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ADHD Newsletter DR. JONES UPDATE© MENTAL FITNESS Vol. 4, 2008 ATTENTION DEFICIT/HYPERACTIVITY DISORDER “Do I have ADD?” No, Hallowell and other experts point out that ADD is not Wayne C. Jones, M.D. but you may be ADD. so much a deficit of attention as it is a “variability of at- tention”. This means that a person is able to pay atten- A board certified Psychiatrist with 30+ ADD/ADHD is a group years of clinical, research, and teaching of different combina- tion to things that they have a high interest in. An exam- experience. He is among the first tions of temperament ple of this theory would be the child that cannot read a Psychiatrists in the U.S. to be certified extremes. The intensity history assignment no matter how hard they try. Their as a Psychopharmacologist. His varies from mild to mod- mind frequently wanders and the task is not completed. specialties include anxiety and mood But the same child can play a video game, or watch car- disorders, stress management, ADHD, erate to severe, and is innovative medication management, unique for each person. toons with total concentration. Why does this happen? sleep and women’s issues. Many people say they Is it because the child chooses to do one thing and not don’t believe in ADD. the other? The answer is, “NO”. The more interesting, Good! ADD is not a religion. Attention Deficit Disorder is a exciting activities stimulate, or turn on the brain’s con- phrase, (like Learning Differences), that is officially desig- centration, and therefore satisfy the need for internal nated to represent a combination of symptoms that are fre- stimulation. One expert says that the ADD person is a quently seen together. ADD symptoms can cause certain “prisoner of the present”, because instant gratification types of life challenges. The symptoms each respond to isn’t fast enough. specific treatments. (see Treatment List below and Symp- Every individual has a range of stimulation within tom List on p.3). which they function well. If stimulation is too low, bore- ADD and ADHD (with hyperactivity), are officially recog- dom occurs. If stimulation is too high, stress occurs. nized in the American Disabilities Act, and People that are ADD have a problem at therefore qualify for certain benefits and con- both ends of the range. In other words, the siderations. The benefits should especially be Behavior is ADD person needs above average stimula- utilized in the school setting. driven by tion, causing boredom with routine situa- “Can I be tested for it?” No, there are no tions and tedious jobs or assignments that tests that reliably prove that ADD is present. interest more are low stimulation. Since they are typically The diagnosis can be made by: than unable to do one task at a time they often ⇒ Clinical interview with a Doctor or Therapist importance get stressed out. ⇒ Evaluation of Symptoms If these problems cause the person to ⇒ Life consequences of symptoms function below their optimal level, stimu- lants are proven to be very effective. Most ⇒ Current level of functioning/performance patients prefer Adderall XR (which is effective about 8- ⇒ Past history of functioning/performance 12 hours) or Concerta (which is effective about 12 ⇒ Input from spouses, teachers, parents, etc. hours). Both Adderall XR and Concerta are three times more effective than Strattera, which is a drug that only STIMULANT MEDICATION OPTIONS works on Norepinephrine and is not a stimulant. Amphetamine Mixed Salt: Adderall XR* and Adderall tablets NON STIMULANT MEDICATION OPTIONS Strattera (approved for children and adults) Methylphenidate: Wellbutrin XL Ritalin, Methylin, Ritalin LA Effexor XR, Pristiq Concerta, Metadate, Daytrana Patch Provigil Clonidine Dextroamphetamine Guanfacine Dexedrine, Dextrostat, Vyvanse* Dextromethylphenidate Vyvanse is the first prodrug to be FDA approved for ADHD in Focalin adults and children. It has a novel release mechanism that pro- vides a smoother, long-lasting control of symptoms. It has re- Methamphetamine placed Adderall XR as the preferred medication by a majority of Desoxyn the patients in my practice. * FDA approved for adults TWO LANDMARK STUDIES SUPPORT ABOUT OUR STAFF MEDICAL TREATMENT FOR ADHD Paige Embrey, M.B.S., L.P.C.Clinical assistant to Dr. Jones, ADHD is one of the best-researched disorders, according to the Council she is certified as a licensed profes- on Scientific Affairs of the American Medical Association. This study is sional therapist. She is available for probably the most extensive study of ADHD to date. It concluded that personal counseling, including chil- ADHD has as much scientific validity and specificity as the best-known dren, teens, social anxiety, and medical diseases, such as diabetes. They also found no evidence of over- ADHD coaching. prescribing or abuse of medication. The opposite was found; as few as 25% of grade school ADD children are diagnosed and treated. Penny Chaney, B.B.A., -does writ- A second study was sponsored by the National Institute of Mental Health. ing/editing, and research. She de- The study took place over a seven year period. It included 6 sites, 579 velops patient education materials, children with ADHD, and a 14 month treatment program for each child. management of presentations, and The children were randomly assigned to one of four groups: web site production. (A) Community treatment (70% got medication) (B) Intensive psychosocial treatment (no medication) Melissa King, B.F.A. –Coordinator (C) Study sponsored medication management (stimulants) of our program for total fitness. She (D) Both B and C will serve as “coach” for patients that Results of the study clearly indicated that medication provides the great- wish to initiate positive lifestyle est improvement of ADHD symptoms. changes. A report by the American Academy of Pediatricians asked its members to increase efforts to identify ADHD and related conditions and see that treat- Chelsea Giddings-A seasoned ment is available. member of our administrative staff. The findings of the studies are very important because they point to She has advanced training in stress the fact that ADHD is primarily a medical disorder. The study data also disorders. helps prove to those people that don’t “believe” in ADHD that it does exist, and needs to be diagnosed and treated. MEDICATIONS FOR TREATMENT OF ADD RELATED DISORDERS Two-thirds of ADD/ADHD children have one or require firm, consistent behavior management. more other mental health disorders (comorbidity). The Mood/anxiety disorders are common with ADD, and need most common co-occurring condition with ADHD is to be managed medically. Stress management and coping Oppositional Defiant Disorder. These children are re- skills also need to be taught. (See suggestions on next bellious to a degree that causes problems for them at page). home and/or school. Their attitude is “you can’t make Underlying Bipolar (Manic-depressive) traits can be aggra- me/you can’t stop me.” Some children also have Con- vated by stimulants. This can be managed with mood stabi- duct Disorder. They violate rules, laws, damage prop- lizers, or cognitive enhancers. (see chart below left) These erty, commit theft, personal injury, etc. These disorders medications can be used with stimulants. SECONDARY ADD MEDICATIONS DISORDERS THAT COMMONLY OCCUR WITH ADD/ADHD Antidepressants Anticonvulsants Enhance Mood, Reduce anxiety Mood Stabilizers •Wellbutrin SR •Lamictal •Effexor XR •Gabatril Learning •Tricyclics •Depakote Differences Anxiety Disorders •SSRI’s-Zoloft, Celexa, Paxil, •Tegretol 25% 25% Prozac, Lexapro •Lithium •Remeron, Serzone, Trazodone •Trileptal Bipolar •Keppra 6% ADD/ADHDADD/ADHD Conduct Tranquilizer/Hypnotics Cognitive Enhancers Disorder GABA, Hyperarousal Atypical Neuroleptics •Benzodiazepenes-Klonopin, •Seroquel 20% Depressive Xanax, Ativan •Zyprexa •Geodon Oppositional •Hypnotics-Sonata, Ambien •Risperdal •Abilify Disorders Defiant Disorder •Neurontin •Seroquel 15-20% 35% •Ziprasidone Pliszka 98, Barkley 98 COPING SKILLS AND STRATEGIES FOR they just can’t do it! Russell Barkley, a specialist in SUCCESSFULLY LIVING WITH ADD ADD research, refers to this as a “disorder of inten- “We were not made for this world.” We adapted over tion.” He says what the ADD person needs is assis- thousands of years to a world of high physical activity out- tance at the point of performance. Having a spouse, doors. Now we have mental stimulation, complexity, and parent, co-worker, etc., that can help organize and relatively sedentary lifestyles. As a result, a large amount prioritize for the ADD person is helpful. of energy is being stored up within us that doesn’t get Time management is “the curse” of the ADD person. used. This can cause stress symptoms. Practicing healthy Most are “near-sighted” about time and how to use it stress management is especially important for the ADD effectively. Rather than a therapist, the ADD person person since they are more stress prone. usually benefits the most from having a person that Being physically active as part of daily routine is essen- serves as a “Coach”. The aid of a “Coach” can help tial to good stress management. Eating healthy foods, turn chaos and stress into a well functioning, produc- with adequate proteins and avoiding excess carbohy- tive life. drates is also important. Sleeping regularly 7-8 hours is probably the single most important health habit to practice. Developing and main- “Human salvation lies in the hands of the taining supportive relationships is also high on the list of stress reducers. creatively maladjusted” Cognitive/behavioral
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