Gifted Issues Discussion homepage Forums Twice Exceptional Pearson presentation TODAY: outing ADHD fakers

That's a MUCH better system.

Dee Dee's post is just so heartbreaking. No child should be made to feel "bad" like that.

I think it is so sad that whatever the choice a parent makes for their child with ADD(usually the dichotomy of drug or not drug) that so many others think it is their responsibility to share their own opinions despite the fact that your child is under the care of professionals with whom you are working to make informed appropriate treatment decisions.

It amazes me how so many can have so little information and such strong opinions that their belief is the only truth about ADD. I think it's one of those challenges that comes with so much baggage.... Beyond the medical debates, there are those who believe ADD is just poor parenting and that there is no disorder--just unruly child and indulgent parent(s). Parents of these children really need support and kindness. An ADD child is one of the most challenging children to parent well and most parents are...just...so...tired! The last thing those who live it need is yet another hurdle to getting help.


Irena, you would likely find Dr. Amen's Six Types of ADD book incredibly helpful and may be something you could share with family. It was life changing for us. I sent a copy to my inlaws and some undiagnosed in the family found themselves in this book realizing for the first time why they had challenges they had never understood.

Addiction is rampant with ADD and much destruction stems from that. Many use drugs, alcohol, or even addictive behaviors to self-medicate trying to just feel "normal". Others had used more healthful activities to manage their brains such as running or other intense exercise.

Interestingly enough, my husband was the last to recognize his own ADD (his family and I came to those conclusion much sooner) and it as well as how he had dealt with it are primary factors in our marriage issues.

Another terrific book we have read is ADD in Relationships also by Dr. Amen. My favorite title was Is It You, Is It Me or Adult ADD?...still make me giggle a bit.

Howler - I'm curious, were the changes you were speaking about in regards to stimulant medication only? Would you expect to/have you seen the same changes when dealing with non-stimulant ADHD medication?

We give DS9 Intuniv and it's been completely, 100% amazing for him. It seems to have a bit of an anti-anxiety effect as well as helping him control his impulses. But I know it's not a med that's been given to children for ADHD for an extended period of time, so I do wonder about the long-term effects on his brain. (In my son's case, not medication is 100% not an option. He'd have been institutionalized or harmed himself by now.)

Yes, I believe this happened with my twin. It is what really worries with regard to DS - seems like medication carries a big risk of addiction and non-medication in a case a true ADHD does as well. And I can't seem to get to a place where I am confident that he does indeed have it.


I will check this book out- Thanks!

epoh, in terms of medications in this class (meaning what they are prescribed for, mind) all of the selective reuptake inhibitors are pretty much the same from a mechanistic standpoint. They may differ in terms of transporter/receptor selectivity and off-rate, downstream metabolites, etc. But fundamentally, the mechanism is the same.

Each works to increase concentrations of post-synaptic biogenic amine neurotransmitter(s) in the midbrain, via blockade of transport of that transmitter substance, (or, in the one mechanistic exception, to prevent its metabolism as in MAOI's); it's functionally operating via the same mechanism as the rest if it sits in a site that would be occupied by the neurotransmitter and locks up the active site.

It's worth noting, as well, that chronic (or just repeated) usage of anything in this class readily leads to habituation in a regulatory sense-- the system is remarkably well-protected from manipulation, having multiple feedback loops that result in up-regulation when you block transport. The upshot is that "rests" from medication may result in potentiated symptoms-- because of the system's determination to circumvent the pharmacology you've been applying.

This includes Adderall, Ritalin, SSRI's like Prozac, Xanax, as well as drugs like cocaine (which is horrifying in terms of being non-selective, btw). Withdrawal from ANY of those drugs is known to be a nightmare filled with anhedonia-- it makes addiction treatment incredibly refractory, because every additional use is not only "reinforcement" through the pleasure/reward pathway, but also because the withdrawal produces a LESS pleasurable baseline than in an untreated brain.

Are those drugs all "stimulants?" Well, clinicians judge "stimulant" on common responses to the drugs. Pharmacologists and neuroscientists don't classify things that way. Some of those drugs have known cardiac liability, of course-- but that is because they are pharmacologically "dirty" and act at cardiac receptors the way some biogenic amines do. Consider the structure activity relationships involved in a transporter/receptor that responds to dopamine or seratonin (5-HT), and then look at epinephrine (adrenaline). ALL of these drugs are, mechanistically speaking, analogs of one or more of those amines, in some way shape or form. Those which act elsewhere in the CNS as adrenomimetics are "stimulants." Caffeine is the one that most people are familiar with, but first generation AD(H)D drugs are generally this sort, as well. Those that act that way ONLY in the midbrain are considered "non-stimulant" drugs, or second gen therapeutics.


In terms of addiction potential-- there really is a genetic component to one's personal risk there. I have no idea how that overlays with AD(H)D, but drugs which act in this particular pathway in the brain? Yeah-- there is a range, of course, but generally speaking, some relatively small percentage of primates will NEVER become "addicted" and some also small percentage are addicts from the first use. In between fall the majority, which require from 3-25 uses to become permanently altered. It's an epigenetic effect, in other words, when you're talking about stimulant addiction potential. Methamphetamine is one of the most well-known drugs in this respect, though I'm more familiar with the literature re: cocaine, which was mostly produced two decades (or more) ago. Some people can use casually with impunity (but there are very few of them)-- and most people can NOT do that. That is a bit outside my area of expertise-- my recollection is that behavioral researchers were pretty busy trying to tease apart markers for which group an animal test subject belonged with, back in the early 90's (at least with amphetamine and cocaine, which were that era's "study drugs" of choice).

Howler - Interesting. I was curious because Intuniv, in particular, is in a completely different class, from what I understand, than the drugs you listed. It was originally a blood pressure medicine, iirc. Wikipedia says it's a "selective α2A receptor agonist" which means pretty much nothing to me. I hated (and still hate) that I don't fully understand the two meds (Intuniv & Risperidone) that my son takes, and some of the side-effects and long-term effects are concerning... but on the flip side, without them he nearly landed in the psych ward, so.... I don't really feel I had a choice? The psychiatrist doesn't seem particularly concerned about the long-term effects, and the therapist is a big fan of Intuniv.. so I just keep going along for now.

Yeah-- that one IS a different class, but it's still ultimately tied into that biogenic amine system. The other thing worth noting is that the use of both is almost entirely empirical at this point-- there's little reason why it SHOULD work from a mechanistic standpoint, just that it seems to be a "lever" which can be used in therapeutic interventions. The up-side, of course, is that such levers may be few and far between, making these drugs MIRACLES for some individuals... and the down side, naturally, is that you don't really know what you're getting as a package deal with them down the road.

http://en.wikipedia.org/wiki/Alpha-2_adrenergic_receptor

This is also a relatively new use for that class-- the link is reasonably non-technical and accurate so far as I can tell.

More specifically--
http://en.wikipedia.org/wiki/Guanfacine

I'm assuming that you have VERY close monitoring, but in the event that you don't-- I would really encourage you to be alert for some of the signs of the drug's other activity (most concerning are the hypotensive features).

Risperidone is better-understood from a mechanistic standpoint (at least kind of -- the receptor function/blockade has been well studied anyway, but that sheds little light on WHY it works)

http://en.wikipedia.org/wiki/Risperidone

http://en.wikipedia.org/wiki/Atypical_antipsychotic

That one is a receptor blocker, so it doesn't impact signalling in the same was as many SSRI's and ADHD meds, which serve to increase post-synaptic neurotransmitter concentrations and duration of signalling. But it's the same dopaminergic system, at any rate. This is where all anti-anxiety, anti-depressant, AD(H)D and most stimulant drugs of abuse act. Just different facets of that system.

DD was on tenex for a few weeks, which I believe is a short acting version of intuniv. I was really hoping that something "non-stimulant" would work for her (thinking it would be safer). It turned her into a literal zombie--she was not the slightest bit hyperactive but seemed to have no affect at all and looked like she was going to drop dead. She had zero focus, so it didn't help that at all. Her teacher called me alarmed, saying that she had never seen a child act like that before.
It's weird (and scary) how one drug can work so well for one kid and be a disaster for another. I wish I understood it better.

Thank you. I make it a point to never judge or criticize parents who medicate their kids, because I believe that each situation is unique, but HK clearly you and I are on the same page about this.

My DS9, never medicated and diagnosed with "severe" combined type ADHD is making massive improvements. Interestingly, we're only one month into this current school year and he's like a different kid - why? New teacher. Her teaching style suits his learning style. It's that simple.

Blackcat you have my sympathies... (and this is what I mean when I say I don't judge those who use medication). Every kid is different.

While your DD hasn't improved, my DS9 HAS (although at your DD's age he still struggled). He's now 9 yrs 3 months, and he will sit and do his homework from start to finish without any assistance. I generally try and have the TV turned off during homework time, but if DH is watching something, then DS will go into his room and do it. When I check on him, he is quietly working (and not distracted by his toys the way he used to be, lol).

His written output has dramatically improved. He can now sit, formulate his thoughts, and put them on paper (paragraphs!). He can also move from one task to the next with no assistance from me (although his teacher still has to prompt him at school - he's not a self starter, but once prompted, will sit and work). At home, if he has three items for homework, he will finish one, then move onto the second, then the third. I'm still trying to figure out who this impostor is and where my real son went, lol.

He's never been medicated (but we have gone through some struggles, let me tell you.. and it has tested my patience and persistence to the extreme).

He still has issues, let me tell you. He has trouble keeping his chair still and his feet on the floor at school (although his teacher says he is very good natured about being redirected). Do I wish he'd sit still? Of course. Do I believe he will learn to? YES. He used to chew on EVERYTHING - destroying shirts, eating pencils, etc etc, and now that has stopped... completely. He has had all these disruptive ADHD behaviours that are disappearing one by one, sans meds.

HOWEVER... not all kids progress the way that he has.

I'm on the opposite side of the fence in that I've had to justify why I haven't medicated, and I'm constantly having to recount examples of his growth and development without it.

I've just stuck to my guns, supporting what I think is a good fit for my particular child, which is all any of us can do.