tag:blogger.com,1999:blog-3045634714760830992.post2891534684454232482..comments2023-06-05T11:51:38.383-04:00Comments on Evolutionary Psychiatry: ADHD: Stimulants, Alternative Treatments, and CriminalityAnonymoushttp://www.blogger.com/profile/04429177284200775781noreply@blogger.comBlogger16125tag:blogger.com,1999:blog-3045634714760830992.post-44131177036726042562012-12-27T17:18:11.628-05:002012-12-27T17:18:11.628-05:00One thing to consider is that OCD can be mistaken ...One thing to consider is that OCD can be mistaken for ADHD. I found this out the hard way since this isn't apparently well recognized in the medical community. My oldest child was diagnosed in elementary school with severe ADHD. She was diagnosed with a stimulant medication which did not help her. It was all the doctors seemed to know how to do; trade out one ineffective stimulant for the next. <br />Someone who is severely OCD can appear to be ADHD. She was so locked up in her own world, she couldn't attend to the world around her and she did not care. She failed at school from kindergarten through high school because she did not care about the same things everyone else does. She was that absorbed into her own interests. The problem with stimulant meds was that they indeed made her focus more, but that was the last thing she needed: more intense focus. Stimulants just made her more agitated to be torn away from her circular thoughts. Finally, at age 17, I begged the psych. to try an SSRI. This was the first time improvement was seen in her ADHD symptoms. She was now able to "let go" enough of her world to attend to the tedious things in life that took her away from her compelling circular thoughts. She does exhibit other signs of ADHD that are classic, but the core of her ADHD are OCD-based. I'll admit, the SSRI was not a cure by any means and she still struggles greatly, but it was definitely a means of relief for the first time ever. I wish I could say she is out of the woods. She is 19 and struggling, unable to hold a job. I'm having a hard time helping her since she is an adult and her younger sibling is autistic and far more impaired. I just hope this aspect of the ADHD/OCD connections becomes more widely recognized by doctors for subsets like my child so no one has to go that long running down the wrong path. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-30598942028763955862012-12-19T05:57:40.956-05:002012-12-19T05:57:40.956-05:00Hi Emily, I've been searching about ADHD on th...Hi Emily, I've been searching about ADHD on the past few days and found your blog as an interesting and very informative. I want to ask question about the product I bought from mercola at <a href="http://products.mercola.com/zinc-supplements/" rel="nofollow">zinc deficiency</a> where i am doubtful about? Is this product an effective one for my teenage child who have ADHD?Dianahttps://www.blogger.com/profile/14290395668905430103noreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-9658831874055147522012-12-09T12:29:04.963-05:002012-12-09T12:29:04.963-05:00Pardon any repetition of information in the above ...Pardon any repetition of information in the above posts, but there are several important points you address which align with a conversation I had with my pdoc this week. (I'm an adult with Bipolar Disorder, very high-functioning but I still have my problems). We started discussing the changes in the DSM-V, in regards to diagnosing children with BPD and the focus on behavior. We were both in agreement that introducing drug-therapies in children before their brains have time to develop can be risky, and therefore behavior modification should be a first line of treatment (and I am biased because I have a background in behavior modification with children (and husbands)). As an adult, I consistently struggle with prescription tolerance, and it's not something I want to see in children. Just like BPD, I believe that when managed and harnessed in the right way, ADHD can often have many benefits.<br /><br />This may take us a little off topic, but my pdoc and I also discussed my husband's inability to focus on work tasks and his "nature" to put out every fire without any regard for his personal well-being. As a child and through young adulthood, my husband never had any problems that could be described as "ADHD" symptomatic. However, when he went through Army Ranger school and did two tours in Iraq (special ops), he came back a changed person...he was taught to always scan the environment, react quickly, and always keep moving. He was also trained to go long periods of time without sleep, and as an end result can easily work 24 hour shifts. There is not doubt in my mind that my husband responds to stress as a soldier would. We are looking at possible use of stimulants to channel this extremely limiting behavior(s) he acquired into something useful. My doctor treats sees this in other similar patients and would love to do more research but is limited by time and money. Everyone can relate with that!<br /><br />So to my point, I fully believe in the genetic component that leads to various mental health issues. I deal with it every day. However, I also believe that malleable young minds can be molded, and ultimately the brain chemistry can adapt to a more functional and adventitious level and hopefully limit the chances of criminal behavior.<br /><br />Check out the Boystown Social Skill Model, if you want to try behavior modification. Just reminder, like any other regimen, you have to be consistent.<br /><br />Thanks! Jackiehttps://www.blogger.com/profile/13269680216564604438noreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-49731708292052223622012-12-08T13:34:43.219-05:002012-12-08T13:34:43.219-05:00i guy i went to school with is a famous neurosurge...i guy i went to school with is a famous neurosurgeon. his dad told me he is the poster boy for ADHD. but he always did well in school- so that seems contradictory. v/vmaryhttps://www.blogger.com/profile/06862544306715636777noreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-85463087635142228292012-12-06T20:46:27.573-05:002012-12-06T20:46:27.573-05:00WonderBread will create other problems. You might ...WonderBread will create other problems. You might be able to fix zinc (it's not for sure, since wheat blocks the absorption of nutrients that itself and other foods contain), but leaky gut will start happening, which creates worse things than ADHD.<br /><br />Besides, Wonderbread only has 10% of zinc per slice.<br /><br />If you want zinc, you go and buy (or fish) the right food: oysters and mussels. That's where zinc is at. If you have shellfish once or twice a week, that's all you need. A portion of oysters has 800% of zinc, not that measly 7-10% that Wonderbread has.<br /><br />This reminds me of all these people who say that for potassium, you just "eat a banana". Little do they know that bananas have only 10% RDA potassium. If you need to supplement hard with it, you either go for potassium salt (supplementation pills are useless for potassium), OR, you eat beetroot *greens* that have 60% of the RDA in their leaves. But no one talks about beetroot greens somehow...<br /><br />Anyways, of course, if you're living in the middle of Africa, you might not be able to find shellfish. In that case, you will have to supplement. A bottle of 333% RDA Zinc shouldn't cost more than a few Wonderbreads, and if there's some rudimentary health system, it could be prescribed for cheap.Eugenia Lolihttps://www.blogger.com/profile/03841412747426733061noreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-80054492548812651532012-12-06T00:27:27.874-05:002012-12-06T00:27:27.874-05:00Maybe really it's not the iron but the zinc, f...Maybe really it's not the iron but the zinc, for which there is no test.<br /><br />A study done in Africa (which was imo totally unethical) determined that zinc supplementation either directly or via beef jerky improved behaviour and school performance compared to children who received a placebo. Teachers were not informed as to which child received what. However, after it was determined that zinc is a positive, the researchers went home and the children returned to their previous zinc deficient state. That is unethical.<br /><br />Childrens' diets these days are quite pathetic. <br /><br />I'm beginning to consider recommending 4 slices of high fibre Wonder Bread per day. It may not be 'chichifoofoo' but for poor people living on the edge, a product like WonderBread will provide them with almost all vitamins and minerals Gabriella Kadarhttps://www.blogger.com/profile/18294468426599703416noreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-70552964543335581802012-12-06T00:13:42.896-05:002012-12-06T00:13:42.896-05:00I would like to see an ADHD cohort having 3D CT ai...I would like to see an ADHD cohort having 3D CT airway studies done. What percentage of individuals diagnosed with ADHD have severe restrictions in airway due to poor development of facial structures or enlargement of tonsils/adenoids or all of the above. <br /><br />My adult patients with ADHD have severe sleep apnea with O2 sats down in the low 80s. The ones with ADD have high hypopnea scores with O2 sat scores down to 86% but usually in the low 90s.<br /><br />The brain needs oxygen. The prefrontal cortex is the most sensitive part of the brain to low oxygen sats. <br /><br />Gabriella Kadarhttps://www.blogger.com/profile/18294468426599703416noreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-73682686542764380702012-12-04T18:24:38.099-05:002012-12-04T18:24:38.099-05:00I think that ADHD is largely a disease of undetect...I think that ADHD is largely a disease of undetected iron deficiency.<br /><br />My own experience with iron has caused me to completely reevaluate how iron status is evaluated. I am no longer convinced that ferritin is a reliable indicator, and I think the risk of iron overload is overstated. There's some evidence that ferritin levels increase naturally with age, and this may not have anything to do with inflammation at all: http://ajcn.nutrition.org/content/78/6/1225<br /><br />(And honestly -- where is the evidence from basic research that ferritin can be correlated with iron status as measured by bone marrow staining? I haven't been able to find it. Bone marrow aspiration is a nasty business; good luck trying to find healthy patients for a study!)<br /><br />I have family members who are schoolteachers and have ADHD kids in their classes; so far, they've managed to convince a few of the parents to get their children's iron levels checked, and every one has come back deficient, even by the arguably soft criteria we currently use. As this is not a routine test in children, I suspect that many more of the kids are low in iron. This shouldn't be surprising when you consider the amount of dairy the average child is hammering back: fruit yogurt and chocolate milk is the stable of the school lunchbox.<br /><br />Mary Pickett gave a great talk last year on the idea of functional iron deficiency in the brain: http://www.ohsu.edu/edcomm/flash/flash_player.php?params=2%60/hosp/ohsuclin/gr100510.flv%60vod&width=640&height=480&title=Restless%20Legs,%20Tics,%20%20and%20ADHD:%20Iron%20Deficiency%20to%20Blame<br /><br />It is against this background that the Canadian Infant Feeding Joint Working Group is revising its guidelines, specifically recommending that first complementary foods be iron-rich: "Infants should be offered iron containing foods two or more times each day. They should be served meat, fish, poultry, or meat alternatives daily. The amount of food offered should be guided by the infant's hunger and satiety cues (PAHO, 2003)." http://www.hc-sc.gc.ca/fn-an/nutrition/infant-nourisson/recom/index-eng.php#a7<br /><br />Pureed meat! Yum!Stephenhttps://www.blogger.com/profile/16662052761273530795noreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-28117657303781767582012-12-03T17:29:38.184-05:002012-12-03T17:29:38.184-05:00Do you know Bruce Wexler from Yale School of Medic...Do you know Bruce Wexler from Yale School of Medicine? He's getting some pretty exciting results using computer games combined with physical exercises. Kinda neat stuff. Danhttps://www.blogger.com/profile/11969254346376018459noreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-49641928034630102842012-12-03T09:32:01.657-05:002012-12-03T09:32:01.657-05:00Speaking first hand from experience to-date for ou...Speaking first hand from experience to-date for our son (diagnosed at age 5 ADHD; age ten diagnosed with mild Asperger's), I can definitely say that stimulants have been key to his treatment plan. I also firmly believe (again based upon first hand knowledge) that these individuals (and their caregivers) need to seek a multifaceted treatment approach. Stimulants definitely helped our son successfully navigate elementary and now middle-school. But we keep an extensive support team and work very hard at teaching our son (and the school district) how to use his skills and strengths.<br /><br />Those affected with ADHD will need to live their own lives in an independent manner at some point. Given the deficits ADHD individuals experience in executive functioning, organizational skills, possible social skills weakness, etc... - this can be daunting. However, these skills can be practiced. We have found that in conjunction with stimulants, the effectiveness related to generalization of these skills increases. What is fascinating is his own desire to continue pursuing knowledge for these skills. He gets the fact that his brain works differently but knows that there are avenues for him to learn how he can overcome the bumps in the day-to-day life that seem more frequent for ADHD individuals.<br /><br /> <br /> Jimmy Geehttps://www.blogger.com/profile/16779443092901038058noreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-20506323855255017862012-12-01T22:59:38.194-05:002012-12-01T22:59:38.194-05:00I started having ADD (the not-focusing part, not t...I started having ADD (the not-focusing part, not the hyper-activity one) at the age of 12. That was the time that my family moved from our mountain village in Greece to a small town nearby. In the village, we had our own chickens and eggs (have you ever had 3-4-year old hen? so delicious compared to the 3-6-month old chickens we can buy these days), and our extended family would give us goat meat whenever they would kill one in their herd. But most importantly, we had our own garden, with our own vegetables. And we would have our own bread, lacto-fermented for many hours before we baked it in our fireplace.<br /><br />And then, we moved to the small nearby town. Nutritionally, everything changed. We lost our garden, our chickens and organic eggs, and our fermented bread. We were buying everything ready-made, from the grocery store, and we started eating more pasta, since we were very poor.<br /><br />That's when my troubles started: I could not focus anymore as well as I could in primary school. I was a stellar student before, and I continued being a good student in middle school, but every year was becoming harder for me. Things turned really bad when I got to high-school. My grades fell to the floor, and no one understood why (especially my older teachers, who had seen a lot of potential in me). I just couldn't focus to study.<br /><br />Scratch that.<br /><br />I just couldn't read, period. Given that I was the intellectual in the family, this just didn't make any sense. I would try to read, and after 5 seconds my mind would wander away! I just couldn't keep it in place. I made it through high-school only because I was smart and had high critical thought, not because I studied.<br /><br />At the age of 16, my hair started falling out too. And things went completely to hell when I moved to the US 13 years later, since the wheat here is different than in Europe, more difficult to digest. I spent 10 years here in the US being extremely sick with various ailments, and I didn't know what was wrong. Every time I would go to Europe to see my family, my symptoms would subside a little, but I couldn't figure out that it was primarily the wheat to blame.<br /><br />In September 2011, I found Paleo. And it has changed my life. Not only almost all of my health problems have lifted, but so has ADD. I'm right now 39 years old, and in the last year I've read 5 books. While this might not be too many books for some book lovers out there, consider that my last out-of-school book-reading happened was when I was 13 years old!<br /><br />As far as I'm concerned, I don't have ADD anymore. I do Paleo and occasionally Paleo-ketogenic (up to 50gr net carbs on average), plus home-made goat kefir (fermented for 24 hours to remove most lactose, and goat/sheep/buffalo casein is gentler than that of modern cows', so there are no problems with it Paleo-wise). I found goat kefir to be a savior for me.<br /><br />Sometimes I get really sad though about all the missed opportunities in my life, just because I couldn't study anymore. In Greece you had to pass exams to get to the university (there were no private colleges at the time), so if you didn't make it in, you would be a low worker for the rest of your life. I eventually made it to the FIRST round of private colleges that appeared in Greece in the early '90s. I still couldn't study hard for it, but I made it through because I had real passion for computers, so I could figure things out myself, rather than through studying.<br /><br />To make the long story short: my life would have been completely different if my family didn't move to a "civilized" town when I was a kid. My ADD started when we moved there and our diet shifted from village-diet to modern diet.Eugenia Lolihttps://www.blogger.com/profile/03841412747426733061noreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-30375057653554660962012-12-01T10:30:19.481-05:002012-12-01T10:30:19.481-05:00My kindergardener gets 2 recesses a day, and 3 on ...My kindergardener gets 2 recesses a day, and 3 on the day she has to stay late while I am teaching. In all honesty, if she got maybe 90 minutes of "class" and the rest was running around, napping, or free play/coloring/crafting, I would be very pleased with her education. <br /><br />The ADHD advantage is very interesting, with respect to hyperfocus. Doctors with ADHD will tend to gravitate toward surgery, for example. I can see how this highly inherited "condition" has been maintained in the population at a fairly high level (5-10%). Our world is so distracting and overwhelming in some ways.Anonymoushttps://www.blogger.com/profile/04429177284200775781noreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-87197838174691431172012-12-01T10:25:20.071-05:002012-12-01T10:25:20.071-05:00Lake reviewed the Barkley study in the article I l...Lake reviewed the Barkley study in the article I linked. You are reminding me of a neuropsychiatrist who gave us a lecture in residency. He was a dementia specialist, and told us to always focus on the executive function. Simple checklist measures of executive function in mild disease for the most part was a far better metric of disability than neuropsych testing of apraxia or even menory problems. I think the same would be true of ADHD. In my clinic, I look for a lifelong consistency of the problem and family history as clues… typically my patients are presenting with anxiety or depression symptoms which are often secondary to the ADHD, so it can be a little tricky. Thanks for the link!Anonymoushttps://www.blogger.com/profile/04429177284200775781noreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-75190996659121041442012-12-01T08:29:26.153-05:002012-12-01T08:29:26.153-05:00Very nice summary of a complicated issue. It woul...Very nice summary of a complicated issue. It would be interesting to go back 50 years to see what label psychiatrists and teachers were giving to ADHD kids. If it's really one in 10 US children, maybe it's not a "disease," but a subset of normal human behavior that doesn't fit in with the modern world very well.<br /><br />-SteveSteve Parker, M.D.https://www.blogger.com/profile/00981614468565811839noreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-26617830608002328172012-12-01T00:20:15.219-05:002012-12-01T00:20:15.219-05:00I am currently reading a fascinating book on Execu...I am currently reading a fascinating book on Executive Function by ADHD expert Russell Barkley. His is trained as a neuropsychologist and debunks the idea that neuropsychological tests are the goal standard for assessing frontal lobe function. He prefers checkslists of social behaviors and cognitive problems. He makes a very sound case for it. He also talks about the neurodevelopmental basis for the disorder and there is an accumulating data base on that side of the story. Barkley uses an extended phenotype model of executive function and concludes that the commonest deficiencies seen in ADHD can be best accounted for using that model. <br /><br />At a recent seminar that I attended - his review of omega-3/6 FFAs were "mixed". Effect sizes were small to moderate (0.25-0.56)and a Cochrane meta-analysis apparently concluded no effects noted on parent or teacher ratings. Additional refs below:<br /><br />http://www.ncbi.nlm.nih.gov/sites/myncbi/collections/public/1bKYFbuqr01nbYE_XTH1oU/George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-72111766284335233752012-11-30T23:24:30.035-05:002012-11-30T23:24:30.035-05:00The great irony is, in Sweden, taking stimulants i...The great irony is, in Sweden, taking stimulants is otherwise harshly punishable by law. [1]<br /><br />"Criminal convictions in Sweden" is a very weak metric of actual criminal activity.<br /><br />[1] http://www.parl.gc.ca/Content/SEN/Committee/371/ille/library/gerald-e.htm<br />strakehttps://www.blogger.com/profile/15253066549264629665noreply@blogger.com