Minggu, 30 Juli 2017

Can I use other drugs when using Ritalin?

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Interaction between drugs is a case which involves some sort of effect that one drug has on the other. For example, there are medications that affect the acidity in the stomach and which may lead to impairment of proper absorption of the other medication. Also, there are cases in which the use of one drug may increase the likelihood of side effects of other medication occurring. There are many different ways in which certain drugs may interact with other drugs and it is always important to inform yourself about any interactions between the drug that you are taking and other medications that you might need to use. In certain cases, these interactions may be quite severe and even life-threatening.

In this article, we are going to cover some of the most common interactions with Ritalin.
The most severe interactions with Ritalin can happen in case you are taking MAO inhibitors, a class of drugs that includes such medications like: selegiline (Emsam, Eldepryl), tranylcypromine (Parnate), rasagiline (Azilect), isocarboxazid (Marplan), furazolidone (Furoxone) and phenelzine (Nardil). The interaction between any of these and Ritalin may be life-threatening. You will need to wait for at least 14 days since the last use of MAOIs and the first dose of Ritalin, as this is the time required for MAOIs to be completely expelled from the body. This also means that you will need to wait for the Ritalin to clear out of your system completely before you start taking MAOIs.
There is a number of other medications that might interact with Ritalin, affecting the way in which your body responds to your Ritalin treatment, or that might be affected by your Ritalin regimen.



These medications include: certain antidepressants like sertraline (Zoloft), paroxetine (Paxil), nortiptyline (Pamelor), fluoxetine (Sarafem, Prozac), doxepin (Sinequan), citalopram (Celexa) and others; seizure medications like Phenobarbital (Luminal), phenytoin (Dilantin) and primidone (Mysoline); diet pills and other stimulants; low blood pressure pills as well as high blood pressure pills; allergy and cold medications that contain pheylephrine which is a decongestant; clonidine (Catapres); warfarin (Coumadin) and other blood thinners; sodium acetate, potassium citrate, citric acide, sodium bicarbonate and potassium citrate; isoproterenol (Isuprel), epinephrine (EpiPen) and dobutamine (Dobutrex).Keep in mind that this is in no case a complete list and that there are other medications that might also interact with Ritalin. The best way to avoid any interactions is to talk to your doctor or the pharmacist about any medications, substances, supplements, vitamins, etc. that you intend to combine with Ritalin. They will let you know if this is safe.

Is Ritalin addictive?

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Before we start answering the question whether Ritalin is addictive, we need to make a basic distinction between dependency and addiction. Dependency to a certain medication or substance involves only the physical and/or physiological aspect of needing to take the certain medication or substance. If the medication or substance is not taken, adverse symptoms start to happen. Addiction involves the social aspect as well, namely affecting the everyday life of the addict and resulting in them engaging in antisocial behavior in order to acquire the medication or the substance. In this article, we will not tackle the addiction to Ritalin as we do not wish to involve the social aspect, but we will tackle the dependency to the medication.

The easiest way to do this would be to simply say that there is a possibility of developing dependency to Ritalin. This medication is very similar in structure to amphetamines and it is a psychostimulant which means that it stimulates certain nerve processes in the brain by increasing the levels of neurotransmitters such as norepinephrine and dopamine in the brain. This results in the enhancement of certain mental processes and can also elevate mood and lead to euphoria.


This is usually perceived as pleasant by the people who take Ritalin which may lead to psychological dependency. In addition to this, Ritalin may also cause physical dependency, due to its effects on the levels of these neurotransmitters in the brain.However, it needs to be said that when properly used, Ritalin does not usually lead to dependency. The chances of this happening increase with using larger doses than prescribed, as well as by using Ritalin once the regimen has finished. Also, recreational use of Ritalin often leads to dependency as the users do not follow any instructions and do not know how much of Ritalin can be used safely and for how long.

What is Ritalin?

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This blogsite is dedicated to Ritalin and it is intended to provide as much information about this medication as possible, covering all the aspects of Ritalin use, talking about what conditions may be treated by this medication, which side effects are possible when using it, how you are supposed to use it, etc. However, this article is an introductory one, giving the short overview of the drug and giving basic information about it.


Ritalin is a psychostimulant drug which means that it basically acts on the central nervous system and improves some of its functions. It belongs to the piperidine class of medications and it is structurally very similar to amphetamines, although it has different mechanism of action and different effects from this class of drugs.

The way in which Ritalin works is by blocking the reuptake of certain chemicals in the synapses, which leads to an increase in levels of these chemicals, ultimately leading to a number of beneficial effects of Ritalin. The chemicals whose levels it increases are mainly dopamine and norepinephrine, while some scientists also claim Ritalin also affects the levels of serotonin in the central nervous system. Among these effects of Ritalin, you will find such as increased alertness and attention, which is why one of the main uses for Ritalin is in treating attention deficit hyperactivity disorder, usually in children and adolescents. It has been shown to be very effective in such cases.

Ritalin is also used in treating patients who are suffering from narcolepsy, a disorder that affects a number of people that is greater than; let’s say multiple sclerosis and Parkinson’s disease, but which is much less publicized than those conditions. 

Narcolepsy involves increased sleepiness during daytime, sleep disturbances during night, as well as cataplexy in certain percentage of narcolepsy patients. Cataplexy is a rather severe condition which involves the weakness of the muscles which occurs without warning and can vary in intensity and the muscles in the body that are involved. In most severe cases, it can lead to complete collapse of the body, or even temporary paralysis.

In addition to these uses, there are several more uses for Ritalin which are not that common and some of which are off-label uses. This includes using Ritalin as an adjunct in treating major depressive disorder, as well as depression in people suffering from cancer, strokes or HIV. Ritalin is also sometimes used in treating patients with substance dependence, most prominently people addicted to cocaine.


It has to be noted that Ritalin is a rather potent medication and that it is important to be very careful when using it. For instance, it has been shown that there is possibility of developing dependency to Ritalin, although this risk is very low if the medication is used exactly as prescribed. It is also very important not to use more of the medication than prescribed as this may lead to side effects that can be quite disturbing and severe if too much of the drug is taken.

As you can see, Ritalin is a medication that can make a lot of difference for people suffering from certain conditions, but it still has to be taken carefully and adhering to the prescribed regimen.

What are the side effects of Ritalin?

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Whenever there is a discussion on any medication out there, there is certainly one aspect that never gets overlooked and which is often discussed in great detail. The aspect we are talking about here are the side effects of a given medication. Namely, it is only natural that 
the people want to know if they can expect experiencing certain side effects when using the medication. No one wants to take a medication for a mild headache that is going to get them to vomit uncontrollably or that is going to make their skin flare up in eczema. That is why we decided to include an article on the side effects of Ritalin to our blogsite about this psychostimulant medication used for treating ADHD and narcolepsy primarily.




We all know that pretty much every medication can cause certain side effects and that this is the most natural things when medications are concerned. Namely, as they affect certain processes in the body, it is perfectly understandable that they might also affect certain processes that are not meant to be affected, in people who have a stronger affinity towards experiencing certain side effects. In this article, you are going to read about the side effects that may be caused by Ritalin.One of the most important things to keep in mind when taking any medication, which of course includes Ritalin as well is that there is always possibility that you might be allergic to said medication, without knowing it. Some medications are more likely to cause allergic reactions and Ritalin is luckily not one of them.

However, there is still possibility that some people might be allergic to it. If you experience such symptoms like hives, difficulties breathing, as well as swelling of throat, face and lips, you should seek emergency medical attention as these are the signs of an anaphylactic reaction to the medication, a reaction that may even be life-threatening.
When we are talking about the very side effects that may be caused by Ritalin, you need to keep in mind that the fact they are listed here in this article, as well as on the label does not mean that you are going to experience them. In fact, it is far more likely that you will go through your entire treatment without experiencing any side effects. If it had been differently, Ritalin wouldn’t have been approved for use by various regulatory agencies, including FDA.

The side effects that are most commonly reported by the users of Ritalin are mild side effects that should not affect your everyday too much and that do not require immediate consultation with your doctor. However, if any of the following side effects become too much to handle or if they change in intensity, you should talk to your physician: mild skin rash, nausea, loss of appetite, sweating, stomach pain, vomiting, dizziness, vision problems, nervousness, insomnia, mild headache, cold feeling, tingling and numbness in the feet and hands.It has to be noted that there are some more serious side effects that may be caused by Ritalin although these are very rare. These are usually signs that your body is negatively responding to the Ritalin treatment and any such occurrence should be reported immediately to the physician, who will decide on the further course of action.




These more serious Ritalin side effects include: easy bruising, hallucinations, restlessness, aggression, unusual behavior, muscle twitches, purple spots on the skin, fainting feeling, severe blistering headaches, severe skin rash, fever, fainting feeling, uneven heartbeats, fast and pounding heartbeats, chest pains, anxiety, buzzing in the ears, blurred vision, seizure.You should be aware that this is not the complete list of all the possible side effects that might be caused by Ritalin and if you wish a full list, you need to talk to your doctor or the pharmacist who will be happy to help you. Once again, do not let this article scare you, as it is far more likely that your treatment will cause no side effects.

Adhd Medications Side Effects

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Adhd Medications Side Effects - Most side effects of the stimulant medications are minor and are usually related to the dosage of the medication being taken.
Side Effects


Most side effects of the stimulant medications are minor and are usually related to the dosage of the medication being taken. Higher doses produce more side effects. The most common side effects are decreased appetite, insomnia, increased anxiety, and/or irritability. Some children report mild stomach aches or headaches.



Adult ADHD Treatment - Best Guide to Finding Treatments That Work




Appetite seems to fluctuate, usually being low during the middle of the day and more normal by suppertime. Adequate amounts of food that is nutritional should be available for the child, especially at peak appetite times.


Adult ADHD Symptoms Test for Adults: ADD Checklist


If the child has difficulty falling asleep, several options may be tried—a lower dosage of the stimulant, giving the stimulant earlier in the day, discontinuing the afternoon or evening dosage, or giving an adjunct medication such as a low-dosage antidepressant or clonidine. A few children develop tics during treatment. These can often be lessened by changing the medication dosage. A very few children cannot tolerate any stimulant, no matter how low the dosage. In such cases, the child is often given an antidepressant instead of the stimulant.

When a child's schoolwork and behavior improve soon after starting medication, the child, parents, and teachers tend to applaud the drug for causing the sudden changes. Unfortunately, when people see such immediate improvement, they often think medication is all that's needed. But medications don't cure ADHD; they only control the symptoms on the day they are taken. Although the medications help the child pay better attention and complete school work, they can't increase knowledge or improve academic skills. The medications help the child to use those skills he or she already possesses.


Ritalin Dosage


Behavioral therapy, emotional counseling, and practical support will help ADHD children cope with everyday problems and feel better about themselves.
Reltaed Keywords: medication, ADHD, side effects, therapy, counseling

Kamis, 27 Juli 2017

Adhd Symptoms In Kids

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Adhd Symptoms In KidsSymptoms of ADHD to Look for in Your Kids

According to the “Diagnostic and Statistical Manual of Mental Disorders”, there are three patterns of behavior that indicate ADHD. Predominantly hyperactive-impulsive, predominantly inattentive type, and combined type.




Symptoms of ADHD to Look for in Your Kids

According to the “Diagnostic and Statistical Manual of Mental Disorders”, there are three patterns of behavior that indicate ADHD. Predominantly hyperactive-impulsive, predominantly inattentive type, and combined type.

Symptoms

The principal characteristics of ADHD are inattention, hyperactivity, and impulsivity. These symptoms appear early in a child's life. Because many normal children may have these symptoms, but at a low level, or the symptoms may be caused by another disorder, it is important that the child receive a thorough examination and appropriate diagnosis by a well-qualified professional.


What is Ritalin?

ADD Medication

The Racing Thoughts of Adult ADHD

Symptoms of ADHD will appear over the course of many months, often with the symptoms of impulsiveness and hyperactivity preceding those of inattention, which may not emerge for a year or more. Different symptoms may appear in different settings, depending on the demands the situation may pose for the child's self-control. A child who "can't sit still" or is otherwise disruptive will be noticeable in school, but the inattentive daydreamer may be overlooked. The impulsive child who acts before thinking may be considered just a "discipline problem," while the child who is passive or sluggish may be viewed as merely unmotivated. Yet both may have different types of ADHD. All children are sometimes restless, sometimes act without thinking, sometimes daydream the time away. When the child's hyperactivity, distractibility, poor concentration, or impulsivity begin to affect performance in school, social relationships with other children, or behavior at home, ADHD may be suspected. But because the symptoms vary so much across settings, ADHD is not easy to diagnose. This is especially true when inattentiveness is the primary symptom.


Adhd Medications Side Effects


According to the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), there are three patterns of behavior that indicate ADHD. People with ADHD may show several signs of being consistently inattentive. They may have a pattern of being hyperactive and impulsive far more than others of their age. Or they may show all three types of behavior. This means that there are three subtypes of ADHD recognized by professionals. These are the predominantly hyperactive-impulsive type (that does not show significant inattention); the predominantly inattentive type (that does not show significant hyperactive-impulsive behavior) sometimes called ADD—an outdated term for this entire disorder; and the combined type (that displays both inattentive and hyperactive-impulsive symptoms).
Keywords: ADHD, predominantly hyperactive-impulsive type, predominantly inattentive type, combined type



What Is Adhd In Teenagers


What Are The Causes Of Adhd

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What Causes ADHD?

A parent might say, Why? What went wrong? What we need to be thinking how can I help? What can we do to move forward to finding the best possible way to help my child.
What can I do to Help My Child With ADHD?

One of the first questions a parent will have is "Why? What went wrong?" "Did I do something to cause this?" There is little compelling evidence at this time that ADHD can arise purely from social factors or child-rearing methods. Most substantiated causes appear to fall in the realm of neurobiology and genetics. This is not to say that environmental factors may not influence the severity of the disorder, and especially the degree of impairment and suffering the child may experience, but that such factors do not seem to give rise to the condition by themselves.

The parents' focus should be on looking forward and finding the best possible way to help their child. Scientists are studying causes in an effort to identify better ways to treat, and perhaps someday, to prevent ADHD. They are finding more and more evidence that ADHD does not stem from the home environment, but from biological causes. Knowing this can remove a huge burden of guilt from parents who might blame themselves for their child's behavior.

Over the last few decades, scientists have come up with possible theories about what causes ADHD. Some of these theories have led to dead ends, some to exciting new avenues of investigation.

Keywords: ADHD, focus, causes

Minggu, 23 Juli 2017

What Is Adhd In Teenagers

Your child is now a teenager!! They are going through so many struggles in life. These years can be very hard on a teen.  What can we do to help them get through the teen years? It starts in the home.  We need to communicate with them. Talk to them and help them out with things they might be in need of.




Teenagers

Your child with ADHD has successfully navigated the early school years and is beginning his or her journey through middle school and high school. Although your child has been periodically evaluated through the years, this is a good time to have a complete re-evaluation of your child's health.

The teen years are challenging for most children; for the child with ADHD these years are doubly hard. All the adolescent problems—peer pressure, the fear of failure in both school and socially, low self-esteem—are harder for the ADHD child to handle. The desire to be independent, to try new and forbidden things—alcohol, drugs, and sexual activity—can lead to unforeseen consequences. The rules that once were, for the most part, followed, are often now flaunted. Parents may not agree with each other on how the teenager's behavior should be handled.

Now, more than ever, rules should be straightforward and easy to understand. Communication between the adolescent and parents can help the teenager to know the reasons for each rule. When a rule is set, it should be clear why the rule is set. Sometimes it helps to have a chart, posted usually in the kitchen, that lists all household rules and all rules for outside the home (social and school). Another chart could list household chores with space to check off a chore once it is done.

When rules are broken—and they will be—respond to this inappropriate behavior as calmly and matter-of-factly as possible. Use punishment sparingly. Even with teens, a time-out can work. Impulsivity and hot temper often accompany ADHD. A short time alone can help.

As the teenager spends more time away from home, there will be demands for a later curfew and the use of the car. Listen to your child's request, give reasons for your opinion and listen to his or her opinion, and negotiate. Communication, negotiation, and compromise will prove helpful.

Keywords: ADHD, communication, teenager, behavior, punishment, rules

Copyright © 2005 by ADDInformation.org
Contact Us

The materials provided on this site are for informational purposes only. This information is no substitute for diagnosis and treatment by a competent medical professional. If you, or someone you love is dealing with the symptoms of ADD or any related conditions, we urge you to seek medical attention. ADDInformation.org, and its respective employees, officers, and agents accept no liability whatsoever for the usage and consequences resulting from any of the contents of this site. Your usage of this site constitutes acknowledgment and agreement to these terms of use.

Living with ADD ADHD

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Here you will find how to live with ADD. Tips on handling a teenager with ADD, to how an adult with ADD can use organizational skills to combat ADD. These articles show how schools are now involved and that there are support groups ready to help.




Attention Deficit Disorder Diagnosis - Informing Others

Ignorance is not always bliss! Attention Deficit Disorder diagnosis is as important for the people around the patient as it is for the patient himself. Once the Attention Deficit Disorder diagnosis is complete the person knows his limitations. And that is the KEY to starting the fight back

Daily Living With Attention Deficit Disorder (ADD) Tips

Here are some ADD tips. Print them out and share with your family, neighbors, friends, church members, relatives and others who have ADD or would benefit by learning some ADD tips to help others with the disorder.

Adult Attention Deficit Disorder - Counter Attack

There are a few basic steps for setting up and using organizer and filing systems to help people with Adult Attention Deficit Disorder. These are only general guidelines and can be adjusted to suit individual Adult Attention Deficit Disorder Patient’s needs. Seek help from a trusted friend, educator or other person who uses successful planning strategy, or check with professional organizational companies that help with Adult Attention Deficit Disorder.

Attention Deficit Hyperactivity Disorder - Know Your Limits!

To deal with Attention Deficit Hyperactivity Disorder and come out on top requires an organized and planned effort on your part. Remember that you can ‘beat’ Attention Deficit Hyperactivity Disorder with sheer effort and willpower. The First thing is to know your limits. If your Attention Deficit Hyperactivity Disorder makes you forget important stuff your best chance is to counter the problem. Here is how. 

Coping With Holiday Stress With Adult Attention Deficit Hyperactivity Disorder (ADHD) 
It is challenging enough to deal with adult attention deficit hyperactivity disorder in normal conditions, but when it comes to the Holiday season the season stress can really get to adult attention deficit hyperactivity disorder patients. To defy adult attention deficit hyperactivity disorder, here are a few tips to help you enjoy the season and forget the fuss!

Schools and ADHD

Once the observation has taken place you will have many questions running through your head. What type of school should my child go to?  Does my child need medication?  Also many others, now that you know the diagnosis you are able to move forward to what can be done to help.

Your ADHD Teenager and the Car

Most teenagers at the age of 15 talk about wanting to drive. The scary thing is, most accidents are caused by the age group of 15-19. Most states are putting a graduated drivers licensing system.  You go through three phases to help out the new driver to get the experience he or she needs to learn how to drive safely.

The Family and the ADHD Child

Medication can help an ADHD child in daily life. There are many problems the child might be going through with the parents.  They might be frustrated, angry or putting the blame on someone else. Both the parents and the child may need some help to manage their behavior patterns.

Advocating For Your ADHD Child In School

You are your child's best advocate. To be a good advocate for your child, learn as much as you can about ADHD and how it affects your child at home, in school, and in social situations.

Never Forget The Cardinal Rule—You Are Your ADHD Child's Best Advocate
Some schools have been reluctant on evaluating a child with ADHD. There are some place you can go. Each state has a Parent Training and Information Center as well as a Protection and Advocacy Agency. These places will help you out to get the help needed for your child.

Your Teenager with ADHD

Your child is now a teenager!! They are going through so many struggles in life. These years can be very hard on a teen.  What can we do to help them get through the teen years? It starts in the home.  We need to communicate with them. Talk to them and help them out with things they might be in need of

Support Groups and Organizations

ADHD can be a challenge in life if you don’t know much about it or how to help overcome it. Here is a list of support groups and oraganizations that can help you overcome those trials in life.



Copyright © 2017 by ADDInformation.org
Contact Us

The materials provided on this site are for informational purposes only. This information is no substitute for diagnosis and treatment by a competent medical professional. If you, or someone you love is dealing with the symptoms of ADD or any related conditions, we urge you to seek medical attention. ADDInformation.org, and its respective employees, officers, and agents accept no liability whatsoever for the usage and consequences resulting from any of the contents of this site. Your usage of this site constitutes acknowledgment and agreement to these terms of use.

Treatment For Adult ADHD

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Treatment of Adult Attention Deficit Disorder
It is important to realize that the treatment of adult attention deficit disorder is only possible through a planned approach. Along with other important methods of treatment of adult attention deficit disorder, the idea to maintain an organized management strategy may prove the difference between success and failure.


Treatment of Adult ADD - Organizational Management Strategy
For successful treatment of adult attention deficit disorder, keep everything in ONE planner. And take your planner around with you throughout the day. There is software out there that syncs handheld and print planners. So find out what your needs and budget are and make sure to keep only ONE planner system going. Make it a habit to log everything in there and use it DAILY. Spend at least 15 minutes a day in quiet, reviewing and planning for the next day. Then at the beginning of the next day, take at least 5 quick minutes to glance at your whole day of plans to make sure of your plan of action for that 24-hour period.

Check off items as they are completed each day. And reward yourself! It doesn’t have to be a monetary reward, either. Enjoy some extra time listening to your favorite music, cooking your favorite meal or spending time with your best friend as a reward.


Treatment of Adult ADD - The Details
What works and what doesn’t? Take notes. Did you miss a meeting? Why - -was your cell phone alarm not set properly? Or did you forget to log it maybe? Mistakes can and will happen. Remember that no one is perfect, not you and not I. So accept errors, forgive yourself and move on. Just prepare better next time.


Treatment of Adult ADD - Always Room for Improvement
Carry blank pages in your planner for taking notes. Jot down ideas for improvement - maybe you’re trying to do too much in one day? Maybe you’re misjudging the time it takes to get back and forth to work? Maybe you have your priorities mixed up? Something happens to everyone at one time or another. Stop and take a second to have a look see. Remember, in treatment of adult attention deficit disorder, “Slow and steady wins the race!”


Attention Deficit Hyperactivity Disorder Treatment
To no ones surprise, the Attention Deficit Hyperactivity Disorder treatment is not an easy job. As a helper at an Attention Deficit Hyperactivity Disorder treatment center, or as a parent trying to help your child out, remember that you are not in this alone. You can always reach out for help on Attention Deficit Hyperactivity Disorder treatment.


ADHD Treatment - Help and Be Helped!
The ADHD disorder being most common in children, you should be willing to share the resources of Attention Deficit Hyperactivity Disorder treatment, and the tips with other people in the child’s network; his or her teachers, parents / guardians and other concerned relatives, pastor, etc. That way you can all share your support and concerns and help one another help the child.


ADHD Treatment - Test Retested
Of course, recommend diagnostic testing as soon as possible to make sure of the Attention Deficit Hyperactivity Disorder diagnosis, if this is in your area of responsibility. If not, maybe you can offer support and the ADHD treatment information in your resources to the one(s) responsible for making that decision.


ADHD Treatment - Level Up!
See how YOU can participate in hands-on help with the Attention Deficit Disorder child. Maybe you can offer tutoring, reading assistance, help with organizational or other behavioral skills? Maybe you can help teach study skills like using 3X5 cards and colored markers. Maybe conduct practice verbal and written quizzes a little every other day. Maybe offer the caretakers (if they are not you) a day off. Maybe simply offer to gather more information. Volunteer to join the “team” and see what you can do to help.


The Training
When you do this, depending upon your role in the child’s life and your level of support, you may need to complete some specialized training first. A workshop or series of training sessions from qualified ADHD professionals may be in order so that you can learn how to best help the child. You’ll need to learn how to teach problem solving, how to reward positive behaviors and reply to negative behaviors, how to develop a game plan and strategy, monitor and log results, identify and focus on strengths, handle weakness and much more. So have patience and be open to learning on your end. And don’t be afraid to follow up, ask questions, etc. - in short, be a team player! .


Attention Deficit Hyperactivity Disorder Treatment - Online Help
Don’t forget to set aside time to take care or you own self and life in the meantime. There are online forums, chat rooms, message board, and listservs (no cost email list subscriptions where you can email others) for communicating and reaching out to others in similar conditions. In this way, you can get some support and encourage for yourself. And you can share with others to help them, too.

You can also find out when local and online Attention Deficit Hyperactivity Disorder treatment and other helpful organizations are having upcoming meetings, presentations, lectures and workshops, and sign up. Many teach and share tips and advice for adults who are helping children with ADHD.

Be Fair to Yourself!
Helping someone with a high energy level, like a child with ADD, can sure take a high amount of energy. And no one can “always” be at the best, highest energy level 24/7. So reach out and take care of yourself, too. “Slow and steady wins the race,” as old Aesop’s story goes.

Related Keywords: ADD, ADHD, adult, treatment, child



Copyright © 2017 by ADDInformation.org

How Is Adhd Diagnosed

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How is AD/HD diagnosed?

There is no single medical, physical, or genetic test for AD/HD. However, a diagnostic evaluation can be provided by a qualified mental health care professional or physician who gathers information from multiple sources. These include AD/HD symptom checklists, standardized behavior rating scales, a detailed history of past and current functioning, and information obtained from family members or significant others who know the person well. AD/HD cannot be diagnosed accurately just from brief office observations, or just by talking to the person. The person may not always exhibit the symptoms of AD/HD in the office, and the diagnostician needs to take a thorough history of the individual's life. A diagnosis of AD/HD must include consideration of the possible presence of co-occurring conditions.


Clinical guidelines for diagnosis of AD/HD are provided in the American Psychiatric Association diagnostic manual commonly referred to as the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision). These established guidelines are widely used in research and clinical practice. During an evaluation, the clinician will try to determine the extent to which these symptoms apply to the individual now and since childhood. The DSM-IV-TR symptoms for AD/HD are listed below:


Symptoms of Inattention
Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities

Often has difficulty sustaining attention in tasks or play activities

Often does not seem to listen when spoken to directly

Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)

Often has difficulty organizing tasks and activities

Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort

Often loses things necessary for tasks or activities

Is often easily distracted by extraneous stimuli

Is often forgetful in daily activities



Symptoms of Hyperactivity
Often fidgets with hands or feet or squirms in seat

Often leaves seat in classroom or in other situations in which remaining seated is expected

Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)

Often has difficulty playing or engaging in leisure activities quietly

Is often "on the go" or often acts as if "driven by a motor"

Often talks excessively



Symptoms of Impulsivity
Often blurts out answers before questions have been completed

Often has difficulty awaiting turn

Often interrupts or intrudes on others (e.g., butts into conversations or games)

A diagnosis of AD/HD is determined by the clinician based on the number and severity of symptoms, the duration of symptoms, and the degree to which these symptoms cause impairment in various life domains (e.g. school, work, home). It is possible to meet diagnostic criteria for AD/HD without any symptoms of hyperactivity and impulsivity. The clinician must further determine if these symptoms are caused by other conditions, or are influenced by co-existing conditions.


It is important to note that the presence of significant impairment in at least two major settings of the person's life is central to the diagnosis of AD/HD. Impairment refers to how AD/HD interferes with an individual's life. Examples of impairment include losing a job because of AD/HD symptoms, experiencing excessive conflict and distress in a marriage, getting into financial trouble because of impulsive spending or failure to pay bills in a timely manner, or getting on academic probation in college due to failing grades. If the individual manifests a number of AD/HD symptoms but does not manifest significant impairment, s/he may not meet the criteria for AD/HD as a clinical disorder.

The Natural Solutions For ADHD

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The Natural Solution To ADD/ADHD: Drugging Your Child Is NOT The Answer!!!




ADD/ADHD: What Is It?
There's often nothing more frustrating than seeing a child, or being an adolescent, who experiences learning problems, or LD (Learning Disorder) and ADD/ADHD (Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder).

These children may often be out of control, over-stimulated, under-stimulated, or experience uncontrolled stimulation patterns throughout their sensorium, exhibiting behavioral patterns which are difficult to explain and which often disrupt an entire household.

Attention Deficit (and its many forms: ADD/ADHD/LD) is a dysfunction of the Central Nervous System (CNS), most specifically the Reticular Activating System, which results in difficulties of maintaining attention and concentration, learning and memory, as well as involving an inability to process and sort out incoming information or stimulus from both an child's inner (subjective) and outer (objective) worlds. It may manifest itself in undue passivity or inattentiveness, or unruly, uncontrollable, aggressive hyperactivity in an affected child.

Common Neural Processing & Behavioral Traits of an Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder Child (ADD/ADHD/LD):

1: Gives up easily on tasks, assignments and self-interests.

2: Poor reality testing skills, and avoidant of reason or logic.

3: Poorly developed skills of integration, interpolation and extrapolation.

4: Poor skills of attention and concentration, unable to sustain focus of interest.

5: Difficulties in short term and long term memory acquisition and management.

6: Difficulty in making up their mind, or making choices without undue anxiety.

7: Poor planning abilities, unable to follow through consistently or complete tasks.

8: Difficulty in differentiating between competing, extraneous stimulation.

9: Easily distracted from tasks, conversations or social interactions.

10: Often over-stimulated and over-sensitized to their surroundings.

11: Poor listening skills, often interrupts others, abruptly changes topic.

12: Overly excitable, reactive and easily perseverating from one situation to another.

13: Inability to manage emotional responses, temper tantrums.

14: Easily frustrated, emotionally labile/unstable leading to immediate changeable moods and behavioral inconsistencies.

15: Often hyperactive, fidgety, overwhelmed with feelings of restlessness.

16: Inability to maintain appropriate social conduct, often disruptive in school.

17: Experiences difficulty in following instructions and guidance.

18: Impatient, continuing difficulties in delaying gratification.

19: Overly demanding, may become self-destructive and aggressive.

20: Poor sleep patterns, often not rested, angry or despondent upon rising.

*If 8 or more of the above listed traits are continuously persistent in your child's behavior, then it is recommended that you see your child's pediatrician for possible ADD/ADHD diagnosis.


What Are The Causes Of Attention Deficit?
Attention Deficit is a limiting metabolic dysfunction of the Reticular Activating System, the center of consciousness that coordinates learning and memory, and which normally supplies the appropriate neural connections necessary for smooth information processing and clear, non-stressful attention. When neural building materials are lacking, demand for further connectivity cannot easily be fulfilled, interfering with the efficient processing of information, and frustrating the ADD/ADHD/LD child.

In other words, neural "hardware" remains in limited production (there's not enough of it), and supply cannot keep up with the demand (increasing stimulus or "traffic") for new neural connections within the Central Nervous System (CNS). Demands for new learning, memory, and the management of information processing cannot be satisfied, and the insufficient "connections" result in existing neural pathways being repeatedly overworked and over stressed, often resulting in complete gridlock or shutdown so that nothing gets processed thereafter. This, most noticeably, generates frustration, bewilderment and behavioral problems in the Attention Deficit child.



The Reticular Activating System and its connections. At the center of consciousness, attention and learning.
The Reticular Activating System appears to be intimately involved in the neural mechanisms which produce consciousness and focused attention, receiving impulses from the spinal cord and relaying them to the Thalamus, and from there to the Cortex, and back again in a feedback loop to the Hippocampus/Thalamus/ Hypothalamus and participating neural structures in order for learning and memory to take place. Without continual excitation of cortical neurons by reticular activation impulses, a child is unconscious and cannot be aroused. When stimulation is enough for consciousness but not for attentiveness, ADD or LD results. If too activated, a child cannot relax or concentrate (and is over-stimulated or hyperactive) often resulting in ADHD.



How Does This Limitation Affect A Child's Perceptual Abilities?
Although Attention Deficit starts in the brain, it really involves the entire sensorium (vision, smell, touch, hearing, etc.) as well as the inner world of cognition and emotion. When deprived of the required number of neural connections needed to process the "traffic" smoothly, competition between various stimulus results. Overly competitive stimulation from multiple external and internal sources (too much visual stimulation, too much sound stimulation, too many internal feelings and emotions, etc.) can cause undue frustration, irritation, aggression and anxiety. When the limited neural network is overly taxed in this regard, it becomes unable to "tune in" or focus on some stimulation, while "tuning out," or "turning down" (attenuating) other stimulation.

This lack of ability to focus on some particular stimulus while attenuating others, creates undue "noise" in the perceptual systems within the brain. For the Attention Deficit child, this perceptual "neural-noise" is so overly noxious and continuous that it appears to be competitively assaultive, crippling any attempt to concentrate on one stimulus while attenuating others. Feelings of helplessness and anxiety are often overwhelming, forcing an Attention Deficit child to look for ways in which to survive the assaultive nature of their world.

A number of strategies are possible, but two are generally the most common and most easily documented. The first is that of an ADHD child. ADHD's are hypothesized to have ample supplies of Acetylcholine and clear, lipofuscin-free, unobstructed Cholinergic pathways, allowing them to actively compete and overwhelm the intrusive messages. Thus, an ADHD child attempts to operate at a "noisier" level (becoming intensely hyperactive), trying to "shout-down" the crowded array of competing stimulation within their brain.

ADD's and LD's are hypothesized to have low Acetylcholine levels and adverse lipofuscin populations within the Cholinergic neural pathways, making a competitive response more difficult and trying. For both an ADD and LD child, it becomes so "noisy" that it becomes necessary to shut down all processing of the senses altogether, avoiding and deflecting all stimulation. The incessant cacophony of "neural-noises" produces a powerfully competitive "numbing," almost hypnotic agent, and an ADHD child simply "gives up" to the competitively powerful undifferentiated "white-neural-noise" being generated by their sensorium because the neural-thresholds of the sensorium have over-fired and can no longer be sustained. Thus, unlike another child (children), the ADD and LD child simply "shut-down" and "tune-out," producing high Theta and/or Alpha brain waves (see brain maps below).

Relative Power Z-Score Maps from Quantitative Electroencephalography (QEEG)





Differences in activity in a normal versus an ADD child (children)
The brain maps on the left (1&2) are of normal children: a 14 year old female and 9 year old male. The ones on the right (3&4) are ADD children: a different 14 year old female and a different 9 year old male. Notice how the two ADD children (3&4) demonstrate high (more red) Theta and Alpha activity in their maps than do the normal children, respectively. High Theta wave actvity is generally associated with drowsiness; High Alpha activity is generally associated with idleness. The ADD results (3&4) are characteristic of states of non-attentiveness, and too little stimulation of the reticular activating system, and probable inadequate number of connections. Thus the ADD/LD child can effectively "tune-out" his/her environment. In contrast, the normal children's results of low Alpha and Theta wave activity (1&2) are characteristic of alertness and focused attentiveness, demonstrating adequate stimulation of the reticular activating system, and thus, an adequate number of neural connections.



What Can Be Done To Correct This Dysfunction Of The Reticular Activating System?
Fortunately, when appropriate (1) neural building materials, (2) precursors to neurotransmitters and (3) an appropriate fund of neural buffers are supplied, neural networks may be created and forged quickly in order to meet the increasing demands of heavy neural traffic, especially in the prepubescent child. In fact, given the chance, individual neurons can grow at the rate of 3-5mm per day! And, there are roughly 100 billion neurons in the brain to be developed, along with a staggering 900 billion supporting glial ("helper") cells -- a grand total of one trillion (1,000,000,000,000) cells to be nurtured -- that's 10 times the number of stars estimated to be in our galaxy!

Are These Neural Building Materials Really All That Important?
Yes, they are! One half of the dry weight of the brain (neurons, glial and brain cells) is made up of fatty acids and lipids. The "hard neural connections," or synapses, between all these essential areas of the brain where the coordination of memory and learning take place is largely made possible by the structures of Fatty Acids and Phospholipids alone. And, the physical number of neural connections then potentiates further production of neurotransmitters and neural buffers, which in turn enhances memory processing and learning even more. If these essential building blocks of the brain's "hardware" and "software" are not adequately provided for, then many "connections" will simply not be made or developed. The good news is that Vaxa's product Attend, supplies these important factors (see below)!

The basic "Hardware" of the Central Nervous System must be in place in order for memory and learning to proceed efficiently. The more neurons there are that can make "connections" with other neurons, the more efficient and easy learning and remembering may become. Without such "connectivity," learning is often frustrated and impaired as it is with an Attention Deficit child. Below is a diagram of a Multipolar neuron with multiple extentions from the cell body, and an actual micrograph of a Bipolar neuron with 2 extensions from the cell body.







Composite Structure of Neuron & Scanning Electron Micrograph of a Neuron 





What Is Attend?
Vaxa's Attend is a Safe, All Natural, Doctor-formulated Homeopathic Medicine and Nutraceutical/Nutritional combination remedy, which is "on-file" with the FDA and carries a National Drug Control Number (NDC# 67514-0266-3) on the label.

It is specifically engineered to help support the function of the Central Nervous System of any child who is inclined to be inattentive, under and/or overactive and perhaps learning impaired, enabling the body to balance both neural growth and neurotransmitter production within the Brain and Central Nervous System (CNS). Attend is formulated to supply the essential building materials for the entire neural network, helping to potentiate balanced stimulation of the Reticular Activating System while aiding the body in appropriate neural buffering within.


How Does Attend Work?
Quite uniquely, Attend is designed to complement the body's natural calming and balancing agents with specific Homeopathic Medicines (Lithium bromatum, Lithium carbonicum, plus others) and neuro-transmitters (GABA, DLPA and other neural buffers) which help to target, direct and smoothly focus attention, while naturally complementing the activity of the Reticular Activating System.

Attend also supplies the essential framework of Lipids and Fatty Acids, natural hormones, as well as neural growth and synchronization factors quintessential for neural and glial cell generation so as to meet the demands of increased neural "traffic" through the Reticular Activating System.

Additionally, Attend supplies the essential catecholamine precursors (such as catechol, phospholipids and natural occurring trans-cis-cloramide, a naturally conjugated form of L-dopa) to dopamine, acetylcholine and norepinephrine, the three most important neurotransmitters within the brain.

And, the natural hormone Pregnenolone is included in Attend to aid in memory retention, which also helps maintain the specific "programming" brain cells need to store and retrieve short term memory, essential in any learning paradigm. Pregnenolone is also directly related to neural genesis, growth and reconfiguration, wherein gene activation is enabled, allowing the multiplication, growth and "connectivity" of neural cells, allowing learning to proceed with less frustration.

Lastly, Pycnogenol®, and other supporting flavanoids within Attend, help feed and strengthen the small capillaries within new neural growth sites, helping to prevent free radical cascade damage to the expanding neural network, protecting neural patterns.

Are There Any Side-Effects With Attend?
No, Attend is completely safe and non-toxic! Unlike other medications, Attend works without the harmful side-effects that may stunt the growth of a developing child. Indeed, Attend works to stimulate neural growth patterning and regenerative activity so as to forge more "connections" within the neural network.

Interestingly, other ADD-specific pharmaceuticals have been suspected of retarding growth of ADD children, which ironically, is the last thing you would want to do to child who has been neurally limited! Furthermore, Attend works without diminishing overall processing, cognitive and learning activities, as does methylphenidate and other drugs, including amphetamines, antidepressants or anticonvulsants normally prescribed for ADD, and all of which have been shown to detrimentally diminish cognitive activity. Attend will likely enhance the positive effectiveness of other pharmaceuticals, and can be used conjointly without difficulty while in transition from less preferred drugs.

How Long Do You Take Attend Before It Begins To Work?
As it takes time for new neural growth to be integrated within existing neural pathways, the effects of Attend generally begin to be noticed within two weeks. You should expect to see improved social skills, more self-control, increased powers of attention, sustained interest, and overall, a more happy, contented, well behaved child.

Children who are exceptionally hyperactive (ADHD) and tend to throw temper tantrums will find additional support with Vaxa's Extress (NDC# 67514-0094-3). Additionally, all children who are ADD/ADHD/LD will find nutritional support from Vaxa's additional supplement called Memorin+ (NDC# 67514-0180-3), which aids in memory retention and makes learning easier with less frustration. For your convenience, our ADD/ADHD Strategy Pac supplies all three formulas (One 60 capsule bottle each of Attend, Extress and Memorin+) with a generous Discount! (More Details Below)

Is Attend Just For Children?
Absolutely Not! Although Attend was originally formulated for attention difficulties in child populations, it can be, and has been, used successfully by adults as well. In fact, Attend is used by several world class athletes, including professional golfers, to help them focus and concentrate on their sport. The only difference, between child use and adult use, is the dosage, So, if you're an adult with ADD or ADHD, or just want more focus and concentration, Attend will be very effective.

How Does Attend Compare Other "So-Called" ADD/ADHD Natural Products On The Market?
Click Here for a Comparison between Attend, BeCALM'd (Neurogenesis) and Focus (Native Remedies). After you compare formulations, your choice will be Strikingly Obvious! Attend is the most advanced, non-pharmaceutical treatment for ADD/ADHD on the market today... PERIOD!

Who Is Vaxa?... Why Should I Trust Your Products?

Vaxa, a Swedish word meaning re-growth or re-generation, is a privately-owned U.S. Biotech Nutraceutical company, which was founded in 1987.

Since 1987, Doctors, Health Professionals, Clinics and Hospitals, as well as Olympic and World Class Athletes have been safely trusting in Vaxa to meet the requirements for themselves and their patient base and clientele.

Vaxa International has been recognized worldwide as a Leader in the Nutraceutical field. For years, Vaxa's advancements in phytomedicinal combinations and biosystem specificity have made the Nutraceutical industry what it is today, not just in the United States, but worldwide.

Since the late 1980's, our successful pioneering efforts in the use of Free Form Amino Acids, DHEA, Melatonin, Glycosaminoglycans, Homeopathic-Nutritional combinations, and their subsequent worldwide popularization, attest to the seriousness and worth of our research to date.

At Vaxa, we believe in the body's ability to heal itself when given the proper nutrition and we have developed our formulas around that logic. With over 40 highly specific, "ailment-targeted" formulas, we offer solutions for many of life's challenges.



Kamis, 20 Juli 2017

The Day After: My First Adult ADHD Assessment Session

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So if you were to enter a large train station, a sports stadium, or a movie theatre, and using the public address system request that 19 out of 20 people be seated, you'd end up looking at the remaining 5% of the group who'd be standing up. Those folks represent the number of adults in the general population with the neuropsychiatric condition of Adult ADHD. Most of them are undiagnosed.




I am currently on a journey of discovery about ADHD, and yesterday I attended the first of 3 sessions which constitute a psychological assessment for ADHD. Yesterday's session lasted 4 hours, and I will have 2 more shorter sessions - the next one is scheduled for a couple of weeks from now.

The first session was broken into 3 sections - I spent about 45 minutes filling in medical, psychiatric, and family history questionnaires and several depression, anxiety, life function, symptom impact, and attention ADHD measures (Note: anxiety and depression are typical and frequent co-morbidities found in ADHD adults, and the testing helps tease out the various elements at play). I believe I needed urgent medical attention after writing furiously for those 45 minutes, but didn't say anything. I put up with a cramped, aching hand and bit my tongue hard to muffle the screams: "Take the pain!" I silently mouthed. "Take it!".

I then met the psychiatrist - an avuncular, kind, calm, older man. He ushered me into a small office with a round table and four chairs and he sat with a clipboard and notepaper. He had already spent some time eyeballing my tests, and told me he had a good sense how to proceed with me. 

He first introduced himself, and explained his experience, expertise and interest in ADHD. He then laid out how we would spent the next hour or so, and how the rest of my day would go. He would ask me a number of questions, and try to get a clear sense of what might be going on, and to see if my presentation matched someone with Adult ADHD. 

He told me that a psychometrist would be spending some of the time reviewing the tests I had written, and run them through a computer program that would match my answers with a generalized population to see where I sat on a bell-curve, so to speak. I was to spend the rest of the afternoon with a psychometrist who would drill down on some of the details, and administer a computer-based test. I was also to bring home a function-focused/symptom severity questionnaire similar to my self-report questionnaire, but to be filled in by a relative or friend who knows me well. My wife filled it out yesterday evening.

I had brought report cards from elementary, middle, high school and university with me. These were apparently quite helpful and provided some perspective on my behaviour from various teachers and professionals.

I thought I would spend a few minutes writing about diagnosis, because I know it is a process fraught with misunderstanding, riddled with myths and popular falsehoods. Simple put, a diagnosis can be made when a 'patient' presents with behaviour and symptoms that match a set of criteria laid down in some sort of empirically-based manual of 'dis-ease', or conditions. 

The Diagnostic Statistical Manual (DSM) version IV is one of these manuals. Generally there is a threshold of criteria that must be met - e.g. 6 of 8 symptoms have to have existed in a significant form for a significant period of time, across several arenas of that patient's life - in such a way that it negatively affects their functioning. All of that sounds a bit vague, but the term significant isn't a subjective one. 

It is a term derived from statistical studies of populations, whereby normal behaviours or symptoms constitute a statistically meaningful 'chunk' of the bell curve, and abnormal behaviours or symptoms constitute the head or tail of the bell curve. All experiences and presentations can be clustered onto a bell curve. 

Even people's heights for example. The average height of North American men is 5 ft 8 1⁄2 inches. Most men would be scattered around this average, as in + or - several inches in height (I'm 6'). They'd constitute the vast majority of people. Few would be 5' or less, and a roughly equal few would be 6 ft 6" or greater. But it has been a long time since I took statistics in university (4 times because I kept failing), so I'm going to stop while I'm ahead and quote the Wikipedia diagnosis section in the Adult ADHD entry.
"The diagnosis of ADHD in adults is entirely a clinical one, which contributes to controversy. It requires retrospectively establishing whether the symptoms were also present in childhood, even if not previously recognized. There is no objective "test" that diagnoses ADHD. Rather, it is a combination of a careful history of symptoms up to early childhood, including corroborating evidence from family members, previous report cards, etc. along with a neuropsychiatric evaluation. The neuropsychiatric evaluation often includes a battery of tests to assess overall intelligence and general knowledge, self-reported ADHD symptoms, ADHD symptoms reported by others, and tests to screen for co-morbid conditions. Some of these include, but are not limited to the WAIS, BADDS, and/or WURStests in order to have some objective evidence of ADHD.

[...]

It should be noted that every normal individual exhibits ADHD-like symptoms occasionally (when tired or stressed, for example) but to have the diagnosis, the symptoms should be present from childhood and persistently interfere with functioning in multiple spheres of an individual's life: work, school, and interpersonal relationships. The symptoms that individuals exhibit as children are still present in adulthood, but manifest differently as most adults develop compensatory mechanisms to adapt to their environment."
My next session is in 2 weeks, and this time I'll be meeting with a clinical psychologist. In the meantime I will update this blog with posts - some of them based on my readings and learnings about Adult ADHD, and some of them will be general resources that are available out there in the form of videos, web sites, books and more. I would love to hear comments from any readers - whether ADHD affects someone in your life, or in your own life, or if you have any questions or general comments.

Wrapping up tonight's post, why not have a listen to Canadian Centre for Addiction and Mental Health (CAMH) 2009 Transforming Lives Award Recipient (ADHD diagnosed) Canadian comedian Rick Green in this video - I went to see him and Dr. Umesh Jain in a seminar on Adult ADHD at the Ontario Science Center a few weeks ago - it was a brilliant experience

Journal Article: Diagnostic Approaches to Adult Attention-Deficit/Hyperactivity Discord

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I was reading some articles on Adult ADHD, and came across the online resource called "Primary Psychiatry". A search on Adult ADHD on this site led me to a number of very interesting articles - and I have pasted one below. This is all about the diagnostic approaches to Adult ADHD. Obviously this interests me because of my Adult ADHD assessment - and it goes into some detail about the tests and symptomatology of the disorder. It gets into some detail that some readers may not be interested in, but presents a fairly authoritative description of how they go about diagnosing Adult ADHD.



My next appointment in a couple of days - a couple of sleeps - will be with a clinical psychologist. I'm curious how this meeting will go. Is 'eagerly curious' a phrase?

They say ADHD adults are prone to thinking "That's great, but what's next?"... even when something wonderful has just occurred (like a gift or a significant conversation). BUT damn it I wish it would hurry up already.
If I may go off on a tangent for a minute: I have read that a symptom of ADHD is a certain difficulty with extracting the signal from the noise - noticing what is singularly important. The other side of that coin is the ability to pick up on a larger number of signals from the environment than other folks. ADHDers as adults sometimes learn to cope with this by becoming good at picking up many signals and using it to their advantage. ADHDers are often 'good' at finishing other peoples' sentences ('good' as in effective, but 'good' can be annoying) probably because they are perceptive enough (when interested) in reading all the subtle cues of communication to effectively tune in very clearly on a person's message.

This may be why (if you know me) I'm often finishing your sentences for you, or even cutting you off - to get to the next part. It is as though I am impatient, and thinking 'yes, yes, yes, I know what you're saying... get on with it, I want to know the next part'. Which is ironic, in that I'm often verbosely prattling on while telling a story, or drilling down into the minutia of a description - likely leading non-ADHDers to think 'yes, yes, yes, I know what you're saying... get on with it, I want to get to the next part'.
That's great. Now cut to the chase:
Diagnostic Approaches to Adult Attention-Deficit/Hyperactivity Discord 
Abstract 
Attention-deficit/hyperactivity disorder (ADHD) remains under-diagnosed in adults. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, ADHD symptom criteria anchor the diagnosis but require interpretation that is sensitive to symptom expression in adults. For example, hyperactive symptoms may become more subjective and hidden in adults. Inattentive symptoms may involve so-called executive functions, such as planning, multitasking, and time management. While collateral reports from significant others are helpful, often the afflicted adults can report meaningfully about their lifelong condition. In addition to symptoms of ADHD, other diagnostic indicators include specific educational, occupational, and psychosocial difficulties. A number of rating scales and diagnostic interviews are available to assist in the diagnostic process.

Introduction
While childhood attention-deficit/hyperactivity disorder (ADHD) was first recognized in the early 1900s, recognition of the disorder’s persistence into adulthood did not occur until the 1970s. Nevertheless, much is known about the persistence of the disorder into adulthood, the common presenting problems of adults with ADHD, and the manifestations of the disorder that are unique to adults. This article seeks to highlight these presenting symptoms of ADHD in order to aid clinicians in making a diagnosis of ADHD and then goes on to examine diagnostic measurements and interviews that can be used to make a diagnosis of adult ADHD.

Presenting Problems

Adults with ADHD usually describe symptoms of poor attention, lack of concentration, easy distractibility, shifting activities, day-dreaming, and forgetfulness.1 They often begin one task and then find themselves in the middle of several projects. These patients appear to have a poorly developed sense of time and are often harried and late. They lose and misplace important personal items, such as keys, as well as items from work and family projects. They usually avoid tasks that require high levels of concentration and patience, such as balancing their checkbook, filing tax returns, and helping children with homework. Projects are often put off until the last minute, at which time they may become highly motivated and able to focus. Often these patients are drawn to novel stimuli, usually at the expense of the designed object of their attention. Their boredom or intrusiveness often compromises conversations with coworkers, spouses, and children. Others may view adults with ADHD as either flighty or self-centered. Adults with ADHD usually have difficulty regulating their attention, which can lead to repeated problems as they attempt to manage affairs at work, home, and with friends.

Additionally, these patients report symptoms of impulsivity, impatience, boredom, fidgetiness, and intrusiveness.1 These symptoms are often evident in the context of social situations. Frequently, adults with ADHD have long histories of social impairment, and are often perceived as aloof or self-centered, as they easily become bored or may interrupt or make socially inappropriate comments. Others are quite gregarious and talkative, “the life of the party”—almost an adult equivalent of the “class clown.” Adults with ADHD have a sense of urgency and immediacy to their lives and have little tolerance for frustration, delay, or planning. They are easily irritated waiting in lines and often make decisions without proper consideration of alternatives. Collaboration with others may be a mutually frustrating experience. Also, adults with ADHD experience increased rates of traffic accidents, traffic violations, and license suspensions.2,3

Symptoms of overt hyperactivity may be diminished in patients who have developed compensatory strategies. Recent data support the clinical observation that symptoms of hyperactivity-impulsivity decline over time while symptoms of inattention persist in ADHD patients.4 However, these investigators note that most patients with ADHD continue to struggle with a substantial number of symptoms and a high level of impairment.

For example, adults with ADHD are thought to have deficits of working memory as exemplified by less ability to attend to, encode, and manipulate information.5 Such deficits in working memory may decrease the ability to filter out distractions, which contribute to further symptoms of inattention in adults with ADHD. Although less defined within ADHD, organizational difficulties and procrastination also appear common.

Like children with ADHD, adults with the disorder may be stubborn, demoralized, and develop low self-esteem.6,7 Relationships with family, friends, and employers are often conflictual, which may contribute to high rates of separation and divorce, as well as to the academic and occupational underachievement characteristic of these adults.8,9

Relationships and Family Life
The constant activity of an adult with ADHD can lead to family tension. Problems include difficulties with organization, setting and keeping routines, day-to-day supervision, stress tolerance, mood stability, and compliance with ADHD treatment plans. Parents come home to children who need time and attention, dinner, and help with homework, which adds to the tension. Difficulties juggling family, work, and other responsibilities highlight executive functioning deficits.

Relationships for ADHD patients can be unstable, so reports of counseling or relational difficulties can indicate an ADHD diagnosis if the underlying problems are due to one partner’s symptoms of inattention or hyperactivity. Common issues include not listening, interrupting when the spouse is speaking, or a disorganized or inattentive approach to household responsibilities. The diagnosis of ADHD alone can help considerably, enabling the couple to understand that ADHD is a condition that interferes with planning and sharing tasks. Effective treatment for one partner’s ADHD can possibly lessen or eliminate problems that a couple is experiencing.

Education

Educational or vocational performance below that which is expected (based on a patient’s intelligence and education) may provide an indication of the diagnosis of ADHD. According to evidence gleaned from self-reports and high-school transcripts in the Milwaukee Young Adult Study,10 young adults with ADHD experience significantly more grade retention, suspensions, and/or expulsions than their non-ADHD peers. The dropout rate is also higher and, on average, students with ADHD may have lower class rankings and lower grade point averages. In addition, fewer enter college. For the students with ADHD that do go to college, the graduation rate is much lower than those without ADHD.10

Occupation

Patients frequently present with occupational problems, such as difficulty finding and keeping a job and job performance below the level of competence. Questions to ask a patient about his or her history of vocational difficulties include: How often have you changed jobs? What was the reason for the job change? and has it been hard to get along with bosses?11 Adults with ADHD often have a low frustration tolerance, which can lead to issues such as high job and relationship turnover and explosive or irritable episodes.

A sense of internal restlessness in adults with ADHD can lead to a compulsive tendency to overwork or choose occupations where frequent movement is an essential component of the job, such as sales and marketing. Childhood hyperactive symptoms, such as difficulty remaining seated, running and climbing excessively, squirming and fidgeting, difficulty playing quietly, and talking excessively, are commonly manifested in adults who work two jobs, work long hours, or choose very active jobs.

Many adults with ADHD do not regulate themselves well and do not self-correct when problems arise, in part due to poor self-monitoring.12 Poor time management and difficulty completing and changing tasks are common manifestations of inattention. If possible, adults often attempt to compensate for limited organizational skills by enlisting the assistance of support staff.12
Diagnosis

ADHD can be diagnosed in adults by carefully querying for developmentally appropriate criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV),13 and attending to childhood onset of symptoms, persistence through adolescence, current presence of symptoms, and impairment. A variety of issues arise in the assessment and diagnosis of ADHD in adults. The appropriate diagnosis of ADHD in adults initially relies on accurate recall of childhood symptoms and a reliable account of current symptoms and their impact. Some clinicians have questioned the reliability of adults with ADHD to accurately report this information,14 though recently, Murphy and Schachar15 evaluated correlation symptoms between adults with ADHD and other informants and found that ADHD adults can give a true account of their symptoms.

Thus, diagnostic information is obtained from the patient and, whenever possible, from significant others, such as partners, parents, siblings, and close friends. If ancillary data are not available, information from the patient is acceptable for diagnostic and treatment purposes since, as Murphy and Schachar showed,15adults with ADHD, like adults with other disorders, are appropriate reporters of their own condition. Careful attention should be paid to the childhood onset of symptoms, longitudinal history of the disorder, and differential diagnoses including medical, neurological, and psychosocial factors contributing to the clinical presentation. Neuropsychological testing should be used in cases in which learning disabilities are suspected, or cases in which learning problems have persisted in treated ADHD adults.16-18

A clinical interview with the patient remains the basis of the adult ADHD diagnosis. Rating scales and neuropsychological testing may help to gauge ADHD symptoms, but a structured or semistructured clinical interview enables practitioners to accurately assess all three core features of the disorder in adults: symptoms dating back to early childhood, significant impairment in at least two settings, and moderate severity ratings for at least six of nine symptoms of inattention and/or hyperactivity.19

Symptoms of inattention in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR),19include failing to give close attention to details or making careless mistakes in schoolwork, work, or other activities; having difficulty sustaining attention in tasks or play activities; not listening when spoken to directly; not following through on instructions; and failing to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions). Other inattentive symptoms include frequently having difficulty organizing tasks and activities; avoiding, disliking, or being reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework); frequently losing things necessary for tasks or activities; being easily distracted by extraneous stimuli; and being forgetful in daily activities.19

Symptoms of hyperactivity listed in the DSM-IV-TR19 include fidgeting with hands or feet or squirming in one’s seat; leaving one’s seat in the classroom or in other situations in which remaining seated is expected; and frequently running about or climbing excessively in situations in which it is inappropriate (in adolescents or adults, this last symptom may be limited to subjective feelings of restlessness). Other hyperactive symptoms include having difficulty playing or engaging in leisure activities quietly; being “on the go” or acting as if “driven by a motor”; and frequently talking excessively. Impulsive symptoms include blurting out answers before questions have been completed, having difficulty awaiting one’s turn, and frequently interrupting or intruding on others (eg, butting into conversations or games).19

In the current DSM-IV13 nosology, at least six of nine symptoms of inattention must be present for the inattentive subtype diagnosis, at least six of nine hyperactive-impulsive symptoms must be present for the hyperactive-impulsive subtype diagnosis, and at least six of nine symptoms for both subtypes must be present for a combined subtype diagnosis.13

A range of ratings scales, forms, and structured interviews have been developed to assist with the diagnosis of ADHD in adults. Rating scales, such as the ADHD Rating Scale (ADHD-RS)20 or the Conners’ Adult Attention-Deficit Rating Scale (CAARS),21 can be used to assess current symptoms, while semistructured interviews, such as the diagnostic portion of the Conners’ Adult ADHD Diagnostic Interview for the DSM-IV (CAADID)22 and the Mini-International Neuropsychiatric Interview,23 can be used to assist with diagnosis. In addition, forms such as the CAADID are designed to assist in obtaining the history of symptoms from the patient. Current symptom scales, as well as diagnostic questionnaires, are available in self-report, observer-rated, and clinician-administered forms. For childhood history, collateral information obtained from a parent or older sibling, if possible, is extremely helpful. Formal records, such as report cards and conduct reports, are also illuminating. To assess comorbidity, one can either conduct a semi-structured interview or use an assessment tool, such as the Structured Clinical Interview for DSM-IV Axis I Disorders.24 These scales are discussed in greater detail below.
Rating Scales

Rating scales are a useful tool for assessing whether a patient meets the DSM-IV13 diagnostic criteria necessary for an adult ADHD diagnosis. Because they provide structure and, in some cases, extensive prompts that can be used to probe patients further, they are especially helpful for clinicians with less adult ADHD experience. Rating scales can also be useful in assessing current symptoms. In terms of diagnosis and severity, the use of the 18 core DSM-IV13 symptoms has been well established as valid and reliable. There are a number of diagnostic systems and rating scales that assess domains outside of the traditional DSM-IV13 core symptoms. While they may provide useful clinical information, the relationship of these additional domains to ADHD itself remains unclear. For instance, while functional impairments, such as social and occupational deficits, are important features of ADHD, they are not specific and are frequently present in individuals without ADHD who have other disorders.

Diagnostic Scales

The CAADID is a clinician-administered interview that assesses the presence of the 18 DSM-IV13 symptoms for childhood and adulthood.22 Specific prompts and examples of symptoms are provided for each query, and impairment in school or work, home, and social settings is assessed for childhood and adulthood. A diagnosis of ADHD, including subtype, can then be established. The interview queries patients about childhood history, including gestational, delivery, temperament, developmental, environmental, and medical history risk factors. Childhood academic history and adult educational, occupational, and social/interpersonal histories are also queried, as are health history and psychiatric history.

Barkley’s Current Symptoms Scale–Self-Report Form25 is a self-report scale of 18 symptom items that correspond to those listed in the DSM-IV13 diagnostic criteria. Odd-numbered items assess frequency of inattentive symptoms and even-numbered items assess hyperactive-impulsive symptoms on a 0–3 Likert-type frequency scale (0=never or rarely, 1=sometimes, 2=often, 3=very often). The scale also asks patients to note how often their symptoms interfere with school, relationships, work, and home life, and to report the age of onset for their symptoms. Finally, it addresses oppositional defiant disorder (ODD) comorbidity with eight questions about symptoms of ODD. Barkley also has a Childhood Symptoms Scale–Self-Report Form, a Developmental Employment, Health, and Social History Form, and Work Performance Rating Scale–Self-Report Forms, all of which can be sent to the patient to complete before their first clinic visit. In addition, the Current Symptoms Scale–Other Report Form provides observer ratings. Together, these scales form a picture of the patient’s past and present symptoms and functioning.25

The Brown Attention-Deficit Disorder (ADD) Scales Diagnostic Form26 is clinician-administered and begins with queries about clinical history, including impact of symptoms on work, school, leisure, peer interactions, and self-image. Patients are also asked whether early schooling was impacted by their symptoms. The clinician asks the patient about the clinical history of his or her family and about the patient’s physical health, substance use, and sleep habits. The clinician also obtains collateral data from an observer or significant other and screens for the full array of comorbid disorders.26

Current Symptom Surveys

Current symptom surveys can be divided into clinician-administered and self-report forms. Some scales are normed and can provide population comparisons. Because some symptoms, such as internalized restlessness, feeling disorganized, and being easily distracted, are not always apparent to observers, self-report scales are an effective way to capture the symptoms of adults with the disorder. However, for new patients who are less self-aware of their symptoms, it is very helpful for the clinician to be able to ask about symptoms in a semi-structured format that allows them to utilize an extensive list of examples given as prompts.

The ADHD-RS20 is an 18-item rating scale that rates symptoms using a 4-point Likert-type severity scale (0=none, 1=mild, 2=moderate, and 3=severe). It is based on the DSM-IV criteria for ADHD, with nine items assessing inattentive symptoms and nine items assessing hyperactive and impulsive symptoms. The ADHD-RS has been developed and standardized as a clinician-administered rating scale for children but can be used as an adult scale after the clinician has been trained to do so.

The Brown ADD Scale26 is a frequency scale with 40 items. In response to descriptions such as “misunderstand directions for assignments, completion of forms, etc.” and “starts tasks (eg, paperwork, chores) but does not complete them” patients give a rating from 1–3 of how often the symptom occurs (0=never, 1=once a week or less, 2=twice a week, and 3=almost daily). This assessment has normed, standardized, validated clinician-rated and self-report forms.

The Wender-Reimherr Adult ADD Scale (WRAADS) is intended to measure the severity of the target symptoms of adults with ADHD using criteria from the Wender Utah Rating Scale.27,28 It measures symptoms in seven categories: attention difficulties, hyperactivity/restlessness, temper, affective lability, emotional over-reactivity, disorganization, and impulsivity. The scale rates individual items from 0–2 (0=not present, 1=mild, 2=clearly present) and summarizes each of the seven categories on a 0–4 scale (0=none, 1= mild, 2=moderate, 3=quite a bit, 4=very much). The WRAADS may be particularly useful if the clinician wishes to assess possible mood lability symptoms of ADHD.

The screening version of the CAARS21 is a 30-item frequency scale with items such as “has difficulty organizing tasks and activities” and “is on the go or acts as if driven by a motor.” Symptoms are assessed with a combination of frequency and severity. Patients respond on a 4-point Likert-type scale (0=not at all or never, 1=just a little, once in a while, 2=pretty much/often, and 3=very much/very frequently). All 18 items from the DSM-IV13 can be extrapolated from the CAARS. There are also observer and self-report versions of the CAARS. Both the clinician-administered and self-rated versions of this scale have been validated and normed.

The full Adult Self-Report Scale (ASRS) Symptom Checklist (version 1.1) is an 18-item scale that can be used as an initial symptom assessment to identify adults who might have ADHD.29 The scale queries patients about the 18 symptom domains identified by the DSM-IV, with modifications to assess the adult presentation of ADHD symptoms. Furthermore, a context basis of symptoms is provided. The scale is intended to be used in patients at risk for having ADHD, whether secondary to presenting symptoms, family history, or comorbidity. A six-item screening version (extracted from the full 18-item symptom assessment scale) is available for assessing patients in the community, regardless of whether they are at increased risk for ADHD. Neither the six-item screening version nor the full 18-item symptom assessment version is meant to be a stand-alone diagnostic tool. The diagnosis of ADHD is still predicated upon assessment of current symptoms, impairment, and childhood onset of symptoms. The ASRS and other symptom assessment tools are designed to be diagnostic aids in fulfilling the first criteria. As this section reviews symptom assessment tools, the discussion will focus on the 18-item ASRS Symptom Checklist.

The ASRS was developed by Adler, Kessler, and Spencer, and a steering committee of experts on adult ADHD. The ASRS Symptom Checklist is now available through the World Health Organization (WHO) and on the New York University Web site.29

In the ASRS, symptoms are rated on a frequency basis: 0=never, 1=rarely, 2=sometimes, 3=often, and 4=very often. Nine items assess inattention and nine assess hyperactivity-impulsivity. Once the patient has completed the scale, it can be readily scored and used as a starting point to talk more in depth about a patient’s clinical history. There are scoring guidelines based upon the total score in either the inattentive and hyperactive/impulsive subsets (using the higher of the two) that yield a diagnostic likelihood of the patient having ADHD. The scale has been validated using the National Comorbidity Survey cohort and in well-characterized adult ADHD populations.

Differential Diagnosis

As always, it is important to remember that when diagnosing for ADHD, a variety of medical and psychiatric conditions should be considered as part of the evaluation of ADHD in adults. Such conditions include sleep disorders, headaches, visual and auditory disorders, seizure disorders, endocrine disorders, hepatic function, use of illicit substances and herbal remedies, and impact of concurrent medications on cognition (eg, anticholinergic or antihypertensive medications). Laboratory tests, such as thyroid studies, electroencephalograms, baseline electrocardiograms, or baseline hepatic function tests are generally not necessary unless indicated by the patient’s symptoms or family history. Additionally, clinicians should obtain a history of anxiety disorders (including trauma), mood disturbances (including bipolar disorder), current and past substance use, aggression and impulse control problems, legal involvement, and psychosis. Furthermore, current stresses, as well as issues involving the patient’s adherence, are important to the overall treatment plan.

Conclusion

DSM-IV13 criteria provide the standard for diagnosis through all age ranges. The cardinal criteria for diagnosing ADHD are the presence of sufficient current symptoms and impairment in two realms (realms include home, school or work, and social interactions). A clinical interview, aided by the use of rating scales and (when appropriate) collateral information about childhood from parents or siblings, provides data for a comprehensive assessment. The poor psychosocial outcomes of patients with ADHD, often a consequence of unrecognized, untreated symptoms, can also serve as diagnostic indicators. Diagnostic and symptom assessment scales can be helpful in diagnosing and establishing the symptoms of ADHD in adults. PP

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