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ADHD medication

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People often ask me if neurofeedback is an effective treatment for ADHD. Given that the expert consensus is “maybe” or “sometimes,” I try to answer along those lines, pointing out that many factors should be considered. For example:

  • How quickly do you need results (is a child about to fail a grade or an adult about to lose a job or relationship)?
  • How plentiful are your resources (if you try neurofeedback and it doesn’t work, is there money left in the budget for traditional treatment)?
  • What are the credentials and reputation of the clinician providing the neurofeedback?

Some people assume that neurofeedback is safer than medication, but the fact is that potential for its side effects has never been studied.

Thanks to David Rabiner,  Associate Research Professor at Duke University’s Department of Psychology  Neuroscience, I can share with you (below) a sophisticated analysis of the research.  Dr. Rabiner has long performed the excellent service of parsing the research around ADHD in his newsletter, Attention Research Update. You can subscribe to his free newsletter here, and read through the substantial archives once you are subscribed

As a layperson, I appreciate his clear writing style, but research terminology can be complex and this analysis might be “too much information” for some of us. Please consider that clear-cut answers aren’t always easy to give on complex subjects.

The bottom line, as Dr. Rabiner writes below:

“The research reviewed here indicates that if parents obtain high quality neurofeedback treatment for their child there is a reasonable basis for expecting that benefits will occur. The decision to do so should be made with the knowledge that medication treatment and behavioral therapy would be regarded as having stronger research support at this time.” Read the rest of this entry »

A quick note to share with you this important article on Vitamin B12 in The New York Times.

I lived for many decades not knowing I had borderline pernicious anemia. Finally, a smart physician directed me to supplement B12 with injections. So every week (or when I remember), I stab myself with the required ccs of the red stuff.

But you needn’t have such an obvious condition to question if your B12 stores are all they should be, especially if you eat a mostly vegetarian diet, you take an antacid, or your meals are haphazard.

Other signs of B12 deficiency include muscle weakness,  fatigue, shakiness, unsteady gait, incontinence, low blood pressure, depression and other mood disorders, and cognitive problems like poor memory. Remember that the nervous system (including brain cells) relies on an adequate supply of key vitamins and minerals. Moreover, some medications will increase your need for these nutrients. Read the rest of this entry »

A quick note to let you know that my book, Is It You, Me, or Adult A.D.D.?, is available as a download from Amazon.com for Kindle devices and Kindle applications for iPads, iPhones, PCs, and so forth.  Just click on the book title above to go directly to the product page.

Please tell your friends in Germany, France, Spain, Italy, and the United Kingdom that the Kindle is available on Amazon.com in those countries. (This is the English version.)

Thank you for spreading the word.

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After advising caution regarding generic medications for ADHD here and here, I’m now hearing that Concerta is recently available in a generic form in the United States. (A generic has been available in Canada for some time, but it is a different type of generic.) The question: Does this generic perform as reliably as Concerta? Maybe. In fact, it might be the exact same medication.

Original Concerta, 54 mg

The details are hard to come by in a field swimming with lingo: co-licensed product, single-source generic, authorized generic, bioequivalent and clinically equivalent. My conversations with pharmacists and the manufacturer’s scientific liaison leave me thirsting for straight talk with no tricky qualifiers. Internet searches and first-person reports in online forums are made murky by the apparently marked difference between Canada’s generic Concerta and that in the U.S.. (Forum participants seldom specify where they live, presumably because most don’t realize there is a difference between the two countries’ generic versions of Concerta.)

The U.S. generic for Concerta is  methylphenidate hydrochloride extended-release tablets.  It is a co-licensed product by exclusive agreement — that is, a deal between the original manufacturer (Ortho-McNeil) and the pharmaceutical marketing arm of Watson Laboratories. Read the rest of this entry »

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We’ve all heard claims about fish oil “curing” ADHD, but what does the latest research show? Mixed results, at best, though further study is warranted.

Make no mistake:  The human brain needs essential fatty acids to function properly; so does the rest of the body. But the question is this: Does fish oil supplementation actually diminish ADHD symptoms?

Following the last post on diet and ADHD, David Rabiner, Ph.D., explains the latest research on ADHD and fish oil, below.  (To subscribe to his free newsletter, Attention Research Update, click here.) Reprinted here with Dr. Rabiner’s permission. Cartoon reproduced under paid license from Cartoon Stock.

New findings: Does fatty acid supplementation help children with ADHD

Although medication treatment benefits an estimated 70 to 90% of children with ADHD, effective alternative treatments are needed for several reasons. First, even for children who respond well to medication, difficulties that need to be addressed often remain. Second, some children experience side effects that preclude the ongoing use of meds. Finally, most studies of stimulant medication treatment are relatively short-term, and data showing that stimulant medication improves long-term outcomes remain scarce. Read the rest of this entry »

This morning, I had the pleasure of fielding some great questions from Totally.com community members in this webinar.  (Note; there are a couple of commercials during the hour-long session, but they are pretty short!)

Watch live streaming video from totallyadd at livestream.com

When I asked Australian writer Matthew Bush to contribute a guest column on his experiences with sleep and ADHD (below), I expected a well-written and engaging piece. What I didn’t expect was a happy ending, too, and perhaps a blueprint to help others.

ADHD’s potential challenges to sleep include the behavioral (putting off sleep because anything is more interesting than lying in the dark waiting for nothing to happen) and the physiological (Restless Legs Syndrome, Sleep Apnea, dysregulated circadian rhythm, etc.). Here is a post from my other blog on ADHD and sleep. Look to the latest issue of CHADD’s Attention Magazine for my article on the topic, a prelude to a short upcoming book: The ADHD Roller Coaster Guide to Sleep. Now to Matt’s guest column!

Sleep, Finally.

By Matthew Bush

I was the 11 year old ninja master.

I had to be awake for school in six hours.

The creaking kitchen floorboards raised the hair on the back of my neck. The house was dark. I could hear snoring.Good. Dad was a heavy sleeper and that meant mum had her earplugs in. Still, there was risk.

The adrenaline pacified me. I inhaled slowly, my pulse pounded through the swell of blood in my ears. I opened the cabinet door slowly and clicked the torch on. I was on a mission.

If I was successful, I’d take my bounty back to my room and quietly self-medicate with caffeine and carbohydrates. Then I’d curl up on my beanbag and read.

My official bedtime was 8:30. I was allowed to read for half an hour, then my dad would tell me to go to sleep. I rarely did. Eventually, my lamp and torch batteries got confiscated. That just added another objective to my mission dossier. Read the rest of this entry »

Having ADHD in the 21st Century means we enjoy a burgeoning body of knowledge as well as myriad media from which to access it. From books to blogs, videos to podcasts, there’s something for every learning style. Perhaps no one has made information available through more media types than Dr. Charles Parker. Here are some of my top picks from Dr. Parker’s YouTube Channel, with captions below each.

Summary: Why do so many people with ADHD experience problems with medication? One reason is not establishing targets before treating them. But there’s more to it….

ADHD Subset #1: “Acting Without Thinking” Many people think that impulsivity/hyperactivity is the only ADHD diagnosis and if the person is suffering from that, that’s a clear indication for medication. But impulsivity/hyperactivity represents only about 20% of the presenting issues. Moreover, it’s important to recognize that ADHD is a contextual challenge. When structure is good and variables are predictable, performance is better than when structure is poor and variables are unpredictable (think a structured workplace vs. home — just one of the reasons some people with ADHD become workaholics). In other words, just because you can focus on a video game doesn’t mean you don’t have ADHD.

ADHD Subset #2: “Thinking without Acting” : This can look like OCD if you don’t know what’s underlying this outer appearance. This is cognitive anxiety, not affective anxiety (thinking anxiety vs. feeling anxiety). You might not “feel” anxious but you might be overwhelmed with thinking. (This is often misdiagnosed as bi-polar disorder.) These folks might abhor therapy because they’re asked to think even more. (No more questions! I don’t need more to think about; my head is already about to explode!)

ADHD Subset #3: “I’m not going to think; I’m not going to act; please go away.”
Key concepts: Avoidance of self, avoidance of close relationships, avoidance of people in general (Looks like “social anxiety disorder” but the core issues are inattention and distractibility), avoidance of projects (too many unpredictable variables and lack of structure)

Gina’s interview with HealthyPlace TV on the pitfalls of medical treatment for ADHD

When I first started advocating for and volunteering in the ADHD community 10 years ago, the overriding goal was creating awareness that Adult ADHD exists. I figured that the next step for many of those newly diagnosed—that is, exploring medication strategies with an informed physician—would be relatively easy.  Ha!

There is good reason that my book, Is It You, Me, or  Adult A.D.D.?.  includes three chapters on medication, including an entire chapter on the medication protocol offered by a top ADHD expert, Margaret Weiss, MD, PhD. Because, in listening to thousands of first-person stories, I so rarely encountered evidence that most physicians treating ADHD followed such a protocol. Or any protocol at all!

That’s why a chief goal in writing my book was creating a grass-roots movement to improve treatment standards.  (It’s also why the book is offered in PDF form, so that readers can easily print out key pages for mental healthcare providers.  The same for the details on evidence-based therapy strategies for ADHD. My book explained the details about  CBT for ADHD long before you read all the headlines.)

A few weeks ago, I wrote this comment on a blog written by a man with ADHD:

You’re right, Douglas. Not everyone with ADHD needs medication. It’s a personal choice.

But when that choice is based on bad experiences with reckless physicians or a tendency to latch onto negative information (a not-uncommon tendency with ADHD), is it really a choice? I don’t think so.

I’ve been an unpaid advocate in the area of ADHD for 10 years not because I have any ties with Big Pharma (or even any stock). I do it because solid information makes a huge difference in individuals’ lives. It is appalling how often people with ADHD get substandard medical care — and don’t even know it. …

The producers at HealthyPlace read my comment and asked for an interview with me on this topic.  Here is the video. I hope you find it helpful!

When I talk about “optimizing medication” in my presentations on Adult ADHD, some faces in the audience look puzzled. That’s not surprising, given the stories I’ve heard for years of careless prescribing patterns that result not only in unnecesary side effects but also sub-sub-optimal positive effects.   Often, I’d vent my frustration via e-mail to Dr. Charles Parker.

Now, I can’t take credit for Dr. Parker deciding to produce a long-awaited comprehensive guide, ADHD Medication Rules: The Meds For Paying Attention, but no one is more thrilled than I am to have this as a resource.  (It’s an e-book, complete with hyperlinks and search function. Very handy!)  Readers of his Corepsychblog have long appreciated his breadth and depth of knowledge (in posts as well as video and audio and podcasts), and now they can benefit from his comprehensive strategy for the medical treatment of ADHD. Read the rest of this entry »

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