Tag Archives: stimulants

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.

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?

ADHD and Dr. Amen Contributions

I am a big fan of Dr. Amen. I find his neuroimaging work to be highly fascinating. Not everyone agrees and some question his science. You may have seen some of his programs on the brain on PBS over the last few years.   I have been using Dr. Amen’s mental health questionnaires on my patients for years. I especially love his ADHD assessments. He identifies at least 6 different types of ADHD that have to be treated differently from each other to get the best results. I have been using them with my patients for the last number of years and have seen some highly effective results from the treatments advocated. Some types of ADHD may necessitate an antidepressant. Other types may be helped best by stimulants. Others may need a mood stabilizer. Some types need a combination of a few types of medications. There are also some supplements that can be effective in its treatment. Of course, as shown last month, there are other psychosocial types of treatment that can help including Cognitive Behavioral Therapy.
 
It is exciting to see all the advancements that are being made with understanding ADHD and its treatment. One day there may even be gene therapy to prevent the problem in the first place. Until then, we can use all the best of what science has to offer us.