Monday, March 08, 2010 by Emily Singer

The ADHD drug, Ritalin, improves attention by enhancing neural plasticity.

New research in animals sheds light on how Ritalin, the stimulant drug prescribed to millions of children each year in the United States for attention deficit hyperactivity disorder (ADHD), sheds light on how the drug works. The molecule appears to boost both attention and enhance the speed of learning by increasing the activity of the chemical messenger dopamine, according to new research inNature Neuroscience.

Rats given Ritalin were able to more quickly learn that a combination of signals–a flash of light and sound–meant they could get a sugar water reward. But if the rats were also given a drug to block one type of dopamine receptor, the effect was lost. Treated animals also focused more intently on the task at hand, engaging in less unrelated behavior. Another drug, designed to block a second type of dopamine receptor, blocked Ritalin’s ability to increase focus.

Researchers also found that drug-treated animals had enhanced neural plasticity, or changes in strength of the connections between nerve cells. The ability of our neural circuits to change strength in response to new information underlies our ability to learn.

“Since we now know that Ritalin improves behavior through two specific types of neurotransmitter receptors, the finding could help in the development of better targeted drugs, with fewer side effects, to increase focus and learning,” said Antonello Bonci, MD, principal investigator at the Ernest Gallo Clinic and Research Center and professor of neurology at UCSF, in a statement from the university. The Gallo Center is affiliated with the UCSF Department of Neurology.

While Ritalin is mostly prescribed for children with ADHD, it also boosts cognitive function in healthy people. A number of studies suggest that a growing number of healthy adults and teens are taking Ritalin and similar drugs to aid in studying or work performance.

Young men with early or heavy use of Marijuana appear to have a 70% greater risk of Testicular Cancer.  This risk is even higher the younger the age of first use.

Researchers at the Fred Hutchinson Cancer Research center in Seattle found an association with Nonseminoma, a fast growing and aggressive subtype of testicular cancer.  Of all testicular cancer, 40% is Nonseminoma and the rest are slower growing.

It appears that hormonal changes during puberty make young men more vulnerable.  The findings were independent of other known risk factors, such as family history, cigarette smoking and alcohol use.  It appears that the testes, like the brain, have receptors for tetrahydrocannabinol, or THC, the chemical component of marijuana.

I found this information very interesting.  In our center, we have seen so many young people with ADHD attempt to self-medicate with Marijuana.  It appears the dangers of Marijuana are greater than we initially understood.

Will:
“A friend of mine calls it “Eclectic Free-Ranging Focus”, not liking the pejorative sound of the words “deficit” and “disorder”. I kind of like that….”

Jennifer:
“Extra thinkers. Thinkers plus? Bonus thinkers.”

Ted:
“Thought-diffused”

Ann:
“I like Attention-Surplus…because nobody can focus like and ADHD’er (when we are interested!)

IF you have another name for ADHD or another analogy or metaphor for how you think of ADHD we would love to hear about it. So please take a minute and post your best ADHD analogy and share it with all of our blog readers.

ADHD Stress- Mom, Husband & Kids

There are two distinct conditions being discussed here. ADHD is one and stress is the other. Both are fairly easy to define and if you are a parent with a child who has ADHD it’s probably fair to say you know a bit about stress. The problem here though is that dealing with ADHD can be a tough task at the best of times, so if you throw stress into the mix, that task just got tougher.

Then, if all that is not hard enough, you add an extra ingredient of the holidays. Travel, visiting folks, having folks visit you, cooking, more cooking, the weather and all these things may make your stress levels soar to new heights. Stress has a way of upsetting the sufferer in many little and large ways. If you are stressed you will not sleep well, you may lose your appetite, you may feel like giving up and are likely to pick up colds and headaches more easily. It’s wise to get rid of stress.

So what else do we know? We know what usually happens during the holidays and even what may happen. So you are forewarned in that area. So we know about your ADHD child, you know about your spouse, you know about the holidays and you know that ball will suffer if you suffer from stress. But it is really possible to reduce or even remove your stress. And that simply has to happen because, let’s face it, a hyperactive child, or overzealous spouse plus the holidays do not need you suffering from stress. Simple. Get rid of the stress or the things which create the stress.

Here are some ways to do just that. Meditation. Now some people react to this idea with scorn and derision. It’s a waste of time, it doesn’t work and I’ll make a fool of myself. And those sorts of comments are usually from someone who has never tried meditation or never been serious in trying it. There are different philosophies and approaches to meditation but it all boils down to you stopping, being still in a quiet place and not doing anything other than relax. That in itself is a big help. For someone who is constantly on the go, constantly looking out for your ADHD child or spouse, putting on the brakes and doing nothing is good for your body, mind and soul. Make it for five minutes every day. Try it for ten minutes. It could mean the removal of your stress. Studies have shown that sitting doing nothing for 30 minutes a day, reduces cholesterol significantly and improves heart functioning. Imagine what a few minutes each day can do for you.

Then there’s logic. This involves you taking out a pad and pen and writing down, one topic at a time, the thing which is causing your stress. Don’t tackle more than one issue at a time or else you will become stressed. How ironical is that?

So let’s say you are behind in your study program. Your latest assignment is due and you haven’t found the time to do the necessary work. Just writing it down is helpful in itself. Then you need to list why this situation has arisen. Why are you behind? Well, obviously it’s because you are busy with other things, many of them essential. And once again, writing down the reasons is helpful in itself. And, now you must make a decision. List the way or ways you can find time to complete your work. Now that you have a plan, follow through, one step at a time. And presto, you feel better already.

Leave us a comment on how you handle Stress…

ADHD Kids & Holiday Travel

The holidays create a special and different time for each of us. For kids they are special, and for kids with ADHD they are different, special and much, much more. As a parent of a child with ADD/ADHD you can make life easier for your child and certainly for yourself, if you take certain steps. They are not difficult, they may take a little time and may cost a bit of money [or may cost nothing at all], and they can pay dividends in the form of relaxation and a real good holiday.

The first step is to be aware that the holiday, even one spent at home, will make for a change in the life of your child. Most kids with ADHD don’t react well to change. It may make your kids behavior even more demonstrative. So know this fact; you have to prepare. Prepare yourself, prepare your child and prepare for your journey and your destination.

So let’s consider your child. Take away the surprise element and build on the anticipation aspect. Let your child in on most of the plan, if not everything, which is likely to happen. If they are going to travel, go through the rigmarole of the journey. If it’s by car, plane or train, take out a map and show your child the route. You could use a large piece of blank paper and do simple things like draw your house, draw Grandma’s house and draw the road. Let your child help. Let them have a cut out picture of your car and have the child ‘drive’ the car along the map. If there are stopping points en route, draw or cut out pictures for the McDonalds, restaurant, hotel, etc. as the place you plan to stop for a meal, toilet break, etc. The whole emphasis is on preparing your child for what is going to happen or is likely to happen. Remember the activity needs to be age appropriate. As an example, younger kids may work with crayons and paste, while older kids may prefer to put their project together on the computer.

Next, you will want to prepare your child for what will happen at your destination. If it’s a motel, explain the room, where the child will sleep, where they can play games, etc.  If it’s Grandma’s house, show your child a photo of their room, of the house and garden. Explain where the child can play, who will be in the house and anything likely to happen on the vacation.

Then there’s the actual journey.  Have plenty of ‘quiet’ activities at hand, so your child can have things to do. It might be following a homemade map, ticking off things they can see out the window, a handheld digital game, listening to a CD or MP3 player, and/or watching a video/DVD on a portable player.

So, preparation is the real key. Have a variety of activities planned and once the holiday is under way and your child behaves in an acceptable way, reward them frequently for their good behavior.  It is the best present at holiday time to give to your child; your thanks and love in recognition of their successful attitude, good behavior and achievement. A hug, a kiss and kind appreciative words (positive attention) are the best forms of reward and can carry the most significance.

Remember a child with ADHD loves security, attention and routine. You can decide if the attention they get is going to be positive or negative. If you change the routine as a result of a holiday, you need to take certain steps to help your child and yourself so that you both can have a fantastic time.

Do you have tips to manage kids with ADHD during the holidays?  Please share your tips by adding your comment on this blog.

Pharmacy Technician

At first, the pharmacy tech was all smiles when she took my prescription and went to check if they had the medication on hand.  Then it started, “Oh really, it says here twice a day – I think that is too much.” “Oh yes, I will have to do some checking. Oh no, No- I don’t think that is o.k.” “This is for you?” she said surprisingly, with a scrunched face of disbelief on her forehead. “We will need to call and speak to the doctor, to make sure he knows about this dose for sure.”  ”We can not fill this for you, without first consulting the doctor. You will have to come back tomorrow.”   I told her that I had just been to my psychiatrist, a 30 year Specialist in ADHD, and Yes, he did prescribe 1-2 capsules per day, and yes I was a high metabolizer, and yes that dose was what my licensed psychiatrist believed was required to provide relief from my ADHD symptoms.

“Still no, no, I will have to speak with him.  After all  this ADHD is still so very new she proclaimed, there are some companies who have age cut offs for it or if they will treat your ADHD, and some will only pay for once a day.”  Was this really happening to me a licensed psychologist running one of the most esteemed ADHD centers in California? The answer was YES.  I was being given a giant dose of pharmacy shame. That feeling I get in my gut when I know someone just thinks ADHD is something for kids, and it is just a disorder de jour.  It was then that I realized that while I am surrounded by insightful and informed colleagues all day, there is still much of the world, including the insurance companies, and apparently pharmacy technicians who still believe that Adult ADHD is not a real disorder.

Then the punch line came, “after all, I think that the world today demands too much from our kids, they were meant to be in fields, that is what our kids need today.”  Now understand that I acknowledge that my fellow ADHDers may have been better hunters than they were farmers, as far as our ability to climb the evolutionary ladder.  Hartmann’s Hunter-Gatherer theory suggests that the hyperfocus and ability to take in many sources of stimuli were essential in our evolution as nomadic hunters. He suggest that as society has moved to a more farmer linear model, the previously helpful attributes are now considered a disorder. Yet, there I was after work on a Tuesday at CVS in Van Nuys, having to defend the validity of my psychiatric diagnosis to a pharmacy technician.

The take away point for me is that Adult ADHD has come a long way in being recognized as a legitimate disorder in the medical community, and still in the everyday world, there are those that are quick to discount this disorder as something that is less than valid, that I should have grown out of, or could be cured if I were not in a world as demanding as ours. Well, the reality is I do live a demanding world. I do have commitments and deadlines, and yes, I do lots of leisurely things to relax including exercise and eating well.  But I don’t have another 1000 years to evolve into a person with less ADHD. I have adult ADHD that deserves to be treated with the sufficient respect and dignity of other disorders that cause as much difficulty as does my ADHD.   Adult ADHD like most things in life, in that it looks unique for every person, and is measured along a spectrum from mild to severe. For many adults living with ADHD, medication is a lifeline to capability and thriving in the world. The stigma about adult ADHD is not gone, and so I say to my fellow ADHD’ers fight back and stand strong. My fellow ADHDers we have come a long way, and the battle for equity in treatment is still upon us. Adult ADHD is real, and life I guess is just hard enough without having to deal with an unwanted dose of “pharmacy shame”.

I would like to hear your thoughts and experiences with pharmacies and /or ADHD skeptics.  Leave your comments and we will post it on our blog.

You will probably just make it

Any adult who has ADHD will not be surprised when they hear someone say that their life is in turmoil. That is often a good description of someone with the condition, an ADDer or ADHDer. They find the following types of behavior or words to be commonplace in their life – procrastination, impulsive, poor time-management, easily distracted and inattention (actually-surplus attention). In fact those words are par for the course with many who have ADHD.

And of course if you do keep putting things off, if you tend to rush into things or find yourself running late or going overtime, your life can be pretty frustrating at those times. But there is a way through the difficulties.

The good thing about being an adult with ADHD is that you can understand the condition; you can have it explained and ask relevant questions. You can then consider strategies which are designed to help you make it through the day. And there are strategies which work. The first is quite simple. It’s in the heading of the article.

If you look at a task you have to perform and you calculate it will take an hour, double that time and thus give yourself the freedom to reach your goal without bumping up your stress meter. It sounds simple and it is but it works. If you have time-management problems and tend to get side-tracked or procrastinate, give yourself more time. Expand your time boundaries.

Another thing which is important to adults with ADHD is that they can consciously make decisions. An adult can look at the options and make a choice. And these choices, these strategies apply equally as well in your personal life as in your professional duties.

You don’t need to be an expert in human behavior, and you do need to follow some simple and tested rules. The first is to make a list of tasks you have to do. This of course is simple but then comes the tricky bit. You have to prioritize the tasks. You have to make a list of your tasks in order of importance

You see one of the characteristics of an ADHDer is they get to the end of the day and they haven’t done one or more of the things they needed to do. Now if the undone tasks are low in priority then that’s not such a bad thing. But if the unfinished task is important, your day could get even worse.

Once your list is done in order of priority – the most important tasks at the top – you make a plan. What do I need to do get those important tasks completed? That could mean setting an alarm clock, allowing plenty of time to finish the task and allowing for travel, meal breaks, tiredness, etc. Then you are armed for battle. You have a plan which is based on a list with tasks in order of importance. You’re ready to go. You’re ready to conquer your ADHD hiccups and make your day go exactly to plan.

When we face a task or a chore at home say like painting the fence, mowing the lawn or baking a cake, we should know approximately how long that chore will take. And this is especially so if we have baked that cake many times before or mown the lawn fifty times a year. But what if we were to get our timing wrong? What if we thought we could paint the fence in two hours and six hours later we were still not through?

Well as crazy as that sounds, guessing the time it takes to do something is a major problem for many people who suffer from ADHD. Their brain simply doesn’t compute the same way a non-ADHD brain computes.

People have what is called an internal clock. They are able to take a nap and set their internal clock to wake in two hours and they do. This skill is not as likely to occur in someone who has ADHD. In fact an ADHDer is more likely to have what is known as the impulsivity trait. A person with this characteristic is likely to underestimate time. They think an hour is ten minutes or thereabouts. They have poor time perception or an impaired time perception.

Poor time perception is demonstrated in other ways as well. A child with ADHD for instance does not always understand when the right time occurs. Their teacher or parent may ask a question and the child blurts out the answers too soon. They have not grasped the appropriate time in which to respond. The answers may need to be given one at a time in turn, and a child or adult with ADHD may answer too quickly or out of turn. This is due to their inability to sense time the ways non-ADHD people can. A short time may seem like a very long time to an ADHDer.

Studies of the brain and how it affects our moods and responses are being carried out at present. One discovery concerns the chemical in our brain called Dopamine which is a key to the way we behave. When there is a ‘malfunction’ of the chemical in our brain, the person can misjudge time. They may also become excitable and impulsive. It is not their fault. They are not being rude or naughty but rather, reacting to a chemical imbalance in their brain. The flow of Dopamine can be slowed or speeded up or even cut off altogether by outside influences. If a someone with ADHD becomes excited or is placed under stress, their Dopamine supply can be affected. This in turn shows up or manifests itself in the way the child or adult behaves.

Wouldn’t it be great if we all had an internal clock that never needed winding and always went off with its alarm reminding us to do something we planned to do?

There are devices available which can help ADHDers to tell the time or see how much time remains without having to be able to tell the time. There are ways to help all of us, and especially those with ADHD, to become better at judging time.

Women Running Late

Adults ADHD in California – what is the main complaint?

Attention Disorder Hyperactivity Disorder or ADHD is believed to affect about 8% of children and about a half of these sufferers will continue with the disorder when they grow into adults. So ADHD is a significant part of the life of millions of people and of course their disorder will impact on their family, friends, teachers, fellow workers, etc.

In recent years rapid progress has been made particularly in dealing with adults who have ADHD. Professionals are better at diagnosis, understanding the full spectrum of the disorder, as well as treatments be it with medication, psychotherapy, coaching or other alternatives.

With adults, one of the major signs of their disorder is their inability tokeep appointments. They may hold down a steady job but being late on a number of occasions puts their employment at risk. Or it can show up in everyday life like meeting someone at a restaurant, attending a family gathering or even collecting your child after school. If the ADHD adult does not put systems and structures in place, then poor time-keeping may often be a feature of their lifestyle. But does not need to be so.

The interesting aspect about tardiness is that it can be overcome. It would be nice to say cured, however, we will have to settle for ways and means to reduce or eradicate your being-late behavior.

You can be proactive with physical reminders. Your email program on your computer will react if you have added details of an appointment. You can get up in the morning and turn on your computer and see your whole day. Bingo, the details come up as to where you have to be today and at what time.

Lugging your computer around everywhere may pose some problems. Some alternative choices that can help are mobile phones, clock radios and portable email receivers which can all be programmed to make a sound and/or show a text message which will remind you of your appointments and schedule. Get into the habit of giving yourself these physical reminders. And don’t be afraid of being early. If lateness is a an issue, set your arrival time to a bit earlier which will help guarantee you will not be late.

One relevant point is to check the reason or reasons as to why you are late. If you can look beneath the lateness and find its true cause, you may be able to remove or alter your being late. Are you late for work because you dislike your job? If that’s the case you may want to try to find work which is more stimulating.

Not having an interesting job is pretty much the same as not wanting to go to a meeting or get-together. We all have to go to places and events we’d rather avoid, yet once you know why you are turning up late, (as an example- you have little interest in your destination), you can tackle your lack of enthusiasm. Find out why you are late and then do something practical to challenge or remove that cause.

The good thing, if that’s the expression, about being late is that the problem can be managed. Sit down with pen and paper and plan your week. List the appointments you have for the next few days. Make notes about how you will travel and when you will depart. Put this plan in a prominent place. Check it daily and follow your own directions. You can be on time every time.

If you find it difficult to tackle this on your own, a professional specializing in ADHD can help you move beyond where you are stuck and help you reach your goals.

Business Women with Deadline

ADHD Symptoms

The ADHD brain has problems doing all sorts of things and we’ve really only just starting to find this out. The ability of scientists such as neurologists and neuroscientists to take photos of the human brain and then analyze what is happening, means we are better able to discuss, define and treat people with ADHD.

The brain is divided into sections and one of these is known as the pre-frontal cortex. Photo imaging or a kind of x-ray of the brain shows that there are differences in the structure of parts of the brain between someone with ADHD and someone who does not have the disorder. Knowing these differences is a major step towards better understanding and thus the treatment of the patient be they a child or an adult.

Referring back to that part of the brain known as the pre-frontal cortex, we know that this part of the brain is linked with executive functioning which manages the following activities – problem solving, attention, reasoning and planning. Now with imaging you can see that the brain of a person with ADHD is likely to have problems with the above activities and will need help.

If the ADHD brain has problems when it comes to planning, then the life of that person will have potential difficulties and hardships. Planning takes the ability to prioritize, forward think, manage time, and factor in consequences.  If you can’t prioritize or you get times confused by thinking that five minutes is really an hour or two, then planning successfully is difficult to impossible. You simply don’t consider  how to successfully judge the real time it takes to complete a task.

Likewise with paying attention, reasoning and solving problems. With the ADHD brain these tasks can be difficult when a person is not interested.

Because ADHD with children tends to get more publicity than the disorder experienced by adults, we need to understand that the brain of a small growing child can be shown to be different when you consider an ADHD child or a child without ADHD.

ADHD symptoms don’t disappear as children grow into adults, the symptoms tend to change from being seen externally to being experienced internally. It is important to understand that distractibility can be an on-going problem for ADHD sufferers.

Distractibility is the primary reason and clear illustration as to why ADHD brains cannot fixate or think logically when it comes to time. When the brain is not functioning normally, when the chemical balance inside the brain may be an imbalance, then the ADHD child or adult gets their timing skills out of line. They think they have been working on a task for a few minutes when in fact they have been absorbed for much longer.

Medication and cognitive behavior therapy have long been a part of helping those with ADHD. Both these methods of treatment can be prescribed to assist the sufferer to better manage their time-keeping.

Rewarding positive behavior is one typical form of treatment. Setting simple tasks, staying with the ADHD sufferer to keep them on track and then rewarding them for using time-keeping successfully is another way to improve the performances of a person with ADHD.