Pay Attention!  5 Things You Need to Know (but don’t) About ADD/ADHD

Dr. Craig Liden | The Being Well Center

Based on my observations and studies treating ADD for the past 30 years, it’s fair to say that ADD touches upward of 20% of our population.  More than ever, we need to understand this often misunderstood, misaligned disorder.

People who are treating their ADD are living and thriving.  Let’s make the path to accurate diagnosis and effective treatment plans clear for all.

5 Things Everyone Should Know About ADD/ADHD:

1.    Attention Deficit Disorder is very common in adults. It is suspected that 1 in 25 adults has ADD.  However, only half have been properly diagnosed and less than a quarter are being properly treated.

2.    Untreated adult ADD can result in many chronic issues: obesity, chronic bowel problems, addiction disorders, depression/anxiety, and college failure, not to mention failed relationships, accidents, or poor job performance.  Properly diagnosing and treating ADD could have a huge impact on our society and health care system.

3.    Proper treatment of ADD with medication and counseling always starts with a comprehensive, diagnostic evaluation that includes objective testing, feedback from various members of the patient’s life, and a look at the whole person.

4.    Risks associated with correct medication use are minimal compared to the risks of untreated ADD.  Medication is often necessary but never sufficient and should always be paired with supportive counseling.  Stimulant medications used to treat ADD are generally very safe and are not addictive.

5.    The preferred name for ADD/ADHD is ADD since “Hyperactivity” is only one of many symptoms of ADD patients and shows up in less than 10% of those diagnosed.

Dr. Craig Liden is the Founder and Medical Director of The Being Well Center, an ADD/ADHD diagnostic and treatment center in Pittsburgh, PA that has helped more than 10,000 people worldwide living with ADD.

TRANShealth Inc. is sponsoring a free download of Dr. Liden’s book, ADD/ADHD Basics 101, in which Dr. Liden gives 10 steps to securing a diagnosis and treatment plan you can trust. 

 

Friends Should Tell Friends About ADD/ADHD

image via Flickr, coolio-claire

While scientific research has only begun to demonstrate it, my observation and experience suggest that ADD may be everywhere in contemporary society. My bet is that ADD is an important biological contributor that interacts with life circumstances to cause some of the more significant health, educational, social, and economic dilemmas that we face.

In fact, by putting ADD into the mix and addressing its role, we may find that some of these perplexing problems are far more solvable than we thought.

Friends Should Tell Friends

image via Flickr, coolio-claire

image via Flickr, coolio-claire

It is imperative in addressing these perplexing societal problems that we increase society’s awareness of this important, but hidden, biological difference. All of us need to be more aware of the critical role that paying attention plays. We need to recognize that difference of weakness in attention places an individual at risk for problems in almost every area of life — problems which, at first glance, hardly seem to be related to a difference in brain chemistry.

Responsibly written and produced articles, books, and media presentations can play a significant role in enhancing awareness about ADD. Too often, ADD is presented in a cursory, negative, and sensational way in the media. Such a simplistic approach to a complex problem like ADD only confuses the picture and heightens parents’ and teachers’ fears.

Professionals Need Informed Training

Another key step in increasing awareness of ADD involves improving and expanding the training that professionals who work with ADD receive.

Too often professionals who are in the position to work with ADD individuals have a poor understanding of ADD. In fact, many professionals continue to be unaware of the fact that ADD is not just a school problem. It is a life problem whose basis is biological. Effective assessment and treatment is impossible without a comprehensive team approach.

Professionals who lack appropriate training and experience with ADD have an obligation to make a concerted effort to match up the ADD individual and his family with the best resources available.

Schools Should Put Some Muscle Behind ADD/ADHD Support

image via Flickr, alamosbasement

image via Flickr, alamosbasement

We also need to break down the barriers that limit access to appropriate comprehensive services. Schools should do more than pay lip service to providing multidisciplinary services to ADD children. The team cannot consist solely of a school psychologist and teachers and other educational personnel.

Since ADD is a biologically-based problem, the team must include a physician who is knowledgeable in this area.

And, because the impact of ADD goes beyond the schoolyard, dedicated school personnel need to feel comfortable encouraging parents to seek appropriate help from other nonschool professionals for management of the problem in other life arenas.

ADD is NOT a “Mental” Problem

To make this possible, insurance companies and government health financing systems need to evaluate critically policies and reimbursement mechanisms that unfairly discriminate against individuals with ADD. At a most basic level, they need to accept that ADD is not a “mental problem,” but that its physical basis is as real as diabetes and coronary artery disease. These health care financiers would be wise to consider the cost efficiency of early intervention, health education, and comprehensive team treatment of ADD.

Give ADD the Middle Ground

Finally, as a society, we need to find the middle ground. We need to strike a balance between emphasis on skill acquisition and on learning how to live, between permissiveness and firm discipline, between reliance on technology and humanistic intuition, and between manipulation of the brain and counseling the mind.

It is in this middle ground that true quality of life is found.

5 Reasons We Know ADD is Real

image via Flickr, woodleywonderworks

I’ve heard some professionals say, “ADD is just a cover-up label for suburban parents who cannot deal with their emotionally-disturbed kids.” Some write it off as “being in vogue–the problem for this decade.” Others wonder, “If ADD is a result of an inborn physical difference, then why wasn’t it around when we were kids?

I respond strongly to this skepticism. ADD is a very real problem!

Because we are more knowledgeable, we are able to identify ADD more frequently and, thereby, it appears to be in vogue. But ADD was around when we were kids. We just weren’t aware of it.

Biologically-based attention differences are probably no more common in 2014 than they were in 1950. However, dysfunction resulting from these differences is more common because societal expectations have significantly changed over the past several decades. Many of these new demands put a high premium on the individual having efficient attentional skills in a way that was never demanded before. As a result, just as with ADD in an individual, these new societal expectations have uncovered an underlying societal problem that has probably always been there.

1.  New opportunities for our children highlight the existence of ADD

In the ‘40’s and ‘50’s, most parents worried about the basics. Nutritious food on the table and a roof overhead. Reading, writing and arithmetic. Basic health. In fact, my parents worried about whether I would survive polio or die like several of my best playmates. Thanks to amazing technological advances, today we, as parents, take these basics for granted and want much more for our children. We want our children to achieve at school, to go to college, and to get a job that is better than the one we have.

I am constantly impressed how far we will go to provide enriching opportunities and to push our children in the name of wanting them to have the chances we did not have. Often, these “chances” backfire because they require proficiency in areas, like paying attention, that some children just don’t have.

image via Flickr, woodleywonderworks

image via Flickr, woodleywonderworks

In our schools, the demand for high achievement and independent learning has filtered down to earlier and earlier grades. Curriculum content has expanded so that many teachers are overwhelmed and unprepared to introduce a wealth of new material, let alone to teach the basics to children who require some extra help.  Support services in most school districts are shrinking rather than expanding. Access to extra help is often contingent upon student failure rather than being viewed as a preventative response to minor difficulties.

It is easy to see why regular classroom teachers get frustrated when they are placed in the bind of producing high group achievement test scores to please the school board while watching 20% of their class struggle to just get by.  Without support to address these children’s needs, most teachers either become guilty or get burned-out, both of which reduce their effectiveness further.

 2.  Modern parenting styles highlight the existence of ADD

Societal attitudes about discipline and behavior management have changed radically as well. These changes have also contributed to our increased awareness of ADD–the problem that has always been there. The pendulum has swung from the rigid, authoritarian, and, frequently, punitive approach of the ’50’s to a more permissive and democratic approach in the ’70’s and ’80’s.

Today’s parents are more likely to provide a detailed answer to the child’s proverbial question “Why?” than to end the discussion with “Because I said so!” In an attempt to promote self-esteem and foster creativity, many parents hesitate to set firm limits on children’s behavior or to structure their lives. Many parents are afraid to say “No.” They walk on eggshells instead. They try to control their child’s behavior with rewards rather than meaningful consequences. Many children can go with the flow and adapt to whatever management style is used.

However, the more democratic, laid-back approach places demands for self-awareness and self-control on ADD children that they are rarely equipped to meet. The resulting behavior problems in the home or school bring the ADD children into the spotlight and allow us to identify them.

 3.  Modern family units highlight the existence of ADD

image via Flickr, Marco Antonio Torres

image via Flickr, Marco Antonio Torres

The nature of the family unit has significantly changed in the past 50 years. Again, this change has forced us to become aware of the ADD population. More children are being raised in single parent homes. More and more, both parents need to hold full-time jobs outside the home. In our mobile society, Grandma no longer lives two houses away but more commonly, two hundred miles away.

All this means that the support system that previously was there to structure and bail out the child with ADD is no longer present.

Moreover, this prop has been pulled out at a time when society has placed increasing demands on children without creating increasing levels of support.

There is, for example, a shocking lack of affordable, quality childcare services across the country. As a result, many children spend countless hours alone or in the care of people who have not received basic training in child development, let alone training in working with difficult children.

In a permissive society, without supportive props, the ADD child is a set-up to misuse the increased amount of unstructured time available to him. Truancy, vandalism, and delinquency are often the outcome. And each time an individual commits such a “crime,” we have another opportunity to identify ADD.

The pace of growing up has quickened and, as a result, children are faced with increasing expectations to exercise mature social judgment. Adolescent children are placed in the position of having to make independent, adult decisions about sex, drinking, and drugs. These demands put the impulsive ADD child with poor problem-solving skills at an even greater risk for alcoholism, drug addiction, and teenage pregnancy and provide him with another chance to be in the spotlight.

4.  Our technological society highlights the existence of ADD

image via Flickr, Mervi Eskelinen

image via Flickr, Mervi Eskelinen

As our society has moved from an industrially-based to a technologically-based economy, a new set of skills and abilities are now required to make it on the job.

The highly structured, physically demanding, manual labor jobs have been replaced by white-collar positions demanding good organizational skills, effective problem-solving abilities, and independent self-monitoring.

Once again, the individual with ADD is at a disadvantage and at risk for being identified. It would not be surprising to find that individuals with ADD have a disproportionately high representation in the ranks of the unemployed.

5.  Increased stress levels highlight the existence of ADD

Finally, because of these and numerous other reasons, life’s stresses appear to be more complex and challenging than they have ever been. And if there is anything that requires us to be reflective, focused, vigilant monitors, and efficient problem-solvers, it is stress management. Without the prerequisites to meet the challenge, the individual with ADD enters into a devastating downward spiral. Marital difficulties. Money problems. Mounting anxiety and depression. Tranquilizers. Just getting by. Social isolation. Back pain. Sick days. Weight gain. Hypertension. Constant fear. Alcohol abuse. Traffic accidents. Hospitalization. Bankruptcy. Immobilization. Giving up.

ADD is Real, and We Know It.

For all these reasons and probably many more, ADD now plays a more significant and very real role in people’s lives. And, as a result, we all have the opportunity to see its impact.  When people are skeptical about the significance or even the existence of ADD, they create a barrier to overcoming a very serious, but very addressable, health disorder.  Don’t let skepticism rob you of progress toward a better, and easier, life.  ADD is a very real problem.  But it’s a problem with very real solutions.


More answers and information about ADD/ADHD can be found in Dr. Liden’s book, Pay Attention!: Answers to Common Questions About the Diagnosis and Treatment of Attention Deficit Disorder.


10,000 people living with ADD have found hope and help navigating the challenges of ADD at The Being Well Center.  No matter where you are in life, we can help, starting today.

 

Hope for Life After the ADD Diagnosis

image via Flickr, pol sifter

What is the prognosis when ADD is treated appropriately?

image via Flickr, pol sifter

image via Flickr, pol sifter

The prognosis of ADD is highly variable depending upon a multiplicity of factors. The individual’s temperament. His language skills. His intelligence. His basic academic skills. The profile and severity of attention weakness. His physical characteristics. The integrity of his nervous system. The presence of illness. Stresses in his life. His attitudes and beliefs. His self esteem. His motivation. The expectations set for him. The profile of strengths, weaknesses, and temperamental characteristics of people in his life.

For each individual, the mix of these factors is a little bit different. And for any given individual, the mix is constantly changing. This is what makes ADD such a challenge.

When all these factors are taken into account and appropriate, comprehensive treatments are put into place, the prognosis for ADD is good but guarded.

That is, the ADD individual can be helped to function successfully academically and on the job; he can have meaningful social relationships; and he can function independently.

However, as long as he continues to take on life’s challenges, there is always the possibility that the problems associated with ADD will resurface.

But this really is no different from what we all face in our own personal quest for self-development.


More than 10,000 people living with ADD have found hope and help navigating the challenges of ADD at The Being Well Center.  No matter where you are in life, we can help, starting today.


Our current blog series is excerpted from Dr. Liden’s best-selling book, Pay Attention!: Answers to Common Questions About the Diagnosis and Treatment of Attention Deficit Disorder.

 

Follow Up Care for ADD Medication

image via Flickr, Kate Ter Haar

How often should an individual with ADD be checked once he starts medication?

image via Flickr, Kate Ter Haar

image via Flickr, Kate Ter Haar

Once the proper medication regimen has been established and the initial adjustment phase is over, my bias is that ADD individuals should participate in follow-up with a clinician at least monthly until all areas of his dysfunction are resolved or stabilized. This can be with a physician who performs brief med-checks and probes patient compliance with all parts of the treatment plan.

Alternatively, follow-up can be with a counselor, ADD coach, tutor, or other professional implementing the treatment plan and communicating to the physician about progress, persistent problems, and observed or reported medication side effects.

Regardless of the frequency of these follow-up visits, I see all of my patients for whom I am prescribing medication every three months for a more comprehensive medication review visit.

Include the Parent or Spouse

I strongly encourage both parents or the spouse to attend these visits with the ADD child or adult. At these appointments, I check height, weight, blood pressure, and heart rate and perform a targeted physical exam when there are specific health concerns. Each patient also participates in a brief reassessment of his attention using specific tests that I have developed. Sometimes we reassess attention on the current dosage of medication to document its current effectiveness. Other times, we assess attention of medication to document continuing need.

I always meet with the ADD individual to directly observe his functioning and to hear his perspective about how he is performing in each major life sphere — school, work, social involvements, home life, and daily routines and responsibilities. I also probe to be certain he is taking the medication as directed and check his perceptions regarding efficacy, side effects, or other problem areas. I then meet with his parents or spouse to discuss the same areas. As ADD individuals are notoriously inaccurate in monitoring their own performance or behavior, another person’s perspective is always helpful.

At the conclusion of these visits, I give my feedback about the progress the individual is making . . . sometimes followed by a hug or pat on the back and sometimes with a kick in the rear! Together we decide whether to keep the medication regimen the same, discontinue it, or to make changes.

Anticipate the Future and Stay in Touch

image via Flickr, in transition

image via Flickr, in transition

This visit also provides me with an opportunity to provide anticipatory guidance about problems that are likely to emerge in the near future as the expectations in the individual’s life change. When appropriate, I also share my treatment recommendations with the other professionals who are working with the individual.

As individuals continue in treatment, do well, and remain stable for a long period of time, occasionally, these visits out to occur twice a year rather than quarterly.

However, this is rare; I have learned over the years that a lot can happen in an ADD individual’s life in three months, let alone six months, that can head him in the wrong direction.

More often than not, the ADD individual is not fully aware of a change in direction or has used ineffective problem solving that complicated matters rather than solved a problem. I prefer more contact rather than less when it comes to management of ADD and so do most of my patients.


Catch up on all of the discussion topics in the Pay Attention! series.


Our current blog series is excerpted from Dr. Liden’s best-selling book, Pay Attention!: Answers to Common Questions About the Diagnosis and Treatment of Attention Deficit Disorder.

Dangerous Side Effects and ADD Medications

Are there any dangerous side effects from use of ADD/ADHD medications?

The stimulant medications used to treat ADD have been used for more than fifty years with children and adults with attention problems. Strattera, the non-stimulant, which became available recently, was studied extensively in thousands of individuals for several years before it was released.

image via Flickr, D Sharon Pruitt of Pink Sherbet Photography

image via Flickr, D Sharon Pruitt of Pink Sherbet Photography

Taking all of this into account, my perspective is that these are very safe drugs when used properly.

Over the years, I have rarely had to recommend discontinuation of one of these medications solely in response to the emergence of a serious side effect. As with all medications, it is possible for some untoward effects to accompany the benefits received.

However, as a physician, I have seen many more serious side effects from such beneficial and commonly used medications as penicillin, aspirin and prednisone than with the medications used to treat ADD.

Unfortunately, over the years, there has been a great deal of negative coverage in the popular media about dangerous side effects occurring with the use of these medications, particularly the stimulants, that is simply not supported by the facts.

Still, it is not unusual for grandparents, friends, school nurses, physicians, or even pharmacists who do not have a thorough understanding of these medications to make negative remarks causing parents and ADD individuals to be concerned about the safety of these medications.

In my experience, some of the side effects attributed to the medication are really the consequences of inadequate medication treatment for ADD. Specifically, some individuals experience things such as increased irritability, jitteriness, and headaches when their dose of medication falls in a sub-therapeutic place just below what they really need. If the dose is increased slightly, these symptoms generally vanish quickly. Others have wondered if such things as temper outbursts or self-injurious behaviors could have been caused by the medication when the reality was the individual was still struggling with residual impulsivity at a sub-therapeutic dose.

ADD Medication and the Internal Stress Response

A common phenomenon that complicates interpreting and managing apparent side effects is the mobilization of the internal stress response by the increased self-awareness that accompanies medication therapy. When this stress response is set off, certain behavioral adaptations including hyper-vigilance (the deer in the headlights look), increased arousal leading to a decreased need for sleep, and suppression of feeding and reproductive behaviors often occurs.

image via Flickr, mrMark

image via Flickr, mrMark

Physical adaptations are also made when the stress response is set off and a message is sent to the adrenal glands to release their hormones. This can result in such things as a dry mouth, sweaty armpits, increase in heart rate and blood pressure and peripheral vasoconstriction leading to cold hands and muscle spasm and/or pain in the back, chest wall, and extremities to name a few.

I have seen each of these natural consequences of the stress response interpreted as medication side effects by unknowing or inexperienced observers. Obviously, the answer for these individuals is not to stop the medication, but to provide supportive counseling and stress management strategies so they can deal more effectively with the consequences of their new self-awareness.

Chicken or Egg: Paying Attention to What’s Already There

Finally, with the introduction of proper medication treatment, some individuals start paying attention to physical problems that have been there all along.

The most common example in my practice is the sudden onset of stomachache or abdominal pain when medication is instituted in an ADD individual who actually has been chronically constipated for years but has not been tuning into the associated discomfort and queasiness that commonly accompanies this problem.

All in all, the interpretation and management of “side effects” that emerge with medication treatment for ADD can be very tricky. I find that I need to rely heavily on my experience with the medications along with my understanding of the whole person in order to help my patients have a positive experience. Overall, there is little to fear when these medications are used by an experienced physician following a comprehensive evaluation.


Our current blog series is excerpted from Dr. Liden’s best-selling book, Pay Attention!: Answers to Common Questions About the Diagnosis and Treatment of Attention Deficit Disorder.

Taking a “medication holiday” from ADD/ADHD?

image via Flickr, Jenni C

Should people take “medication holidays” off the medication?

There is no way to justify having a child discontinue taking medication for a sustained period of time over the summer or on weekends before he has demonstrated that he has developed strategies to work around his attention weaknesses without the aide of medication.

The same holds true for adolescents and adults with ADD, but the consequences of a medication free weekend can be even more frightening and tragic. I have more than a dozen adolescents who have gotten pregnant or got someone pregnant and, in each circumstance it occurred when they chose not to take the medication on weekends because their friends said they were more fun off. I also have several patients who were killed behind the wheel of the car or killed others when they drove off medication over the weekend.

image via Flickr, Jenni C

image via Flickr, Jenni C

ADD is a life-long problem that does not take holidays. The price a person pays for being impulsive, being distractible, monitoring poorly, and being unable to sustain focus while “on vacation” is certainly not worth being medication free. Such independence is a fallacy for the off-medication child who is now faced with Mr. Smith angrily knocking on the door holding the baseball that went through his window, Mom screaming at the top of her lungs for the eighth time of the day, the neighborhood children refusing to play with him, boredom at 10:00 on Saturday morning, or a fractured ankle after jumping out of the tree in the backyard.

Discontinuing the medication for any reason before a person is able to successfully meet the expectations set for him in all life spheres is like removing a person’s reading glasses and expecting him to read, or discontinuing a diabetic’s insulin and telling him to make his own insulin and – when he is unsuccessful – demanding that he “try harder!” Unlike the person who requires glasses and the diabetic who needs insulin injections, the ADD individual may, at some point, not require the use of his aid – medication. However, premature discontinuation of the medication is a set-up for serious failure.

Secondly, when the medications are taken only at selective times, a subtle but important paradigm shift is being made. Under these conditions, the medications that should be used for continuous symptom relief of a problem that is there all the time become drugs that are selectively used to enhance performance. I feel this is the wrong message to be giving an ADD individual who, by the nature of his problem, is at a greater risk for substance abuse.


Catch up on all of the discussion topics in the Pay Attention! series.


basics301_addbasics.orgFor a more detailed, clinical discussion of the use of medication to treat ADD, visit ADDBasics.org to download Dr. Liden’s free ebook, ADD/ADHD Basics 301: Rationale for Clinically Necessary Off-Label Use of Stimulant Medications in the Treatment of Attention Deficit Disorder / Attention Deficit Hyperactivity Disorder (ADD/ADHD)


Our current blog series is excerpted from Dr. Liden’s best-selling book, Pay Attention!: Answers to Common Questions About the Diagnosis and Treatment of Attention Deficit Disorder.

ADD Medication: 24 hours a day, 365 days a year?

image via Flickr, JulieFaith

How often should ADD medications be administered?

Since ADD is a biological problem that is with the individual from the beginning to the end of every day, the goal in using medication should be to provide relief of the ADD symptoms continuously throughout the whole day, seven days a week, 365 days a year.

This means that depending upon the characteristics of the particular medication that is selected as optimal, it is important to define a regimen of administering the medication (or combinations of medications) that provides improved attention from as early in the morning to as late into the evening as possible.

The easiest time to pay attention

image via Flickr, JulieFaith

image via Flickr, JulieFaith

Some people hold onto the mistaken notion that the only times the ADD individual needs the benefit of medication is during school or work hours. Actually, these are really the easiest times to pay attention during the day! They are generally highly structured situations where it is likely that the individual will receive immediate feedback if his behavior or performance is off the mark.

The same cannot be said for other daily life tasks like completing homework, remembering to complete chores, and maintaining healthy routines for eating, exercise, and sleeping. While there are structures that can be used to ensure these independent functioning tasks are completed efficiently, the individual must impose them on himself and self-monitor the results. Feedback often comes well after the fact in the form of nagging from a parent or spouse or shock when stepping onto the bathroom scale.

 ADD, medication, and social skills

Controlling our emotions and communicating effectively during social interactions are even more attentionally demanding. They occur at unpredictable times and, most often, in unstructured situations. Feedback, if it comes at all, can be very subtle . . . a raised eyebrow, a change in tone of voice, a sudden change in plans that makes it impossible to get together.

When you know you need it…

I have talked to some adults with ADD at conferences who say they do well just taking the medication only when they know they need it. I find this particularly troubling for two reasons. First, “knowing you need it” requires efficient attention. Without proper medication, the individual with ADD doesn’t always monitor himself. It’s an unfortunate irony that ADD is one of the only health problems we deal with where the problem itself stands in the way of the individual knowing he has a problem. It should be no surprise that these individuals often, inadvertently, come across as rude . . . interrupting, straying off topic, and monopolizing the conversation.


basics301_addbasics.orgFor a more detailed, clinical discussion of the use of medication to treat ADD, visit ADDBasics.org to download Dr. Liden’s free ebook, ADD/ADHD Basics 301: Rationale for Clinically Necessary Off-Label Use of Stimulant Medications in the Treatment of Attention Deficit Disorder / Attention Deficit Hyperactivity Disorder (ADD/ADHD)


Our current blog series is excerpted from Dr. Liden’s best-selling book, Pay Attention!: Answers to Common Questions About the Diagnosis and Treatment of Attention Deficit Disorder.