Tuesday, February 03, 2015

What Does ADHD Look Like in School?

What It Looks Like In School

*Excessive talking
*Off-task behaviors
*Distorted sense of time
*Disorganized or Perfectionistic
*Responds negatively to correction
*Often unprepared, loses materials
*Poor/conflicted peer relationships
*Disruptiveness, clowning, defiance
*Difficulty with Transitions/Changes.
*Physical restlessness or slow moving
*Careless mistakes, omissions, rushes
*Doesn’t seem to “get it” (cause-effect)
*Incomplete work, not finishing on time
*Misses and/or misinterpret social cues
*Poor recall, forgets, trouble memorizing
*Homework is missing; but it’s completed!
*Inconsistent performance (grades, behavior)
*Defiant and/or uncooperative, or overly submissive
*Relates better to older and younger children (not with peers!)

Academic Problems -
*Messy, stilted hand-writing
*Trouble copying from board
*Poor reading comprehension
*Difficulty reading; dislike of reading
*Written expression (getting it on paper)
*Difficulty with sequencing (auditory, visual)
*Math. concepts, word problems, times tables, algebra
*Poor grammar; sentence structure; punctuation; capitalization

But, often does well in PE, Art, Music, and/or Science

Not All symptoms need be present

Monday, November 24, 2014

5 trends driving global rates of ADHD

"5 trends driving global rates of ADHD"
Brandeis University
Peter Conrad and Meredith R. Bergey attribute ADHD’s growth to five trends:

1. Drug companies are effective lobbyists, and have spurred some countries to relax marketing restrictions on stimulants.
2. Psychoanalytic treatment with talk therapy is giving way to biological psychiatry—treating psychological problems with drugs.

3. More European and South American psychologists and psychiatrists are adopting the American-based Diagnostic and Statistical Manual (DSM) standards, which are broader and have a lower threshold for diagnosing ADHD.
4. Vocal ADHD advocacy groups work closely with drug companies to promote pharmaceutical treatment.

5. The easy availability of ADHD information and self-diagnosis online empowers consumers to ask for prescription treatment.

I approached this story with great interest.  But the more I read the more annoyed and disillusioned I became.  It is written by a sociology professor and a doctoral candidate at Brandeis University.  One of Professor Conrad's areas of academic emphasis is the "medicalization of society".  Another is the "sociology of ADHD."  Ms. Bergey appears to be primarily a medical researcher, most recently from the University of Pennsylvania, with no apparent background in ADHD.  These factors are important as they directly underlie the basic theme of their "study", i.e., the international medicalization of ADHD.  So that's their bias.
My bias stems from being a 40+ year veteran of direct clinical practice and study of ADHD.  From my viewpoint, Professor Conrad and Ms. Bergey are academicians whose "theories" clearly emanate from the "ivory tower" of education.  Not the "real" world.  There are several clues within their "5 trends" to their cloistered perception of the world of ADHD  -

1. Drug companies do have a significant influence but are not a primary driver of ADHD diagnosis or of medication usage.  Stimulant medications are not "bad" in and of themselves.  Their appropriate prescription, management and usage are the key problems.
2. "Psychoanalytic treatment" never, ever was considered an appropriate treatment for ADHD.  One form of "talk therapy" called Cognitive Behavioral Therapy (CBT) along with Family Therapy are evidence-based treatments for ADHD.  There is no mass-movement from these latter therapies to "biological-psychiatry."

3. The "broader" diagnostic guidelines in DSM-V ARE research and evidence-based.     
4. Stating that, "ADHD advocacy groups work closely with drug companies", tends to imply some collusion.  For the most part, ADHD advocacy groups maintain a primary allegiance to consumers  -  parents, families and ADHD adults.

5. The easy and increased availability of ADHD information and screening tools on the Internet are primarily positive public education mechanisms.  The action of consumers asking physicians for prescriptions is a doctor-practice-management issue.  Perhaps THE most significant factor in both excessive and inaccurate ADHD diagnosis is the FACT that over 90% of physicians who first see potential ADHD patients do NOT follow accepted guidelines for diagnosis or treatment.
Prof. Conrad and Ms. Bergey appear to be out to make-their-mark in the current realm of ADHD controversies.  Their contribution is of dubious value.

Sunday, October 19, 2014

A More Complete List of ADD and ADHD Symptoms

ADHD Symptoms:

1. Difficulty Waiting: Impatience (Rushes; waiting is frustrating)
2. Hyperactivity or Restlessness: In motion a lot (fidgeting; squirming)
3. Emotional Over Arousal: Anger, silliness (Over-reacts to many situations)
4. Stubbornness: Defiant, oppositional (Resists many things; wants own way)
5. Distractibility: Trouble sustaining concentration (Can’t stay focused; off-task)
6. Impulsivity: Behavioral and cognitive (Acts without thinking; mind always going)
7. Tactile Over Arousal: Skin sensitivities (“Touchy-feely”; bothered by touch; too rough)
8. Social Problems: Trouble with relationships (Offensive behaviors; argues; isolates self)
9. Disorganization: With time, things, thoughts, short-term memory (Poor time-sense; looses things; messy; overwhelmed, poor recall, confabulation)
 ADD Symptoms (without  hyperactivity):

*Distractibility: Off-task
*Trouble Focusing: Can’t get focused; drifts
*"Spacey", Daydreaming: Mind wanders, a lot
*Shyness: Loner; social anxiety (isolates; social avoidance)
*Emotional Sensitivity: Feelings easily hurt; compassionate
*Passive Non-Compliance: Avoidance (silent; absent; sullen)
*Cognitive Impulsivity: "Mind mess", wanders at “light speed"
Disorganization:  With time, things & thoughts
     *Poor recall (ST memory deficit)
     *Poor time sense (lose track of time)
     *Appear "Perfectionistic" (compulsive efforts to compensate)

Tuesday, July 29, 2014

What's it Really Like to have ADD/ADHD?

What's it Really Like to have ADD/ADHD?
OK, now I've read just one-too-many media stories about ADD/ADHD that simplistically say it's inattentiveness, hyperactivity and impulsivity.  OMG people!  It is much more than that!  No wonder ADD/ADHD has an image-problem and about one-third of the world thinks we're just a bunch of wimps and whiners.  Let's get real.  Here's what it is REALLY like ……
*Often mentally and/or emotionally overwhelmed
*"Body Clock" is out of sync (different sleep pattern)
*Exceedingly difficult to wait in many circumstances
*Frequently feel "not OK" mentally; feel “different”/"odd"
*Frequent “I don’t want to” sensation, and can’t explain it!
*Others frequently react - angry, avoid, annoyed, frustrated
*Mind "wander off", "tune-out", frequently and involuntarily
*Poor emotional control in frustrating or exciting situations
*Distorted sense of time, passage of time, and of the future
*Frequently lose, misplace or forget many day-to-day things
*Real fatigue in response to frustrating/distasteful situations
*The harder we try, the worse it gets (brain activity decreases)
*Sloppy and disorganized, or struggle intensely to be organized
*Great difficulty paying attention to uninteresting/difficult tasks
*Intense difficulty facing the consequences (self-consciousness)
*Often say/do things impulsively, automatically, without thinking
*Involuntary physical and/or mental restlessness: ongoing or off/on
*Average or above-average IQ + inconsistent symptoms = severely challenges others efforts at understanding ADHD
*Worst of all, many believe the ADHD person purposefully, willfully, and knowingly does the above things
*So, they believe the ADHD person makes a "choice" to do these things
*So, they treat the ADHD person accordingly!

(Note: Not All ADHD individuals have All these problems.  However, most ADHD people experience a majority of them.)

Saturday, May 03, 2014

No Evidence That Stimulant Medication for ADHD Influences Lifetime Risk of Substance Use or Dependence

Review: No Evidence That Stimulant Medication for ADHD Influences Lifetime Risk of Substance Use or Dependence

Alison Poulton

Evid Based Ment Health. 2014;17(1) 


Humphreys KL, Eng T, Lee SS. Stimulant medication and substance use outcomes: a meta-analysis. JAMA Psychiatry 2013; 70:740–9.


Does exposure to stimulant medication for attention deficit hyperactivity disorder (ADHD) have an effect on the lifetime risk of substance use or dependence?


Lifetime substance use or dependence (alcohol, cocaine, marijuana, nicotine and illicit non-specific drug). Method of assessing substance use/dependence is not reported for included studies.



Systematic review and meta-analysis.

Data Sources

PubMed search for key words related to ADHD and substance use, supplemented by a hand search of reference lists of relevant articles, listservs of research organisations and contact with authors who have published longitudinal studies of children with and without ADHD; study inclusion dates January 1980 to February 2012.

Study Selection and Analysis

Longitudinal studies in children with ADHD where pharmacological treatment preceded the measurement of substance use. ORs were calculated for the risk of substance use/dependence among children with ADHD treated with stimulant medication compared with those not treated. Results were pooled using a random-effects model, and heterogeneity was assessed using the Cochran Q test. Publication bias was assessed using the Egger and Begg tests. Additional analyses examined whether the association between stimulant treatment and substance use/dependence was moderated by demographic and methodological factors of: age at follow-up, sex, race, age at initial ADHD assessment, percentage of participants in the medicated group, study population source, diagnostic and statistical manual of mental disorders version used to diagnose ADHD, and length of follow-up.

Main Results

Fifteen longitudinal studies (n=2565) were included. Pharmacological treatment for ADHD, typically methylphenidate, did not influence the risk of later substance use or dependence. Pharmacological treatment did not influence the risk of alcohol use (OR 0.99, 95% CI 0.61 to 1.62, 4 studies), alcohol abuse/dependence (OR 0.80, 95% CI 0.46 to 1.38, 11 studies), cocaine use (OR 2.21, 95% CI 0.87 to 5.65, 3 studies), cocaine abuse/dependence (OR 1.10, 95% CI 0.51 to 2.38, 7 studies), marijuana use (OR 1.01, 95% CI 0.68 to 1.50, 4 studies), marijuana abuse/dependence (OR 0.97, 95% CI 0.59 to 1.59, 9 studies), nicotine use (OR 1.55, 95% CI 0.73 to 3.30, 4 studies), nicotine abuse/dependence (OR 1.34, 95% CI 0.90 to 1.99, 6 studies), non-specific drug use (OR 1.27, 9% CI 0.88 to 1.82, 3 studies) and non-specific drug abuse/dependence (OR 0.85, 95% CI 0.51 to 1.40, 7 studies). No significant publication bias was detected. Moderator analyses found that a higher proportion of children with ADHD receiving pharmacological treatment reduced the risk of alcohol dependence/abuse, whereas longer follow-up was associated with increased risk of alcohol abuse/dependence. A higher proportion of males in the study population increased the risk of non-specific drug abuse/dependence.


Treatment of ADHD with stimulant medication does not predispose towards or protect against later substance use or abuse.

Notes (If Necessary)

One of the included studies had a population of children with a reading disorder rather than ADHD.


ADHD has long been recognised as a risk factor for substance abuse and dependence, particularly in association with conduct disorder. Increasing rates of diagnosis and treatment have been paralleled by increasing levels of community concern about whether stimulant medication could increase individual susceptibility to substance use. An earlier meta-analysis by Wilens et al [1] suggested that stimulant medication had a protective effect for subsequent substance use disorder. Although the larger meta-analysis by Humphrey and colleagues did not replicate this result, it still suggests that, on average, stimulant medication appears not to increase the risk of substance use and addiction across a range of substances.

Meta-analyses are useful because they can derive an overall risk based on large cohorts derived from a series of studies. The main drawback is that much detail is lost. This means that significant confounders may not be evaluated and findings can be difficult to interpret. The individual studies were carried out in a range of settings and it was noted that as the size of the treated group declined relative to the untreated group, the proportion of treated individuals meeting the diagnostic criteria for alcohol abuse and dependence increased. Although this could be indicative of subgroups of individuals with ADHD for whom stimulant medication might increase the risk of alcohol abuse, it could also reflect different prescribing practises.

A meta-analysis is limited by the quality of the data reported in the included studies, and importantly, Humphrey and colleagues were unable to control for baseline symptom severity. They could not therefore determine whether those who were treated were more severely affected and should actually have had a higher risk of substance use.

Although reassuring, this study is unlikely to change clinical practise. The need remains for longitudinal studies that extend well into adulthood and report symptom severity as well as the presence of associated diagnoses and important individual and social factors. Once all of these have been controlled for, it is likely that any residual contribution of stimulant medication, whether protective or otherwise, will be small.


1.     1. Wilens TE, Faraone SV, Biederman J, et al. Does stimulant therapy of attention-deficit/hyperactivity disorder beget later substance abuse? A meta-analytic review of the literature. Pediatrics 2003;111:179–85.


Competing interests


Sources of funding

National Institutes of Health.

Evid Based Ment Health. 2014;17(1) © 2014  BMJ Publishing Group Ltd, the British Psychological Society and the Royal College of Psychiatrists