brain in a different way. 

Non-Stimulant Medications for ADHD

There are two types of non-stimulant medications that can help to alleviate some symptoms of ADHD. While they don’t have the efficacy that stimulants do, and they have very different side effect profiles, they may be an option worth trying if stimulants aren’t a viable option due to concomitant disorders like tics. Just as with stimulants, it may take several attempts to find the right medication and dosage, with the least side effects.

Clonidine (Catapres, Kapvay) and guanfacine (Tenex, Intuniv) are called alpha-adrenergic agonists, and these medications were developed to lower high blood pressure in patients with hypertension. But they are also prescribed in adjusted doses for children with ADHD who don’t tolerate stimulants well, and are sometimes also used to treat tics. These medications can cause fatigue related to low blood pressure, so blood pressure and heart rate must be regularly monitored while taking these medications. These are typically short-acting medications that require several doses each day, but they come in longer acting versions, Kapvay and Intuniv.

Atomoxetine (Strattera) is in a class of drugs called norepinephrine reuptake inhibitors. Norepinephrine is one of the CNS neurotransmitters needed to control behavior.

Unlike stimulants, Atomoxetine can take 4-6 weeks to take effect and has to be taken daily.

Busting Myth-information

There’s a great deal of false information out there on ADHD and stimulants. 

Does using stimulants stunt growth?

In spite of concerns that have been voiced regarding growth and stimulants, a recent well-validated clinical study showed that neither ADHD, nor treatment with stimulants, was associated with a decrease in growth rate during the maximum growth period in childhood, or a change in final adult height. Combined with other studies, it is clear that treatment with stimulants has no impact on growth rate or final adult height.

Are psychostimulants addicting?

Provided they are taken via the prescribed route, at the level they are prescribed for ADHD, methylphenidate medications do not raise the dopamine level high enough to produce euphoria, and they are not considered addictive.

Does using stimulants make children prone to addiction later in life?

Observational studies conclude that stimulant medication to treat young children with ADHD does not affect- neither in an increasing nor decreasing way- the risk for substance abuse in adulthood.

Does using stimulants change a child’s personality?

ADHD medications should not change a child’s personality. If a child taking a stimulant seems sedated or zombie-like, or tearful and irritable, it usually means that the dose is too high and the clinician needs to adjust the prescription to find the right dose.

Does using stimulants have negative long term effects?

In over 50 years of using stimulant medications to counteract the symptoms of ADHD, and hundreds of studies, no negative effects of taking the medication over a period of years have been observed. On the contrary, using methylphenidate to treat childhood ADHD especially, is associated with the positive effects and benefits of normalization of neurotransmitter levels and structural brain differences.

Using Methylphenidate for ADHD in Children:

Parental Considerations

As a parent, making a decision to place a child on a stimulant for ADHD isn’t to be taken lightly. As a physician, it’s certainly one I take very seriously. The following are things to keep in mind when weighing the decision.

All research studies indicate that stimulants are the most effective treatment for symptom reduction in ADHD. 

Methylphenidate has been used for decades, and is considered safe and generally well tolerated by most people, including children and adolescents, with low side effect profiles. 

Do a risk/ benefit analysis. You have to weigh the risks associated with treating ADHD with a safe and effective stimulant with a good track record versus not treating the ADHD, and all of the areas of the person’s life that decision impacts, including the well documented academic and social implications. In the total analysis, the risks associated with living with untreated ADHD are generally greater than treating with a methylphenidate stimulant that has an excellent safety profile and actually has the benefits of normalization of neurobiological and structural brain anomalies associated with ADHD. 

When the symptoms of ADHD are negatively affecting every aspect of a child’s life, medication is a better and safer alternative than allowing that negative impact to persist throughout school age years and beyond.

Methylphenidate, like all medications, may cause some side effects, but most are mild, temporary, and/ or can be relieved by a change in formulation or dosing. It may take some trial and error to find the prescription and dosage that works well with the least side effects. While this may take time and patience, it’s time well spent. 

Deficiencies in neurotransmitters such as those in ADHD also underlie many common disorders, including anxiety, mood disorders, anger-control problems, and OCD, obsessive-compulsive disorder. As a result, ADHD often occurs concomitantly with other disorders. In other words, ADHD may not be the only thing going on with an ADHD brain. At least two-thirds of people diagnosed with ADHD are also diagnosed with at least one other mental health or learning disorder in their lifetime, according to the American Academy of Child and Adolescent Psychiatry. Some of the more common accompaniments, especially in children, include anxiety disorders, depression, and learning and language disorders. As a parent, you may find you’re looking for the right mix of medications or treatments for multiple issues.

Granted, there are a lot of issues to consider, but hopefully I’ve managed to cover most of them here. My opinion is clear, and it is that overall, given the high efficacy, the track record, the safety, and the many well proven benefits of its use, methylphenidate treatment for ADHD far outweigh the risks associated with not treating it. 

I hope you enjoyed this blog and found it to be interesting and educational. If you did, let me know. If you didn’t, let me know that too!

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Thank you and be well people!

MGA

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The Skinny On Psychostimulants

The Skinny on Psychostimulants

Happy 2021 people! Are you as happy as I am that 2020 is finally in the rearview?! Weirdest. Longest. Year. Ever. 

That actually makes me think of a new and hilarious commercial I just saw for a big online dating site. It starts out with Satan bored out of his mind in hell, and then he gets a text message from the site saying he’s been matched with a girl, and he’s very intrigued. When they meet, it’s obvious that they’re both instantly smitten. Then the starry-eyed girl introduces herself as 2020. They fall in love. And they live happily (?) ever after… apparently in hell. Unless they stay at her place I guess. Anyway, 2020 is over, even though unfortunately, we’re still schlepping some of its covid baggage, but hopefully not for much longer. 

Considering the euphoria surrounding the new year and the stimulation of resolutions, I thought it very fitting that I start with a three part blog series on pharmacological central nervous system stimulants, aka psychostimulants. One of the main compounds in this class of drugs are the amphetamines, and that will be today’s blog topic. 

As psychostimulants go, amphetamines are very strong ones; they are a group of very tightly controlled and well monitored schedule II drugs. Add a little carbon atom, bind some hydrogens to it, and you’ve got a methyl group; and that makes it methamphetamine, which everyone’s heard of. When prescription methamphetamine is (very) illegally altered…tah-dah…you’ve got crystal meth, aka speed, ice, crank, etc. Other examples of psychostimulants include caffeine, nicotine, cocaine, and other prescription compounds that I’ll cover next week. 

Because of their stimulant activity within the central nervous system, prescription amphetamines are used in the treatment of several disorders, including narcolepsy, obesity, binge eating disorders, and very commonly, ADHD, or attention deficit hyperactivity disorder. They can also be used recreationally in certain populations to get high, to stay awake for long periods of time, and/ or to improve focus and study for exams. In fact, it’s those last two that make amphetamines very popular party favors among college students.

Structurally speaking, amphetamines are drugs that are related to catecholamines, which are chemical messengers that help transmit a message or signal across neural synapses in the central nervous system, from the terminal end of a transmitting nerve cell to the receiving end of a target nerve cell. In an over-simplified explanation, when a signal gets to the end of one neuron, catecholamines help the signal jump to the beginning of the next neuron, hence the name “neurotransmitter.” That message is repeated billions upon billions of times, as there are billions upon billions of neurons in the central nervous system. These neural signals activate emotional responses in the amygdala of the brain, such as fear in a “fight or flight” situation. At the same time, catecholamines also have effects on attention and other cognitive brain functions. Examples of catecholamines include the neurotransmitters dopamine, epinephrine, and norepinephrine. Pharmacologically speaking, amphetamines increase levels of the specific neurotransmitters dopamine and norepinephrine in the neural synapses, which helps the message to make the jump from one neuron to the next. In a way of thinking, amphetamines “speed” the transmission of the message by increasing the levels of these neurotransmitters. Amphetamines increase these dopamine and norepinephrine levels through three different mechanisms of action, at least that we know of: 1) they reverse the direction of the transporter pumps that would normally divert dopamine and norepinephrine away, 2) they disrupt cellular vesicles, thereby preventing the storage of excess dopamine and norepinephrine, which frees them up, and 3) they also promote the release of dopamine and norepinephrine at nerve cell terminals, making them readily available in the synaptic cleft. These three mechanisms combined ensure that there are very high concentrations of dopamine and norepinephrine in the synapses of the central nervous system. The “catecholaminergic” (try that one next time you play scrabble) actions of increasing the levels of dopamine and norepinephrine result in the very strong psychostimulant effects that amphetamines produce.

You’ll notice that I keep saying amphetamines, plural. Why? Because like the neurotransmitters dopamine and norepinephrine it effects, amphetamines are chiral molecules; this is a fancy way of saying that in their three dimensional world, they can exist in different forms called enantomers (more scrabble points!) that are mirror images of each other. I know this sounds complicated, but it’s really not. Think of it as “handedness.” Your left and right hands are mirror images of one another: they look similar, except the placement of the fingers and thumbs are mirror images, and they can do pretty much the same things, like hold a fork or a pencil, but the way they do so differs slightly. The same is true of amphetamines. The two enantiomers of amphetamines are usually referred to as dextroamphetamine (also denoted as d-amphetamine) and levoamphetamine (also denoted as l-amphetamine). All prescription amphetamines boil down to four variations of the amphetamine molecule, which have markedly similar, but potentially slightly variable effects: dextroamphetamine, aka dexadrine; lisdexamphetamine, which is a precursor or pro-drug of dextroamphetamine; methamphetamine, aka methamphetamine HCL, which has that methyl group I mentioned before; and mixed amphetamine, which is essentially a mixture of dextroamphetamine and levoamphetamine at a specific ratio. 

Of those four active forms of amphetamines, there are several brand name drugs on the market, some of which have generic forms available. They are all oral formulations that may be immediate-release, which are typically taken twice a day, or extended-release, which are obviously released more slowly and taken once a day. 

Adderall XR (generic available)

Dexedrine (generic available)

Dyanavel XR

Evekeo

ProCentra (generic available)

Vyvanse

Methamphetamine (Desoxyn)

The desired effects of amphetamines include: stimulation (thank you Captain Obvious), increased alertness, cognitive enhancement, euphoria, and mood lift. Amphetamines have been around for a long time and when taken as prescribed, they’re fairly safe, but there are potential negative side effects. These can include insomnia, hyperfocus, GI irritation, headache, anxiety, slight increase in heart rate and blood pressure, and anorexia. There is addiction potential associated with amphetamines, and there is a short and fairly mild associated withdrawal period where one might feel some fatigue, sleep a lot, and experience strange dreams. 

When taken as directed, and by mouth, usually 20mg – 40mg per day, amphetamines are fairly safe. However, when smoked, injected, or snorted, they are decidedly UNsafe; especially in large doses. I’ve seen people take up to 1000mg per day… though not for long. Why? Because they usually end up dead of overdose. What happens if you choose to use amphetamines in large quantities and/ or via routes other than oral? Hallucinations, delusions, psychosis, seizures, cardiovascular collapse/ arrest, stroke… the bottom line is it ain’t pretty, people, so don’t do it. 

Because amphetamines have multiple mechanisms of action and thereby are very strong psychostimulants, I generally restrict their use to adults only, and choose to use another type of psychostimulant in children called methylphenidate. And that will be the topic next week in psychostimulants part 2 of 3. 

I hope you enjoyed this blog and found it to be interesting and educational. If you did, let me know. If you didn’t, let me know that too!

Please feel free to share the love! Share blogs and YouTube videos with family and friends. 

Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, and share those vids too! 

And if you like what you see and want more of it, or if you want a specific topic, leave it in the comments- I love reading them! 

As always, my book Tales from the Couch has more educational topics and patient stories, and is available in the office and on Amazon. 

Thank you and be well people!

MGA

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Attention-Deficit/Hyperactive Disorder : Signs, Symptoms, and Treatments

Attention-Deficit/Hyperactivity Disorder: Signs, Symptoms, and Treatments

ADHD is a disorder that makes it difficult for a person to pay attention and control impulsive behaviors. They may also be restless and seem to be active constantly. Contrary to some beliefs, ADHD is not just a childhood disorder. While the symptoms of ADHD often begin in childhood, ADHD can continue through adolescence and into adulthood. While hyperactivity generally improves as a child ages, other problems with inattention, disorganization, and poor impulse control often continue through the teen years and into adulthood.

Causes of ADHD

Current research suggests that ADHD may be caused by a combination of genetic and non-genetic factors. These factors include genetics, cigarette smoking, alcohol, or drug use during pregnancy, exposure to environmental toxins at a young age (ex: lead), low birth weight, and brain injuries.

Warning Signs of ADHD
People with ADHD typically have a pattern of three different types of symptoms:

1. Difficulty paying attention (ie inattention) 
2. Being overactive (ie hyperactivity)
3. Acting without thinking (ie impulsivity)

These symptoms get in the way of development and functioning. The way these three symptoms are manifested varies by person. 

Problems with paying attention (ie inattention) may manifest in:

– Overlooking or missing details, making careless mistakes on schoolwork, work projects, or during other activities
– Having problems sustaining attention during tasks or while playing, including conversations, lectures, or lengthy reading
– Seeming to not listen when spoken to directly
– Failure to follow through on instructions, failure to finish schoolwork, chores, or duties in the workplace, or starting tasks but quickly losing focus and getting easily sidetracked
– Having problems organizing tasks and activities, such as doing tasks in sequence, keeping materials and belongings in order, keeping work organized, managing time, and meeting deadlines
– Avoiding tasks that require sustained mental effort, such as schoolwork or homework, or for teens and older adults, preparing reports, completing forms, or reviewing lengthy papers
– Losing things necessary for tasks or activities, such as school supplies, pencils, books, tools, wallets, keys, paperwork, eyeglasses, and cell phones
– Becoming easily distracted by unrelated thoughts or stimuli
– Being forgetful in daily activities, such as chores, errands, returning calls, and keeping appointments

Problems being overactive (ie hyperactivity) and acting without thinking (ie impulsivity) manifest in:

– Fidgeting and squirming while seated
– Getting up and moving around in situations when staying seated is expected, such as in the classroom or in the office
– Running or dashing around or climbing in situations where it is inappropriate; or, in teens and adults, often feeling restless
– Being unable to play or engage in hobbies quietly
– Being constantly in motion or “on the go,” or acting as if “driven by a motor”
– Talking nonstop
– Blurting out an answer before a question has been completed, finishing other people’s sentences, or speaking without waiting for a turn in conversation
– Interrupting or intruding on others during conversations, games, or activities

Showing these signs and symptoms does not necessarily mean a person has ADHD. Many other problems, like anxiety, depression, and certain types of learning disabilities, can have similar symptoms.

Treating ADHD
Although there is no cure for ADHD, there are some treatments that may help to reduce symptoms and improve functioning. Today, ADHD is commonly treated with medication, education or training, therapy, or a combination of these treatments.

Medication for ADHD

Many people with ADHD find that medications reduce their negative symptoms of hyperactivity and impulsivity while helping to improve their ability to focus, work, and learn. 

There are many different types and brands of ADHD medications, and all have potential benefits and side effects. Sometimes several different medications or dosages must be tried before finding the one that works well for an individual person. Anyone taking medication(s) for ADHD must be monitored closely and carefully by their prescribing doctor.

Stimulants: The first line treatment for ADHD is the stimulant class of medications, and stimulants are the most common type of medication prescribed for ADHD. While it may seem unusual to treat someone that has a hyperactivity disorder with a stimulant, they have shown great efficacy in boosting concentration and reducing impulsivity and hyperactivity. The stimulant class of medication includes widely used drugs such as Ritalin, Adderall, and Dexedrine. Researchers believe that stimulants are effective because they increase the brain chemical dopamine, which plays an essential role in thinking and attention.

Non-Stimulants: These medications take longer than stimulants to start working, but they can also improve focus, attention, and impulsivity in a person with ADHD. A non-stimulant may be prescribed if a person had negative side effects from  a stimulant, if a stimulant was not effective, or if the combination of a non-stimulant with a stimulant increases effectiveness. Two examples of non-stimulant medications include atomoxetine and guanfacine.

Antidepressants: Although antidepressants are not approved by the U.S. Food and Drug Administration specifically for the treatment of ADHD, antidepressants are sometimes used to treat adults with ADHD. Older antidepressants are sometimes used because they affect brain chemicals dopamine and norepinephrine, just as stimulants do.

Therapy for ADHD: There are different types of therapy that have been tried for ADHD, but research shows that therapy alone may not be effective in treating ADHD symptoms. However, adding therapy to an ADHD medication treatment plan may help patients and families better cope with the daily challenges posed by ADHD.

Help for children and teens with ADHD: Parents and teachers can help children and teens with ADHD to stay organized and follow directions with tools such as keeping a routine and a daily schedule, organizing everyday items, using homework and notebook organizers, and giving praise or rewards when rules are followed.

Help for adults with ADHD: A licensed mental health provider or therapist can help an adult with ADHD learn how to organize his or her life with tools such as keeping routines and breaking down large tasks into smaller, more manageable tasks.

Children and adults with ADHD need guidance and understanding from their parents, families, and teachers to set goals for success and reach their full potential. Mental health professionals can educate the parents and family of a child or adult with ADHD about the condition and how it affects them. They can also help them develop new skills, attitudes, and ways of relating to each other.

If you are concerned about whether you or your child might have ADHD, the first step is to talk with a healthcare professional to find out if the symptoms fit the diagnosis. The diagnosis of ADHD can be made by a mental health professional, like a psychiatrist or clinical psychologist, primary care provider, or pediatrician.

For more on ADHD and other similar diagnoses, check out my book, Tales from the Couch, available on Amazon.com.

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How To Learn With ADD

How to Learn Best with ADD/ ADHD

I want to talk about learning with attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD). I have been working with patients with ADD/ ADHD for over 30 years. In that time, I have helped people pass exams of all sorts: the bar, CPA exam, medical boards, police entrance exam, lieutenant exam, marine captain exam, ACT, SAT, MCAT’s, LSAT’s, marine captain’s license, firefighter exams, pilot exams, GED’s, on and on. It’s a unique situation, because people with ADD/ ADHD have specific study methods that work, but may not be the conventional way. They have a distinct problem with concentrating while sitting. They cannot just sit there and read and incorporate the information they read, it just won’t work. They also do not do well sitting and listening, so sitting in a lecture will do little to no good. Large groups are virtually impossible. Sitting in a group of 500 people listening to a professor during a freshman English lecture is useless for someone with ADD/ ADHD, it’s a waste of time. Studying and learning may be more challenging for those with ADD/ ADHD, but it’s definitely doable, so if you have either of these diagnoses, don’t use it as an excuse! Based on my experience listening to literally thousands of patients with ADD/ ADHD, I’ve come up with 15 guidelines on study methods and the do’s and the don’t’s that will help to process, incorporate and recall information in preparation for any test.

Before I get to those, a quick note. Your diagnosis is your business, but if you do choose to inform your teacher(s) or prof(s), you may find they’re willing to help you by possibly giving you more exam time, giving you extra materials (like questions or even practice tests) or by giving you one-on-one time to guide you as to what topics or ideas are most important. This may not be possible in professional exams or standardized exams, but if it’s a grade 1 to 12 school or even a college situation, it’s very likely they’ll assist you. Often they have policies in place already, so if you do have the diagnosis, don’t be afraid to tell them and ask for help. You certainly can’t be penalized in any way for doing so. If you do feel comfortable disclosing the diagnosis, a guidance counsellor is a great place to start. Now for my guidelines.

1. Do not just sit and read, do not just sit for lectures unless they’re required, and do not just sit (get my drift?) and watch something being done and expect to learn from it the way others might. It won’t necessarily hurt you, but your time might be better spent learning in a different way. If you do go to lectures, maybe use that time to create questions on the material as the teacher or prof drones on about it….insert Charlie Brown teacher soundbite here….wahn wahn waaahhhn waahnn wahhnnn wahn…. More on questions later.

2. With ADD/ ADHD, you will learn best by using interactive methods. Tutorswork very well whether you have ADD/ ADHD or not. Group interaction works well too, so start a study group. Better yet, combine the two- start a study group and have everyone pitch in to pay a tutor to help study for exams. Working with an interactive computer program would be great, a program where it asks you a question and you choose an answer and enter your choice. Some textbooks have those types of study aids online, so check out whatever resources exist at the end of chapters in your textbook, whether it’s online or printed.

3. Never cram for a test! Study over a prolonged period- this will allow you to “sleep on it,” which will help you retain more of the material. During sleep, the brain rehashes the information you’ve learned. Reviewing it over several days will increase the odds that you will better understand the material and remember more of it. And always do a before bed blitz… Studies show that you remember more when you take 10 to 15 minutes to review material you’ve studied or learned just before you go to sleep. Obvi, don’t do all of your studying at bedtime, just do a quick review so the brain processes the information as you sleep. And be sure to catch enough shut eye. Experts say that most people need to sleep eight to nine hours a night to remember what they’ve learned, and teens need even more than that.

4. Study the material, not the clock. When you sit down to study, note the time you start, but do not study by the length of time spent studying. Instead, study by the amount of material you cover; ie decide to cover x number of chapters, and do not stop until you know that material. And while your goal is to cover x amount of material, do try to make your study sessions last as long as the time allotted for the exam. This will start habituating your mind to be active for (and be able to sit for) a 2- or 4-hour exam or whatever the case may be.

5. When you sit down and study, treat it like it is an exam, don’t get lazy and knock off early. When you sit down and study, you sit down and you rock and roll, you pretend like you are in an exam situation. If you’re not willing to sit down and put your mind in an exam situation, then studying is a waste of time. Train your mind to be in the exam. Pretend you are in the exam so that when you do get in the actual exam, you are well practiced, your body is habituated for that situation, and everything comes more easily.

5. Learn to study anywhere, anytime. You don’t know the exam situation: if the person next to you will be coughing, if the clock on the wall will be ticking, ifthere will be noise outside, if you can hear the sound of the street, if the overhead lights are buzzing, if the fan is clicking rhythmically, etc. Break up your study locations or study in different situations so that you learn to adapt. Plus, you can get superstitious if you always study in the same place…I’ve had patients tell me they can only learn in one particular place- their room, kitchen, or the library. Also, you may find that you increase your focus and motivation for studying by seeking out locations outside of your house or room, like a Starbucks. 

6. When you read questions, read very carefully! This is key. If you have study questions, read carefully to prepare yourself to do so in the actual exam, because obvi, that’s where it matters. Remember to pay very close attention to words like yes and no and phrases like the most, the least, which one is, which one is not. Also pay close attention to absolutes in questions, words like never and always. Take it from a physician who is dual board certified: critical reading of the question is the most important thing in exams. Focus! Do notread the question quickly and always read it twice to make sure you understand exactly what is being asked. If some key words in the test question are familiar from studying, you might be inclined to just skim the question when you see the words, assuming it uses those words in the same context as they were in the book or study materials. Don’t make that assumption- pay attention and read the question again, even if you’re sure you got it the first time. Maybe the question only has a minor difference, like ‘is’ instead of ‘is not.’ Sometimes your brain can trick you….and sometimes the test maker can too! 

7. Work out every day. Thirty minutes of aerobic exercise a day improves focus and executive functioning skills, especially in students with ADD/ ADHD. It doesn’t matter what you do: sit ups, pushups, squats, planks, running…do it for half an hour every day.

8. Be mindful with socialization. You can study in a work group, but as for going to parties the day before a test, that’s a negatory! Your brain will not have time to regroup before the exam. Actually, it’s better to rsvp no to all parties during the entire study period- not only do you lose that study time, but you won’t be able to redirect your thought processes back into the study mode the next day. Save the party for after the exam, when you hopefully have something to celebrate…knowing you did well! 

9. Drugs. Caffeine helps bigtime, so have coffee and tea on hand when studying and learn to love it. Caffiene and studying are like an AmEx card- you shouldn’t study without it. Other amphetamine stimulants like Adderall are very helpful. Patients I’ve placed on stimulants see a dramatic difference in their ability to study and retain information. It’s a tool for them, just like a number 2 pencil, which btw, don’t forget to have at least three sharpened number 2 pencils and a good eraser so you can fully erase mistakes. This is especially important in scantron tests! If you’re struggling in exams and school and you haven’t tried a stimulant like Adderall, maybe you should ask your physician about trying it. And on the topic of drugs, Captain Obvious says don’t drink or smoke pot because it makes your brain discombobulated for a looooong time! If you do drink and smoke pot, don’t bother wasting time studying. It would be pointless.

10. Set goals. Tell yourself ‘I will get through x amount of material today,’  ‘I will do so many questions today,’ ‘I will be able to recite so much material today.’ Set goals that challenge you, but are attainable. If you have a tutor or are in a study group, it’s much easier to stay on track and stick to goals like these, so if that’s difficult for you, consider going that route.

11. Never ‘kind of’ know something. If, after you have studied and done questions and practice tests, you can close the book and recite what you have just learned, you should be golden. If you can teach the material to a total stranger, you should be golden. Be careful testing that theory though- it would suck to miss the exam because you’re in jail.

12. Always study with a computer or an iPad next to you so that you can look things up if you don’t know the definition of a word or understand a concept. A question may hinge on the definition of a key word, and it would suck to get it wrong because you thought you knew the definition when you studied so you didn’t bother to look it up. That would be the definition of dumb.

13. Questions, questions, questions! Here it is. I’m all up in your grill with questions because they’re the best way to learn if you have ADD/ ADHD. The best way to create questions is to make a practice test. Try to predict what your teacher may ask on the exam. If they give a review in class, you definitely want to be there, because they’re not giving a review just to hear themselves talk. If they give out a study guide, know it, because they didn’t take the time to make it just for funsies. Study old quizzes, making sure you’re using the right answers, and ask classmates what they think is importantenough to be on the test. And then create a practice test. Obvi, that doesn’t mean you should only know the material you put in your practice test. If you study in a group, which you should, have each person create a practice test, and then make copies and distribute to everyone in the group for a better variety of topics. Then go over every test as a group and study those questions. The very best way to prepare for a test is to get a tutor, join a study group, and do questions. That would be the winning trifecta for exam preparation. 

14. Keep a positive attitude. If you have ADD/ ADHD, chances are you beat yourself up throughout your whole life, and people may have even put you down, saying you’re not that smart blah, blah, blah. Well, screw them. You are smart. Study and get excellent grades as a big F.U. to anyone who ever put you down. Know your stuff and stay positive.

15. You must be determined. Have a can do attitude. You must say ‘I will do this at all cost.’ Make success the only option. Yoda said it best: “No try. Do.”

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Attention Deficit Disorder and Attention Deficit Hyperactive disorder

Attention Deficit Disorder

ADD, Attention Defecit Disorder is a chronic condition marked by issues with attention. It is most often seen in childhood, but can persist into adulthood, and there are 3 million US cases per year. Due to it’s high prevalence, I want to take the opportunity to discuss the diagnosis, symptoms, and treatment of ADD.   

ADD has a sister disorder called ADHD, Attention Defecit Hyperactivity Disorder. What’s the difference between them? It’s pretty simple. ADHD includes the symptom of physical hyperactivity or excessive restlessness. That’s what the “H” is for. In ADD, the symptom of hyperactivity is absent. 

What are the hallmarks of this disorder?  Basically, it is a disorder of concentration, marked by problems concentrating and the inability to stay on task. These individuals are easily distracted and readily bored. They move from project to project without finishing and start projects without all of the appropriate tools needed to complete them. This all leaves them very anxious. In cases of ADHD, they are also impulsive, intrusive, disruptive, and hyperactive, often constantly fidgeting. 

What percent on the population are we dealing with here?  Roughly 20% of boys and 11% of girls have some type of attention deficit disorder. 

What are the causes of attention deficit disorder? While we don’t know exactly, there are several suspects. Maternal use of alcohol or cocaine while in utero is an extremely common finding. Brain infections when pregnant or during early childhood, head trauma, and any birth defects that affect child development are also suspected. Exposure to enviromental toxins and pesticides are suspect. Excessive video games alter brain chemistry, as does a diet of processed foods and sugar, and these are also suspected causes for attention deficit disorder. I would say the number one cause of ADD is most likely genetic, inherited from mother or father. 

What is the result of having attention deficit disorder? How does it affect one’s life? It results in having problems fitting into the academic world or the job world. People with attention deficit disorder don’t fit into a regimented or organized educational or work environment. They can be very intelligent and productive people, but they don’t fit into what we would consider the stereotypical or standard type of academic setting or work setting. Also, due to their impulsivity and their disorderly conduct, they can wind up getting in trouble in school and in trouble with the law. They can be unsuccessful at work, not because they aren’t smart enough, but because they cannot stay focused. In terms of lifestyle, they also have a much higher rate of obesity. This is likely due to lack of impulse control, causing them to overeat. They have problems in relationships, and their divorce rates are much higher. Their propensity toward domestic violence may also be higher. They may also be more prone to Alzheimer’s disease. Because of all of these failures and shortcomings in the stereotypical organized worlds of education and career, they have much lower self-esteem. There are studies that report that up to 52% of people with attention deficit disorder have drug or alcohol problems. 

So how can we help these people? How do we treat these illnesses? The number one treatment is behavioral training with a mental health professional. The gist of that is educating them to focus on one thing at a time. They are not able to handle instructions with multiple levels at once, but they can focus on one thing at a time and have success with that. Pharmacologically, ADD and ADHD are generally treated with amphetamine stimulants. Some antidepressantants may also benefit people with attention deficit disorder. Essentially, a combination of behavioral therapies, special education programs and medications show the most promise in the treatment of attention deficit disorder. But a diagnosis of ADD or ADHD isn’t all future doom and gloom. Eventually, people find their niche in the world and can become successful. The actor Ryan Gosling takes medication for his ADD and says that it may take him longer to read his scrips than other actors, but he manages to get the job done. Uber successful comedian Howie Mandel has successfully done just about all there is to do in Hollywood. I have met a lot of CEO’s with ADD, and they function well because they have people around them to take care of all the boring mundane tasks, giving them the chance to think freely and create business opportunities. They are creative and capable people. They are another example of why you can’t judge a book by it’s cover…you can’t assume that someone with a psych diagnosis will never make it in the world. Ask Richard Branson. I think he’s done pretty well for himself in the corporate world despite his ADD. Justin Bieber has ADHD and has managed to record a few hit songs. Olympian Michael Phelps has ADD, depression and anxiety, and that hasn’t stopped him.These are some examples of people that have adapted and overcome their diagnoses rather than be labeled by them. If you have ADD or any psych diagnosis, I’d suggest you follow their lead. 

For more patient stories, check out my book Tales from the Couch, on Amazon.com.  

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ADD / ADHD

Dr. Mark Agresti discusses the signs, symptoms and available treatments for those suffering from ADD / ADHD (Attention Deficit Hyperactivity Disorder).

Dr. Mark Agresti, West Palm Beach Drug & Alcohol Detox Specialist, Psychiatrist

Call (561) 842-9550 or email: info@206.189.200.158 Dr. Agresti today to get psychiatric help today.

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