Tag Archives: ADHD

Side effects to watch for with ADHD medication

The Centers for Disease Control estimates that about 11  percent of children (ages 4-17) have been diagnosed with ADHD and about 6 percent are taking medication for the disorder. The National Institute of Mental Health estimates about 4 percent of adults have ADHD.

With so many people in the U.S. being treated for Attention-Deficit/Hyperactivity Disorder — we’re talking tens of millions — it’s good to know potential side effects from common medications.

The usual prescription for ADHD is either a stimulating antidepressant, like Strattera or Wellbutrin, or a more powerful stimulant, like Ritalin or Adderall. These stimulants work in the brain’s prefrontal cortex, the region associated with attention, decision making and personality. They increase the levels of two chemical messengers: dopamine and norepinephrine. Dopamine is thought to act in memory formation and addictive behaviors, while norepinephrine plays a role in attentiveness and arousal.

With stimulants, common side effects include nervousness, agitation, loss of appetite, weight loss, increased heart rate, dizziness, etc. More concerning to me is a risk for schizophrenia-like symptoms including hearing voices, paranoia, and mania. These side effects occur in about 1 in 1,000 people taking the more powerful stimulants.

It’s important that when a health care provider considers prescribing stimulants to a patient with ADHD, he or she evaluates that patient for psychiatric risks, including a family history of mental health problems. If the patient begins taking the stimulants, care providers and family members should be vigilant about detecting psychiatric side effects.

ADHD medication can do a lot of good, but it should be used with care.

Satu Woodland is owner and clinician of Mental Health Solutions, an integrative mental health practice located at Bown Crossing in Boise, Idaho. She sees children, adolescents, and adults. Information in this blog is not intended as medical advice. Please consult your health care provider about decisions regarding your health.

Family stressors tied to ADHD

A link I’ve long suspected has now been confirmed by scientists: Children who come from homes with troubling conditions are more likely to have ADHD than their peers from non-troubled homes.

The parent survey analysis showed ADHD has the strongest connection with economic hardship, divorce, familial mental illness, neighborhood violence, and familial incarceration. More severe cases of ADHD were tied most strongly with economic hardship and familial mental illness.

Children who deal with situations like these can develop toxic levels of stress, which can impair their brain development, behavior, and overall physical and mental health.

This is another reason it’s so important to look at a complete picture when it comes to mental health. For someone dealing with stressors at home as well as ADHD, it would be easy to confuse responses to stress with ADHD symptoms. We need to be sure we’re treating the symptoms from the most informed perspective about where they’re coming from.

Your child’s general practitioner may not know to ask these questions when a child shows signs of ADHD. Make sure you’re involving a specialist when it comes to helping your child with his or her mental health.

Satu Woodland is owner and clinician of Mental Health Solutions, an integrative mental health practice located at Bown Crossing in Boise, Idaho. She sees children, adolescents, and adults.

 

Critical parenting tied to persistent ADHD

I read an interesting study this week that showed a link between parental criticism and persistent ADHD.

It’s common for ADHD symptoms to decrease as children get older. That’s not true for all cases, though, and an important question for those developing treatment strategies and medications for ADHD is: What’s the difference?

This study identifies one difference. The researchers examined over 500 children–some with the attention disorder and some without–and their families for three years. They asked parents on two occasions to talk about their relationship with their child uninterrupted for five minutes.

In those families where parents used harsh, negative language when talking about the child, the child failed to show the usual improvement in ADHD symptoms over the three year period.

As with all studies, saying the connection shows a cause would be inaccurate. All they know right now is that there’s a link between parental criticism and persistent ADHD.

Here’s what one of the researchers says:

“We cannot say, from our data, that criticism is the cause of the sustained symptoms. Interventions to reduce parental criticism could lead to a reduction in ADHD symptoms, but other efforts to improve the severe symptoms of children with ADHD could also lead to a reduction in parental criticism, creating greater well-being in the family over time.”

ADHD is hard on families.  That’s one reason I recommend involving the whole family in therapy for this and many other disorders.

Go here to read more about the study and here to read more about ADHD.

Satu Woodland is owner and clinician of Mental Health Solutions, an integrative mental health practice located at Bown Crossing in Boise, Idaho. She sees children, adolescents, and adults.

Basic things to know about ADHD

What is ADHD?

ADHD is a term that’s thrown around so frequently these days, we all assume we know what it means. Used to apply to everyone from a kid who misbehaves in school to an adult who has trouble focusing on a single TV or computer screen at a time, ADHD is actually a clinical diagnosis. Learning more about what ADHD is – and isn’t – can help you determine if you or someone you love warrants further testing

ADHD stands for “attention deficit-hyperactivity disorder.” In common parlance, it’s used interchangeably with ADD, which stands for “attention deficit disorder.” However, this term refers to cases where there’s attention deficit, but no hyperactivity involved.
From a layperson’s point of view, ADHD means the person – often a child — has problems concentrating and paying attention.

Of course, that can be applied to pretty much any child over the course of a typical day. What sets people with ADHD apart is that the area of the brain responsible for clarity, mental focus and activity is actually wired differently. What that means is that even when you try to “settle down,” your mind just doesn’t want to comply. You can tell yourself to relax, focus, and pay attention, but you just can’t make your mind and body comply.

So from an outsider’s perspective, how do you tell if your child is just suffering from normal “wigglies,” or really has ADHD? Let’s take a look more closely.

Signs and Symptoms of ADHD

There are three main components of ADHD: hyperactivity, inattention and impulsivity. Each has similar symptoms but they can be distinguished enough to determine if your child has one, two or all of the components.

Hyperactivity
Signs of hyperactivity include:
• difficulty sitting still, frequent fidgeting and squirming uncontrollably
• the inability to stay seated, even when they’re instructed to stay still
• inappropriate behavior like climbing or playing at inappropriate times, or on inappropriate objects like chairs or desks
• problems playing quietly when requested
• incessant talking even when instructed to be quiet

Inattention
Signs of inattention include:
• trouble staying on task for even short periods of time
• lack of attention when you are speaking to them
• issues with staying organized at school, work and home
• forgetfulness regarding assignments, requests, chores, homework, etc.
• easy distractability when performing a task

Impulsivity
Signs of impulsivity include:
• difficulty waiting in line
• blurting out of answers in class or in meetings even when not called on
• constant interruption of conversations

If you or your child has exhibited any of these signs, the next step is testing. A professional assessment can give you more insight into the condition, with regards to possible treatment and management.

The role of apathy in the success of weight loss programs

Obesity is sadly at epidemic proportions. Most of us  are very aware of the devastating health consequences of obesity: diabetes and other metabolic syndromes, heart disease, stroke, even Cancer.  So many are trying to fight the battle of the budge whether it be Weight Watchers, Jenny Craig, Nutrisystem, Atkins and others. There is numerous studies identifying the pros and cons of these programs.
This month I read a very interesting article  in the journal of “Diabetes, Obesity and Metabolism” (December)  This article reported a very intriguing study not normally looked at in weight loss studies. The study looked at how different weight loss programs effected weight loss success. There were three groups. (1) standard nutrition counseling; or (2) the Department of Veterans Affairs (VA) weight loss program called “MOVE” ;, or (3) methylphenidate treatment plus the MOVE program together. The intervention was for 6 months (26 weeks). The last group targeted decreasing apathy. They did this by administering a medication that decreased apathy (Methylphenidate. ) The results showed all groups to lose weight but it was observed that those in the group that targeted the symptom of apathy lost the most weight. This is no surprise to me.
In my practice I see many people who present with the symptom of apathy, a state of being where this a lack of interest or caring in the things around them. Often a patient will have no motivation or energy to eat healthy, to exercise, to address a health problem or do those things that will help them feel better or be in a healthier state. Many of these patients are depressed but others have anxiety, psychotic illness or sometimes ADHD. Interestingly, I will notice after treatment which may include Cognitive Behavivoral Therapy, nutritional supplements, goal setting, and for some, the use of medication that has an added effect in decreasing apathy, that many report  they lose weight.  They notice a higher engagement in healthy habits that wasn’t there before. They may notice less binge behavior.

While I don’t advocate the use of medication for everyone,  for some people with diagnosable mental health conditions medication may be quite helpful in losing or preventing weight gain through the mechnism of decreasing apathy.  Psychotherapy, particularly CBT, is also very useful in helping with weight issues. Anything that will help a person be more mentally healthy I believe will contribute to healthy weight.

Now, I know it is the holiday season, but please do not pass the eggnog!

Is caffeine good or bad for mental health?

There have been numerous articles extolling both the benefits and harmfulness of caffeine. Less often has there been research on the effects on mental health. What’s my opinion? I advise caution in its usage.

There has been insufficient studies showing any benefit of caffeine on mental health. A few studies have suggested caffeine has a positive effective on depression and ADHD. This may due to caffeine increasing alertness, attention and cognitive functioning and by possibly elevating mood. There is also preliminary evidence of caffeine benefiting some people struggling with Obsessive Compulsive Disorder which I thought was interesting because OCD is a subset of an anxiety disorder and my experience has seen caffeine making anxiety worse. Neveretheless, the research is compelling.

But do the benefits outweigh the negative side effects? We know that caffeine can increase heart palpitations and contribute to stomach problems such as Gerd. These are annoying troublesome physical side effects. What do we know about its mental health downside? We do know that caffeine is addicting and may encourage other types of addictions like cigarette smoking. We also know that caffeine in large amounts can bring out psychosis and manic behavior as well as exascerbate general anxious states, panic disorder or social anxiety disorder.

My advice is to keep caffeine to a minimum. If you struggle with Depression, OCD or ADHD, see your primary care mental health provider to investigate safer, healthier treatment for your mental health conditions. There are other things less harmful and that can do the job more effectively than caffeine.

Gender-neutral parenting ideas don’t match brain science

Attention parents out there! Have you noticed that your children from the very earliest ages display male or female type of behavior no matter how hard you try to “unbias” them and give them the full spectrum of experiences of cars and balls, baby dolls and barbies? As a mother of five I remember a particular daughter from babyhood who only liked frilly pink and purple dresses and baby dolls but never pants, cars and balls.  I deliberately tried to get her to wear blue clothing as I was never dressed in pink as a child and was never attracted to that ultra-feminine frilly look. I also never liked sports as a child and tried to introduce her to something I never had like soccer and soft ball with the hope of making her a more-rounded individual. No such luck! She hated sports, she hated pants, desired only to wear pink and purple with frills, and played dolls and barbies having no interest in balls or cars. She was so rigid in her ways that she often drove me to the brink of parental craziness!

Yesterday, there was an article in my local Bend, Oregon newspaper about gender neutral parenting being on the rise. This is really concerning to me with my personal and professional experience and what I know about brain science. I believe while it sounds like a good idea in reality is harmful to our kids. The article quoted a person in a Social Work program who stated that sex was determined at birth and that gender is socially learned. This is a politically correct philosophy but it doesn’t match up with current brain science. Boys and girls brains are different and are used differently by each sex. There is a learning difference that  isn’t recognized in a majority of education curriculum. This is why I believe that we have many more diagnosed ADHD boys out there. Teachers aren’t engaging them in the way they need to be engaged and the boys are bored, restless, distracted, even physically aggressive. I am a professional that works regularly with ADHD kids and their families. I prescribe medication often per parent request which is sometimes unfortunate as we really don’t know the long term effects of stimulant medication. I feel the problem needs to be partly remedied in teaching methods that recognize sex differences and not one size fits all. Boys learn by games, challenge even competition. That has been largely removed from school with a preference of touchy feely types of teaching which works great with girls but not boys. Until our school’s teaching methods match up to current brain science, I am afraid our children will not learn up to their full potential.

Stimulants not always the answer for Attentive Deficit Hyperactivity Disorder

In my practice, I’m amazed about how many people come to me and have taken some test online and have self-diagnosed themselves with ADHD or ADD and want me to give them stimulants. It happens every week. I also don’t know how many times I’ve had to tell these same people that stimulants may not be the answer to their problems and can even make their mental health symptoms worse! Let me give you a case in point of when stimulants may have done more harm than good.

Larry, (not his real name) is a 53 year old male who reports that he has taken Adderall or the equivalent for 30 years. He reports it makes him organized. It makes him be able to focus and concentrate and complete tasks. I take careful note but also observe that this same guy is very rigid, angry and irritable during our visit. He has a history of attempted suicide and has been hospitalized several times. He also tries to hide the fact that he lived in a reclusive situation away from civilization for years and has been unable to work for authority figures. He also reports he is estranged from friends and family.

Yes, it is true that stimulants help many people with focus and concentration. It is also the fact that ADHD is not the only condition that makes a person disorganized, unfocused and unable to complete tasks. For instance the guy above ended up being diagnosed with Schizophrenia. Other conditions like Bipolar Disorder, Depression, anxiety disorders and Thyroid Disorders can look like ADHD. Giving the above patient stimulants can bring out his rigidness, his anger and irritability and even psychotic symptoms. If one has tendencies toward obsessive compulsive disorder it would be especially important to avoid taking stimulants. Stimulants can make the OCD worse. A better way to go might be to effectively treat the OCD symptoms and the patient may find that their ADHD like symptoms greatly improve.

Sadly, years of stimulant misuse for the above patient made him so rigid in his expectations that he was psychologically unable to consider other possibilities for his problems. This is why it is so important that when suffering from ADHD like symptoms that a specialist who works regularly with the various mental illnesses be called upon to do the initial evaluation. It can potentially prevent years of problems and help a person become quickly more functional to reach his goals. I wish this guy could have been spared all the pain he went through! Can you imagine the implications for posterity and other family members?

Hoarding Disorder: A subtype of OCD or ADHD?

Most of us probably know someone who has issues with hoarding, whether it be our great aunt who saves newspapers and cannot throw any away because she plans on one day reading them all, or a neighbor who has 25 old cars on his property that haven’t been touched in years.   Hoarding can often be a debilitating condition that is hard to cure.  Hoarding is defined as the acquisition of and failure to discard large volumes of possessions, resulting in clutter that precludes normal use of living spaces.  Yes, you may  have seen television shows that devote their entire existence to our voyeuristic tendencies of peering into the households and lifestyles of mentally ill individuals with hoarding disorder.

Up until recent years, I have largely believed that hoarding is a subtype of obsessive compulsive disorder (or OCD).  That is what I was taught in graduate school, although I’ve noticed that over the years my patients haven’t necessarily met the criteria of someone who has OCD. Maybe sometimes, but not always. Alas, there is a recent study that casts further light on the difficulties of hoarding disorder.

In the December 2010 issue of the Behaviour Research and Therapy Journal appears a study that examines the core features of hoarding which include clutter, difficulty discarding and acquiring to decide whether hoarding is more like OCD or attention deficit hyperactivity disorder (ADHD).  Participants underwent careful diagnostic interviewing and completed questionnaires that measured features of hoarding, OCD symtoms, negative affect (or mood) and the inattentive and hyperactive/impulsive symptoms of ADHD.  What they found is that OCD symptoms did not significantly predict any of the core features of hoarding disorder. Instead what they found was the inattentive (but not hyperactive or impulsive) symptoms of ADHD significantly predicted the severity of clutter, difficulty discarding and acquiring.

I find this information very informative and is helping me reformulate my ideas and treatment plan for the problems related to hoarding disorder.

Differentiating Bipolar Disorder from ADHD in children

There is a perception that ADHD is an over diagnosed condition in children. There have been studies over the years that have challenged that perception, even suggesting that ADHD is under diagnosed. At least one study that I know of reports that 75 % of the prison population meets criteria of ADHD. I would venture to believe that many in prison have never been properly identified or treated. I can’t help but wonder whether we could have changed the course of events for these prisoners had they been properly diagnosed and treated as children before they dropped out of school and turned to crime believing they were dumb and defective with few options.

One of the problems in diagnosing children is that sometimes ADHD is confused with bipolar disorder. There is a lot of overlap between these two brain diseases. There is an interesting study in the Journal of Affective Diseases this month that tries to determine the differences between these two diseases and the accuracy of The CBCL pediatric bipolar profile as a diagnostic measure. It found that children with bipolar disorder were verbally aggressive and argumentative, who respond with anger when frustrated. Children diagnosed with bipolar disorder and ADHD exhibited significant levels of impulsive behavior and attention problems, but youngsters with bipolar disorder also exhibited significant levels of aggressive behavior and dysphoric mood. Finally, the study found that the CBCL pediatric bipolar disorder profile did not accurately identify youngsters who were diagnosed with bipolar disorder.
So, although the news often reports that ADHD has sky rocketed in frequency in recent years, I suspect that some of those cases may very well be undiagnosed bipolar disorder. It is important to know the difference and to be aware that although certain symptoms of bipolar disorder may very well get better with some types of ADHD medications other symptoms can surely get worse. This is why it is so very important that a specialist in the field who daily works with these two types of conditions be the one to diagnose and treat your child. It can make all the difference in the world in the success of your child’s future.