Paying the Wrong Kind of Attention to ADHD

An email alerted me of a study concerning ADHD medication.  Since I prescribe it every day and take it myself, I’m always interested.

When I clicked on the link I was directed to a July 15 article with this headline:  “Do ADHD Medications Boost Substance Abuse Risk?”  The article was reporting on a June 2016 study from the University of Michigan published the Journal of the American Academy of Child and Adolescent Psychiatry.

In brief, the study concluded that if stimulant medication treatment is started earlier (before age 9) and continued, it actually cuts the rate of substance abuse in half.  Put another way, treatment cuts the risk back down to the rate for kids that do not have ADHD.

You might think that the media would have noticed a study from a respected university publishing in a major medical journal on a topic that affects ten percent of Americans. They haven’t.  They either aren’t paying attention or they aren’t willing to be perceived as highlighting even one of the significant benefits of stimulant medication.  Make no mistake; this is a landmark study that re-affirms previous work suggesting the same conclusion.  But society and the media seem interested only in perpetuating the myth of “over-medicating” kids in increasing numbers as well as emphasizing the recognized but avoidable side effects of stimulants.  While this may help sell copy, it doesn’t help families like mine who struggle with ADHD every day because it keeps them afraid of reaching out for help.

ADHD is the most common neuro-genetic disorder of childhood.  It is associated with significant complications and mortality.  In addition to doubling the risk of substance abuse, it increases the risk of school failure and under performance, accidents, divorce, premature death, anxiety, depression, suicide and incarceration.  All of these adverse outcomes have been shown to improve when ADHD is treated with stimulant medication.

Why are we not being proactive? Why are we are not advocating screening and early intervention?  ADHD meets all the criteria of a medical disorder that we should look for proactively.  It is common, can have bad outcomes, and is very treatable.

It’s time we pay the right kind of attention to ADHD. 

So back to the HealthDay article and its headline.  If it had been an article on an asthma medication helping kids improve their fitness it would have read something like, “New Asthma Medication Improves Fitness in Kids.”  But because it is about ADHD medication it was posed as a question that suggests the opposite of the study’s finding.

We need to watch our language and stop this type of slant that stigmatizes mental illness in general and ADHD in particular.

ADHD and OCD in Childhood – The Chicken, the Egg or Both

Obsessive Compulsive Disorder is not rare in childhood and it is more common in children with ADHD. Few parents come to my office concerned that their child has OCD. They are more worried about social skills issues and disruptive behavior at school and meltdowns and tantrums at home. Often a teacher or some other professional will have suggested that the child has ADHD, ODD-Oppositional Defiant Disorder or ASD, Autism Spectrum Disorder or Asperger’s Disorder (no longer diagnosed). These observations are a great place to start. When we listen to the voices of people who know the child well and then take the time to look carefully at the presenting symptoms, we are more likely to get the diagnosis right. Remember that sometimes OCD occurs with ADHD and sometimes OCD diagnosis alone best explains the patient’s symptoms. In other words, the diagnosis can be either or both. To make matters more confusing some patients have other conditions tagging along. Mood disorders, anxiety and tics are all more common in these kids. At my office, Focus-MD, we find that when we look at the whole child, including their struggles and their strengths, we are better able to arrive at a correct diagnosis or combination of diagnoses that make sense to parents. Helping you put the pieces of the behavior puzzle together is what we strive to do every day. 

How to spot OCD

Just because your child’s room is a mess doesn’t mean that he/she doesn’t have OCD. Remember both neat freaks and hoarders have OCD. The neat are obsessed with cleanliness and order while hoarders are obsessed that they may need that half used ketchup packet tomorrow.  One compulsively cleans, the other compulsively holds on to trash. Look for these common symptoms

Symptoms of OCD

1. Counting
2. Lining things up
3. Sorting
4. Making things symmetrical
5. Checking behavior—asking the same question over and over even when the answer  is known or verifying that the door is locked a certain number of times. This is also called Need to Know.
6. Need to Tell—will start stories all over from the  beginning if narrative gets out-of-order or they forget a detail.  Will need you to listen to the detail that is in their mind no matter if it doesn’t matter.
7. Persistent thoughts
8. Rituals – having to do things in a certain order.
9. Food aversion due to texture or one food touching another or having to eat foods in a certain order.
10. Sensory issues — loud noises, tags in clothes, the way under wear or socks fit or feel, texture of clothes or other fabrics.
11. Picking at fingers, biting nails, twirling or pulling out hair, eye lashes or eyebrows.

In reading below you will see that OCD impairments can look a like with ADHD problems.

Functional Impairment in OCD compared to ADHD

OCD compared to ODD

• OCD kids are often defiant but they don’t tend to be vindictive or spiteful like ODD kids.
• Once they have their way, they’re happy again though they’ll remember a grudge!
• In OCD it’s ‘my way or the highway’.
• In ODD it’s ‘anyway but your way’.

OCD compared to ASD

• OCD kids have more reciprocal interaction than ASD kids.
• Their social skills issues are not a lack of interpersonal connection but rather that things have to be a certain way on certain things.
• They will talk about or engage other things but on certain topics/procedures but they are very inflexible.
• ASD kids are happier with parallel interaction if any at all.

Treat Your ADHD Brain Like a Race Car and Get on the Road to Better Focus.

ADHD brains are like race cars. I don’t know who coined the metaphor, but I use it frequently with my patients. ADHD brains are fast; they are powerful. Some of the most creative and successful people on the planet drive one. But here’s the flip side: the steering is difficult and the brakes are lousy.

Like any car, a race car requires maintenance. Things like oil, gas, a clean windshield and air in the tires are all essential regardless of the type of car—whether it’s a Ferrari or a Yugo from back in the day. It’s the same situation with the brain. Good nutrition, exercise, adequate sleep, fresh air and sunshine are all important for any brain to function well, and these are even more important for ADHD brains. But like any high performance vehicle,  an ADHD brain requires much more than typical maintenance.

Here are some strategies to tune up your ADHD care, race car style:

Medication. A race car can go nowhere without the motor being fueled effectively. An ADHD brain lacks the right chemistry for attention, motor and impulse control, so it usually needs medication to enhance those chemical connections. Think of medication as a necessary fuel additive that helps the brain run smoothly. Most of us need medication to operate more efficiently and without it, some of us won’t even make it out of the garage.

Skills. It takes skill to drive a high performance vehicle. Getting medication optimized to the just right dose of the just right medication is often the first part of acquiring the skills needed. Another key is being in the right academic or work setting. With the medication and environment tuned, some ADHD brains are able to flourish and develop the needed executive function to be less frustrated. But for others, more help is needed.

A team. No race car gets to the finish line without a pit crew. And ADHD patients often benefit from a pit crew of their own—supportive people who understand ADHD mentality and play specific roles in the patient’s life. Putting together that pit crew—whether it’s adding an ADHD coach, a nutritionist, a behavior therapist or someone to help with organization skills— and getting them to work in harmony can be difficult for families.

““Every day I learn something new about ADHD from the wisdom of my patients.””

— James Wiley, MD, FAAP