I want to have a thread for discussions on ADHD. I know for some, this may be a controversial topic. It is only over the last two years that I have come to understand some of the many manifestations of ADHD and how it has impacted my life and the lives of family members. I also have a belief that ADHD has a largely unacknowledged impact on society beyond the school years.

There is much more to say but I will see where this goes.

Tags: ADD, ADHD, brain, neuroscience

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Yes ADHD is a real disorder.

It is a collection of symptoms/behaviors that can originate in several areas of the brain. It is frequently co-morbid with other psychiatric orders. This is why it can be difficult to diagnose or rule out.

It is present in different kids with different degrees of severity. This is why some parents can manage their ADHD kids with diet and behavior modification, and some need meds.

Some kids outgrow it in different stages of their childhood, and some kids never outgrow it. This is why some people think that they can "cure" their kids, and others never get better.

The rapid increase in the number of ADHD cases is due to the fact that more kids who were previously just disregarded as "behavior problems" are now being looked at more closely and critically.

One of the key elements in successful management of this disease is the presence of a strong support system for the entire family.
An excellent overview.

I think the part about outgrowing is one that clouds the issue and leads many to believe this is only a disorder of school-aged children. I am coming to see that it is not; it is a life span disorder.

I would like to hear more about the support system. I don't seem to have any of that expect possibly my oldest daughter who is not really effected by the disease. I have come to see that my wife IS effected and consequently has been little or no help all these many years.
I agree that Cowpunk's overview is pretty good. Thanks.

I have a couple of very small nitpicks.

1. The general medical consensus is that ADHD (and ADD) is a lifelong condition. However, the symptoms change as the brain matures. It is possible to learn how to compensate for most of the problems as the brain matures. My son (ADHD) and myself (ADD) are positive examples of this.

My son, now 14, no longer needs medication to help him function tolerably in the school or home environment and to keep him safe from the harm caused by improperly controlled impulses. He has stopped running out in front of traffic, pouring boiling water on himself, running away from his companions during school trips, walking off the school campus, biting and spitting at other kids, kicking people he takes an instant dislike to, publically threatening to kill himself, loudly complaining that the school's patriotic speech was rotting his brain and he could not stay in the room a moment longer (fortunately the school staff involved had a sense of humor) etc. etc. I do not, however, imagine that this means that he will be a safe driver when he gets his license or that he will be able to curb his impulses after drinking alcohol. The vulnerability will always be there.

I have a more turbulent history as the disorder when unrecognized when I was growing up. My early academic record looks like a sine wave - brilliant performances bordered by inexplicable failures. One year I topped the class in two subjects, was the only girl in the class who got a lower grade for arithmetic than math (by a huge margin), received a lament from the PE teacher that I frequently forgot my gym uniform and a comment from my home room teacher that I stared into space too much.

I had a tumultuous and troubled "late adolescence", bumbled through my first professional degree and came good during my second one. The first program required a lot of "performance" and time dependent memory regurgitation. The second program was based on a continuous assessment model which allowed me to write essays under home, rather than examination, conditions. While the workload was punishing and quite exhausting, I shone because it allowed me to compensate for my attentional lapses. The down side was that I had to spend far more hours than my neuro-typical colleagues. Keeping on topic was hard and I was often overwhelmed by what I came to call "ideational soup". The up side was that the work I had to do to suppress and organize the ideas paid off in terms of eventual clarity of expression. At the end of four years I came fifth in the class of forty students who had been progressively weeded out from the original class of 500 students, my research project was published in a university publication and I won a postgraduate award which paid for me fees during the specialization years.

While I generally manage the disorder O.K. these days, I am not cured. Symptoms reoccur in times of physical stress: notably insufficient sleep or viral infections. I function best on a permanent (maintenence) dose from a small range of dopamine enhancing anti-depressant medication. The classic stimulant medication interferes with my blood pressure problems.

2. ADHD, like the schizophrenias and speech and language disorders, is not a unitary disease. A small handful of victims (about 2 percent, I think) appear to exhibit symptoms as the result of metabolic abnormalities. These are the ones that benefit from dietary restrictions. Sometimes the more general kind is worsened by some foods. My son, for example, used to go sky crazy after eating cakes laced with green dye. Unfortunately green was his favorite color. Sugar had no notable effect. Absense of green dye did not reduce his symptoms much. It soon became obvious that he was a danger to himself and others without ADHD medication. It took several years of medical tinkering before we found the right drug and the right dose of the right drug. To complicate matters, what worked best in his elementary school years was not what worked best in his middle school years.

As mentioned, he is now off stimulant medication entirely. Unfortunately, as his ADHD symptoms subsided his Asperger's symptoms became more salient. There is no medication for that problem. The treatment is social skills training and lots of it.

There has been an enormous amount of research done on ADHD over the past 20 years. From my point of view, the most interesting are the PET brain scans which show the areas of the brain which are implicated in the disorder and the cytology studies which show why these areas do not function as they do in neuro-typical people. In a nutshell, cells in these regions are the kind of cells which are normally found in other areas of the brain. That is, they are not well suited for the job which they are required to do.
Thank you, Rosemary, for this informative contribution.

I am interested in the dual diagnosis in your son. I have heard recently that there are similarities and co-morbidities between ADHD and ASD. My #2 son seems to have more of the ASD but also shows some possible ADHD issues. For me it is discouraging that it can take so long to find and adjust medication. None of my ADHD family are currently on meds and, due to my weak financial situation, I can't afford the meds or professional assistance.

I would also like to know more about the brain studies you mention in the last paragraph of your comment. Do you have a reference you can share on that?

Thanks
One of the challenges I am facing is manifestations of anxiety and oppositionality in my children. This is making it very difficult to work with them therapeutically. The result is a lot of obstinancy and little progress toward recognition and developing compensatory strategies.

I found this article by Sam Goldstein PhD contains some good descriptions of the challenges:

The Catalytic Role of ADHD

These patterns of behaviour in more than one of my children feed my own depression. How am I to have a positive outlook for their future? It is made worse since my spouse is generally unwilling to recognize, accept or address the issues.

I guess this is just a venting of frustration for me. ADHD can be such a pervasive impact on an individual and an entire family. I have no doubt that many people that we consider as irresponsible, reckless, and even criminal suffer from some form of ADHD. I feel this presents some difficult ethical issues for society about personal responsibility.

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