Tag Archives: ADHD

Slip sliding away

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My brain in hyper drive.

Everywhere I go - my office, my house, my car, my computer desktop - there is evidence of a brain moving so fast that the physical world can't keep up. A jacket tossed hurriedly over a chair; mail ready to be sorted on the kitchen island; file folders in disarray on the desk, floor, conference table.

Perhaps most telling are the blue-and-white copies of a list entitled "50 Things to Love About ADD." There are several scattered on the carpet, former members of a neatly stacked pile. After three weeks on the floor, two oblivious dogs and my occasional attempt at straightening, they now stick out at odd angles to and from each other.

I glimpse another bright blue copy peeking out from the middle of miscellaneous clutter on my desk. And in a distant drawer, in my well-labeled but underutilized file cabinet, an entire folder of those craft little copies repose in smug harmony.

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Does NC really have more ADHD than any other state?

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According to the Centers for Disease Control (http://www NULL.cdc NULL.gov/mmwr/preview/mmwrhtml/mm5944a3 NULL.htm?s_cid=mm5944a3_w)North Carolina has the highest prevalence of ADHD in the United States for youth ages four through seventeen (15.6%). Nevada, by contrast, reported only 5.6% prevalence of ADHD among the same age group. Does the population of North Carolina really have three times the number of kiddos with ADHD? Or is there something else going on here?

ADHD prevalence in US ADHD ever-diagnosed prevalence in US, 2007, courtesy CDC 

Dr. Stephen Hinshaw (http://psychology NULL.berkeley NULL.edu/people/stephen-hinshaw) believes there is more to the picture than statistics reveal. In a presentation at the 2012 CHADD conference (http://chadd NULL.org) in San Francisco, Dr. Hinshaw told an rapt audience that his UC-Berkley psychology lab showed that the highest prevalence of ADHD among children was found in states that had implemented achievement-based testing for promotion from one grade to another. 

In other words, when children were required to pass a state-mandated test to go to the next grade level, more ADHD was discovered by parents (as the likely culprit for failure). According to Dr. Hinshaw, most of those states were in the South. The states reporting the highest prevalence of ADHD were North Carolina, Louisiana and Alabama (15.6%, 14.2% and 14.3% respectively). And other southern states also showed high prevalences of ADHD as well (see chart).

So, ADHD diagnoses are not correlated to geography as much as they correlate to political influence on school testing. An interesting finding that has far-reaching implications for diagnoses for adults as well as children, since adult diagnoses are assumed to be residual aftereffects of childhood diagnoses.

Hmmm.. will we ever have accurate statistics about ADHD? Hard to say, but the stats are obviously misleading in 2012.

Aerosmith’s Steven Tyler admits to being wildly ADD!

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 It's not exactly a news flash, but yes, Steven Tyler told the world that he was "ADD personified" on 60 Minutes (http://www NULL.cbsnews NULL.com/8301-18560_162-57394902/aerosmith-livin-on-the-edge/?tag=contentMain;contentBody) during a tribute to Aerosmith's 40th anniversary tour. And there's no question that his ADD includes the Big H-"Hyperactive."

"I used to say my train of thought makes all the stops!" said Tyler, grinning broadly at his own joke.

In a post-show interview (http://www NULL.cbsnews NULL.com/8301-504803_162-57394683-10391709/lara-logans-backstage-adventure-with-aerosmith/?tag=contentMain;contentBody), 60 Minutes producer John Hamlin was taken aback by Steven's wild mental leaps. "Interviewing him was a challenge. When you ask him a question about Subject A, he ends up on Subject D, E or F," he said. "A lot of times [the answer] has nothing to do with the question we've asked."

Shocking. Yet so familiar to we of the ADD tribe. Tyler's brain, like ours, beats to a different drummer (and not just Aerosmith's percussion guy, Joey Kramer). And it beats fast. Tyler needs a heaping helping of stimulation to maintain a modicum of focus, which might be part of the reason he was deep into the drug scene early in his career. Cocaine, heroin - you name it, he was doing it. But drugs are often part of the ADD coping arsenal. Most of us aren't wildly rich and famous while we're doing it, though.

Hamlin also seemed surprised that Tyler needed some brain fidgets to help him stay on track during concerts. "A lot of artists these days have things they call "in ears" so they can hear a perfect mix of all the musicians on stage.

"Steven Tyler has a guy who's Stage Left with a sound effects board and [he] fires sound effects [into the earpiece]. Crazy wacky [sounds] sorta like "wooboobooboo!" like the Three Stooges or "Boing!" to keep Steven entertained!

"I would think that if you're onstage, the front man of a rock and roll band in front of 15,000 people, that you're pretty focused on what's going on. But he's got a guy in his ear keeping him entertained!"

Yep, sounds like ADD to me. In Steven's own words:

(Reporter) Lara Logan: So you will actually write lyrics while you're driving?
Tyler: Oh yeah. Yeah, yeah. Uh, you know what? I'm ADD personified.
Logan: And OCD?
Tyler: I'm not sure about that. But I'm ADD.
Tyler: Um, uh, now I forgot what I was saying.
Logan: Sorry. I interrupted you.

I think I'll send Steven an ADDiva T-shirt. He'd get a kick out of it. For 6.5 seconds. Before he's off to his next shiny object. Gosh, it's good to know that I have something in common with 63-year-old Steven!

Warning! Doctors can sell your Rx history to Big Pharma

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In yet another consumer-bashing move, the US Supreme Court ruled June 23, 2011, that pharmaceutical companies may now purchase lists of the drugs that individual doctors prescribe (without the name of the patient) for marketing purposes.

The ruling was made using the First Amendment Freedom of Speech argument that if researchers and journalist were allowed to gather such records, then marketers deserved equal access. Um, this doesn’t exactly seem like freedom of speech to me. It’s more like data mining. And that pretty much sucks.

Not only do the pharmaceutical companies not need to know what drugs our doctors are prescribing to us (even anonymously), they don’t need to be putting pressure on doctors to prescribe more of their particular drug.

What I hear from doctors is that they feel besieged by drug reps who pound them with expensive brochures, volumes of research and "educational" materials. There is unprecedented marketing influence over our most personal body mechanics. I, for one, don’t like it a bit.

One consumer advocate said that the ruling could create a conflict of interest for physicians who must fight to maintain the best interests of their patients while being bombarded or pressured by pharmaceutical companies.

Having come of age in an era when consumer protection was firmly entrenched in the culture (although I might have been naive about my trust), it’s still a shock to see just how little our individual needs influence the marketplace. And make no mistake, the medical field is a marketplace; has been for more than a decade. I hate it. I hope we can withstand the commercialization of our health. Even more, I hope we can survive it.

Warnings on generics: Supreme Court rules against consumers

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I am outraged!

And more than a little scared.

This week, on Thursday, June 23, 2011, the US Supreme Court ruled 5-4 against two women who claimed that they were not properly warned about the risk of taking a generic equivalent drug, (http://www NULL.latimes NULL.com/health/boostershots/la-heb-generic-drugs-20110624,0,5484443 NULL.story)saying that consumers were not allowed to sue for side effects not listed on the label. The justices said the generics companies didn’t have the same responsibility as brand name pharmaceuticals to update their warning labels when new side effects were discovered.

Are you kidding me?

Those generic drugs, the ones pushed hard by insurance companies because they cost less, the only ones that some people can afford to take, are not even required to toe the same line for warning labels as Big Pharma?  Ridiculous. Absurd. And dangerous.

The two women, Gladys Mensing of Minnesota and Julie Demahy of Louisiana took a generic equivalent of Reglan (originally developed by Wyeth) to treat acid reflux for about four years and developed serious neurological symptoms (involuntary muscle movements). Although the Supreme Court did not dispute that the symptoms were side effects of the generic drug, it said that companies who manufacture generics should not be held to the same standards as research pharmaceutical firms to add new warnings to their labels. Their contention is that the original warning label is sufficient for a generic equivalent.

Justice Clarence Thomas wrote that the reason generics were granted special exemption was that "It is the special, and different, regulation of generic drugs that allowed the generic drug market to expand, bringing drugs more quickly and cheaply to the public."

But what about our safety and our right to full disclosure? Is the tradeoff for cheaper prescription prices an incomplete warning label about a potentially long-term, debilitating neurological condition? In this case, apparently so.

What does this mean for generic manufacturers? That they may skip merrily down the road producing medications that may or may not negatively impact the end user without telling us about newly-discovered problems.

What does this mean for ADD medications? It means "caveat emptor" – let the buyer beware. The drugs that are "off patent" may or may not have new, serious side effects. But if we take a generic we’ll never know, because there is no requirement that we be told about them. And now, no way to seek legal recourse against the company that produced the drug.

I am reminded of the severe warnings issued to cash-strapped consumers who ordered prescription drugs over the internet from foreign countries. There was no published warning of the purity or efficacy of the mail order drugs. Isn’t that exactly what is going on here? Granted, it is not a contamination or substitution problem, but we are buying (and taking) life-saving drugs without updated information about their potential for damage. So how can we know whether the generic we are taking is prone to cause problems that appeared after the original FDA approval? We can’t, thanks to the Supreme Court.

If Reglan was still under patent, Wyeth Pharmaceuticals (now part of Pfizer) would certainly be held responsible for warning the public about these serious side effects. But not the generic companies. This ruling allows generic drug manufacturers to hide the bad news from us. Until we experience them first hand.

Now I am even MORE outraged.

I will continue to request brand name prescriptions from my doctors. Thank goodness my health insurance still pays for them. My fingers are crossed that yours does, too. Which doesn’t mean those side effects on the label make me feel safer. But at least I know the possibilities.

Tell me about your prescriptions — do you take generics or not? Are you outraged too?

Finishing my book

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I am writing.

Well, I am charged with writing my book, but instead I am writing a blog post.

We are at the beach and it's a gorgeous morning (after a series of awful, cold, windy and rainy mornings). "We" refers to me and the two Shelties that are doing a good job of distracting me from writing. Milli and Boomer are here because I knew I would worry about them if they were home. But they sure require a lot of my precious attention.

They are out wandering on the deck right now. I'm at the beach house that will be occupied by the ADDiva retreat women in October, I am living in it so I will know how we can best use it for the retreat. Already I am envisioning yoga at sunrise and meetings at the octagonal deck on the sand. It's a marvelous place to be.

But my book is going more slowly than I anticipated and I have a DEADLINE. OK, I will say it out loud: my book is going to be written, edited and printed by my birthday, April 29, 2011. OMG! Are you kidding me?

The more I write, the more I need to write. I worked with Judith Kohlberg for a weekend and she encouraged me to drop out a lot of stuff I thought was important ("You have other books to write. Save something for them," she told me). But I am adding that stuff back in. It IS important. And I want this book to be rich and full of tidbits and anecdotes about life in the non-linear lane.

Here I am sitting at my brought-from-home desk with adjustable tables all around me. It's an amazing view. I wish I had more time (don't I ALWAYS Wish I had more time?) but I promise you this: the book WILL be done. DONE, do you hear me? DONE. By my birthday.

So I'd better write…see you later..and keep WRITING!!

CogMed – Take 2

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About a year ago, in the interests of giving everything a try that purports to help ADHD, I plunked down my money (a lot of money actually – $1500) and set about trying CogMed, a computer-based memory training program. (http://cogmed NULL.com)

At the time, I was absolutely overwhelmed – more than usual overwhelm – and knew I wasn't going to be able to give the program the time and, um, attention, it needed. But I plunged in valiantly. The result was not so good. The exercises are difficult and get more difficult as the program progresses. That's by design – there is a computer somewhere in Europe that constantly monitors my efforts and scores. If I am doing well, it increases the difficulty. If I am floundering, it eases up a bit to let me get back in the groove.

But there's the rub – there IS no groove. Every time I start feeling confident, the doggone program ups the ante. It's maddening. And frustrating.

Embarrassingly, of all the people Dr. Tracy Ware has coached through CogMed, I was the ONLY person who didn't finish. A sad distinction, especially since I had a year to finish the program. I even stopped taking my Adderall, in part, because I'd heard that people did better on CogMed without meds.

To be fair to myself, CogMed is a PC program. I am a Mac person. I had a really old PC laptop that died this year. So it was a major headache to load the program and DO it. Tried to install Windows on my Mac and never did get it figured out (I am sure it's possible, I was just too overwhelmed with other stuff to make it work).  Then there was the question of time. My sessions lasted 90 minutes – sometimes longer. It took me a long time to buckle down my brain and force it to work in the way that CogMed demands. My head hurts remembering it.

So why in the world would I try it again? Because apparently it really makes a difference for ADDivas like me. Some of my best friends have had remarkable success with CogMed. They say the old patterns still had to be changed but thanks to the results of CogMed, new patterns were POSSIBLE.

I've always said that most of the advice given to ADHD folks is just the same old advice given to linear people. The only problem is that linear people can IMPLEMENT that advice. I recently was disheartened to hear a noted psychologist tell someone to "just DO it" – like we haven't tried that already! But if CogMed can help my brain actually conform to those linear standards a little better, then it might be worth another shot.

A few weeks ago, I plunked down more money (not quite as much, thankfully) and decided to give CogMed another try, especially in light of the buzz at CHADD this year that working memory is the key to ADHD problems and perhaps treatment.

I still had the disk from last year so I could start any time. Tracy sent me the new login but I let it languish for two weeks. I was at CHADD, the ADDA board retreat and I knew I wouldn't be able to start or sustain training in the midst of travel. So….this weekend, I blew the dust off the CD cover and popped it into my new PC laptop (I actually bought a laptop for CogMed  … and my Quickbooks files which suck on a Mac).

I was guardedly optimistic – I had some experience with this, after all, so perhaps it would be easier. Nope. The program still kicks my butt. I have no idea what my baseline working memory showed when I started yesterday but it couldn't have been good. I still stumbled, mostly on the spatial tasks that require chasing a series of lighted dots and reproducing the same pattern with my mouse. Ha. Good luck with that one.

This time, I have scheduled CogMed into my life five days a week. I am going to finish it, I swear. The research is too compelling NOT to jump into this again. And I will keep you posted right here. Deal? OK then. I'm going to talk about Day Two in a separate post.

Depression delights

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Maybe it was my husband’s near-fatal heart condition (http://lindaroggli NULL.blogspot NULL.com/2007/03/nailing-down-cloud NULL.html ) three years ago. Maybe it was the cease-and-desist order for GardenSpirit (my dream come true retreat house) (http://gardenspirit NULL.com) last year, which is forcing me to jump through extremely bureaucratic hoops (can you spell R-E-D T-A-P-E?). Maybe it was my parents moving into assisted living this week with virtually no notice. Maybe it was the failed project to redirect water away from my front yard that culminated in an ugly gash 4 feet wide and 200 feet long. Maybe was my dear Sheltie painfully hobbling toward an inevitable end. Maybe.
 
Or maybe, under a constant attack of stress, my brain reverted to its genetic predisposition. Depression.
 
Ugh. I really hate that word. And it seems to have descended on me despite my best efforts to 1) ignore it 2) pretend I was far too ‘healthy’ to fall victim to it and 3) work like a madwoman to outrun it. But thanks to my new psychiatrist, I am starting to view depression in a different light.
 
“It is really unfortunate that we use the word ‘depression’ because it sounds like you are sad. That’s not what depression is,” Dr. Ware (http://www NULL.chapelhillpa NULL.com/providers NULL.htm) told me yesterday. “It’s more like the frontal lobe of the brain goes dark.”
 
Frontal lobe? Hey, isn’t that an ADHD issue? Isn’t that all about executive function and planning and impulse control? Hmmm, could they possibly be related? Well yes. And no.
 
Depression isn’t ADHD. I was pretty angry when I found out I had ADHD because depression and ADHD in women are often confused. Even after I learned that ADHD often has a sidecar disorder along for the ride (like depression, bipolar, obsessive-compulsive), I was mad at all those doctors who had misdiagnosed me. I decided I’d probably never been depressed at all. It had been the ADHD all along, right?
 
Uh, probably not. Dr. Ware reminded me that signs of depression include lack of concentration, distractibility, trouble with focus. Huh. Sounds a lot like my good friends Inattention and Distraction, who pop up in a diagnosis of ADHD.
 
I suspect that for me, depression and ADHD take turns at the helm. One is in the driver’s seat while the other rides in the sidecar, then they switch places. Since it has been years since I was really depressed, I blithely decided that it would never return. Ever. WRONG.
 
Many of you wondered why I chose to stop taking my Adderall, especially when it had served me so well in the past. What I now realize is that the Adderall was keeping me afloat, squishing that depression into a corner so I could get something DONE (my favorite four letter word, remember?).
 
It was actually a miracle/stroke of genius/blessing that I stopped taking my Adderall because it peeled back the covers to reveal a more basic issue that I probably wouldn't have noticed otherwise. When Dr. Ware told me that  depression actually causes cell death in the brain (which is repairable, thank goodness) I suddenly understood why I’ve been struggling with even basic tasks (but embarrassed to admit it).
 
I have lots more to say about this but I know the ADD brain prefers short, sweet articles, so I’ll stop here for today. Stay tuned …
 
Oh, and my treatment plan includes being consistent with my antidepressant, fish oil, exercise and folic acid….tantalized???? Come back tomorrow for more….
 
(But first, tell me about your experience with depression…were you ever diagnosed with depression before your ADHD diagnosis? After? Talk to me!)

Does Ritalin make you smarter?

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Watch CBS News Videos Online (http://www NULL.cbsnews NULL.com)

 

Last night's broadcast of 60 Minutes (CBS) confirmed my worst nightmares: that ADHD meds will become so popular they will be treated as "brain candy" instead of as a medical necessity for people with brains like ours.

College students agreed that pill popping is rampant on campus, especially with  stimulants like Adderall and Ritalin. They take them to stay up late studying; they take them to finish papers; they take them to focus on tests.

Apparently the stimulants are prescribed for truck drivers who are on the road for hours; and even doctors who work double shifts. But hey, back in my college days, didn't we do the same thing? Except the drug of choice then was No-Doz, 200 mg of caffeine concentrated in little white pills.

I went online to see if NoDoz was still around. Yep, it's still sold and it's a lot cheaper than Adderall or Ritalin. College students said Ritalin was selling for $3-$5 per pill. A bottle of 60 NoDoz costs only $9 online. Free shipping, too..

My fear is not that college students will get hooked on Adderall. My fear is that Adderall and its ilk will become so commonplace that their legitimacy as treatment for ADHD will be diminished, dismissed or even discarded.

The non-ADHD students interviewed by Katie Couric said they could focus better, they could read fine details even about uninteresting information. That's sure not what they do for the ADHD brain. I have clients who take their ADHD meds faithfully but still can't keep their attention on the chapter or the math problem or the To Do list. The pills help us pay attention; but sometimes we veer off into worlds of focus that have nothing to do with the original task.

So, let's be clear here. Just because everybody can take stimulants and gain some focus, it doesn't mean that ADHD isn't a valid diagnosis. We're out here. We still need our meds. And even if we forget to take a few each month, we shouldn't be sharing them (and especially not selling them) to all of the rest of you out there.

I guess it makes the drug companies happy. I guess students are happy and perhaps their professors.

I'm not so happy.