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Old 08-14-04, 06:30 PM
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Attention Deficit Disorder 101: What every beginner in ADD needs to know

ADD 101: What Every Beginner in ADD Needs to Know

by Cynthia Hammer, M.S.W.
Tacoma, WA—May 12, 2002
Terms of Use: This educational material is made available courtesy of the author and Attention Deficit Disorder Resources. You may reprint this article for personal use only.


There is no test for ADD. The diagnosis of ADD is made based on your history with, when possible, corroboration from others who knew you as a child or who know you now. Testing may be helpful to learn more about your mental strengths and weaknesses, but not to learn if you have ADD.

To obtain an ADD diagnosis:

Locate a clinician knowledgeable about ADD in adults. Start with recommendations from your family physician, your child's pediatrician, your therapist or an ADD adult. Other referral sources are the CHADD group in your area, other ADDult support groups; physician and psychologist referral services; a medical school or a learning disabilities specialist at a nearby college. Look at the listings in our National ADHD Directory. Do a search at www.google.com for "ADHD (your state)" and "ADHD (largest city near you)." As a last resort, work your way through the yellow pages: psychiatrists, neurologists, psychologists.

When you call for information, ask several questions:
  1. Do you diagnose ADD/ADHD? Do you accept my insurance?
  2. How long have you been diagnosing this disorder in adults?
  3. How many ADD/ADHD adults have you diagnosed in the past five years. What percent of your practice has a primary diagnosis of ADD/ADHD?
  4. How familiar are you with the day to day tribulations of having ADD? (You're trying to learn if they or some one they are close to has this condition. How intimate is their understanding of ADD on a daily basis?)
  5. What is your treatment philosophy? (Will the clinician work with you and be open to suggestions or will he/she call all the shots. Is their treatment of ADD the same for everyone or is it individually tailored?)
  6. In a subtle way, learn what they do to keep current in their knowledge about adult ADD and its treatment protocols.
  7. How do you make a diagnosis? How many visits will it take and how much will it cost?
  8. How long will I have to wait for an appointment?
  9. Ask psychologists how they handle the medication part of treatment as psychologists do not have prescriptive authority. Ask physicians (and other medical personnel with prescriptive authority) what medicines they use to treat ADD/ADHD.
  10. Keep track of who you called and how they answered these questions.
If you are still unable to locate a knowledgeable clinician, consider educating your family physician and getting him/her to work with you. The simplest way to educate your family physician is to have him/her view Dr. Daniel Amen's Clinician's Guide to ADD (a 4 1/2 video), read Driven to Distraction, by Drs. Hallowell and Ratey. You, too, should be knowledgeable about ADD so you know what to ask about.

Before your first appointment, write down what symptoms you have. Suggest an ADD diagnosis, but not too loudly. You are the patient after all! What the doctor says can reveal his attitude. Listen for comments, such as, "It can't be that bad." "ADD is the least of your problems." "You've done quite well; you can't have ADD." or "The worst part of ADD is not the ADD itself, but the damage that's been done to your self-esteem." If you repeatedly hear one or more of these statements, translate this as, "I don't take ADD seriously." Be wary of clinicians who, laughingly, tell you they "think" they have ADD but have never sought a professional diagnosis or treatment. Again, they are making light of the condition, not recognizing it's serious nature.



Some general considerations:

Does this clinician listen? Ask relevant questions? Respect your intelligence? Does he or she seem flexible, open-minded, interested in what you have to say? Attitude is key. Does this clinician make you feel like he, and he alone, knows what's best for you or does she seem more like a co-investigator, i.e., Let's learn together about what can be most helpful to you and how I can best help you.

Ask yourself, "Can I work with this person?" If the answer is "no," you need to look elsewhere. Even after choosing a clinician, vigilance is needed. Some clinicians verbally accept an ADD diagnosis, but do not prescribe the most accepted medications. If this occurs, ask your clinician for an explanation.

Sometimes you find a physician who will mange only the medications with someone else handling the therapy, counseling or coaching. This can be a good arrange-ment and often is more economical. Occasionally, family physicians will be comfortable working with you on medications, if someone else has made the diagnosis. For example, you could see a psychiatrist for the diagnosis and getting stabilized on medications, then be followed by your family physician.



Primer on Medications:

The medications used to treat ADD in adults are the same ones used to treat ADD in children. The first medicines tried are typically the stimulants: Ritalin, Dexedrine, Cylert, Desoxyn, Adderall. Some clinicians shy away from prescribing stimulants because they are controlled substances, i.e., physicians and pharmacists have extra paper work when prescribing these medications. The prescription cannot be "phoned" into a pharmacy; and it cannot be written for more than a month's supply.

Some physicians worry they will have licensing problems or FDA concerns if they prescribe stimulants or they may think you are seeking an ADD diagnosis just to obtain controlled substances. A response to this concern is the dosages at which stimulant medications are prescribed for ADD are minuscule compared to what a drug abuser would take. Commonly, people with ADD, have a reverse effect when taking stimulants. Instead of the "high" that addicts seek, ADDults feel calm. ADDults with a history of substance abuse—alcohol, marijuana and cocaine are the most common—frequently report a cessation in their desire for these substances once they are medicated for ADD.

The nationally prominent ADD clinicians believe that the earlier substance abuse was probably an inappropriate self-medication that the treated ADD adult no longer needs. Research on teenagers with ADD taking stimulant medication shows they have a lower rate of substance abuse than their peers. Ritalin, the most commonly used medicine for ADD, has been in use for almost fifty years and is very safe when taken as directed. Dr. Hallowell says it is safer than aspirin.

Research with Ritalin over the past 50 years with children diagnosed with ADD demonstrates conclusively that this medicine helps most ADDers significantly reduce their ADD behaviors. (Ritalin is said to help over 70% of those diagnosed with ADD with the proviso that it be given in the right dose.)

No one fully understands what role Ritalin or other stimulants play, but research conclusively demonstrates that these stimulants make most of us with ADD function better. (from mild improvement to significant improvement). We are assured, by our physicians and the FDA, that the stimulants are not harmful to us in the doses prescribed.

ADD is a neurochemical disorder. People with ADD lack one or more chemicals (still to be determined) in our brain in the right quantities in the right places at the right times. We may have these desired chemicals sometimes in the amounts and places we need, but not always, and not at our choosing—i.e. that's why we have variable performance. When our brain chemicals are not flowing normally, (i.e. as they flow in people without ADD) we are very ADD.

Dr. Daniel Amen, M.D. of Fairfield, CA,. says that the brains of those with ADD/ADHD benefit from stimulants as they cause more blood flow (which is healthy) to our frontal lobes than they would otherwise receive. It is commonly believed by clinicians treating ADD that a greater harm—emotionally and socially—occurs to those with untreated with ADD, than any possible harm from the medications. Unfortunately, this knowledge is not accepted by the public, and the media often adds to the public's fear of the medicines used to treat ADD.

Some clinicians continue to increase the medicine's dose until there's a desired effect or too many undesirable side effects, such as jitteriness, stomachaches or headaches, that do not subside after a few weeks. Some clinicians use Zantac or Pepto-Bismal to help patients who experience stomach-ache to help them through an adjustment period.

If, after trying the stimulant medications at various dosages the desired effect is not achieved, then certain anti-depressants such as imipramine, desipramine and nortriptyline along with Wellbutrin and perhaps Effexor are tried. If none of these work for you, your physician might try other medicines, or combinations of medicines. Proper dose levels are determined on a case-by-case basis, not by weight or age.



How do you determine if the medicine is working, if you are taking the best medicine for you, at the best dose and on the best dosing schedule?

Thomas Phelan, Ph.D. suggests all patients try a second or even third stimulant. Individuals may respond quite differently to each one. He will start with, say, Ritalin,and note what is the best result the patient achieves and at what dose. He'll then have the patient try dexedrine or ADDerall or Cylert , again observing the best result at what dose. After this, he and the patient jointly decide which medicine at what dose is best for long-term usage. The point is, you may be "treated" for ADD, but without some comparisons with other medicines used for ADD, you may not be taking the one that will work best for you.

This is why it is very important to work with a clinician knowledgeable about ADD who is willing to work "with you;" not dictate to you. You need a clinician who is aware of what changes medicines can bring about in an ADDer's ability to function and who knows it's not a disorder where one medicine or one dosing schedule suits all. In turn, you, the patient, need to learn what changes to watch for in your functioning when you take medicine. Sometimes you might need another person in your life to note these changes, as ADDers can be poor self-observers.



What are some specific changes to look for when taking medicine?

When medicated you may be able to stay involved in a conversation or finish a task before moving on to something else or you may remember to do something that you needed to do. You may find your social interactions more relaxed and that others seem to enjoy being with you more.

Dr. Theodore Mandelkorn of Seattle says that ADDers on (proper) "medication IMPROVE their attention span, concentration, memory, motor coordination, mood,and on-task behavior. At the same time they DECREASE daydreaming, hyperactivity, anger, immature behavior, defiance, and oppositional behavior. Medical treatment allows intellectual capabilities that were already present to function more appropriately.

When medication is used appropriately, patients notice a significant improvement in control. Objective observers notice better control of focus, concentration, attending skills, and task completion. Many are able to cope with stress more appropriately, with fewer temper outbursts, less anger, and better compliance. They relate and interact better with family members and friends. Less restlessness and impulsiveness are noted."

He goes on to say, "It is very important to remember what medicine does and does not do. Using medication is like putting on glasses. It enables the system to function more appropriately. Glasses do not make you behave, write a term paper, or even get up in the morning. They allow your eyes to function more normally IF YOU CHOOSE to open them. YOU are still in charge of your vision. Whether you open your eyes or not, and what you choose to look at, are controlled by you. Medication allows your nervous system to send its chemical messages more efficiently, and thus allows your skills and knowledge to function more normally. Medication does not provide skills or motivation to perform.

ADDers often complain of forgotten appointments, incomplete work, mistakes in written work, frequent arguments with family members or co-workers, excessive activity, and impulsive behaviors. With medication, many of these problems dramatically improve. Patients successfully treated with medication typically can go to bed at night and find that most of the day went the way they had planned."

Dr. Gross in Santa Clara, CA suggests asking if the medication you are taking is significantly helping with these concerns:
  • Academic underachieving and inattentiveness
  • Hyperactivity or troublesome fidgeting
  • Verbal and/or behavioral impulsivity (blurting out, interrupting others, acting before thinking)
  • Difficulty falling asleep at night
  • Trouble coming awake (not getting out of bed) in the morning
  • Excessive irritability without cause and/or easy frustration
  • Bedwetting or primary nocturnal enuresis
  • Dyslexia with spatial or verbal reversals
  • Episodic explosiveness, emotional outbursts, or temper tantrums
  • Unexplained and persistent emotional negativity
If your ADD/ADHD medication is not significantly helping with most of these concerns, ask about changing the dosage or changing medicine. Medication is not acceptable if it relieves only one dysfunction such as trouble falling asleep but not any others.

Finding the right clinician and the right medication can take time, but those who persist are well-rewarded for their efforts. Good luck with your search.

Editor's Note: None of the preceding information should be construed as medical advice and should not be used in lieu of seeking medical attention. Much of the preceding material is adapted from material initially written by Paul Jaffee, NY.



Primer on therapy/counseling

Selecting a good therapist to help you with the pyschosocial treatments for your ADD can be difficult. How can you make the best choice? How will you evaluate your choice? Which kind of therapist to choose? Will expense be a factor? What your medical insurance pays for can limit your choices, although being diagnosed and treated for your ADD will probably be the best spent money in your life.

Psychiatrists are medical doctors (M.D.) who receive special training in psychiatry. Note that only M.D.s, physician assistants (PA) and certain nurse practitioners can prescribe medications. Psychologists (Ph.D.) have doctorate degrees in psychology while social workers (M.S.W., ACSW or CSW) and marriage and family counselors (MFT or CMFT) have master degrees in their respective disciplines. Other counselors may have Master's Degree in Counseling (M.A.) and related fields. In addition, they may have specialized training in Chemical Dependency (CDCC), or Mental Health (MHC).

Verify that they are both licensed by the state and certified, which demonstrates a higher level of training, by their professional organization or by the state. If you do not understand their titles, ask for clarification. No professional or ethical therapist should mind being asked about their educational or professional back-grounds.

While it is not possible to say one kind of training is superior to another when choosing a mental health provider, a good rule of thumb is to go with a therapist you can afford. You are not going to be helping yourself if you go into deep financial debt trying to get out of deep emotional pain. Most therapy sessions last about an hour and the cost ranges from $50 to $125/hr, with some clinicians offering sliding scale.

Plan to briefly interview one or more therapists on the phone before you set up an initial appointment. Ask about their training and background. Describe the kinds of issues you want help with.

Make absolutely sure that the therapist is familiar with ADD in adults.

(use the same questions asked when finding someone to diagnose you for ADD, see page 1).

They should be knowledgeable about ADD and its manifestations so they can help educate you and help you realize your difficulties in life were the result of subtle neurological deficits in the brain, not character defects or moral shortcomings.

Therapists for ADD adults should be more directive than is typical in a "therapeutic relationship." ADDults often talk and talk with-out achieving insight or direction from their "ventilating." They need structure and guidance to stay focused, to stay on topic, to get the most benefit from their therapy

If you find a therapist that seems good via the phone, set up a longer, in-person, interview. Some therapists provide an initial half hour session at half their regular rate. Others expect you to devote a full hour to getting acquainted and seeing if you can work together.

Pay attention to your feelings during this initial session. It's important that you find someone who makes you feel comfortable and who gently challenges you to explore your inner life and past experiences. It is important to find someone who respects your individuality and your opinions, and who you feel you can trust 100%. If you feel the need to lie or withhold important information from your therapist, you are not going to get any real help.

When you find a therapist you like, plan to give therapy about six sessions before deciding whether or not to go on with it. It usually takes that long to uncover areas of concern and begin to identify your issues.

Most good therapists work with their clients to develop treatment goals. When these are formalized and written down, it ensures that you and your therapist are on the same "track" and working on the same problems. Also, by occasionally reviewing the goals, you can chart your progress (or lack thereof) in therapy and work with your therapist to change therapy if need be.

Six months to a year of counseling is often needed to work through most problems. For ADDults, this can be faster. After dealing with an issue, people with ADD are generally ready to move on. We tend not to dwell on the past; to not be reflective. You should feel that going to the therapist is helping you and that you are improving. Watch out for therapists who want to continue therapy when you feel ready to end it. They may need to "help" you more than you need to be helped.

Many ADDults don't require intensive long-term therapy to get their lives on track and to improve their self-esteem and confidence if they don't have a lot of lifetime baggage that needs to be worked through. Often, medication, learning about what ADD is and is not, putting good coping skills in place, exercising regularly and taking good care of themselves, along with belonging to an ADD support group, even via the computer, are enough. Sometimes, instead of therapy, ADDults only need "coaching." They benefit by having someone who regularly checks in with them to see how things are going; someone who helps the ADDult develop and carry out strategies that will work for him in achieving his goals.

After you stop therapy, it may take a few months or longer before you fully integrate the knowledge you gained in counseling into your daily life. That's to be expected: Good things—like new, healthy behavior—always take time to develop.

Cynthia Hammer was diagnosed 11 years ago at age 49 with ADD. Her life improved so much after the diagnosis that she started a support group in Tacoma for adults with ADD. From that small beginning, ADD Resources, a non-profit organization, has now grown to a national organization with over 600 members with Cynthia serving as it's part-time director.

(copied off http://www.addresources.org/article_add_101.php)
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Old 04-23-05, 02:42 AM
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This is such a great article! I just came across it and it will be valuable to other members too, if they haven't read it.
Thanks gabriela, from way back in 2004
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Old 05-01-05, 09:00 PM
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wonderful content! It is appreciated.
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Old 08-08-05, 06:48 PM
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I struggle with the question of "Do I medicate myself and conform to the way 90 percent of the world operates? or Do I build my world in such a way as to maximize my ownm unique ADD personality?" Does this make any sense to any of you? In other words, I am extremely creative and a great problem solver, although, very messy and unorganized. Should I become neat and organized and sacrifice my other strengths? Is this a common question? I'm sure I could be more of an achiever if I were medicated, I fear losing the only person I've known.
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Old 08-08-05, 08:43 PM
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Hi oddjobace. I'm a creative person and a problem solver too. Just want to mention that the messiness and disorganization you have are just byproducts of your ADD. A lot of that can be worked over through discipline and helped with medication or therapy. I am neater now and a whole lot more organized, but my creativity has not suffered because of my taking something for ADD. I'm not into conforming either..I think buiding your own world sounds marvelous!

~gourmet~
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Old 08-09-05, 07:23 PM
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Quote:
Originally Posted by Gourmet
Hi oddjobace. I'm a creative person and a problem solver too. Just want to mention that the messiness and disorganization you have are just byproducts of your ADD. A lot of that can be worked over through discipline and helped with medication or therapy. I am neater now and a whole lot more organized, but my creativity has not suffered because of my taking something for ADD. I'm not into conforming either..I think buiding your own world sounds marvelous!

~gourmet~
I will have to find a happy medium. I should try meds again and work on building good habits more. What an adventure my life is. If only I could get around to writing a book about it.

Best regards,
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  #7  
Old 08-09-05, 10:35 PM
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I was kind of hoping this guide would teach people how to act more hyper instead of explaining mundane basics about being diagnosed and finding the right treatments. Maybe I should write just such a guide so that other newbies' hopes aren't let down too.


^ I just really like that smiley.
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Old 08-04-06, 12:33 PM
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Quote:
Originally Posted by oddjobace
I struggle with the question of "Do I medicate myself and conform to the way 90 percent of the world operates? or Do I build my world in such a way as to maximize my ownm unique ADD personality?" Does this make any sense to any of you? In other words, I am extremely creative and a great problem solver, although, very messy and unorganized. Should I become neat and organized and sacrifice my other strengths? Is this a common question? I'm sure I could be more of an achiever if I were medicated, I fear losing the only person I've known.
I always think the same thing! Like, "why should I conform to the societal norm?" oh... it rhymes.. lovely.
But on the other hand, it has become incredibly frustrating to never get any work done on time (for school, especially) as I am on academic probation for the second time... oops!
Sometimes I just really hate the fact that I have to take medicine to fit in. (even though that may not be the case, it just feels like it at times, you know?)
I have more questions about obtaining a perscription for ADHD medication, but I think I'll post that in another section that's more relevant!

But thanks for posting that thought! I'm really glad I'm not the only one who thinks about that!
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Old 12-17-06, 07:38 AM
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Hi, I'm new here but won't right much as I can't seem to bear doing anything. Only to say great article and from this it seems that I'm not on the right meds at all. I've been given fluoxetine which isn't mentioned at all. I must look into stimulants such as ritalin.
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Old 12-17-06, 07:59 AM
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Awesome article, this sheds light on many of the questions I see posted on this forum. I think I am going to print it out and keep it for future reference. Thank you.

For anyone who is skeptical of adhd treatment for themselves, you could always do a trial run, record improvements, things you dont like, etc, then re-evaluate whether treatment is for you. It seems like with medicine their can be a lot of trial and error, but when you find something that works, it really can help.
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Old 12-17-06, 02:03 PM
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Thanks for posting this!!! Will help lots of people.
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Old 12-17-06, 02:15 PM
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Quote:
Originally Posted by !Matt!
Hi, I'm new here but won't right much as I can't seem to bear doing anything. Only to say great article and from this it seems that I'm not on the right meds at all. I've been given fluoxetine which isn't mentioned at all. I must look into stimulants such as ritalin.
Thank you Matt in northern Ireland for bumping this up!

EXACTLY what I have been searching for before my appt w/psyciatrist Jan 8.

PJ

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Old 01-03-07, 11:29 AM
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Giving this thread another bump for the new members asking questions about diagnosis.
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Old 01-04-07, 08:08 AM
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Hmmmmm I haven't thought of it but it may be worthy of a sticky. . . . .
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Old 01-04-07, 08:10 AM
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Now the thread will remain easy to locate for all seeking this information as it has been successfully "stuck" to the top of the topic list.
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