Lepage Associates Newsletter
Mental Health Matters
October 2012


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In This Issue
AD/HD in Children and Adults
Getting A's to Getting Hooked


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Greetings! With school in full swing and so many parents concerned about AD/HD ('ADD'), we thought we'd take this opportunity to take a more comprehensive look at AD/HD. And it's not just kids! Adult AD/HD can impact work and adult relationships as well.



Dr. Tina Lepage

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AD/HD in Children and Adults


To Begin, What Is AD/HD?

Attention Deficit/Hyperactivity Disorder (AD/HD; also sometimes referred to as 'ADD') is a neurological condition which is characterized by inattention, hyperactivity, and occasionally both. It impairs the regulation of attention, motor activity, and impulsivity. There are 3 main subsets of AD/HD: Predominantly Inattentive Type, Predominantly Hyperactive Type, and Combined Type, which includes symptoms of the other two. Though it begins in early childhood, it can continue through the life span and take the form of adult AD/HD. When this occurs, most hyperactive symptoms typically evolve into inattentive symptoms. AD/HD occurs in approximately 5-7% of school-aged children in America, and 2% of American adults, though it's estimated that up to 85% of adult AD/HD goes undiagnosed. There is a large biological component to the disorder, as of children with AD/HD have a parent with AD/HD.


How Would I Know If My Child Has AD/HD?

Some warning signs to be on the lookout for include: failing to give close attention to schoolwork, difficulty sustaining prolonged attention, not listening when spoken to directly, being easily distracted, frequent fidgeting, excessive talking, and having trouble waiting turns.


How Would I Know If I As An Adult have AD/HD?

Difficulty with attention is a key signal. As an adult you may have memories of struggling in school. Undiagnosed adults often say upon testing and diagnosis that it explains problems they had with being called lazy or difficult/adversarial regarding schoolwork. You may notice it takes a lot of mental energy to change tasks or follow long conversations, and you may feel irritable when interrupted because your body is reacting to having to exert a lot of mental energy to switch gears.


What Should I Do If I Notice These Things In My Child or Myself?

If you suspect that you or your child has AD/HD, it's important to get a sound diagnosis through a psychological evaluation. One of the challenges with AD/HD is that it manifests so similarly to other common childhood and adult disorders. For example, anxiety -- read through the symptoms above and they could all conceivably be explained by anxiety. And imagine the dangers of putting a child suffering solely from anxiety on stimulants, or even from putting an adult on the wrong medication. In addition, depression can appear as irritability, and can easily be confused with AD/HD. The importance of a sophisticated diagnosis through psychological testing cannot be overstated, not only for medication, but also so the correct interventions and strategies can be explained to you and implemented.


If It's Determined A Person Has AD/HD, What's The Next Step?

If you think the symptoms of AD/HD are significantly interfering with your child's thriving (socially, academically, or within the family), or with your work and adult relationships, it's probably time to start exploring treatment options. Once AD/HD is definitively diagnosed through testing with a psychologist, treatment can typically include both psychopharmacological options and behavioral interventions. For kids, a child psychiatrist can determine the best medication, and a child psychologist can help you with interventions for your child's specific challenges. Medication typically involves some sort of stimulant (Ritalin, Adderall, etc.), which may sound counter-intuitive. The research isn't entirely clear why stimulants are so effective with AD/HD, but one hypothesis is that these people have very high thresholds for attention, and when they aren't satiated, they'll naturally look elsewhere for more stimuli. A stimulant expands the attention spent on each stimulus, and thus the child or adult is able to meet his/her unique threshold. There are some side effects to manage, however, with medication; stimulants can affect a person's appetite, sleep schedule, irritability and mood, etc. In addition, these stimulants have become a popular drug of abuse, with many adolescents using them for recreational purposes, frequently via snorting. So it's important to keep an eye on medications.


There are also various effective behavioral interventions parents can provide their children so they can more easily manage the symptoms of AD/HD, and strategies help adults cope as well. These interventions focus on providing as much organization as possible around the home (having designated places for items and labeling these places), creating standard routines (including waking up and going to bed routines), and combating forgetfulness (for example, keeping a "Day List" of things you might need throughout the day - keys, glasses, notebook, medicine, etc., and a "What did I forget? List" in the car of commonly forgotten items). Between medication and specifically tailored structures set in place, a person with AD/HD can typically manage the symptoms very effectively.



Getting A's to Getting Hooked


Today's competitive academic environment has brought about a variety of methods to get the edge on fellow classmates. Perhaps one of the most risk-prone behaviors has been the use of "pick-me-up pills" or "study drugs" such as Adderall (amphetamine and dextroamphetamine) or Ritalin (methylphenidate hydrocodine). Prescriptions such as these are typically given to individuals with Attention-Deficit/Hyperactivity Disorder (AD/HD), Postural Orthostatic Tachycardia Syndrome, and Narcolepsy. These drugs are known to make the user capable of focusing for long periods of time, concentrating on a single task without being distracted, and working more efficiently.

These psychostimulant drugs have a unique effect on the body which can benefit those with an attention disorder, but it can also damage the delicate chemical balance within the body of someone without such a deficiency. Dopamine is a neurotransmitter chemical produced in the brain which moderates nerve conductions within the brain, thus influencing concentration and typical functions. Individuals suffering from AD/HD may have an uncommon level of a neurotransmitter called dopamine. Using a drug such as Adderall or Ritalin corrects this discrepancy, allowing them to focus on tasks and function normally. Although there are some minor side effects, these prescriptions benefit the user when supervised by a physician; however, there are significant risks to using Ritalin or Aderall outside of a doctor's recommendation.


Perhaps the most problematic situation with this type of drug abuse is that the pills are distributed by peers to others, who may not have the disorder, and precautions have not been taken to assure that the drug will not interact in a manner that is harmful. There could be serious health risks if such drugs are taken in combination with other prescribed substances. Pre-existing conditions, particularly heart related, can be fatal when using psychostimulants. Also, psychostimulants are physiologically as well as psychologically addictive, making them very dangerous when abusing them without a prescription. Normally, a physician would moderate the amount given the their patient in order to reduce the chances of becoming dependent, but when the drug is abused by going outside of the medical authorization, there is no way to properly limit its use. The other side of addiction means that the effects are psychologically addictive because students find it much easier to study. They are able to focus and get more work done, much more quickly, which means they are free later to do what they please.


There are several signs which parents can look for when deciding whether they suspect their child of using psychostimulants.

  • Feeling as though they may pass out
  • Easily bruised
  • Numbness or tingling
  • Insomnia or excessive nervousness
  • Dramatic weight loss
  • Irritability


If you suspect your child is taking these drugs unprescribed, talk with your child about the issue of stimulant drug abuse. First, you should assure that your child knows the difference between needing the substance and using chemicals to gain academic advantage. They should be aware that there are people who have a need for Aderall and Ritalin because they are incapable of functioning otherwise. One reason children may feel tempted to use psychostimulants is the peer pressure they feel from their fellow students. Academic competition has become a major contributor to "study drugs" as long as they provide the necessary boost to improve scores. Talk with your child about doing their absolute best without drugs, assure them that is success in your book. Your words of encouragement and praise when they try their hardest can help combat unhealthy pressure.