Attention Deficit Hyperactivity Disorder

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A discussion about ADHD...
 


The first thing to mention is that Attention Deficit Hyperactivity Disorder (ADHD) is one of the more under-diagnosed conditions out there for adults.   Unless you were a hyperactive child, disrupting your class, then the diagnosis is likely to have been missed.  It is common for the condition to be overlooked by psychiatrists as well.

One reason that the diagnosis is often missed… Adults with ADHD generally have coping strategies and systems in place as a work-around for their symptoms.  An example is an elaborate to-do list, or a ton of reminders in their phone, or a very strong habit of placing items always in certain places, else they are lost (example would be car keys in an exact spot, always).   Those measures tend to help some, but they also tend to mask the symptoms, and make it harder to identify those who have ADHD.

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'Adults with ADHD generally have coping strategies and systems in place as a work-around for their symptoms.  Those measures tend to mask the symptoms'.

Another reason the diagnosis is often missed… Physicians are hesitant to give the appropriate medications due to concerns about the potential for abuse.  Stimulants will help anyone to slight degree during a finals week, and if someone is a heavy abuser of illicit drugs, then they are likely to abuse the stimulant medication for ADHD as well. 

That said, those who truly need the medication…  They are very unlikely to ever abuse it.  For one, stimulant medication calms them down, it doesn’t produce a high, and the benefit is too powerful and important.  They will not casually misuse the medication.

 

ADHD Symptoms

Attention Deficit Hyperactivity Disorder (ADHD) has two subtypes, these are ‘predominately hyperactive & impulsive’, and ‘predominantly inattentive’). In addition, some patients have multiple symptoms from both categories, and are referred to as a ‘combined type’.

Hyperactivity & Impulsivity Symptoms: 

·      Feeling restless

·      Being talkative

·      Tending to be constantly active

·      Tendency to chose active jobs, and be ‘on the go’

·      Being quick to end relationships or quick to end jobs

·      Overreacting to frustrations

·      Driving violations
 

Inattentive Symptoms:

·      Procrastination

·      Difficulty making decisions

·      Poor time management skills

·      Difficulty staying organized

·      Not paying attention to detail, or not listening well

·      Difficulty sustaining attention in tasks or a tendency to avoid tasks that require attention to be maintained.

·      Losing items often, or being forgetful


Not to say someone with ADHD cannot focus, they actually at times can hyper-focus on something interesting to them, whether it be a video game, or a hobby, or even a certain class subject.  Sometimes patients with ADHD have a history of making A’s in the interesting classes, but barely passing the rest.  

 

Learning Style

For one, they tend to be best at visual learning and hands-on learning, but their ability to learn just using verbal information is rather poor.  An example of verbal learning would be a teacher talking to the class, without giving any visual information or organization.

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'For those with ADHD, it is often very helpful to have information presented visually.  Without visual aids, learning is much more difficult.'

 

Chronic Anxiety

Another trend generally found in those with ADHD as an adult….  They tend to have chronic anxiety.  Sometimes it is necessary to directly treat their anxiety with medications targeted to that issue.  That said, the stimulant medication treatment for ADHD (e.g. Adderall, Ritalin, Vyvance) often has a calming effect for those patients.  Therefore, the decision to treat anxiety is typically made further down the treatment course.

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'Adults with ADHD also tend to have chronic anxiety.'

 

Benefits of Treatment

ADHD left untreated steals an education level.   For example, if someone with ADHD has the intelligence to finish college, but the diagnosis wasn’t ever made, then typically the best they can hope for is finishing high school.   The same is true if the person had the intelligence necessary for law school or medical school.  Without treatment the best they can hope for is just finishing undergraduate college.  When it comes to the benefit of treatment, it is easiest to quantify in school…  It gives an education level back, and allows someone to live up to the full potential of their intelligence.  Improvements in job performance can also be noticed with proper treatment. 

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When it comes to benefits of treatment, it is easiest to quantify in school.  It gives an education level back, and allows someone to live up to the full potential of their intelligence.'

 

Genetics

An aspect unique to Attention Deficit Hyperactivity Disorder…   Family history is a powerful determinant of someone developing ADHD.  If a man has ADHD, each son will have a 70% chance of having ADHD as well (If the parent with ADHD is a woman, or the child is a daughter, the risks are slightly less).   Overall, this is a staggering percentage, especially when you consider that all the other mental health conditions have dramatically lower inheritance rates.  For example, if a parent has Schizophrenia, there is only a 10% chance the child will develop Schizophrenia, with Bipolar Disorder, the risk is 15%.

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'Family history is powerful determinant of someone developing ADHD'

 

On a side note, ADHD does come with one gift.  These patients are often able to come up with multiple solutions to a problem, or see an issue for all its subtlety.  If ADHD is left untreated, this gift isn’t that helpful because they have trouble focusing on the best approach.  However, once they are treated, they retain this gift, which can be rather valuable.  Seeing every angle of a problem, coming up with novel solutions, what someone might refer to as ‘thinking outside the box,” comes naturally to them.

 

How to Treat ADHD

For those with Attention Deficit Hyperactivity Disorder (ADHD), treatment with a stimulant medication is the most effective form of therapy.  Stimulant medications have names like Adderall, Ritalin, and Vyvance.  As far as the best approach to the medication dosing for the stimulant, it is generally best to use the minimally effective dose, just enough to get a very big improvement.  Generally it is best to save the dose increases for the future, because over a thirty-year treatment course the dosage will likely need to be slowly increased.  

That said, there are some useful steps to be used along with the medication.   Counseling with Cognitive Behavioral Therapy can help with time management skills, and help the person change tasks more efficiently during their day.

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'For those with ADHD, treatment with a stimulant medication is the most effective form of treatment.' 

 

In closing, if you think you have symptoms of ADHD, please seek a professional evaluation.  The benefits of treatment are incredibly high, and it is a diagnosis that is frequently missed.  Making an appointment with a mental health professional is a good first step.    

-Erik Cantrell MD, Psychiatrist

 
Note:  The decision to start a patient on a stimulant medication for ADHD does require careful consideration.  Abuse of the medication occurs on college campuses, and research show that those who abuse illicit substances will likely abuse any ADHD medication given to them.  Recently, the South Carolina Medical Board passed a mandate requiring physicians to check a state database prior prescribing these types of medications.  This was an important step, and it shows if someone has a pattern of prescription drug abuse.