ADHD Spotlight

ADHD “Plus” : Anxiety

Many people think of ADHD as “just ADD.” The facts are different. Most people who have ADHD also have at least one other psychiatric disorder. Isn’t one disorder enough? Maybe if it should be that way, but it’s not. Having one disorder makes it likely that you will have another.

In patients who have ADHD I always try to look for anxiety and mood disorders and, hiding in the background, abuse of alcohol and other substances. (I dislike the use of the word “substances.” It sounds so neutral. So scientific. What would I substitute, though? “Stuff”? “Drugs”? Looks like I’m stuck with “substances” for now.)

Here are the facts as we know them. In one study* 47.1% of ADHD adults had an Anxiety Disorder, and Social Anxiety Disorder was the commonest disorder, at 29.3% .** So adults with ADHD often DO have other significant psychiatric disorders. The commonest psychiatric symptom that occurs in adults with ADHD is anxiety. That anxiety is worst in social settings. No surprises there. Being anxious because your brain doesn’t function well consistently makes perfect sense.

These studies push me to look for significant problems with anxiety in my patients, and to treat them when they occur. The reverse is also true. Persons who are severely anxious are likelier to have ADHD than other people. I can get so preoccupied with treating the anxiety that I forget to look for ADHD. *sigh* It’s a major challenge to a clinician like me: keeping my mind open to other possibilities, not hyper focussing on one problem.

Why should you care about these studies? If you’re an adult who has ADHD, don’t be surprised if you also have anxiety symptoms. Often, with effective treatment of your ADHD, your anxiety symptoms will subside. Not always, though. If you’re still uncomfortably anxious, let your clinician know. Good treatment for anxiety will make you feel MUCH better.

________________________________________________________________________

*Kessler R et al: The prevalence and correlates of adult ADHD in the United States:results from the National Comorbidity Survey Replication. American Journal of Psychiatry 163: 716-723, 2006

Posted in Diagnosis, Related Conditions | Add Comment »

“Just a Sliver of Me!”

“I was just sitting there getting nothing done, feeling overwhelmed and discouraged,” said my patient, his eyes flashing, “and then I suddenly realized, ‘You have ADD!’ ”

He frowned, indignant : “It’s hard, because everyone jokes about it: ‘I’m so ADD!’ No one believes it’s for real. It is for real. You have been trying to tell me this for 2 years now. You see just a sliver of me. It’s more than taking medicine. That’s the easy part. I have to do the rest. I have to get myself organized and keep myself organized. This is serious. It’s really messing up my life.”

As I was listening, I was doing my best to maintain my professional demeanor, but inside I was yelling, “Yesssssssss!”

What suddenly makes a patient able to hear what I am telling him? More to the point, though, what makes it possible for a patient to listen to the wisdom inside herself? Damned if I know, but as a clinician I keep on trying. The clinical skill involved is what Sheldon Roth, MD, a colleague of mine, calls the “art of wooing nature.” Well, sometimes nature is reluctant to be wooed.

As my patient said, “You only see just a sliver of me.” I have to recognize that, to keep my limitations in mind. Seeing “just a sliver” reminds me that I have to do more with patients than just prescribe medication and then monitor them to be sure they are taking it correctly. That’s fine with me, actually, because I have no interest in just prescribing medicine for patients. In some settings writing prescriptions is all the doctor has time to do. Not for me, lucky that I am. I get to see them whole, not settle for what I see in the “sliver of me.”

Posted in Diagnosis, Medications, Other Treatments | Add Comment »

What About Coaching?

Generally I enjoy my work with adults who have ADHD. They are interesting, vital people and it’s a pleasure to help them. Sometimes we are lucky, and the patient’s life just “lights up.” Happy patient, happy doctor.

Sometimes, though, I feel that something is missing . I know about ADHD medications, their uses and side effects and benefits. I enjoy doing psychotherapy with patients who frequently have life issues as a result of having AHDH. There’s still a chunk of the patient’s life which I don’t reach.

One way to help in these circumstances is to suggest an ADHD coach. Such persons provide practical, often daily advice about how best to cope with ADHD. What’s a coach, though, and what does such a person DO?

I found some answers in a new book called, The Disorganized Mind: Coaching Your ADHD Brain to take Control of Your Time Tasks and Talents. (Long enough title?) Nancy Ratey is the author. She, incidentally, is the wife of Dr John Ratey. A child psychiatrist, Dr Ratey with his colleague Edward Hollowell, MD, put ADHD “on the map.”

In a breezy, upbeat style, Nancy Ratey gives inside information about coaching. She has a program for clients, called ANSWER, to address their major problems. One aspect of the book I liked was that she provided guidelines for self-coaching, too. She gave attention to the issues of being the spouse or employee of adults with ADHD. What she didn’t do is tell the reader how to find and evaluate presons who claim they are coaches for adults with ADHD.

For information about this topic for my Washington,DC, area patients, I often suggest www.ADDVance.com website of Kathleen Nadeau, PhD. She and her colleagues are good at linking patients up with coaches and other resources.

I’m still uncertain about the role that “coaching” can play with adults with ADHD. Any comments or experiences to share?

Posted in Books & Articles, Diagnosis, Other Treatments | Add Comment »

Non-Medical Use of CNS Stimulants

Abuse of the central nervous system stimulants used to treat ADHD is causing more and more trouble. For example , there is a sharp rise in the calls to emergency physicians about the drugs. When teenagers use these medications in an uncontrolled way, bad things happen.

My patients tell me that when they were (or are) in college, they and their friends matter-of–factly lent each other such meds to improve test performance or to stay up all night to finish a paper. Like using steroids to enhance athletic performance. It isn’t the best students who do this, though, it’s the worst. An estimated 60% (60%!) of students with a prescription for an ADHD medication share or sell the medication to someone for non medical use ( my italics).

Trying my best to be nonjudgmental, I point out to patients that this is illegal as well as potentially dangerous. My patients grin back at me with that, “Oh come on, doc, get with it!” look.

This issue bothers me. I write a lot of CNS stimulant prescriptions for ADHD. There is surely some abuse of my system, even if I monitor patients’ use carefully. Any reactions ?

Posted in Medications | Comments Off

ADHD Meds and Chromosome Damage

Posted in Uncategorized | Comments Off

Treat ADHD — To Lose Weight??

Posted in Uncategorized | Comments Off

Weed, Young Adults, and ADHD

Posted in Uncategorized | Comments Off

Fresh, New Start

Posted in Uncategorized | Comments Off

Sex, (Violence) and ADHD

“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

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 »

ADHD
Spotlight

ADHD “Plus” : Anxiety

“Just a Sliver of Me!”

What About Coaching?

Non-Medical Use of CNS Stimulants

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

Categories

Links

Archives