What to Do for Urgent ADHD Problems
by Richard L. Rubin, MD

While some experts are baffled by the drive for finding a rapid response to treatment in chronic disorders such as ADHD, during my consultation and medical education activities in many parts of the US, I hear this demand often from pediatricians in general and some child psychiatrists working in community clinics. This is driven by the frequent acute, even crisis presentations of what is presumed to be ADHD. However, multiple problems can cause impulsive, hyperactive behavior, and need to be considered. I offer these clinical directions:

1. As ADHD is a chronic disorder, a different condition is likely creating the urgency, and the correct acute diagnosis must be sought. Common reasons are conduct disorder disciplinary reactions, children suffering abusive family or environmental circumstances, mood disorders, and covert adolescent substance abuse. Sometimes the urgency is administrative, meaning the child's longstanding behavior has crossed a line of their school, family, or community's tolerance.

2. While ADHD may be present, the acute disorder needs treatment first. The family or school demand for immediate medication, and the doctor's temptation to a quick fix, may be misguided and even harmful. For example, family counseling intervention may be better than quickly prescribed medicine.

3. Even when new ADHD medication is indicated, the family and concerned agency need to understand that stimulants require at least 4 weeks and atomoxetine 6 weeks for proper titration, tolerability management, and initial safety supervision.

4. When such medicine is started under urgent circumstances, and improvement occurs, conscientious follow up is required to ensure continued progress. While we have numerous initial treatment studies and guidelines, ongoing ADHD treatment methods are less defined and continuing adherence is poor for the longterm treatment needs of ADHD.

Richard L. Rubin, MD is Adjunct Associate Professor, Dartmouth Medical College and Director, Vermont Clinical Study Center

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Is ADHD a Gift?
by Ari Tuckman, Psy.D., MBA

Some people say that having ADHD has positive qualities, for example that it gives people greater energy, intelligence, spontaneity, creativity, fun, and artistic abilities. While I can certainly appreciate the well-meaning motives behind helping ADHD folks feel better about themselves and their various struggles, there are some important problems with this tactic. There is also a better way to conceptualize this.

The first problem is that research has consistently found that ADHD does not give any kind of advantage. The handful of studies that found things like greater intelligence had serious problems in their design, making the results unreliable. Of course, people with ADHD have all sorts of good qualities, but it isn't because of their ADHD. It's like saying people with green eyes have above average intelligence-some of them do, but it has nothing to do with the color of their eyes.

The second problem with touting ADHD's benefits is that a lot of people have worked really hard to gain accommodations in school and at work for folks with ADHD. To talk about the positive qualities gives ammunition to those who would like to remove those protections. Not to mention the battles over research funding.

Finally, touting ADHD's positive qualities also subtly undermines the need for treatment, since why should we treat something that brings all these benefits?

A Better Way
So, rather than relying on something that is incorrect, it's more helpful to keep in mind that you are more than your ADHD, that you have individual strengths and weaknesses and your own personality. Everyone has strengths and weaknesses, so for us all it's a matter of making the most of what we have, to achieve what we want. Therefore, since you have all those good qualities anyway, it isn't necessary to assume that they came from your ADHD. If you're creative, then run with it. If you have above average intelligence, then use it to your advantage.

Work on valuing your strengths while accepting your weaknesses:

1. Some people say that ADHD has positive qualities, for example that it gives people greater energy, intelligence, spontaneity, creativity, fun, and artistic abilities. While I can certainly appreciate the well-meaning motives behind helping ADHD folks feel better about themselves and their various struggles, there are some important problems with this tactic. There is also a better way, which we'll talk about second.

2. Use your strengths to work around the weaknesses that you can't improve. Don't feel like you have to do things the way other people do, if it doesn't work for you. Use your strengths creatively to make up for skills that you're weak in.

3. Be smart about the situations that you put yourself in. There's no pride in stubbornly putting yourself into no-win situations. For example, if it's really hard for you to get to work on time, then maybe find one that is more flexible about that. If you can't change your abilities, then change the demands that are placed on you.

Visit myADHD.com and use the follow tools this month to help children and adolescents improve behavior:

• 3029 My Morning Job List
• 3030 My Bedtime Job List
• 1007 Is Your Bedroom Organized?
• 3004 Home Token Economy