[Saffron]

This is part of an ongoing anti-ADHD series in the Globe & Mail called “Failing Boys.”

It has become the BIBLE of my son’s father, who steadfastly refuses to allow medication for our son with severe-range ADHD. I’m appalled that, while the authors spout every logical fallacy, generalization and cherry-picked study in the book to gain readers for the paper, few bother to challenge them. The commenters are composed of believers in Big Placebo who represent the fashionably scientifically-illiterate general population, and they eat this stuff up.

Articles like this have appeared on the CBC website and in our local paper. And it’s like there are two camps, but the public is only hearing from one. The genuine experts don’t seem to be visible in the same forums actively challenging the growing myths and misconceptions around ADD. Maybe they aren’t being given any air-time when they do, or maybe journalists seek only the Fox-news versions of info on ADD. Maybe they’ve been silenced silly by the constant chorus of accusations that they’re co-opted by the pharmaceutical industry.

Or maybe they’re just busy — actually working on the front lines of treatment and research in ADD — while the band plays on around them. And while my son throws his pencil across the room for the third time and erases his homework so hard he rips the page.

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[Saffron]

@NZadd — Thanks for the empathy! Welcome.

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[Saffron]

I find that the meds give you get-up-and-go and they give you the presence of mind to follow through on tasks once you start them. But their tragic limitations, as far as I’m concerned, are that they can’t give me the same perception of time as other people, and they can’t keep me from regularly becoming overwhelmed and needing to steal time to mentally rest (or becoming bored and needing to steal time to focus on something more interesting). As you know, there’s a fine line between those last two.

This means, despite the meds, I *still*:

~ take too long to do things

~ run out of time constantly despite my best intentions and efforts

~ have trouble distributing tasks throughout a time frame (on paper it looks lovely and is all prioritized, but in practise it’s a wash)

~ get stuck on one task longer than is reasonable (either because it’s more interesting than the others so I start to hyperfocus, or because it’s damn boring and my brain is turning to mush, so I start to slow down)

~ become discouraged about my remaining tasks when the above happens, and feel overwhelmed (which paralyzes me and causes an urgent need for escape to do something restorative)

~ feel desperately cheated out of unwinding time when the day is ending and my to-do list is only partway done, despite going at it the whole day

~ end up robbing sleep to pay me-time, which no doubt lops off some of the effectiveness of the meds

~ beat myself up for inefficiency.

My mission lately has been to figure out how to bite the bullet and cut corners way, way more (i.e., as large as I can stand to cut them) and not to take on (or create for myself) any more tasks, responsibilities or hobbies than those I already have.

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[Saffron]

@ADDfiremedic, your line:

“I have the schedule split into blocks of time in which I have certain tasks to do”

… was *exactly* what I needed to read to figure out how to better set up and follow my agenda. Thank you for that—and welcome!

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[Saffron]

Oh, and um… anyone who knows how to tackle that Wikipedia entry, please have at it!

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[Saffron]

zsazsa, thanks so much for the insight and encouragement. As of the end of his third week of school, we’ve seen some settling down by my son—so what you say is very validating! I’ve also had a chance to speak with his teacher and ask her to do certain things (e.g., let him bring small toys to class to fidget with during listening times, let him grab an extra snack in the gap), and she was very receptive. Last year’s teacher had flatly refused to make any such adaptations for him (thus my going after an IEP), and the results were disastrous.

His dad was indeed present for every part of the assessment that involved the parents. And the clinician, I thought, did a wonderful job of addressing his preconceptions and explaining the if-no-meds scenario. But I’m dealing with a true ideologue. He has become more intransigent since then and expanded his worldview to include our “deceptive” psychologist and her recommendations.

BuxomDiva, were you indeed saying that teachers can designate kids as ADHD and have them given meds in Florida without formal psychological or medical assessment? If so, this would partly explain explain the results of the latest “overdiagnosis” studies that have been in the news.

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[Saffron]

Thanks for weighing in, Rick.

These videos are so nice and succinct. If only the Wikipedia entry on ritalin didn’t directly contradict most of what the interviewed experts say in the videos while appearing to be very well-referenced.

I waded into the bewildering world of contesting (and editing) this Wikipedia entry, and came out feeling rather helpless and more than a little overwhelmed. The article already seems to enjoy frequent input, monitoring and fine-tuning—including from at least one MD who claims it as an expert area—and I wouldn’t know where to begin to make an impact without being drowned out or having to take several days off work to learn Wiki protocol and to research, think and work it all through.

The problems with the entry go right down to selective wording and massive overemphasis on harms, with nearly nonstop ambiguity about whether the cited harms even apply to on-label usage by ADHDers. Apparently the “experts” who monitor the page think it’s fine as is overall.

On another note, I burst out laughing so suddenly at your antics in one of the videos that my cat flew out of the chair beside me and nearly hit the wall. This happens a lot. He’s okay, I think.

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[Saffron]

Do you mean that kids can be designated as ADHD and given meds in Florida without a formal psychological or medical assessment? Really?

Not surprisingly, the two studies that have appeared in the news lately showing that large proportions of medicated kids are falsely diagnosed have been big boosters for my children’s father in his argument against treatment.

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[Saffron]

Fernando, the info & link you posted on our apparent subtype of ADHD were really validating—thanks. I’ve also found a very good article (blog post) by Gina Pera about this issue:

http://adhdrollercoaster.org/adult-adhd-diagnosis-issues/a-new-type-of-adhd-for-next-dsm-revision/#more-1423

Its passage about students with this problem who found it “necessary to re-read passages multiple times in order to comprehend” hits straight home for me. I loved the learning aspects of university, still collect piles of books on my favorite topics, and can spend hours researching on the Web. My career is completely based on my literacy skills. But ironically, reading has always been a very hard slog for me in terms of speed, and school was all about late and unfinished assignments despite top marks for the work I did accomplish.

Since discovering that Concerta helps me take in material up to four times faster, I’ve become much more proficient at work. And I’ve had to wrestle with so much regret over how different my academic path would have been had I been able to work at a normal speed. I would absolutely have aimed for medical school had I known about my ADHD and been given medication in my teens and 20’s. (As an aside, now that my children’s father is refusing to allow meds for my son—whose favorite book is anatomy of the human body for kids—I’m reliving this regret. *sigh*)

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[Saffron]

Fernando, I’ve been thinking about your post all week, but haven’t had an opportunity to respond until now. I wanted to let you know that the kind of intermittent, debilitating fatigue you describe has been a huge problem for me as long as I can remember. I could never understand why I couldn’t seem to get hold of my energies, or why other people didn’t seem to have this issue.

In other words, I believe I know, viscerally, what you’re referring to. I also want you to know that the meds I take for my ADHD (first Wellbutrin and then Concerta) have helped *enormously* with this problem, and that I now know what it’s like to have a fairly constant and predictable energy level throughout the day. There is HOPE, my friend. Things are going to get easier for you, okay?

Tell me, do you also find it nearly impossible to carry out “time-managed” tasks and activities that you planned out ahead of time (because when that time slot arrives, it’s always your energy level that decides whether or not you can follow through)? Does this happen even when what was planned was an activity that is normally pleasurable or that you thought you were looking forward to?

That’s been my story. Then I started noticing the same problem in my little boy, who has just been diagnosed with ADHD “in the clinically severe range.” The frequency and intensity of my son’s physical and emotional ups and downs, almost from day one, were stunning! At first I thought he was showing early signs of bipolar disorder, but other signs (like the length of his worst “downs”) just didn’t check out. He simply has a cup that runs dry way, way faster and sooner than that of other children.

I started to take note of the things that he does to stim, and the things that seem to work to “wake up” his brain and re-energize him physically (playing his favorite music and dancing with him, filling his self-esteem cup with praise and attention, making a game of the task, or asking outsiders like a neighbour he likes to join in).

I observed that he seemed to need more rest than the average kid. Although nutrition certainly didn’t account for the enormity of the problem, he apparently needs more protein to keep his body fuelled than the average kid too. He asks for snacks whenever he’s engaged in a cognitive task and craves carbs between meals to the point of tantruming if you can’t come up with one. (I caught on to this one early, because I myself had always functioned a bit better if I “grazed” all day. Big meals with big spaces in between were a recipe for particularly disastrous energy levels, and I kept quick pick-up sweets with me just to get through my school days and, later on, my work days.)

I noted that my son gets mentally and physically drained much, much faster when applying himself to a cognitive task. I can almost see his brain shut off. And generally, within moments of that shut-off point, he’s also lolling on the floor complaining that his legs and arms don’t work properly anymore. At the end of day, when he’s running dry overall, he’ll *only* put his pajamas on if he doesn’t have to climb the stairs to get to them—and is willing to take whatever consequences that noncompliance brings him! I walk with him upstairs now and tickle his back. So I’ve learned a lot from my son. Clearly he will need meds too.

When I’m not relying on my meds (usually because I’ve forgotten to take them before the “threshhold” time), I know now that there are certain things that will help me stim (e.g., listening to upbeat music sometimes helps, and for some reason making contact with other people who are lively and funny nearly always helps!) And when my brain wakes up and especially if I’ve had some little boost to my self-esteem, I get a jolt of physical energy. It’s the damndest thing. Might be short-lived, but hey, if it gets me to the next part of the day…

A last word about energy and dopamine levels (subject to Dr. J’s greater wisdom of course). I personally have to watch out for iron deficiency and vitamin D deficiency, both of which I understand make it harder to produce dopamine as well as serotonin. So do make sure you have those two areas covered. You might also want to have your TSH checked at your next physical exam (along with iron and vit D), to make sure everything that needs to work properly is doing so and you can get the best results if and when you try meds.

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[Saffron]

((((hug))))

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[Saffron]

Wellbutrin XL definitely gave me a shorter fuse. It seems to be a very, very common adverse effect.

You would need to be prepared for the irritability it can cause (particularly when it is wearing off) and for the impulse to react with aggression where you were once too tired or depressed to stand up for yourself. (Really; this will sneak up on you!)

It seems to rev up the body’s metabolism and give one a greater sense of energy (a huge difference over the inertia of an SSRI), even restoring libido and reducing the urge and the need for more sleep. So basically, you would need to be prepared to *channel* this extra energy into exercise or other outlets. Be prepared to put your fist in your mouth in annoying situations. And because it’s so much easier to wake up and to get out of bed with this med, you would need to resist a powerful tendency to burn the candle at both ends and to sleep too few hours, which itself leads to irritability.

A common solution is to combine Wellbutrin with a low-dose SSRI. The Wellbutrin counteracts the libido-dampening effect of the SSRI, and the SSRI can often blunt the irritability of the Wellbutrin.

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[Saffron]

@ Dr. J: Interesting! I’ve often thought about how coincidental it was that every child with autism I’d met seemed to have longer eyelashes, fuller hair, rosier lips, more symmetrical and proportionate features, etc., than most NT kids.

Now I myself have a daughter with mild autism, and she is indeed unusually pretty—just like a tween Brook Shields. People actually stop us at supermarkets and approach us at her school to comment on how stunning she is.

(P.S. Good looks aside, she is also an utterly magical child in terms of personality and creativity, and we can’t believe how blessed we are to have her.)

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[Saffron]

I heart you too, Nimthiriel!

Cheers

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[Saffron]

Is there someone in your life who can act as your “body double” for studying? ADDers often find memorization much easier and quicker when someone else systematically quizzes them out loud at set intervals. It keeps you on track, and engages the other parts of your brain. The other person needs to be someone with a lot of initiative who can be firmly supportive.

Congratulations on your accomplishments so far!

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