Health Care and ADHD

Do you know someone who appears to be a little �scatter-brained�? That person can�t seem to keep a logical thought connected from beginning to end without going off in multiple directions at the same time. Or perhaps they are really hyper-active and full of constant energy, unable to sit or stand still for more than a few seconds. Maybe that even describes you! And, possibly, they may have a kid who constantly �bounces off the walls�, or who are unable to sit still in their seat at school. They, or you, may have attention deficit hyperactivity disorder�ADHD.

According to the NIH (National Institutes for Health), Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders and can continue through adolescence and adulthood. Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity (over-activity). ADHD has three subtypes:

Predominantly hyperactive-impulsive:

--Most symptoms (six or more) are in the hyperactivity-impulsivity categories.

--Fewer than six symptoms of inattention are present, although inattention may still be present to some degree.

Predominantly inattentive:

--The majority of symptoms (six or more) are in the inattention category and fewer than six symptoms of hyperactivity-impulsivity are present, although hyperactivity-impulsivity may still be present to some degree.

--Children with this subtype are less likely to act out or have difficulties getting along with other children. They may sit quietly, but they are not paying attention to what they are doing. Therefore, the child may be overlooked, and parents and teachers may not notice that he or she has ADHD.

Combined hyperactive-impulsive and inattentive:

--Six or more symptoms of inattention and six or more symptoms of hyperactivity-impulsivity are present.

--Most children have the combined type of ADHD.

Much more information can be found at their website: http://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml.

People with ADHD may have trouble paying attention, controlling impulsive behaviors (may act without thinking about what the result will be), or be overly active�especially children. Although ADHD can't be cured, it can be successfully managed and some symptoms may improve as a child ages, according to the Centers for Disease Control: http://www.cdc.gov/ncbddd/adhd/.

ADHD usually appears first in childhood, but can also now be diagnosed in adults (as long as some symptoms were present in the individual's childhood, but simply never diagnosed), according to this website, where more detailed material is also available: http://psychcentral.com/disorders/adhd/.

Recent steps forward in our understanding of ADHD include:

ADHD is about three times more common among boys than girls.

The symptoms of ADHD do not always go away � up to 60 percent of child patients retain their symptoms into adulthood. Many adults with ADHD have never been diagnosed, so may not be aware they have the disorder. They may have been wrongly diagnosed with depression, anxiety, bipolar disorder or a learning disability.

ADHD has been identified in every nation and culture that has been studied.

ADHD can be difficult for everyone involved to deal with. As well as the difficulty of living with the symptoms, wider society may face challenges. Some experts have linked ADHD with an increased risk of accidents, drug abuse, failure at school, antisocial behavior and criminal activity. But others view ADHD in a positive light, arguing that it is simply a different method of learning involving greater risk-taking and creativity. ADHD is often accompanied by:

�         Anxiety

�         Learning disabilities (in children & teens)

�         Speech or hearing problems (in children & teens)

�         Obsessive-compulsive disorder

�         Tics

�         Behavioral problems such as oppositional defiant disorder (ODD) or conduct disorder (CD) (in children & teens)

Exactly what causes ADHD has not been pinpointed, though many practitioners believe neurobiological or genetic elements play a role. In addition, numerous social factors such as family conflict or poor child-rearing practices, while not causing the condition, may complicate the course of ADHD and its treatment.

According to the Wall Street Journal, it's no longer shocking to hear of children with attention-deficit hyperactivity disorder�and others simply facing a big test�taking ADHD medicine to boost their performance in school. But new studies point to a problem: There's little evidence that the drugs actually improve academic outcomes.

Stimulants used to treat ADHD like Ritalin and Adderall are sometimes called "cognitive enhancers" because they have been shown in a number of studies to improve attention, concentration and even certain types of memory in the short-term. Similar drugs were given to World War II soldiers to improve their ability to stay alert while scanning radars for enemy aircraft.

However, a growing body of research finds that in the long run, achievement scores, grade-point averages or the likelihood of repeating a grade generally aren't any different in kids with ADHD who take medication compared with those who don't. (Typically, studies take into account accommodations schools provide kids with ADHD, such as more time to take tests.)

Other studies have shown that kids who take ADHD medication and study early for an exam tend to do just as well, if not better, than kids without ADHD. But those who take medication and study at the last minute don't do any better. Together, these findings suggest that medication alone isn't enough to improve academic performance. The medicine may help with focus, but it doesn't help with deciding what to focus on, experts say. Rather, it needs to be coupled with skills training, such as learning how to organize or prioritize. More story details can be found here: http://online.wsj.com/news/articles/SB10001424127887323368704578593660384362292?mg=reno64-wsj&url=http%3A%2F%2Fonline.wsj.com%2Farticle%2FSB10001424127887323368704578593660384362292.html

People with ADHD can be very successful in life, according to the professional organization CHADD. But without appropriate identification and treatment, ADHD can have serious consequences, including school failure, depression, conduct disorder, failed relationships, and substance abuse. Early identification and treatment are extremely important. - See more at: http://www.chadd.org/Understanding-ADHD.aspx#sthash.YRN13yTF.dpuf.

Finding a way to help with ADHD, or to receive proper diagnosis, should be done with a registered mental health counselor or physician. Research the options for care and management of this disorder, and talk with support groups that can assist you with information.

Until next time.

    

Public Talk at the University of Virginia on Friday, January 17

This Friday, I'll be giving an invited lecture at the University of Virginia, my undergraduate alma mater.  I was kindly invited by a medical student named Robert Abbott, and it worked out well because I was already traveling to Charlottesville.

The talk will be titled "Why Do We Overeat?  A Neurobiological Perspective".  Here's the teaser:

Obesity is a leading cause of morbidity and mortality in industrialized nations, yet this is a relatively recent phenomenon.  In the United States, increasing obesity prevalence has paralleled a gradual increase of daily energy intake.  Why do most Americans eat more than we used to, and more than we need to maintain a lean state, despite negative consequences?  This presentation will touch on the neurobiology of action selection, the neurobiology of energy homeostasis, and why our central nervous system hardware may not be up to the task of constructively navigating the modern food environment.

The talk will be attended by medical students, but I also hope to have some doctors and researchers show up, as well as people from the broader Charlottesville community.  It will be a thought-provoking talk regardless of your background, and it will touch on some of my own work.

The talk will be held in the main medical school auditorium, MEB 3110, on Friday, January 17 at noon.  You can find driving directions and parking information by following this link.  You'll probably have to park in a parking garage, either the Lee Street or Central Grounds garage (directions in the link).

For a map of the UVA health system, follow this link.  The Medical Education Building is number 44 on the map, and the talk will be in room MEB 3110 on the 3rd floor of the building.

See you there!