Would you like medication with that?
Questions about strategies – are they enough? Questions about medicines – are they enough?
My opinions:
Some people just use strategies, and do OK. Some people, for various reasons, don’t like the idea of medicines. They don’t work for everyone.
Some people just use medicines, and that’s enough. Some people for various reasons, don’t like the idea of strategies. They can be hard to use. You have to pick a problem that bothers you enough to make using the strategy worth the effort. But if you stick with it, it will become a habit and then it takes no effort anymore.
For most of us, the combination of medicines and strategies works best. One of the experts, Dr. Goodwin, says that the purpose of the medicines is to enable us to focus enough to use the strategies.
There are also alternatives to medicines. Some of them apparently are helpful to some people. I’m working on my lack of information (i.e. ignorance) about them.
doug
Note: I’m still working on trying to correct some of my previous misconceptions. A mind is hard to change. I looking at information from Maya, Dr. Parker, and others, and will get back to you.
Question: do you use medicine- ritalin, strattera, adderal, concerts, vyvanse? Or strategies? or both? or neither? (this is like a survey!)
Life is hard. It’s harder with ADD ADHD.
ADDadultstrategies 
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As a more general response to your initial question- my initial reaction when diagnosed with ADHD was to use the stimulants and learn strategies that increased my structure and decreased the number of things I needed to carry in my head.In time I came to realise that neuroplasticity was a real and clinically exploitable phenomenon.
SecondIy had a flash of insight when I realised that the tagenting and losing sight of our initially goal, is in formal, logical terms, the antonym of has been called mindfulness in the formal Buddhist sense of the word and that hyperfocus is a modern term to describe what in Buddhist meditation training is called “judgmental awareness” and that its opposite of non judgmental awareness is a skill one develops in meditation.
So that led to sitting meditation, which was very helpful but not the whole answer, as with my improved self awareness I could now clearly observe the sympathetic hyperarousal that would return soon after I stopped meditating. HOwever sitting was painful due to abad neck and back- and in the course of getting that problem treated my chiropractor was able to explain to me that the cerebellar and basal ganglia dysfunction that was behind my back pain and my clumsiness and poor balance was also driving many of my ADHD symptoms- so I have been working with him fora bout 3 years.
The gains made there though accelerated very powerfully with the addition of the Tai Chi.
Effectively the chiropractic and exercise work is working on neuroplasticty of subcortical structures, while the sitting meditation operates more at the level of the cerebral cortex.
As time goes on the strategies become automatic and the need for stimulants is once again decreasing rapidly ( I have had them on 5 days out of the last 21, and 4 of those days were a single dose of 10mg dexamphetamine. Four of the five days were requred because of sleep deprivation – from being woken by some residual (but diminishing) back pain.
I think we make a immense error if we assume that all we can do is palliate ADHD.
Given the amount of trouble it has caused me I aim to eradicate mine.
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dr. k- thank you. seems complicated, but i think i understand most of it. i see the cost of a spect scan is 3-5000$. may be hard to get for most. if you just be sure to do all exercises bilaterally would that work or do you need to know which side to work on? can you tell clinically? any idea what percent of us have this type of problem?
thanks for all the info
doug
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Hi Doug,
it is complicated and the neurophysiology is only just being clarified.
The books to look at are “ADHD as a model of Brain- Behavior Relationships” and Subcortical Structures and Cognition”. both by Leonard Koziol and Deborah Budding
On my physical assessments I have seen only maybe 2 ADHD patients out of probably 200+ in the last 18 months who do not exhibit both signs and symptoms of cerebellar dysfunction. As yet I am not as sharp at detecting the physical signs of basal ganglia underfunction- but hyperactivity, fidgeting, picking at the skin, and difficulty in turn taking in conversations are all classic manifestations of basal ganglia issues.
Vestibular issues are also obvious in about 95% of patients once a thorough assessment is done, and the latest discovery is that eye convergence issues (driven by the cerebellar- and vestibular issues) are also highly prevalent ad greatly increase the effort involved in reading. This often shows up as a slightly unstable gaze with a table microsaccading of the eyes or as easy fatiguabiliy when the patient is asked to saccade rapidly between the two fingers. That test is done in the horizontal plane from midline to extreme left and right and in the vertical planes from eye level to above eye level and eye level to well below eye level to test vertical eye movement in both the inner upper and lower quadrants and the outer upper and lower quadrants. The patient must remain sanding and keep his level with his nose pointing towards your nose.
The results may be:
slow or poor ability to move the eyes, blinking and eye watering, movements that are not smooth or disintegrate as the various extraocular muscles move in a desynchronised fashion, or initially good movements that deteriorate as they are repeated.
Re SPECT scans I mentioned mine because it had been done and it produced the predicted results.
I now use Dr Daniel Amens brain system checklist instead. The interpretation of the SPECT scans is based on that checklist and I have found, in the SPECT scans I did do, a high correlation between the questionnaire and the results.
I just dont think we need spend the money or expose ourselves to the radiation.
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Dr K
thank you for the good information. do you think the amen checklist is better than the brown? what is the scoring?
I skin pick – had no idea that ALSO is related to my ADD!
that’s good news about the scan.
thank you for your comments
doug
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They are very different things– the Amen Brain System checklist divides symptoms according to their site of origin– frontal lobe, anterior cingulate gyrus, deep limbic system, basal ganglia and temporal lobe.
It pays though to remember what I have said below that many frontal lobe symptoms may originate from basal ganglia and cerebellum in ways that we are only just starting to appreciate.
However there has been good correlation between the questionnaires and the scans that I have seen.
The questionnaire is very useful as many of the temporal lobe symptoms relate to explosive temper, and it is often a good idea to treat them with one of the antieplieptics that are used as mood stabilisers. Note that this is very specifically NOT the same thing as calling them Bipolar disorder and patients appreciate having that spelled out.
The Brown questionnaire is purely ADHD to the best of my knowledge. I have never reviewed a copy. I rely more on DIVA for assessment of positive ADHD symptoms and history taking to rule out causation of those symptoms by other psych illnesses listed in DSM as exclusions for the ADHD diagnosis.
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dr k – thank you. you give a lot of good information, partly evidenced by its stimulating more questions.
so the skip lines in the Amen system denote the different brain structures involved?
i found DIVA – had never heard of it (http://www.psyq.nl/files/1263005/DIVA_2_EN.pdf).
do you have thoughts about the brain systems you note vs the left/right brain model of dr levin?
thank you
doug
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Picking at the skin?! Holy cow, I’ve been picking at all the teeny-tiny unevennesses at my arms (and sometimes face) ever since I was in my teens, causing some scarring (and lots of friends and relatives admonishing me to “Stop that! You’ll scar and feel ashamed!!”)! It happens especially when I’m stressed (it’s soothing) And sometimes I feel an awful urge to rub all the places where the skin “folds” – between the fingers, toes, inside the elbows and behind the knees. Never would’ve thought it was ADHD related!
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ram- i was very surprised by this too. been picking at least since teens.
thanks for commenting. and thanks to dr. k for the information.
doug
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I am unable to take mediations. I must use tools, tactics, and strategies to accomplish what I want and need to do. There really is no alternative for me. You can imagine my surprise when my life became manageable without the medications after years of being told that the meds could help so much. Then the other shoe fell and it was found that other medical factors made medications dangerous for me.
I don’t think that there is a “this or that” approach for ADD/ADHD. While medication helps, it does not solve all of the problems, nor does it substitute for knowing how to do things without the support of medication. For most people, I think the medication slows down the brain activity well enough for them to use the skills that they have acquired over time and in response to the situations they have fond themselves in over the course of their years.
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dianne –
i certainly agree,although i tend to think that the medicine helps us focus, and then that helps us slow down. doesnt matter, either way, it works.
thank you for commenting, and glad that you are doing better even without meds.
doug
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Interesting post. I think I mentioned to you that I had an appointment with a psychiatrist to be officially evaluated for ADHD. I cancelled the appointment. My son went also and he told me about his appointment and I wasn’t impressed. He said he got the idea they were bored with the whole idea of ADD/ADHD and the only reason you went was to get meds. He said that if I wasn’t going for meds, it would probably be a waste of time. So I cancelled the appointment. Honestly, I wasn’t impressed with anything he told me about this group and I don’t really want meds.
But I’ve been thinking about it. My ADHD has gotten SO bad since I started in peri-menopause. I’m taking 20 mg of citalopram for depression which has helped a lot but I’m still having so much trouble with focus. Two or three times last week I was telling my husband something and got sidetracked in the middle of the sentence. He finally finished one of them for me and prompted me to finish the others. This is not me. I’ve struggled with this my whole adult life (that’s when I realized I had it) but it’s never been this bad. I’m seriously thinking about looking into medication. I hate taking meds, though, and I already take meds for high blood pressure. At this point I haven’t made any decisions. I’d have to find a good psychiatrist first and I’m not sure how hard that will be. How do you find one?
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homey – sorry for the bad experience. to find a psychiatrist that knows ADD ADHD ask friends, check with a CHADD or other organization, try to talk to them on the phone. the meds might be very helpful, or might not. worth trying. you might need to up your BP meds a bit while on them, or not.
why do you hate taking meds?
thank you for the commments
link https://addadultstrategies.wordpress.com/2014/09/04/do-they-know-what-theyre-talking-about-adhd-o-the-day-358/
doug
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Hi Doug,
Would you please advise us on the best way to obtain the medication we need to treat our ADD?
I currently only use the many strategies that I’ve developed over the years – constantly adding new ones I hope may help me, and also dropping others that weren’t as helpful as I had hoped. But I truly believe that a combination of both strategies and some medication would help me the most. Unfortunately, I have not been successful in learning how to get the medication I need.
I have been to two neurologists over the past couple of years after getting a referral from my family doctor. But I learned that neurologists don’t like to treat ADD. When I once again asked my family doctor for a referral to an ADD specialist, recently, she just gave me pamphlets from a couple of outpatient mental health providers. Both only had a limited number of psychiatrists, and those that treated ADD only treated ADD in children.
There seem to be many psychologists who treat ADD, but I believe they do not write prescriptions for medication. Is this true? Do the psychologists request that a psychiatrist they work with write a prescription for the ADD patient? Any advice you can give would be helpful to us. Thanks! Jeff
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jeff- you need a psychiatrist who really knows ADD ADHD. can be hard to find. maybe if you called the psychologists they could refer you to a good psychiatrist? its a problem. good luck
doug
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I use medication (same substance as ritalin) 30mg a day (20/10). I also use strategies. Sort of. Still trying to shove a lot more change into my life, but trying to keep positive. Whenever I feel low because I’m still not cleaning the place regularly, I pat myself on the back because the places I’ve decluttered Düring the last few months…. Actually remain decluttered!
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ram- Great!. focus on what you have done, not what you haven’t. increase morale, makes it easier to do more. small steps.
as always, thank you for commenting
doug
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I use strategies, but as I’ve said before–I have to change my strategy every time we move. The instability of Military life is No Bueno for ADHD! However, I have found that a change in food makes a huge difference. Saty away from red food dye, sugars such as high fructose syrup, corn syrup, corn syrup solids–just stay away form corn unless it is in its natural state! I eat more whole grains and eat more fruit (pears, apples, oranges). Veggies are a key to better health and better concentration.
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Angelique- a healthy diet is great. it is becoming clear that it makes a difference in ADD ADHD for some people, I’m not clear about for how many. and moving is a real booger!
thank you for commenting
doug
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The latest studies that I have read, “Artificial food dyes and attention deficit hyperactivity disorder.” by Robin B. Kanarak and “A randomized controlled pilot study into the effects of a restricted elimination diet on family structure in families with ADHD and ODD.” by Liddy Pelsser et al. seem to indicate that furhter large scale studies are warrented due to thier findings. I have also read several articles about Yoga and Martial Arts as effective strategies to aid in concentration. If you have access to a library with a large periodical database you can find a lot of interesting studies on ADD/ADHD.
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angel – when i find some time i will get into the big library. til then i will procrastinate and depend on well informed folks like you and maya and dr parker. i appreciate any information you have.
thank you for commenting
doug
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I would love to share the article but can’t upload it to your page. I looked for an email contact on your page as well, but either it is not here or I missed it completely. I can email it to you. You don’t have to post your email here, I understand keeping emails private. my email is chicbyangelique@gmail.com. Drop me a line and I will make sure you get the article as well!
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Hi Angelique,
do you have any good articles on martial arts? I have had huge improvements through use of Tai Chi/ Qi Gong in the last 15 months. Now the most current evidence I can obtain is that the major areas driving dysfunction in ADHD are subcortical (cerebellum, vestibular system and basal ganglia) and that the dysfunctional input from these structures into the frontal lobes is what drives the frontal lobe dysfunction.
I am one of the over 50% of ADHD individuals who also suffers from dyspraxia and it is acknowledged that dyspraxia is a big drain on working memory. It is very clear from my perspective as a medical practitioner that the really minute attention to precise and complex motor sequences involved in doing Qi Gong etc accurately has a enormous training effect. It directly impacts the dysfunction in all those subcortical systems and through repetition and close attention it progressively produces neuroplastic change that addresses these problems.
Even though I have been doing it for 15 months I am still operating at quite a basic level- and have to be content with falling behind the class and going at my own pace as I am much slower to learn the new sequences. However I am content because it is producing far greater benefit when I take the time to learn it correctly.
It also has flow on effects- better coordination, fewer accidents, better orientation, losing far fewer things and much improved memorization skills. Not bad for an hour a week and 10 minutes here and there.
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Dr. Kinsella,
I will see if I still have the article. I used it for a paper that I did in my Child Developement Psych course. If I don’t have the article, I can get the citation info for you from the paper.
The study on the effects of Martial Arts on children (which I think can be used for adults as well) was a small study, but their findings indicated that a larger study is warrented. I will do a search in EBSCO Host and JSTOR to see if can find a newer study as well.
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I have the article in PDF. I can email it to you.
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Thanks Angelique, can you send it to andrew@vcps.com.au?
One thing I forgot to mention was that the major impetus that pushed me towards looking Martial Arts was the work of Dr John Ratey ( co author of Driven to Distraction, and himself an ADDer), particularly that presented in his book “Spark”. I would recommend that book to anyone- ADHD or not. The ADHD chapter is only 22 pages but it covers a lot of ground very efficiently.
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I have “Driven to Distraction” and I love that book! I have notes in the margins, highlighted phrases, and sticky notes marking my favorite pages. I will have to check out “Spark,” Thank you!
I sent the email last night, so you should have that waiting in your inbox.
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angelique- could ;you also please post the article here?
thanks
doug
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dr. K
would anything that exercises the cerebellum help with ADD ADHD?
thanks
doug
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It would depend on whether the exercises are global enough – or alternatively targetted enough.
The Dore program was a set of exercises that targetted whole cerebellum and it did produce lasting changes in many patients-. I have met a patient who did it as a child and improved greatly. Unfortunately that program was supported by a poor business structure and it folded – leaving many patients owed money.
The patient reported regression of symptoms after stopping the program.
One of the issues with exercises that stimulate only part of the cerebellum is that they may not affect the relevant part that is producing the worst symptoms.
Equally there may be asymmetrical cerebellar involvement.
In my own case (and I have a pattern I see in many patients)- I had a pattern of chronic suppression of right cerebellar activity secondary to intense input form the right subocciptal musculature- which was bracing to stabilise the right occipto- atlantal joint- as a result of a birth injury.
( This was associated wit a feed- forward effect of deactivation of the LEFT prefrontal cortex- which was depending on the right cerebellum to drive its resting tone.
The deactivation is actually demonstrated very nicely on a SPECT scan I had when my ADHD was being worked up– it is most severe when i sit up and the neck is dealing with the load of the head.
So I had ( and am still having a) a slow process of rehabilitation involving brief exercises repeated several times each day and modified according to response by my specialist ( a chiropractor who specialises in functional neurology.
What is interesting is his method of demonstrating the effectiveness of the exercise.
Once he had isolated and tested an exercise that produced the desired effect he would then see what happened if he applied the same exercise to the opposite side of the body. Invariably it would annull the benefit produced by the exercise applied to the dysfunctional side.
So carelessly applied unilateral exercises may worsen the problem.
(More later- off to work now!)
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