ADHD

ADHD - Paper airplanes.  Not the class topic!
Paper airplanes. Not the class topic!

A Reader In New Zealand Wrote…  No Amphetamines There

A reader in New Zealand wrote to say that they do not have any amphetamine-based compounds allowed, even to treat ADHD.  One can get methylphenidate-based drugs, like Ritalin, Ritalin LA, and Concerta for ADHD but not the amphetamines like Dexedrine, Adderall, Adderall XR, Vyvanse.  This situation is highly unfortunate.  While most people with ADHD do well with methylphenidate, there are children, adolescents, and adults that respond much better, that are treated much more effectively, with one of the amphetamines.

People with ADHD are Not Defined by being Overly Active

After all, it’s right in the name, hyperactivity.  So, it might seem to make sense that a person with Attention Deficit Hyperactivity Disorder must be overly active or “hyperactive”.  Not true.  It’s true that many children and adults with ADHD are really overly active.  But it is also true that there are many that are not very active.  In fact, that are mostly inactive.  Individuals with ADHD who are calmer are mentally the same as the hyperactive ones in that they also find it hard to focus their thinking on one thought for very long. 

The “Attention Deficit” Part of ADHD

It gets less public “air time” and discussion, but there is this “attention deficit” part.  It’s a problem with focusing one’s attention for very long.  Without the overly active part, these individuals sit quietly, daydreaming, their mind wandering from one thing to another.  And here’s the dilemma.  Girls and women are more likely to have this calmer type.  Remember, we’re trying to get more girls into STEM studies.  Clearly this poor attention situation creates problems in school in younger years and at work as their careers start.  Because they are sitting quietly and are not being disruptive, they don’t come to anyone’s notice.  But because they are daydreaming and not focused, it’s much harder to learn appropriately or accomplish at their aptitude level, much less to learn and accomplish in science, technology, engineering, and math.

Beneficial ADHD Children, Adolescents, and Adults

Individuals with ADHD are mostly fine, valuable children, adolescents, and adults.  Too often people with ADHD are not shown in a good light.  They can be a great asset to most situations.  They are bright people, typically easy to work with, and prefer to be problem solvers, not problem creators.  That said, some individuals with ADHD can be more complicated.  More on that below.

The Added Value of Having ADHD in Human History

Those who study early man and early groups and tribes think they know why those early communities came to value members with ADHD.  Imagine yourself in prehistoric times when communities were local tribes of several families.  This is how all the world’s civilizations started, how your ancestors started, in little clusters here and there around the world.  In this setting, the way people with ADHD acted made them the town’s hunter for animals for dinner and gatherer for plant food to eat.  Hunting brought a protein-rich diet to the tribe allowing growth of a bigger brain, more muscle, and more height.

The Quick and the Vigilant – ADHD

You see, people with ADHD are quick and always on the watch.  They also have lots of energy.  These traits allowed them to find and bring in more high-quality animal and fish protein.  Over the eons this better protein and dietary fat rich diet supplied what was needed for human brain growth.  As people in settlements became smarter mentally they realized that they could grow their own food, too.  This meant they were less dependent on the hunt and it’s sometimes meager supply of food.  “Grow their own” meant seed and crop planters and farmers who could provide a more dependable food supply.  Humankind’s march to world dominance started with the hunters.

A Funny Thing Happened on the Way to the Coffee Pot

A few years ago one of us at the Neuroscience Research and Development Consultancy was standing around with a group of scientists at the annual meeting of the Society of Neuroscience.  This small group had randomly come together in an open hallway as one or another of us were walking down the hall looking for a place to get a cup of coffee and we ran into each other.  There were 7 or 8 of us who stopped and chatted for about 5 minutes.  The others in this informal discussion circle were some of the most brilliant and productive neuroscientists in the United States. 

Those with ADHD as a Community’s Brain Bank

One in this group of neuroscientists made a joke about an East Coast colleague being so active in research and published so many papers that, “It’s as though he has ADHD!”  Another in the circle spoke up, “So what, I have ADHD!”  Then another chimed in, “So do I.”  Then another.  In this circle of about 8 of these bright neuroscientists, 5 or 6 each said he had ADHD.  Each was clearly proud of it and happy with the great gift of clear thinking and high energy that it gave.

ADHD – It’s How the Brain Is Wired

That Inattention Part of ADHD

ADHD is a brain-based condition.  It is not imaginary and not changeable with stern parenting or strict education.  It’s how a person’s brain is wired, hard-wired, often for life.  Some people with ADHD have the “inattentive” type while others have the “hyperactive/impulsive” type.  Inattention means that your mind drifts and allows you to wander off the task in front of you.  It’s difficult to pay attention over time to the narrow, limited focus of a job or task.

Now the Hyperactive Part of ADHD

The “hyperactive/impulsive” type is the ADHD type that most people think of when they think of ADHD.  The overly active, or “hyperactive”, means full of energy and continuously on the move, not staying still.  Or at least this is the way that the person with ADHD might appear to parents, friends, spouses, and relatives who do not have ADHD.  The social situations in which this individual finds himself only matter if he is restricted and cannot freely move around.  If stopped, he/she becomes really uncomfortable.  Maybe uncomfortable to the point of being upset and disruptive.  In the classroom or in a business meeting these individuals talk out of turn.  Children “fidget” even when they are asked to sit still.  If he cannot move much he might start tapping his fingers or the toes of his shoes.  Anything that helps “get the wiggles out.”  They’re restless.  Continuously.

And That Impulsive Part of ADHD

The impulsive part of ADHD might be funny if it did not so often lead to problems.  The quick action of ADHD means that at times these individuals’ bodies move and act before the executive circuits of their brain, their mind, has even thought about it.  The problem with this situation can be shown using the old military firing sequence of shooting a weapon at a target: ready, aim, fire.  The impulsive person with ADHD might shoot the weapon before any thought takes place, then he thinks about it and gets ready and aims.  One can see the risk of harm.  The summersault can start and complete before the child thinks about the mud puddle just ahead.  Another aspect of this is interrupting others when they are talking.  Or bursting into a social group uninvited.  And making snap decisions, even important ones with long-term consequences, without much thought.

As These 3 Aspects of ADHD Sort Out Among Individuals…

As we sort these 3 parts of ADHD among the people who have ADHD, it gives us 3 types:

  • A combined inattention and hyperactivity-impulsivity type
  • A mostly inattentive type
  • A mostly hyperactive-impulsive type

ADHD Remains a Medical Puzzle

Though medical science and research is moving closer to an explanation and cause for ADHD, the puzzle is not yet solved.  And because no one has nailed down the true cause, there is a “laundry list” of things that experts think might cause it.  Those experts who believe in one or another cause come up with the reasons why they think their view is the correct one.

Here are a few examples

  • maybe a family history and inherited genes cause ADHD
  • or, a mother’s cigarette smoking, alcohol use, or drug use during pregnancy
  • maybe a mother’s exposure to harmful environmental toxins during pregnancy
  • perhaps direct toxic exposure of the person with ADHD, like high lead levels at a young age
  • or low birth weight
  • maybe brain injury during birth or while growing up

Then Reality Steps In…  Complex ADHD Situations

The ADHD described at the start of this page is just typical, garden-variety, uncomplicated ADHD.  The reality out in the wide world is that ADHD is a medical condition and as a diagnosis it can become complicated.  In addition to ADHD, children can have learning disabilities, anxiety disorders, conduct problems, depressed mood states, and the poor judgement to use harmful drugs and/or alcohol.  Mix any one, or two, or three of these situations with ADHD and that person really struggles in life.  A good doctor who believes in the person with a complicated ADHD situation can be a powerful support to assist the child, adolescent, or adult to work through everything and come out winning.

ADHD Treatment

Treating ADHD is covered more on the page https://www.neuroscirandd.com/adhd-treatment/.

Here’s A Brief Overview of Treating ADHD

To put it right out in front, a person with moderate ADHD, or ADHD that is more severe than moderate, needs medicine.  There is no way around it.  Many people hope to avoid using medicine.  People use all sorts of words for medicine for AHDD, like drugs or pills, in a tone of voice that tries to make any medicine sound bad.  Parents often try to avoid using a medicine for their children.  But skipping a needed medicine increases the risk for the child, both in the short run and life-long.  It might be that a person with mild ADHD could work it out, make it through life and not use a medicine, and still win.  But even so, why?  Why, on purpose, spend a life at 80% when one can spend their life at 95% with very little extra cost and effort?

Here’s Why People Need Medicine for ADHD

In the ancient black-and-white television days of the 1950s there was a popular series, The Adventures of Robin Hood.  Little John was the large, strong, muscle-man in Robin Hood’s gang.  In one episode, Little John (played by Archie Duncan) is carrying a box.  As they walk through Nottingham Forest, he struggles to carry the box.  Finally, he can’t keep carrying it.  He just can’t do it.  Little John can’t understand why he has this “weakness” because the box is not that big and he can carry anything of any weight.  He’s the “Lou Ferrigno”, the “Arnold Schwarzenegger”, of their band of thieves.

Why Little John Feels Weak; Mystery Solved

He thinks there must be some wicked black magic in the box that’s making him weak.  But, when they open the box, he finds that it holds a stone block used for minting the King’s gold coins.  That’s why he couldn’t keep carrying it.  It was one huge piece of solid rock.  The point of the story is this.  Anyone can put a 10-pound backpack on their back and hike all day.  Put on a 150-pound backpack and most of us would collapse in a few steps.  Without medicine, you’re asking a person with ADHD to carry around a 75-pound backpack all the time, for life.  They are going to struggle and at times fall.  With medication, that backpack shrinks to 10-pounds like the rest of us can carry.

What the Medicine Does

The medicines are supposed to lessen the over activity, lessen the impulsive actions, increase the individual’s ability to focus, and improve how long the person can stay focused.  If all this works they do better in school, earn more money and get more promotions at work, and are more fun and happier at home with family.

Which Medication?

The Stimulants

Methylphenidate, the amphetamines, and other “stimulant” medications work best for most people with ADHD.  At the right dose, these medications increase the activity of the brain’s circuits for the executive part of the brain.  The person can think more clearly and keep everything under better control.  These medications also turn down the volume knob on the brain circuits that push for endless activity and and change curcuits for have less impulsivnes.  For most people these medicines are safe to use with a good doctor following along.

No Amphetamines for ADHD in New Zealand

As we said at the top of the page, a reader in New Zealand wrote to say that they do not have any amphetamines available for medically treating ADHD.  And as we also said, this situation is highly unfortunate.  There are children, adolescents, and adults that respond much better, that are treated much more effectively, with one of the amphetamines than with one of the forms of methylphenidate.

Non-Stimulant Medicines

There are other medicines that sometimes work when the stimulants don’t work or when they cause problem side effects.  These medicines are not stimulants.  These non-stimulants take a few weeks to start working.  The stimulants start working right away, within a day or two.  See the page on treating ADHD for more information about the non-stimulants: https://www.neuroscirandd.com/adhd-treatment/.

A Person with ADHD Needs More Than Just a Tablet or Capsule

To Use Diabetes to Illustrate the Idea

Take diabetes, for example.  Let’s say Type I diabetes, for which the person needs insulin.  If a teenager develops Type I diabetes, how well would he do if you gave him a vial of insulin and a syringe with a needle and said, “There you are,” and sent him home.  No instructions.  No explanations.  He would not do well.  He wouldn’t know how to do it all.  There are entire medical clinics set up everywhere for diabetes education.

Educating Someone on their ADHD

Like the diabetes example above, just tossing a medicine dose toward a person who needs it won’t work.  Someone with ADHD needs to learn what this brain-based medical condition is all about.  The education and support might come in the form of “therapy”.  The combination of the right medicine and best-fit therapy is the most powerful way to lessen ADHD’s problems.  These two together give a guide through the ADHD treatment jungle.  There are many types of therapy.  There is behavior therapy or interpersonal therapy.  Family therapy or marital therapy (for parents or for adults) might be helpful.  Training on specific skills or situations (stress management, test taking in school, dating relationships) could improve success in life.  Another helpful set of skills one can learn is parenting skills training.  Raising a child with ADHD, while rewarding in the long run, is a fast-moving challenge day-to-day.

 And Now for a Bit of Medical History

If we watch how people with ADHD move and act one can understand those history buffs who think back to prehistoric times and the ancient hunters and gatherers.  Quick runners, attention rapidly changing (focus, shift, focus, shift), acting almost before thinking.  If you want someone who can catch a wild boar for the family dinner and not get himself killed in doing so, maybe this is the person you want.  In more recent medical history, seeing ADHD as a medical condition might have begun with Melchior Adam Weikard, followed later by Sir Alexander Crichton in late 1700s.  Others mark the origin with the clinical descriptions of Sir George Still, a British children’s doctor.  In 1902 he said he saw, “an abnormal defect of moral control in children.”  He thought that these children, though intelligent, could not control their behavior a way that a typical child could.

Dr. Charles Bradley and Benzedrine

A big first step to actually treat ADHD came from Dr. Charles Bradley.  A new medicine, the amphetamine Benzedrine, had been FDA approved in 1936.  He noticed, to his surprise, that when it was given to school children their behavior and performance in school improved.  At the time, though, his findings were ignored.  The first edition of the DSM (Diagnostic and Statistical Manual) in 1952 did not mention ADHD or anything like it.  But DSM-II, in 1968, listed Hyperkinetic Impulse Disorder.  Finally, with this different name, ADHD had been listed as a true medical condition.  In 1980, in DSM-III, it was given the name Attention Deficit Disorder (ADD).  The newest term, ADHD, started 1987 in DSM-III-R, the Revised Third Edition.

Did You Know That…  Astronaut Scott Kelly has ADHD?

Astronaut Kelly is currently on the lecture circuit.  As part of his talk he said that he has ADHD.  He described it at the Marin Speaker Series in February 2018 (Marin County, California).  He said it’s true that he was a child before ADHD was considered as a diagnosis for problems in school, but he feels certain that if he were a child today he would be diagnosed as having ADHD.

Scott Kelly’s Santa Barbara Independent Interview

Astronaut Kelly also discussed his ADHD in an interview with the Santa Barbara Independent, a news, arts, and alternative newspaper published every Thursday in Santa Barbara (California).  He said that, as a child, every year he promised himself that he would pay attention in class and finish his homework.  It never happened.  He could not get it done.  Then he was inspired by the book about astronauts, The Right Stuff, and used this as his motivation to learn new habits of study, school, and work to become an astronaut.  He succeeded, of course, and, among other achievements, spent a year on the International Space Station.

 Helpful links:

Attention Deficit/Hyperactivity Disorder – National Institute of Mental Health

Attention Deficit/Hyperactivity Disorder – Center for Disease Control and Prevention (CDC)

Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD)

Attention Deficit/Hyperactivity Disorder in Children – The Mayo Clinic

What is ADHD? – American Psychiatric Association

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