psychiatry
Attention Deficit Hyperactivity Disorder Refresher
Thu, April 26, 2007 at 11:42PM Sometimes I get a little too serious in my entries here...
I then have to remind myself that few people really care about most of those more serious topics. Such ideas don't usually lead to that warm and secure feeling inside that we all seek. Much of the time reality does tend to suck. And then you die. At least once a week I find myself asking why I do the work I do when so many of the people I see seem to suffer endlessly. Without fail, someone will then come in who has responded exceptionally well to treatment to the point their life seems to be transforming. Instantly I'm distracted from thoughts of those who may seem to be in a perpetual state of hopelessness and realize that my intervention has contributed to some degree of happiness for a person in need. It then begins to feels all worthwhile again.
I find treating pediatric or adolescent patients to be most rewarding because they possess so much potential. These youngsters are in the process of being molded. I find it so exciting to work with young minds while they are still impressionable. When I first see them they are usually in trouble with parents or teachers for some type of behavioral problem. This means they are more likely to listen to some of what I say to them because of not wanting to get into more trouble. During these encounters I find it easy to venture in my mind back when I was their age and probably getting into the same predictaments. As a child, I struggled with traits of ADHD but fortunately was bright enough to compensate academically. Often I wonder how I survived college and medical school and have eventually reached the conclusion that I was just too darn stubborn to allow myself to fail. Stubborness is a useful ADHD trait if one can make it work for them in a positive manner. My motivation usually came from being told I could not do something for which my reply would always be "I'll show you." This was my biggest secret to success. Also at times the stubborness worked against me. It can be a two way street. Many successful people in entertainment, sports, business, politics, and professionals have learned to make their ADHD traits work for them in a productive way. The disorder doesn't have to be a liability. The key is learning to control the condition instead of being controlled by it. Dr. Ed Hallowell, author of "Driven from Distraction" provides very insightful and useful reading with a focus on the positives of ADHD.
ADHD is transmitted genetically at close to a 50% rate. Many adults have failed to be diagnosed and many end up self medicating with alcohol, pot, or other drugs. Symptoms include: procrastination, forgetfulness, tardiness, failing to finish projects, daydreaming, irritibiliy, rapid mood shifts, not listening or comprehending well, relationship problems, scattered thoughts, underachieving. Adults are less likely to have physial hyperactivity than kids but the thinking is usually not well coordinated with behaviors. Kids are usually unable to stay seated, restless, fidgety, intrusive, blurts out answers, constantly talking, distracted, unable to stay focused, staring into space, hard to get to sleep, aggressive in play. Girls usually show a tendency to be less hyperactive than boys.
Some teachers are very skilled at identifying and referring the child for treatment. Some teachers and parents can worsen the condition by excessive criticism, punishment or blaming the child for behavior that they are incapable of controlling without the proper help. In my day there was a stick known as a paddle. From a behavioral standpoint it often provided a positive incentive but there likely were times the effect may have been detrimental for the psyche of the child/student. I've heard people sometimes say that they don't believe in ADHD or Psychiatry. Neither are a religion and it is quite likely that their belief system directly contributes to exacerbation of their child's condition. Not treating a child in many cases places them at much greater risk than the minimal risk of using a stimulant medication. In the untreated state a child is at greater risk for injury in an accident or impulsive act. Their self esteem is at greater risk due to underachieving or being labeled as a trouble maker. They are more likely to drop out of school or become pregnant or addicted to a drug, tobacco, or abuse alcohol.
It should be emphasized that ADHD is not a mental illness but a specific neurological disorder that responds to treatment over 80% of the time. If not treated it often leads to mental problems such as anxiety and depressive disorders. Untreated ADHD makes it much harder to cope with the ordinary stressors of life. Many parents refuse to accept the diagnosis of ADHD in their child usually because it requires the parent to admit to the possibility that they themselves might have a problem. Usually they do, but it is a problem with a high probability of succesful treatment if they are willing to comply.
The primary treatments available today for ADHD include a variety of preparations of methylphenidate (Ritalin), Amphetamine Salts (Adderall), and Dexadrine. Alternatives include Strattera, Provigil, Wellbutrin, and other antidepressants sometimes help. There are several drugs in the pipeline and also a Ritalin patch now available. Medications such as Clonidine and Tenex can help with the hyperactivity in kids and are relatively safe and usually well tolerated. There has even been evidence to suggest a benfit to the use of the omega 3 fatty acids of fish oil and dietary supplimentation with folic acid and vitamin b-12. The future looks very exciting for the treatment of ADHD in children and adults.
Reader Comments (5)
hi dig your blog. I found it via a banner on blog explosion did feedburner provide your the banner? please let me know :)
Thank you for the update on ADHD. I would like to provide the link to this entry on my blog if you don't mind. BTW, I love this new template for your blog. As a person dealing with ADHD and chronic depression, let me say that your blog gives me hope that I may someday return to medicine and complete my psychiatry training.
This is very helpful information, cogently stated - especially including your personal experience. Thank you.
"ADHD is not a mental illness but a specific neurological disorder"
this statement makes no sense. ALL mental illness is a neurological disorder in the sense that ones brains are made of neurons and when those neurons are not working well it manifests as behavioural, emotional or cognitive problems.
if you say ADHD is not mental illness but neurological then schizophrenia, BPAD, depression, OCD, panic attacks, PTSD are also not mental illnesses.
and you cannot argue that there are specific abnormalities known in ADHD that differentiate it. there are plenty of theories about ADHD and treatments that work, but this is the same as any other mental illness. it is as much a mental illness as any other, and as much a neurological condition too, as all mental illness is.
With all due respect, this information is from the experts who diagnose and treat ADHD not my opinion. Mental illness is broken down into psychotic disorders and neuroses. Schizophrenia is a psychotic disorder whereas OCD is a neurosis. ADHD is believed to be a disorder in the wiring of the brain causing a deficit in dopamine in the prefrontal cortex. Psychology is not a factor in this basic deficit. The neurons work fine but are lacking the amounts of dopamine required. This is treated medically just as diabetes and hypertension or asthma. Based on your logic a stroke, Alzheimers, and Parkinson's would be classified as mental illnesses. They are neurological diseases, not mental illnesses. ADHD is more related to these disorders than to schizophrenia or other psychiatric illnesses. If you need more clarity I will be happy to provide references.