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Adult Diagnosis & Treatment This forum is for the discussion of issues related to the diagnosis of AD/HD

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Old 09-24-05, 05:18 PM
bookfan bookfan is offline

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Newly diagnosed......

I went to the doctor yesterday & was diagnosed with ADD....I have been doing some research on the subject over the last month or so & was pretty sure this is what I had.....when I came here & read some of the posts & did a couple of the online tests I said "wow..this is me".....the lightbulb finally went off.....

I havent felt comfortable in my own skin since I was a little kid....I was always introverted & shy....even though there were six kids in my family I was the quiet one....I did well in most subjects in school [I could never pass algebra or geometry] the time I went to college I wanted to go to law school but didn't have the confidence in myself that I could succeed in that endeavour....I ended up getting involved in drugs & alcohol & stayed high for 13 yrs.....I ended up going to nursing school but was stoned throughout college.....I always did well in my job [I worked ER & liked the fast pace....I was also good at multitasking there] age 25 I figured it was time I got married so 3 months after meeting wife #1 we were married....I have a 19yr old son from that marriage who I barely know......I was clean & sober for 10yrs from 1993 I met wife #2 & we moved in together 1month after meeting [yes I know I'm impulsive when it comes to relationhips]
there were some ups & downs in the marriage & alot of my traits were present at that time but I didn't know what to call it.....I was diagnosed with depression & stated on the first of many antidepressants [my wife just thought I was weird] wife & I owned a bookstore for 5 yrs & when it closed I started using drugs [opiates] 2004 I got clean again & I now have over 18months......I hid my drug use from my wife & coworkers & I don't believe others knew I was using [I wonder if the ADD was helping keep that hidden also].....I do have a 5yr old from that marriage.....

my wife & I are seperated & actually get along better since we dont live together...I have inattentive type ADD & recently have been having trouble concentrating & reading....I also have a very hard time listening to others [my boss].....I've discussed some of these symptoms before with my therapist but now it seems like the pieces of the puzzle are starting to fit together.......

I saw my doctor yesterday & was started on Strattera 40mg.....I know that it takes awhile to build up a level in your bloodstream .....I also take Effexor XR 150mg for depression.....I see a psychiatrist on 10/03 to discuss ADD also....
I have been going to counseling regularly for the last 18months but recently switched therapists when I moved away.....

I believe that medication will help me [I'm one of those nurses that believe theres a pill for everything] but I also know that a pill won't fix me.....I need to learn how to change some of my old behaviors.....I need to improve my self esteem....I need to interact better in social situations & not avoid them entirely or be the fly on the wall.....I need to organize things & FOLLOW THRU on things that I have planned......I need to continue to stay clean & sober also......I need to continue therapy......etc......I could go on&on&on&on&on...

Thanks for listening to me.....I will try to keep things a little shorter next

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Old 09-24-05, 06:08 PM
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Sounds like you have made some great first steps. Let us fellow Innattentive type know how it goes. I'm very curious about Strattera. Most of I-ADHD subtypes are grasping in the dark too. It's not cut and dry like it is for the regular ADHDers. The world's leading expert doesn't have all the answers either although what he knows is very interesting. Here it is.

Some further info on the Innattentive type from Dr. Russell Barkley's lecture in San Fran 2000

Now I want to come back to this group that we call Inattentive AD/HD. We used to call them ADD without Hyperactivity. These days some people are just using the term ADD for them. I don’t like that. Part of the problem with using that term is that that was the old term for AD/HD over 10 years ago, so it creates a lot of labeling confusion.

ADD and AD/HD are the same thing. ADD is the earlier, 1987 term—goes all the way back to 1980, in fact, whereas AD/HD is the more recent label.

So let’s talk about this Inattentive type: the kids who come to see us who don’t show problems with hyperactivity, who aren’t impulsive. What do we know about that subtype? We know enough that several of us in the research community have taken to arguing that this is a different disorder. This does not belong in AD/HD. This is not AD/HD. This is a real attention disorder with real information processing deficits, and it has little in common with the other two kinds of AD/HD.

The Hyperactive type of AD/HD and the Combined type of AD/HD are the same disorder. You’re just catching it at different developmental stages. Kids start out with Hyperactivity; the attention deficits come within a few years after that, and then they move into being the Combined type. But these children, on the other hand, are a different story all together. Why do I think this is a different disorder? Why do some of my colleagues agree with it? Why do the rest of my scientific colleagues certainly agree that this is a qualitatively different group of children? Whether you view them as a different subtype or as an entirely different disorder is less of concern to me than that you understand these are not the same kids. They do not have the same risk, the same co-morbidities, the same causes and the same outcome, and it is likely that they do not respond to the same treatments the same way.

But we will not know any more about treatment if we don’t view them differently, because everyone will assume as you may do, quite naively, that the treatments for one apply to all the subtypes, and they don’t. We have discovered a new disorder and it does not belong here. It needs its own name and its own criteria and it needs to get out of this category known as the disruptive behavior disorders, because it has no affinity for them. So let me show you why many of my colleagues are now slowly coming around to an idea that 10 years ago I argued for. This is a different disorder. Why do I think it’s a different disorder? Because these children come in with the opposite symptoms. Instead of being hyperactive, intrusive, distractable, they’re lethargic, slow-moving, hypoactive, spacey, daydreamy, quiet, passive, withdrawn, confused, in a fog. They are the polar opposite of the AD/HD child in their clinical presentation. This is not an impulsive, disruptive, intrusive, aggressive, emotional, naive child. This is a kid who is staring, daydreaming, confused, and not processing information accurately. This is a real attention deficit, if attention means information processing. These kids have a processing deficit. AD/HD children do not. Do not confuse these two groups. They do not have the same problems with paying attention.

Other things we see in these children: when we bring them into the clinic, and we run them through a battery of neuropsychological tests, they have deficits in an area we call selective attention. Selective attention is how quickly you can deduce what’s important from unimportant in a spatial array of information, how fast you accurately process information coming at you. AD/HD children have no trouble with selective attention. And by the way, let’s put an end then, to this metaphor for AD/HD that it’s a filtering problem. Because it isn’t. Real AD/HD has no trouble with filtering, selecting information. AD/HD children perceive the world exactly as everybody else does. These children don’t. These kids have a selective attention problem, which by the way explains something that we have found in about six different studies. These kids make more mistakes in academic work than AD/HD children do, many more mistakes. The problem that AD/HD children have is with productivity; number of problems attempted. The problem with these kids is accuracy: the number of errors made. These kids have a real problem with input coming into the brain, how quickly they can handle it, how accurately they can select it out, and deal with it. These children have memory problems. AD/HD children do not. These children have trouble with getting information out of short-term and longterm memory and doing it correctly. It’s especially so for long-term memory, so that they show a very erratic recall of information. AD/HD children, if they have a memory problem, it’s going to be in a very unusual form of memory we’re going to talk about later today. But this is traditional long-term storage, and these children have some trouble with that, probably for the same reason. They’re not getting information out of memory any more accurately than they’re processing information coming into the brain.

There are problems with selection, with filtering, with focusing their attention. These children have a very different social profile. The traditional AD/HD child is often a rejected child, because they’re immature and emotional and hotheaded and demanding and controlling and impulsive and often aggressive, so that when we compute a social profile of the AD/HD children they often wind up as being the least liked, the least popular and most likely to fight. That is their peer group profile. That is what Ken Dodge and his profile of peer acceptance views as the rejected child. And 50 percent or more of AD/HD children are utterly rejected by their peer group; these [inattentive] children, very different picture. These children are overlooked. In Ken Dodge’s taxonomy of social problems, they’re neglected. Why? Because they’re passive, uninvolved. They’re staring, daydreaming, hypoactive, absent-minded, passive. Unengaged is a better term for them. They’re not disliked by the other kids. They’re not rejected by them. The other kids just don’t know them. They’re not engaging. They’re not out there participating. They’re just kind of passive kids. They have more friends than AD/HD children have, actually. These kids tend to be neglected, not rejected. It’s a very different social profile.

Other differences: there is no affinity of this disorder for Oppositional (Defiant) or Conduct Disorder that we can tell. They basically have the same base rates as the normal population. But many AD/HD children are likely to go on to develop Oppositional Disorder and Conduct Disorder. Forty-five to 55 percent of AD/HD children develop Oppositional Disorder by age 7, and another 25-45 percent move up to Conduct Disorder by ages 8 to 12. AD/HD goes with Oppositional and Conduct Disorder. The inattentive group does not.

You see another reason why they don’t belong in this group? Those three disorders—AD/HD, ODD, and CD—are all part of a larger category we call the disruptive disorders. The inattentive group isn’t and it shouldn’t be there. Other differences that we see: by definition, of course, these kids are not impulsive. They don’t have any difficulties with inhibition. These children do not respond to stimulants anywhere near as well as AD/HD hyperactive, impulsive children do. Only about one in five of these children will show a sufficiently therapeutic response to maintain them on medication after an initial period of titration. Oh, you’ll find that about two-thirds of them show mild improvement, but those improvements are not enough to justify calling them clinical responders, therapeutic responders. Ninety-two percent of AD/HD children respond to stimulants. Twenty percent of these children respond to stimulants. And the dosing is different. AD/HD children tend to be better on moderate to high doses. Inattentive children, if they’re going to respond at all, it’s at very light doses, small doses. So the drug response is different. And that’s all we know.

[At this time] there are no other studies of treatment of this group—none. The only studies are five involving medication and mine was the only one that tested multiple doses with a placebo control. There are only two pages in my parents’ book, Taking Charge of ADHD, on this group, and it tells you what I just told you. This is what we know. These are different kids. This is a different disorder. Stay tuned. We don’t know what to do with them. It’s up to you. You’re just going to have to cobble together some help any way you can and hope that it works, because there is no science beyond what I just told you.

They may have different causes. They certainly have different family histories. Those children tend to come from families where there are more anxiety disorders and learning disabilities. AD/HD children come from families where there’s more AD/HD, Conduct Disorder, antisocial behavior, and substance abuse. The family histories of these two groups are not the same. Now, we have to be careful here, because the Inattentive group, it turns out, is rather a wastebasket group of kids. First of all, in that group are the true Inattentive kids. But also in that group are AD/HD children who came in one symptom short of being in the Combined group, right? They’ve got six inattention and five hyperactive symptoms, and according to the DSM, if they don’t have six, they’re not in the Combined type. Well, yes they are, and you should think of them as being Combined type children, even if they come up one symptom short. Don’t put those kids into the Inattentive group.

The Inattentive group in our clinic is for kids with three symptoms or fewer off of that HyperactiveImpulsive list. Any more than three and you’re better off thinking of them as what we call subthreshold Combined type children. There’s another group, the group that starts out being in the Combined type and by adolescence or adulthood are no longer so hyperactive, but they meet the criteria on the Hyperactive list. Now you would flip them over into the Inattentive type. Don’t do it. You always think of them as Combined type.

So, bottom line is this: If any point in your history there was a whiff of problems with inhibition and impulse control, you’re a traditional AD/HD Combined type kid, and it shouldn’t matter what the DSM is telling you about cut-off scores. Clinically that’s how you would approach that child. That’s a Combined type kid. And you reserve this Inattentive group for kids who have never in their lives had trouble with inhibition. Those are the spacey, daydreamy, confused, in a fog, sluggish, hypoactive, slow-moving group. And as long as you conceptualize them that way, you won’t make any clinical mistakes. But if you follow the DSM as it’s written—perhaps you have OCD and you just have to follow all those criteria, just as they’re written—then you’re going to get yourself into some trouble.

Because remember, the DSM was not chiseled in stone in Israel. It’s a set of guidelines developed to help make clinical decisions, but it’s to be used with clinical judgment and understanding of the criteria. Okay, that’s just to resolve some confusion.

And by the way, I said the Inattentive group was a wastebasket. Why did I say that? Inattention is nonspecific. Inattention is unhelpful in defining what disorder you have, because most mental disorders produce inattention. So if somebody walks into your clinic and says, you know, I’m having a lot of trouble concentrating, can’t pay attention, can’t finish work, you have no idea what they have. You don’t automatically say, oh, that’s AD/HD, I’ve heard about that. This could be a psychotic. This person could be a substance abuser. This person could have a generalized anxiety disorder or panic attacks or major depression or bipolar illness. How the hell do you know what they have? For now, just know that the Inattentive type of AD/HD is a real wastebasket category of really inattentive children, along with children who have other disorders that are producing their inattention. There really is an Inattentive group out there, but they have a different disorder, and it’s not AD/HD.
"Time's glory is to calm kings, to unmask falsehood, and bring truth to light". - William Shakespeare
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Old 09-25-05, 01:21 AM
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Getting treatment for ADD and being on ADD medication has helped me retrain myself,discipline myself.I have follow through now.Now my brain tells me to put the wet laundry in the dryer instead of take it out,put it on top of the dryer and then go do something else and then eventually forget about it!LOL!!!!
Its automatic now,like everything just flows.Its wonderful!Its very important to never stop learning and trying to find out your weaknesses and improve ones self.
My meds give me that missing link to self control and making my brain function on my channel.LOL!!Good luck to you.
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