ADHD Spotlight

April 15th, 2009

ADHD Meds and Chromosome Damage

Posted in Uncategorized | Comments Off

April 8th, 2009

Treat ADHD — To Lose Weight??

Posted in Uncategorized | Comments Off

March 18th, 2009

Weed, Young Adults, and ADHD

Posted in Uncategorized | Comments Off

January 21st, 2009

Fresh, New Start

Posted in Uncategorized | Comments Off

December 5th, 2008

“Fuck!” said my patient. He looked away from me, ruefully. “If only I had done something about this earlier, my life would have been so different.” He thought some more and then sighed, “I read your book. I was surprised to find so much that applied to me. I’m doing fine now, but so much would have been easier earlier.”

“Chad” (that’s not his real name) looked up at me with some embarrassment and then continued, “I mean, the sex….” He trailed off. As a young adult, his sexual indiscretions profoundly delayed his life progress. He has just started treatment but I predict that he will make good use of it. I may well have the great pleasure of seeing him thrive.

Chad’s acting on his impulses got him in trouble. Lord knows he’s not the first young man, nor the last, whose surging hormones will run him. We can’t blame his sexual indiscretions on ADHD. His having ADHD does not excuse his youthful folly. He has ADHD, the combined form, with both inattentive and hyperactive/impulsive features. Having ADHD makes it more likely that he won’t control his sexual impulses as well as his peers who don’t have the disorder.

He has just started treatment, but I think he will make good use of it. I may well have the great pleasure, one of the best aspects of the work I do, of seeing him thrive. Chad’s situation is poignant but not overwhelming.

In contrast, a few weeks ago I visited a former ADHD patient, “Tim,” in jail. He committed a violent crime which had tragic consequences: the loss of life. He is facing the certainty of prolonged jail time; the only question now is how many years he will have to serve. For a young man (Tim is only in his mid-twenties), this is an awful prospect.

He was in treatment with me in the past but slipped away from it. During the time he was untreated, Tim was irresponsible about sex. Poor control of his sexual impulses was followed by poor control of his aggressive impulses. The outcome? Tragedy. Now he sits in jail, tortured by guilt. “What could I have been thinking?” Tim moaned, softly. “I feel like I am sitting on the bottom of the ocean floor, with all that water bearing down on me, with no way to get up or to escape from it.” He’s right, of course.

This combination of ADHD and thoughtless, impulsive sexual actions profoundly affected the lives of Chad and Tim. Their stories remind us how important it is to identify people, women as well as men, who have the disorder. In addition to identifying people with the problem we need to persist in treating them effectively. Lives depend on it.

Posted in Uncategorized | Comments Off

November 24th, 2008

I Feel in Control

Often I think that patients with ADHD are the easiest patients to take care of. Sometimes the simplest treatment turns their life around. Often I think they are the hardest to treat, because their ADHD is just one of their psychiatric problems. With these patients, it’s hard to know where to start.

My patient today is from the first group. A small amount of the first medication we tried has made a big difference in two weeks. Both of us are happy with his progress.

What has changed? ”I feel more in control,” he said. “I’m self-monitoring in a new way. I can actually consider what I’m thinking now; I don’t just have to say it. I’m less anxious, and I’m more productive. It’s remarkable.”

He paused for a few moments and then added, “You know, I’m using a lot less caffeine. Before, I was using so much that it tore up my stomach. I’m drinking a lot less coffee, down to as little as 2 cups a day. I’m not even taking any caffeine pills. That’s a big change! ”

Looking thoughtful, he said, “At home I try to do some of the housework– you know, just to keep up my end. Now I’m doing it all so easily, so steadily. I can practically see my wife relaxing, with these changes in me. She doesn’t have to worry about managing her out-of-control husband all the time.”

In response, I told him that he reports on his progress is much like that of other patients I have who take these medications successfully. Which, of course, does not always happen.

My patient is an impressive man. By any standard he has accomplished greatly, but accomplishing has come at such a high price. “It has been so grinding,” he said, eyes closed and brow furrowed. “If I had just had this medication in college…..” He trailed off. Clearly his current improvement is exciting, and we hope to maximize it. For now, though, he is registering how hard it has been, and for how long it has been hard, for him to reach his current eminence.

We’re both happy that, in his personal life as well as at work, he is more in control.

Posted in Uncategorized | Add Comment »

November 22nd, 2008

Surprising Findings in Women with ADHD

For many years, we clinicians thought that ADHD existed only in children, and then, virtually always in boys. To be blunt, we were wrong. It’s clear now that adults have ADHD, an estimated 4.4% of them. Girls and women have the disorder, not just boys and men.

We used to think that girls and women who had ADHD usually had the inattentive form of the disorder. That contributed to missing the diagnosis in girls and women; they were ” under the radar,” so to speak, compared with those wild out-of-control little boys. We used to think also that women’s symptoms were less severe than those of men.

Are those common conceptions wrong, as well?<

Looks like those assumptions are wrong, too. My friend and colleague Patricia Quinn, MD, recently summarized the new clinical research.* She asserts that women who have ADHD most commonly have the ”combined” form of ADHD. That means they have problems being hyperactive and impulsive as well as inattentive. Not only that. Their ADHD was more severe than the men’s, when rated by several different clinical measures.

Also, adult women with ADHD had more additional psychiatric symptoms than men with the disorder. They had much more symptoms of anxiety and of depression than the men did. Problems with sleep were also commoner among the women with ADHD.

These findings are important. They steer us in the direction of looking more actively for ADHD in (girls and) in women. It may be specially important to suspect undiagnosed ADHD in women who are depressed. This is especially true in women whose depression is not responding well to treatment.

An additional new finding in women and girls with ADHD is that they are likely to develop eating disorders. Symptoms of bulimia — out-of-contol eating binges– were common in this group. In a way that is not surprising, considering that many persons with ADHD have poor control of their impulses.

What this all means is that we have new reasons to be thorough in taking care of adult women who have ADHD. They are likelier to have symptoms in addition to their ADHD: depression, anxiety, sleep problems and eating disorders.

————————————————————————————————————————

* Quinn PO: ADHD and Its Comorbidities in Women and Girls: an Evolving Picture. Current Psychiatry Reports 2008, 10:419-413

Posted in Uncategorized | Add Comment »

October 1st, 2008

ADHD and College Performance

In recent decades there has been better identification of children with ADHD and better treatment for them. This has resulted in more of them being able to attend college. Once there, with adequate documentation and allowing for their particular needs, they can successfully negotiate the academic demands of college life.

On their side, colleges and universities are being more flexible in working with students who have ADHD. Some colleges have developed special programs to meet the needs of students with ADHD, actively recruiting such students to higher education. More and more, it looks as if college students who have ADHD are likely to function and cope better with life than those with the diagnosis who do not go to college.

This all sounds great. But how well do college students with ADHD do academically? The most recent research shows that they do not do as well as their peers who don’t have ADHD. A recent study compared the actual cumulative grade point average (GPA) of 316 college students with ADHD. These students had significantly lower GPAs than they “should have” had. Not surprisingly, symptoms of inattention related strongly to a lower GPA. Hyperactivity symptoms did not.*

Parents of college students with ADHD often ruefully refer to their children as on the “five-year track.” This gently refers to the reality that such students often need more time to get through college successfully. The recent research suggests that such parents may need to be tolerant of a lower GPA than is hoped.

The extra effort is worth it, however. Going to college opens so many educational and life possibilities – and a college degree is highly associated with higher earnings over a lifetime.

So, parents of children with ADHD, hang in there: your efforts will pay off. In dollars as well as in sense.

———————————————————————————————

* Schwanz KA et al: Attention problems and hyperactivity as predictors of college grade point average. Journal of Attention Disorders, 11:368-373, 2007

Posted in Uncategorized | Add Comment »

January 26th, 2008

ADHD and ODD

Posted in Uncategorized | Add Comment »

January 24th, 2008

Devastation and Pain

It’s rare for a psychiatrist to discuss openly and publicly psychiatric illness in his family. That’s what makes the recent editorial by Dr. Jan Fawcett so impressive.*

Dr. Fawcett is a distinguished psychiatrist who specializes in depression and is the editor of a journal, Psychiatric Annals. In the most recent issue, January 2008, he writes about the experiences of his son, Craig, who had attention deficit hyperactivity didsorder.

Craig’s first diagnosis was ADHD, but after that came drug and alcohol abuse, depression and antisocial behavior, failures at college, fights, arrests, and the diagnosis of bipolar disorder. In the meantime he continued suffering from ADHD: accidents, injuries, losing important items, unable to follow through with tasks.

Somehow, Craig survived to marry a healthy and supportive young woman. He was responsible about his bipolar medication. Then this last July, he was found dead in bed, his death secondary to damaged heart muscle. “At least Craig isn’t suffering any more,” was his dad’s first reaction.

Dr. Fawcett writes about watching Craig struggle all his life, unable to benefit from his high intelligence, creativity and outgoing manner. He was always trying to help people — and then picking the wrong people to help.

He had more to deal with than ADHD. But it was ADHD that started the negative cascade and that persisted. It was the “prison that made it impossible for Craig to benefit from his intelligence,” writes Dr. Fawcett.

If anyone thinks that ADHD is not “serious enough” to justify every possible treatment effort, and even some risk, just ask Dr. Fawcett about his son, Craig.

—————————————————————————–*Fawcett D. Devastation and pain. Psychiatric Annals 38 (1):5, 2008

Posted in Uncategorized | 1 Comment »

ADHD
Spotlight

ADHD Meds and Chromosome Damage

Treat ADHD — To Lose Weight??

Weed, Young Adults, and ADHD

Fresh, New Start

Sex, (Violence) and ADHD

I Feel in Control

Surprising Findings in Women with ADHD

ADHD and College Performance

ADHD and ODD

Devastation and Pain

Categories

Links

Archives