More ADD & ADHD Questions

Here are some more questions that I’ve received.

Hi Dr. Eckman,
I’m a college student in danger of failing all my classes. I can’t seem to keep focused in class and find that my mind wanders during lectures and concentration is a real problem. I’ve always had these problems since grade school but somehow managed to get decent grades. One counselor at school suggested that I talk to a specialist and find out if I have ADHD. Can you help me?

Hi BF,
Thanks for your question. Yours is quite typical of calls and e-mails that I receive from students wondering if the problems they are having with inattention, concentration, inability to focus, task completion and procrastination are related to ADD/ADHD. They like you are wondering how they were able to function in grade school to high school with adaptions but now that they are in college, those adaptions either don’t work as well or not at all. This makes sense given the extreme loads that college students are put under. This increase in load overwhelms the system that was designed and students become disillusioned and either drop classes or in some cases are put on probation. I would suggest that you take your counselors advice and find an ADD/ADHD specialist ASAP. If you are located in the greater Portland OR area, feel free to contact me at (503) 492-2200. Either way, good luck in your academic career.

Dear Mr. Eckman,
I’m 22 years old and use to take Ritalin when I was younger. It was very helpful but when my parents divorced, my new step father didn’t allow me to take medication claiming that it wasn’t necessary. My grades went down and my problems in school returned so eventually I dropped out of high school. I completed my GED and now started college but am having the same problems. Should I think about taking Ritalin again or is there something else that would help?
Please don’t use my real name if you answer this question.

Hi Anonymous,
I wish I had a nickel for all the times I heard a story like yours. Some parents and step-parents feel that any mental health medication is either unnecessary or a ploy of the pharmaceutical companies to get rich. Unfortunately, well meaning parents with that belief might end up causing their children problems academically, socially, emotionally and in some cases legally. While ADHD medication is not warranted in all cases, it has been shown to be effective in 70-80% of patients and given that you found benefit in the past, may be helpful now. Of course I would suggest you find an ADD/ADHD specialist to go through all your options including medication, therapy, coaching and life style changes. Whatever you decide, I would suggest you do it soon, as you might find that waiting only exacerbates the problem.

Please keep your questions, comments, and suggestions coming. If you or someone you know might have ADD or ADHD and lives in the greater Portland Oregon (OR.) area, have them contact me at (503) 492-2200 to discuss their needs.

ADHD & ADD Questions

I’ve received a number of positive responses to this ADHD blog and suggestions for future postings. Here are a few questions that prospective patients wrote in:

1) My doctor thinks I have ADHD and suggested that I see a psychiatrist. My friend has ADHD and is recommending that I see a psychiatric nurse practitioner instead. What’s the difference between the two?

Both psychiatrists and psychiatric mental health nurse practitioners can assess, diagnose, give treatment and prescribe medication for ADD and ADHD in Portland OR. The key might be to find a practitioner that specializes in ADD and ADHD which may be difficult in Portland as some have closed their practice, are not taking new patients, do not accept insurance, or are several months out in scheduling. Some of my patients have indicated that they prefer psych nurse practitioners over psychiatrists because of the more holistic approaches to patient care, but that is very much an individual choice.

2) I’ve heard some people call it ADD while others call it ADHD. Which one is more accurate?

For many years there was both ADD (attention deficit disorder) and ADHD (attention deficit hyperactive disorder). As the names indicate the difference between those two is the hyperactive component. Now, we simply have one diagnosis with many sub-headings and the old ADD is now referred to as ADHD-predominantly inattentive type. In the near future there will be another change in the DSM (diagnostic and statistical manual) to make those distinctions between the different forms of ADHD/ADD more understandable.

3) I read an article in the local paper where some college student indicated that stimulants were over prescribed, that he could get them easily on campus, and that some doctors were giving them out like candy. Is this true?

While I couldn’t speak to that student, nor to his specific college, stimulants are classified by the DEA (drug enforcement agency) as a Schedule-II narcotic and subject to intense scrutiny and monitoring. The dispensing of these medications illegally is a felony as is selling or possessing them without a prescription. The DEA takes this very seriously and penalties for the prescriber could range from losing ones’ license to practice, being sued, and for both the practitioner and student having to pay large fines or even imprisonment. This is why I get many referrals from local Portland Oregon area primary care physicians and other health care practitioners about their patients who may have ADHD because they might not have a specialization in this area. I do not know of any doctors, psychiatrists, or psychiatric nurse practitioners that are dispensing stimulants in a cavalier fashion.

Thanks for your questions. I welcome your thoughts, comments or suggestions. If you or someone you know can relate to any of this information, please consult with an ADHD specialist for assessment, diagnosis and treatment.

Adult ADHD

I’m often asked by prospective patients “I think I might have ADHD, but have been told that there is no such things as adult ADHD, does it really exist?” The answer is unequivocally, yes. It is unfortunate that some perhaps well meaning people continue to assert that ADHD is non-existent, that it is really related to some anxiety or trauma that you might have experienced in your past and that mantra continues for adults too. Now there are even some insurance companies that will only cover ADHD medication for those under 18 as if the symptoms magically disappear once you turn 18.

What studies are showing is that for many children who have ADHD, the hyperactive part, for reasons unknown at this juncture, seems to fade while the inattentive part continues. This is not true in all cases but true for many. Adults who might have somehow managed to avoid being diagnosed in childhood, now find the increased responsibilities, whether they be personal, academic, or professional, overwhelming and seek my assistance. Some adults may have ADHD symptoms that include: poor organization, difficulties concentrating, procrastination, problems initiating and completing tasks, forgetfulness, chronic lateness, difficulties prioritizing responsibilities, troubles organizing thoughts, making decisions impulsively, poor self motivation, problems with comprehension, easily frustrated, and easily bored. These are just some of the symptoms that I see, but certainly not a comprehensive list. What patients report is having these symptoms undiagnosed can lead one to feel depressed, anxious, have low self esteem, be told they are “stupid, lazy and clumsy”. Some resort to using caffeine and other energy drinks as a means to deal with these problems but it oftentimes makes them worse. If you or someone you know can relate to this posting, I invite you to seek professional assistance.

As always, I invite your comments, questions, and suggestions for other topics.

What does it feel like to have undiagnosed ADD or ADHD?

Too often, those who don’t have ADD or ADHD, may have no real clues what it is like to have that diagnosis. Patients remind me of what it feels like to grow up knowing that there is something wrong with them but they hear comments from parents, teachers, family members and friends that all they have to do is “try harder”. They are told that they are lazy, stupid, or “not working up to your potential”.

Many patients with ADD or ADHD, are not stupid, nor lazy. They speak poignantly about the pain and suffering of working as hard as they could and still not accomplishing their goals which leads to an overwhelming sense of dejection.

Once they make a decision to seek professional help, this oftentimes changes. One patient told me this week after starting medication, “now I don’t go into things expecting to fail”. How powerful a statement. Imagine going into tasks with a pervasive sense of doom knowing that you are not ignorant, yet not being able to perform to the best of your ability? Perhaps it would be like entering a clapping contest with one hand tied behind your back, or running in the Indy 500 with a 4 cylinder engine while most of the other cars had 8 cylinders.

What is key here is for those who are in relationship with someone that may have ADD or ADHD, to have patience, awareness, understanding and compassion for their friends, family and or loved ones that may have this diagnosis. If they have not sought treatment, have a conversation with them and encourage them to contact someone who understands what that might feel like.
As always, I welcome your questions, comments, and feedback.

ADHD & Hitting the Wall

Marathon runners run a total of 26.2 miles in a race. For many, when they come to the 18-22 mile marker, there is a feeling of hitting a wall, where the racers feel sluggish, find each step more and more difficult and self doubts begin to creep in about their ability to perform.

So it is with many patients who suffer with undiagnosed ADHD. Patients have reported knowing very early on in life that they were different from their peers but many develop a system to deal with their inadequacies. This system may work with varying degrees of success until additional loads are added. This could be academically such as moving from elementary to middle school, middle to high school, high school to college, college to graduate school etc. Perhaps the additional loads are employment related such as getting a new job, or a promotion or self employment. For some the additional load is personal such as getting married, or having a new baby. Wherever the addition load comes from, it overwhelms the system that undiagnosed ADHD patients suffer with, and they begin to seek outside assistance. This assistance could be medication, counseling, coaching, therapy, other modalities, or a combination of these.

If any of this relates to you, a colleague, a friend or a loved one, I encourage you to contact me to discuss your options at (503)492-2200. As always I welcome your thoughts, comments or questions.

ADHD Success Stories

I have been honored over the years to work with hundreds of patients who had ADHD symptoms. Many knew that they weren’t like the other kids in the class as children, or like the other colleagues at work or students in college. They had problems with concentration, focus, organization, completing tasks, procrastination, losing or misplacing things, were easily distracted etc. Some went online and read about the bias against medication and tried all the other strategies to combat their symptoms. They used herbs, Chinese medications, naturopathic medication, increased exercise, yoga, biofeedback, fish oil and other modalities and found while some were more helpful than others, they still had the same problems. In desperation, they came to me and we discussed their options. Some tried medication and found it to be miraculous in the changes they were able to make. One patient this past week indicated “now I know that I am not stupid or lazy”, another marveled at how well they were able to stay on task and complete things that had piled up for years saying “I accomplished more in three weeks than I had in three years before”. They describe stories of spouses, partners, co-workers, friends, classmates, and teachers noticing huge differences and wondering what had changed. Of course medication may not be best for each and every person, but if you can relate to any of the above mentioned symptoms, I encourage you to contact me and discuss your situation. I welcome your comments and questions about ADHD.