Attention Deficit Hyperactivity Disorder Refresher

 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.

Mind of a Killer

   The tragic shooting spree at Virginia Tech on Monday was shocking to all. . . 

But psychiatrists in particular are likely breathing a sigh of relief along with the deep sorrow felt across the nation and world. In our worst nightmares, mass murder is probably the one thing we dread and fear more than a patient we are treating committing suicide. No treating psychiatrist wants to be associated with being the one who could have prevented such an occurence. We know that such behavior cannot be predicted with any reliable degree of certainty and that a ball park estimate of risk is about the best that can be expected in most cases.

The notorious case of the Law student in Chapel Hill, NC several years ago is a constant reminder of the unrealistic expectations a psychiatrist can face when the worst does happen. This hits home because of actually knowing the doctor who was dragged through the courts for just being associated with the psychotic gunman who randomly shot and killed innocent bystanders in a nationally covered story. The gunman voluntarily dropped out of treatment several months before committing the acts and the doctor was found liable by a jury who awarded the shooter's family $500, 000. To this day, that verdict makes no sense to me.

I listened to the interview of a Forensic Psychiatrist on the news last night and his expert opinion that majority of people committing such acts, as the student gunman at Virginia Tech, do not have a diagnosable mental illness. Apparently, it is really their close association with normality that provides the advantage to premeditate and execute succesfully such haneous crimes. People with severe mental illness usually aren't the best at organization and are more likely to act thoughtlessly or impulsively due to an immediate emotional overload. Mass murderers Are more likely to be more capable of calculating their acts and often belong to the category of Personality Disorder or what is known to mental health professionals as Axis 2 Disorders. Such individuals are quite rigid in character and idealistic, often frozen emotionally in some pre-adolescent emotional stage of development. They are more likely to be highly sensitive to criticism or rejection, sociopathic, narcissistic, or dramatic in their encounters with other individuals in society. They can be wounded deeply by treatments from others that might be overlooked by one with healthy coping mechanisms. Sometimes these emotional wounds can fester and ignite responses that are markedly disproportionate to the originally perceived offenses. They may keep their own score card which others are often unaware of. They can become walking time bombs.

On the grandest scale, when they decide they can no longer cope with the stresses of their situation and find themselves feeling boxed in they may decide to go out in blazes and take as many as possible with them. People with most Axis 1 mental illnesses as the primary diagnosis usually lack such drama and grandiosity unless they are bipolar and in a floridly manic or psychotic state or under the influence of a mind altering substance. When they do choose suicide as an escape the inclusion of multiple homicide is rare. They really just want the pain to end. Those of an Axis 2 flavor want to make as many as possible pay for their psychic pain and suffering and they wish to be remembered for doing something no one else has done and reach a state of immortality. They must have the intelligence and be able to plan and organize well. Usually it is alcohol or a psychoactive substance that lights the fuse and there is no turning back at this point.

The issue of gun control must be addressed. There are points on both sides of the argument but the current laws are obviously not working. Such killings as the recent massacre could become a trend. There are enough weapons in this country for every citizen to have five guns. The balancing act that exists is how to keep the guns away from the bad guys and avoid violating the perceived right to bear arms. Is this really possible? The alternative is to arm everyone and return to the days of the wild, wild west and vigilante justice. Personally, I don't care for guns and do not own one but if someone is coming to kill me I would love to have one if I can't depend on the police to protect me. The invention of the taser and other less lethal weapons than guns has probably saved many lives. At the very least, I think the gun laws have to be more strict than those of states like Virginia where all thats required to buy a pistol and 50 rounds of amo is citizenship and 2 forms of identification. What benefit is there to having assault rifles available to the general public? I see several people a month that probably just need one more thing to happen in their lives to push them to the point that suicide/homicide starts to  become a more attractive option. A bottle of liquor and easy access to a gun is not what they need. We should review the models of other free societies that have a fraction of the gun crimes and see what can be learned. I think this will become a hot political topic in the months to come.

Update on Sun, April 22, 2007 at 04:48PM by HEADoc

COMMENT FROM READER  SLC94@aol.com

I think that the fact that he spent time on a psych ward several months before the shooting could be a contributing factor to his break from reality.  People underestimate what this experience may have on a person's psyche.  I think that it must be mandatory that he continue to see a mental health professional after going through this experience.  He was not seeing anyone and this seems rather odd to me.  Why didn't his family have a closer eye on him?  I am baffled by this.  Plus, I think people underestimate the power of these psych drugs and the negative effects they may have.  I think we as a nation need to take a closer look at these issues.
Comment from slc94 - 4/22/07 2:58 AM

REPLY from HEADoc

The Public mental health system has become a joke. You are right that it does more harm than good in many cases but it is the fault of the irresponsible idiots voted into office that have no concept of what is needed and are too arrogant to ask someone that might know. If this person were in my state and were commited to the state hospital he could have just denied everything and would have been home in less than 72 hours. Had he followed up with the mental health center he would have been told he could see a doctor in 3 to 4 months. It would have stopped nothing. The truth is that the goverment is doing all it can to allow a merger of mental health and the jail and prison system. The goal is to not have mental health care financed by the federal government. In my state the focus is on closing all facilities. The plan has gone pretty much like the war in Iraq is going. Actually we have been quite fortunate not to have had a tragedy before Virginia Tech. This is a wake up call. There are thousands of Cho's walking around daily and have been for some time. This is not the last time we will see such a crime. I have grown to realize that the government has their own agenda and it is not saving lives. If they had their way mental health care would be completely eliminated for the citizens most in need. Systematically, this is already occuring. I speak from fact not fiction.

Mental Health Care providers are among the most dedicated professionals in the country but have an impossible job due to being constantly undermined by the lawmakers and bean counters. And it is not because of lack of money. We have already spent a trillion dollars in Iraq for an unecessary war. The general public is totally uninformed of the real truth about matters and don't seem to care until there is a crisis. The cocaine and heroin crisis hasn't even been mentioned. Prescription medication effects are negligible. It's not complying with taking them that is dangerous. My question is what do you get when you mix an emotionally troubled individual with cheap cocaine and easy access hand guns?

Imus : Scapegoat of the Week

Usually not much into commenting on pop culture issues but the Imus saga seems worthwhile to explore a little. . .

The perspective offered is from that of a mental health professional who happens to be of color. One thing has nothing to do with the other but chances are this perspective is not commonly heard. I think what happened can turn out to have a net positive effect. I think the punishment was a bit harsh and abrupt but also understand that he should have been aware of the consequences of crossing the line from the past mistakes of others in the business. A patient told me that Snoop Dogg had commented about how it was acceptable for him to use similar descriptions repeatedly in the lyrics of his raps but did offer some criticism of Imus' use of such language. I couldn't help but laugh. I have never been a fan of rap music but have dug the charisma of a few artists. It has been my opinion that keeping it real has often been a big pile of b.s. Art can imitate life only so much then it becomes time for art to take some responsibility and accountability and contribute to a positive vision to help lead the people out of the Egypt of ignorance and despair. It seems that many artists don't realize the overall negative impact that some of their creations play. It's referred to as selling out when an artist makes an attempt to blend in the mainstream. I think it should be called maturity and growth when the individual truly has the talent to pull it off. Many rappers have functioned to illuminate problems in society but seem to have eventually offered either nothing or have contributed to worsening of the situation.

Nothing touches the mind and the soul the way music does. I still remember tunes and lyrics from early childhood. I'm really bothered when I see an artist with so much influence over masses of people and nothing is done to try and empower those people through their work. Such an artist is believed to only be concerned about their own interests no matter who is hurt in the process. They are often pimped by the media moguls and those of considerable wealth who really run the show. I believe this to be a major source of the black stereotype of being stellar athletes and entertainers but not good for much else. Reality is far from that stereotype as evidenced by myself and millions others who never get a chance to be seen on the televisions and magazine covers across America. To many we don't really exist despite achievement by African Americans in every imaginable area. When entertainers and athletes are the main positive characters piped into the homes across the globe and the negative characters consist of pimps, hoes, or criminals, there is no wonder that a negative image exists in the minds of most of the majority population.

Much of the non-news entertainment media has a double standard of what is acceptable. There is no line for black comedians, but in their favor, it's understood they are just comedians. I think they too have an obligation to be socially responsible. Often they are not during standup or in films. Many whites become confused when observing some of the things black entertainers get away with on stage. Most black comics that make it big do tend to mellow out a bit as their careers grow. This may represent a social and personal conscience at work. Still, I think over the past several years the line has become somewhat blurred which has resulted in the Freudian slips of those such as Michael Richardson and Imus. I sincerely believe that harm was not the motive of their gaffes. Psychologically, it must be considered that all human beings harbor certain prejudices about those different from themselves. It is a fact. These prejudices usually tend to diminish once the individual has the experience of interacting and learning about those who are different. Most normal individuals eventually are able to separate fact from fiction in regards to their ideas about others. A person described as a racist differs only in the reality of being in the majority culture which can posses the power to negatively influence the individual he holds the specific prejudicial thoughts against. So yes. black people are at least as prejudiced in thought as whites but in the present state of society it is moot for a black to be considered a racist, except under highly specific circumstances. This is the basis of the double standard that exists. Socially we are still evolving and from time to time a phase of regurgitation of stuff that is tainted occurs. Thank God for Comedians such as Pryor, Carlin, Murphy, Rock, Chappelle who allow us to laugh as we vomit. We cannot avoid or hide from the issues they have addressed from time to time. I think their talent has made more of a positive impact on society than most gangsta rappers. 

Back to Imus' slip up... Let's face the reality that black personalities seem to be able to say what they choose over the airways with little repercussion, mainly because few in the majority population seem to really care about what their particular topic is. Many white personalities have felt forced to suppress their darkest thoughts on the air or in public. I'm pretty sure they probably let it flow in the privacy of their own home or social circle. The average mind lacks the capacity to filter 100% of the thoughts 100% of the time before they are sent to the speech apparatus. So if one really thinks and believes certain things in private, sooner or later something will accidentally escape publicly. It never fails. What's done in the dark will eventually come to light. I feel mostly pity for Imus since he has no direct impact on me one way or the other. He offered his apology and actually a public service was done by allowing the Rutgers players to articulate their thoughts and feelings about the situation before the public and erase any doubt about their intellectual abilities as well as their basketball talent.

Imus has been the scapegoat of the month, but we as a nation need to stop sweeping racist propaganda and ideology under the rug and address the issue once and for all publicly. Our nation is too great to continue this and other hypocrisies. We have lost enough credibility throughout the world through the past 6 years of repeated episodes of dishonesty from those in high places. We should bring freedom to Americans in need at home before proclaiming the liberation of other nations.