Sunday, February 18, 2007

Larry's Story- An adult with untreated ADHD

Larry is a fourty-three year old real estate agent who lives alone. He has three children from two different marriages. He has held many different jobs in sales. He briefly attended a community college, but never received a degree. Everyone who meets Larry likes him, but all of his employers perceive him to be irresponsible and careless. Both of his marriages ended due to financial strains and his inconsistent job history. There have been three episodes of depression. In his mid twenties, Larry had difficulties with excessive alcohol use, and briefly lost his drivers license due to a DWI charge. His parents and teachers always thought him to be smart, but accused him of being "lazy". Larry was eventually accurately diagnosed with ADHD. He finally received treatment and readily admits that his life is finally stable for the first time.
Larry's story is a great example of some of the potential consequences of not treating ADHD. Whenever a medical decision is being made, it is vital to understand the risks of not treating the condition. This is also true for ADHD.

(Adapted from Making the Connection: A Parent's Guide to Medication in ADHD- p 17-19)

Tuesday, February 13, 2007

Bupropion/ Wellbutrin for ADHD

One of my patients yesterday asked me about Bupropion (Brand is Wellbutrin) for treating ADHD. Bupropion is primarily an antidepressant that is sometimes used in the treatment of ADHD. Its actual benefit in treating ADHD symptoms is mild especially for symptoms such as impulsivity and hyperactivity. The data in children and adolscents is minimal in comparison to other medications. There is a clear need for more research on this drug. For people who have a history of substance abuse or depression along with the ADHD, it can be a safe first alternative. (See Making the Connection- A Parent's Guide to Medication in ADHD- pages 81-82)

Saturday, February 10, 2007

Can you do a brain scan to diagnose ADHD?

(Adapted from Making the Connection- A Parent's Guide to Medication in ADHD)

The field of psychiatry is always searching for a conclusive diagnostic test to aid physicians in diagnosing the various mental conditions. Unfortunately this test doesn't currently exist for any psychiatric illness and ADHD is not any different. Brain scans are used frequently in research studies. Research has shown that children with ADHD have smaller brain volumes in specific parts of the brain (frontal lobes, white matter, and cerbellum). These are only research studies and cannot and should not be used to diagnose ADHD in a specific child or teenager.

Does Sugar cause ADHD?

I meet many parents who wonder whether their children's sugar intake is causing ADHD. Currently, there is no research evidence that this is the case. There are studies that have compared kids on sugar and off of sugar. These studies show that there is no link between sugar in kids and attention or behavior problems. However, parents need to exercise common sense and good judgment. There are many legitimate reasons to limit your children's sugar intake such as good nutrition. Unfortuantely limiting sugar intake does not result in an amelioration of ADHD symptoms.

Thursday, February 8, 2007

What is the best ADHD medication?

There are many different medications on the market that are used to treat ADHD. The two classes are the stimulants and the non-stimulants. The stimulants (such as methylphenidate, mixed amphetamine salts, etc...) are still considered the most potentially beneficial medications in the treatment of ADHD symptoms. However, the nonstimulant Atomexetine can be potentially beneficial. The potential benefit of the different stimulants is the same. One stimulant is not better than another. Each person has a unique response to a given medication, so for some people there is one medication that works better than another. This can only be evaluated for each person.

Saturday, February 3, 2007

Do you have to be hyper to have ADHD?

One of the most common reasons that many parents, teachers, or clinicians don't recognize ADHD is the lack of hyperactivity. Unfortunately, the name of the diagnosis "Attention Deficit Hyperactivity Disorder" contributes to the confusion. It is also certainly true that being hyper doesn't make one have ADHD either. Hyperactivity is just one of the symptoms that can be present in the hyperactive/impulsive type of ADHD. Most doctors these days use the term ADHD to refer to the three different kinds of ADHD. ADHD is currently classified into 1)predominantly hyperactive/impulsive 2)predominantly inattentive/distracted 3)combined type. It is crucial to remember that it is not necessary to have every symptom to have ADHD.

Friday, February 2, 2007

ADHD Medications: What is a Parent to do?

The number of articles and books devoted to the topic of Attention Deficit Hyperactivity Disorder (ADHD) and the use of medications is enormous. It seems that everyone has an opinion on the matter; some are well-informed, while others are merely well-intentioned. The predicament is that the overabundance of conflicting information is resulting in the fear and paralysis of many parents of ADHD children. It is clearly becoming much more difficult for parents to make medication decisions on behalf of their children. At some point, every parent of an ADHD youngster will have to make a decision regarding the use of medications for treatment. Parents need some basic rules to follow to help with this arduous task.
I receive many phone calls every day from parents who want to know if they should put their son or daughter on an ADHD medication. My answer tends to be the same for almost all of them: in order to be able to make that decision, we have to know what the diagnosis is. A thorough evaluation is the first and most essential step in the process. It is impossible to treat any condition without knowing what you are treating. It is not prudent to “try a medicine to see if it works.” That is an inappropriate way to proceed and can actually be harmful. Many children who appear to have some ADHD symptoms actually have a different condition, such as anxiety or depression. Furthermore there are some kids who have anxiety in addition to the ADHD. In either scenario, it is essential to determine the diagnosis prior to initiating any kind of medication trial.
Once the diagnosis has been established, the second step is to weigh the benefit of medication treatment against the risks of its negative effects. The potential benefit of medication treatment of ADHD has been documented in numerous studies that have been successfully replicated by many researchers. At the same time, every medication has potential side effects. It is important to understand the different potential negative effects. Some are merely nuisance side effects that go away after a few days while others are more problematic. In order to proceed with a medication trial, the potential benefit should outweigh the potential negative effects.
Once the diagnosis of ADHD has been established and it has been determined that the potential benefit outweighs the potential negatives, the parents need to understand the risks of not treating the ADHD. Many studies have been conducted to examine the consequences of untreated ADHD. It is clear that there are numerous potential consequences such as academic failure, peer rejection, depression, accidents, substance abuse, etc…These consequences are significant and are typically not transient; they tend to continue to manifest into adolescence and adulthood.
If you are a parent of an ADHD child or teenager you need to understand these three basic rules before you proceed with trying a medicine for your son or daughter. It is also critical to work with a clinician with whom you are comfortable and who is able to explain the diagnosis of ADHD and how the diagnosis was determined. The decision to use medication can be an arduous one, but if you follow some basis rules and you work with a knowledgeable clinician the process will be much easier. One of the things that I emphasize in the book "Making the Connection: A Parent’s Guide to medication in AD/HD" is that this decision needs to be thought through and that it is never an emergency to start an ADHD medication.


The goal of this blog is to discuss and comment on the most current information and research that relates to the treatment of ADD/ADHD. This will include discussing medications as well as non-medications treatment.