Distracted this morning: an ADD/ADHD Assessment
My world must be getting better.... I am waking much earlier than I used to. Of course, I have also been indulging in naps lately.
Truthfully, I was dreaming about creating a powerpoint presentation all night... so I figured I'd just get up and do it. This is a good sign, considering I am not under the effects of adderall for the time being. :)
It's funny... Now that I have been on it fairly regularly for the past few years (fall of 99-2001, in grad school, skipped a year in the Marine Corps when recalled, and then back on it 2003-now) but only about 60% of the time (either in classes, teaching or, like now, when I am at work) I actually NOTICE the difference when I have not taken the drug for more than a few days.
IN fact, I chalked it up to getting recalled when in the Marines (you can't take even prescribed amphetamines in the military) stating "I got more stupid the moment I put on this uniform!"
Truthfully, though, its not a matter of stupidity. Many of us with adult ADD who were diagnosed as children (before it was cool... ) and who REALLY have "no lights on" in the pre-frontal cortex (which organizes thoughts in the brain) AND who benefit from an overactive neuron base (the Hyper "H" in ADHD than often presents itself as too much sugar) have often learned coping skills (sometimes poor ones, like addictive behaviors) to adjust to "normal life."
ADD/ADHD : A History
Stewart was also diagnosed with ADHD as a kid, as was his sister, and comparing our coping skills was always interesting. We both, especially off drugs, spend 30-50% MORE time on every project (work, academic or even organizational every-day stuff like bills) in order to produce the same result as someone in our IQ bracket/academic class or whatever (I'm 138 and I believe Stewart claims to be a 135.) This is a LOT of work, and the only reason we exert the effort, unlike the majority of folks with ADD is that we are both achievement-oriented. (His externally and mine internally, but that is a result of psychological nature/nurturing rather than brain function.)
ADD/ADHD Diagnoses
One of the reasons I attribute to the difference in our coping skills is that, unlike myself, Stewart was prescribed medication (Ritalin, I believe) for most of his post-diagnoses childhood. Interestingly, the diagnoses was "accidental, resulting from his sister's assessment when she did not perform as well as expected in school. Estimates for childhood ADHD DIAGNOSES vary between .02 and 10%, with most modern (academic/psychological/medical) experts agreeing that the actual range is between 1-3%. This means out of a graduating class of 100, 1 to 3 kids will have some form of ADD. Additionally, though ADHD is diagnosed twice as often as "typical" (or "inattentive") ADD, as well as three times more often in boys, researchers agree (and have consistently since the 80's, so unlike early changes I buy this statistic) ADHD boys are more likely to undergo a psychiatric evaluation initiated by a frustrated parent or concerned teacher.
ADD/ADHD MIS-Diagnoses
It is important to keep in mind, however, that 50% of "attention deficit" diagnoses are not actually the neurological condition of ADD. Pet scans reveal that about half of those diagnosed with ADD do have normal pre-frontal cortex (or "organizational") activity, and regulated dopamine (the cause of Hyperactivity.) These cases exhibit similar symptoms, but the majority of them end up being due to alcohol/drug related exposure during pregnancy and/or poor nutrition/diet during brain formation years (age birth-10.) Though I underwent a pet scan around age5 that verified my diagnoses, (the early days of ADD research, 25-30 years ago!) it is not a procedure that doctors typically recommend, due to the undesirability of exposing young, still forming brains to x-ray. Often, it is easier and actually safer to try a few different medications and watch the child's behavior (the effect is almost immediate and does not need to build up in the system like SSRIs, etc) in order to confirm diagnoses.
ADD Characteristics
During her initial consultation (ADD/ADHD is often assessed when children exhibit signs of learning disorders, like dyslexia.) the doc asked if Stewart's sister exhibited signs that signaled attention-deficit disorder. Characteristics like being easily distracted, hyper-sensitivity to criticism, messiness or carelessness in tasks (room-cleaning or homework,) difficulty following through and/or organizing and a "suspect" (appearing almost willful) rate of tuning out and/or forgetfulness are shared by both ADD & ADHD. Stew's mother agreed that her daughter suffered from most/all of these symptoms.
ADHD Characteristics
Though it rarely diagnosed in girls/women (1 in 5,) the presence of ADD prompted the doc to ask questions that would differentiate typical "inattentive" ADD from the additional "H" of Hyperactivity. Is she hyperactivity? Does she have problems staying in her seat? Waiting her turn? Is she defiant or argumentative? Is she difficult to control? Stew's mother found herself saying, "No, but Stewart is..." "No, but Stewart is..." and by the end of the appointment, Stew's mother found herself with two diagnoses.. an ADD diagnoses for her daughter and, surprise! ADHD for her son.
Lets Talk Numbers
Most of the stats I am using are typical averages from a life-long study of the benefits and burdens of my own "disease," which means subject-matter expert publications, doctors analysis, medical and psychiatric journals, etc. I was in the early diagnoses era, which is why I received the scan, but the excessive spread of "inattentive symptoms" AND medication reliance of the 1980's made ADD/ADHD a "popular" diagnoses for all sorts of behavioral and dietary (and television parenting) issues.
The backlash came in the 90s when kids whose parents, after filling them with 18 years of fast food and television babysitting, fed them drugs like ritalin to control their responses, started going to college and questioning some of the more verifiable symptoms. Excess refined sugars, dye allergies, in-uetero alcohol exposure, lack of nutrition, and television-influenced brain development patterns all tested positive for inhibiting brain concentration and control. Many of these kids found that they could reestablish some brain improvement by changing their diets and lifestyle, going on to try more holistic methods such as these with their own children.
Others, resentful of "medicative parenting," blamed ritalin and other drugs for depression, health problems and other adult-illnesses, and so started to anti-medication "meds are bad, ADD/ADHD isn't real" phenomenon that still exists in chat rooms today. That being said, the 80's and early 90's saw a sharp rise in ADD/HD diagnoses, but by the mid-90's the backlashing generation and concerns over drug abuse (because addictive behaviors often accompany ADHD) evened out the diagnoses to about what it is today, with approx 3% being initially diagnosed, but after medication testing only 2% are verified, and only about half of those stay on meds.
As stated in my opening, boys are diagnosed 2x as often as girls, and the majority of boys (4:1)are ADHD. Using a mean average (1-3%) of 2% ADD/ADHD children, statistics come out this way:
Out of 5000 average elementary school-age kids:
ADHD Girls
Wow.. I've been writing for two hours! I cant believe it... Wasn't this supposed to be on coping skills? Well... There you are, ADHD at work... Anyway.. on to ADHD Girls
For the past two hours, I have been writing from my head - though my guess is that, being practically a report, I will go back and add links to sources when I get done hyperfocusing. :) That being said, I will refer you other sites for information on types of girls with ADHD in general so I can get onto the "coping skills" comparison, which was the initial focus of this blog (and yet, there I prove my own case, correct?) At any rate, I began exhibiting many male ADHD characteristics, a stereotypical "Tomboy" profile, though not overly physically aggressive, I adored my teachers and was constantly seeking approval from them, but my mother would be embarrassed hearing "she's SO smart and SO bright, but I cant keep her in her seat, get her to be quiet, rarely remembers to do - or at least to turn in- her homework, and she finishes her classwork work very quickly and often misses directions - yet when asked a question in class she knows the answers and grasps concepts and ideas much faster than most of the students. Oh, and though she's difficult to control she is just a very sweet young lady. "
So,Whose Fault IS it?
Like most parents, my mother felt as though this was a plague on her parenting skills. Unlike most parents, she sis not have the resources or the maturity (She was a very young parent) to handle it at that time. She was already overwhelmed with just the responsibilities of being a young mother, plus suffering from ADD herself, (and without the benefit of my Hyperactivity) accompanied by frequent depression and eventually panic attacks, diagnoses that would not take place for some time. Medication, Ritalin being the only one back then, was very expensive. Eventually out of frustration and exhaustion, my mother and grandmother sent me to a psychiatrist that they both knew well. I was diagnosed, started on a very low dose of ritalin, and immediately became a drowsy mess. I was not on it long, ever. I estimate I took it for less than a month the first time (due to switching between my mother and grandmother - two sides of North America, and a lack of money on my mother's side) and during the summer & Christmas breaks I had no reason to take it.
Lost Opportunities: A Typical Story (Mine)
As is considered typical, it Wasn't until 3rd grade that it really started to affect my ability to learn in the classroom environment. Having taken the full gamut of tests by then, we knew I had ADHD, and we (I use the term "we" loosely, as I am not sure I thought about it much) also knew how high my IQ was. Knowing by this time (the early 80's) that kids with ADD have the lowest learning capacity in the classroom (unless trained early to cope) and highest in GATE and montisorri-style classrooms, I was asked to enter the GATE (Gifted and Talented) program which took place once a week at a nearby elementary school. I enjoyed the program immensely, but attending meant you had to keep up with work in your home school (which was sent with you the Friday prior) which, not being on medication, I failed to EVER remember to do.
In Fourth Grade I was re-diagnosed, again to be prescribed ritalin, which I defined as "putting me in a fog," even at the low dose I was on. My work was well done and I tended to stay in my seat and not talk out of turn, which I am sure was appreciated by all - but I remember thinking that I just felt tired. After a couple months of taking it fairly regularly, I must have been out of my seat and/or talking when my teacher (again, who I adored, and initiated my continued love of LaCoste) Mr. Gross, yelled crossly, "Did you take your medication, young lady?" The other kids laughed at me, and I remember being stunned and embarrassed, more by the tone than by what he said. Though I had never considered it a bad thing - or even worth mentioning to anyone- that I took Ritalin, either the look on my face or what he said had all the kids asking at recess "You take medicine? For what? Are you retarded? I didn't know you were retarded!! You should be a nerd then!"
This resulted in two reactions: 1.) I became incredibly reluctant to take any medications or tell anyone I had ADHD and 2.) I became suddenly terrified of being a "nerd."
I refused any other meds until Jr. High school, when taking AP history classes and getting bumped in math from the normal 7th grade math to 8th grade algebra HALFWAY through the year (note: don't ever do that to ANY kid... Despite the fact that I am actually made to do math it made me hate it for years!) I was struggling! I was, once again, diagnosed (because there were so many years in between, and so much research, every doctor those first few years wanted to re-diagnose me just in case the new research revealed that I Wasn't really ADHD. The only one who didn't was the doctor who diagnosed me in 4th grade who said he didn't need to after watching me sit down, get up, walk around, go outside and fidget in the waiting room for 15 minutes from his office dark-window) This time, now in 7th grade, I was diagnosed for the third (possibly forth?) time, prescribed Ritalin for a month, and then stopped when my doctor died or was killed on the day of our follow-up appointment.
Diagnosed yet AGAIN in 9th or 10th grade, the appointment initiated of my own will. I believe I stayed on Ritalin for a few months, but eventually just stopped remembering to take it. My grades were never as good as they could be - I NEVER did homework until the night before, and pulled almost straight B averages... the drive for perfection had not yet begun.
The Drive For Perfection
No... Changes in my focus didn't surface until my return to college.. I had a 1-year hiatus between my first two years on scholarship and 2nd two where I joined the Marine Corps Reserve. I was still not on meds, but ADD was no excuse for anything... I was to get my thoughts organized or be defeated, and Lord knows I don't handle defeat very well.
That year I suddenly and rapidly began learning coping skills for my ADHD. I learned how to organize my thoughts, identified and mitigated my greatest weaknesses by leveraging my strengths against them, and got really honest about who I am and what I am made of. I didn't start meds again until I attended grad school in 1999-2000, and then I went through trying ritalin (still to sleepy), Dexedrine (which FELT like crack even on a low dose,) Straterra (when it came out, but it made me incredibly sleepy AND I never remember to take anything regularly) and finally adderall - which was adjusted a few times, and settled on. Since then I have taken low doses (my body is easily affected by meds, so it doesn't take much) about 50% of the time, with the exception of 2001-02 when I was recalled for the war. I do not (usually) take meds on the weekend, and frequently forget even on the weekdays. However, the coping skills I developed during college, combined with my compulsive perfectionist tendencies allow me to perform at close to the rate of an average person (bills, work, school) even when I am not on meds - and despite my handicap. However, it does take me longer, and there are lots of ways I manage that.
I will cover that in the next blog though... I just got off a phone call and now realize that its actually 9am already - so I must start on the PowerPoint before I go to the picnic this afternoon. Otherwise, I will be doing it in my head and not having any fun at all. :(
~Psyche
Truthfully, I was dreaming about creating a powerpoint presentation all night... so I figured I'd just get up and do it. This is a good sign, considering I am not under the effects of adderall for the time being. :)
It's funny... Now that I have been on it fairly regularly for the past few years (fall of 99-2001, in grad school, skipped a year in the Marine Corps when recalled, and then back on it 2003-now) but only about 60% of the time (either in classes, teaching or, like now, when I am at work) I actually NOTICE the difference when I have not taken the drug for more than a few days.
IN fact, I chalked it up to getting recalled when in the Marines (you can't take even prescribed amphetamines in the military) stating "I got more stupid the moment I put on this uniform!"
Truthfully, though, its not a matter of stupidity. Many of us with adult ADD who were diagnosed as children (before it was cool... ) and who REALLY have "no lights on" in the pre-frontal cortex (which organizes thoughts in the brain) AND who benefit from an overactive neuron base (the Hyper "H" in ADHD than often presents itself as too much sugar) have often learned coping skills (sometimes poor ones, like addictive behaviors) to adjust to "normal life."
ADD/ADHD : A History
Stewart was also diagnosed with ADHD as a kid, as was his sister, and comparing our coping skills was always interesting. We both, especially off drugs, spend 30-50% MORE time on every project (work, academic or even organizational every-day stuff like bills) in order to produce the same result as someone in our IQ bracket/academic class or whatever (I'm 138 and I believe Stewart claims to be a 135.) This is a LOT of work, and the only reason we exert the effort, unlike the majority of folks with ADD is that we are both achievement-oriented. (His externally and mine internally, but that is a result of psychological nature/nurturing rather than brain function.)
ADD/ADHD Diagnoses
One of the reasons I attribute to the difference in our coping skills is that, unlike myself, Stewart was prescribed medication (Ritalin, I believe) for most of his post-diagnoses childhood. Interestingly, the diagnoses was "accidental, resulting from his sister's assessment when she did not perform as well as expected in school. Estimates for childhood ADHD DIAGNOSES vary between .02 and 10%, with most modern (academic/psychological/medical) experts agreeing that the actual range is between 1-3%. This means out of a graduating class of 100, 1 to 3 kids will have some form of ADD. Additionally, though ADHD is diagnosed twice as often as "typical" (or "inattentive") ADD, as well as three times more often in boys, researchers agree (and have consistently since the 80's, so unlike early changes I buy this statistic) ADHD boys are more likely to undergo a psychiatric evaluation initiated by a frustrated parent or concerned teacher.
ADD/ADHD MIS-Diagnoses
It is important to keep in mind, however, that 50% of "attention deficit" diagnoses are not actually the neurological condition of ADD. Pet scans reveal that about half of those diagnosed with ADD do have normal pre-frontal cortex (or "organizational") activity, and regulated dopamine (the cause of Hyperactivity.) These cases exhibit similar symptoms, but the majority of them end up being due to alcohol/drug related exposure during pregnancy and/or poor nutrition/diet during brain formation years (age birth-10.) Though I underwent a pet scan around age5 that verified my diagnoses, (the early days of ADD research, 25-30 years ago!) it is not a procedure that doctors typically recommend, due to the undesirability of exposing young, still forming brains to x-ray. Often, it is easier and actually safer to try a few different medications and watch the child's behavior (the effect is almost immediate and does not need to build up in the system like SSRIs, etc) in order to confirm diagnoses.
ADD Characteristics
During her initial consultation (ADD/ADHD is often assessed when children exhibit signs of learning disorders, like dyslexia.) the doc asked if Stewart's sister exhibited signs that signaled attention-deficit disorder. Characteristics like being easily distracted, hyper-sensitivity to criticism, messiness or carelessness in tasks (room-cleaning or homework,) difficulty following through and/or organizing and a "suspect" (appearing almost willful) rate of tuning out and/or forgetfulness are shared by both ADD & ADHD. Stew's mother agreed that her daughter suffered from most/all of these symptoms.
ADHD Characteristics
Though it rarely diagnosed in girls/women (1 in 5,) the presence of ADD prompted the doc to ask questions that would differentiate typical "inattentive" ADD from the additional "H" of Hyperactivity. Is she hyperactivity? Does she have problems staying in her seat? Waiting her turn? Is she defiant or argumentative? Is she difficult to control? Stew's mother found herself saying, "No, but Stewart is..." "No, but Stewart is..." and by the end of the appointment, Stew's mother found herself with two diagnoses.. an ADD diagnoses for her daughter and, surprise! ADHD for her son.
Lets Talk Numbers
Most of the stats I am using are typical averages from a life-long study of the benefits and burdens of my own "disease," which means subject-matter expert publications, doctors analysis, medical and psychiatric journals, etc. I was in the early diagnoses era, which is why I received the scan, but the excessive spread of "inattentive symptoms" AND medication reliance of the 1980's made ADD/ADHD a "popular" diagnoses for all sorts of behavioral and dietary (and television parenting) issues.
The backlash came in the 90s when kids whose parents, after filling them with 18 years of fast food and television babysitting, fed them drugs like ritalin to control their responses, started going to college and questioning some of the more verifiable symptoms. Excess refined sugars, dye allergies, in-uetero alcohol exposure, lack of nutrition, and television-influenced brain development patterns all tested positive for inhibiting brain concentration and control. Many of these kids found that they could reestablish some brain improvement by changing their diets and lifestyle, going on to try more holistic methods such as these with their own children.
Others, resentful of "medicative parenting," blamed ritalin and other drugs for depression, health problems and other adult-illnesses, and so started to anti-medication "meds are bad, ADD/ADHD isn't real" phenomenon that still exists in chat rooms today. That being said, the 80's and early 90's saw a sharp rise in ADD/HD diagnoses, but by the mid-90's the backlashing generation and concerns over drug abuse (because addictive behaviors often accompany ADHD) evened out the diagnoses to about what it is today, with approx 3% being initially diagnosed, but after medication testing only 2% are verified, and only about half of those stay on meds.
As stated in my opening, boys are diagnosed 2x as often as girls, and the majority of boys (4:1)are ADHD. Using a mean average (1-3%) of 2% ADD/ADHD children, statistics come out this way:
Out of 5000 average elementary school-age kids:
- 150 may be diagnosed with ADD or ADHD, half incorrectly
- 100 will have actually have ADD or ADHD
- Out of the 100 who actually have ADD/ADHD, only 75 will be diagnosed and
1. 34 will have ADD - 11 Boys
- 23 Girls
- 66 will have ADHD
- 55 Boys
- 11 girls
ADHD Girls
Wow.. I've been writing for two hours! I cant believe it... Wasn't this supposed to be on coping skills? Well... There you are, ADHD at work... Anyway.. on to ADHD Girls
For the past two hours, I have been writing from my head - though my guess is that, being practically a report, I will go back and add links to sources when I get done hyperfocusing. :) That being said, I will refer you other sites for information on types of girls with ADHD in general so I can get onto the "coping skills" comparison, which was the initial focus of this blog (and yet, there I prove my own case, correct?) At any rate, I began exhibiting many male ADHD characteristics, a stereotypical "Tomboy" profile, though not overly physically aggressive, I adored my teachers and was constantly seeking approval from them, but my mother would be embarrassed hearing "she's SO smart and SO bright, but I cant keep her in her seat, get her to be quiet, rarely remembers to do - or at least to turn in- her homework, and she finishes her classwork work very quickly and often misses directions - yet when asked a question in class she knows the answers and grasps concepts and ideas much faster than most of the students. Oh, and though she's difficult to control she is just a very sweet young lady. "
So,Whose Fault IS it?
Like most parents, my mother felt as though this was a plague on her parenting skills. Unlike most parents, she sis not have the resources or the maturity (She was a very young parent) to handle it at that time. She was already overwhelmed with just the responsibilities of being a young mother, plus suffering from ADD herself, (and without the benefit of my Hyperactivity) accompanied by frequent depression and eventually panic attacks, diagnoses that would not take place for some time. Medication, Ritalin being the only one back then, was very expensive. Eventually out of frustration and exhaustion, my mother and grandmother sent me to a psychiatrist that they both knew well. I was diagnosed, started on a very low dose of ritalin, and immediately became a drowsy mess. I was not on it long, ever. I estimate I took it for less than a month the first time (due to switching between my mother and grandmother - two sides of North America, and a lack of money on my mother's side) and during the summer & Christmas breaks I had no reason to take it.
Lost Opportunities: A Typical Story (Mine)
As is considered typical, it Wasn't until 3rd grade that it really started to affect my ability to learn in the classroom environment. Having taken the full gamut of tests by then, we knew I had ADHD, and we (I use the term "we" loosely, as I am not sure I thought about it much) also knew how high my IQ was. Knowing by this time (the early 80's) that kids with ADD have the lowest learning capacity in the classroom (unless trained early to cope) and highest in GATE and montisorri-style classrooms, I was asked to enter the GATE (Gifted and Talented) program which took place once a week at a nearby elementary school. I enjoyed the program immensely, but attending meant you had to keep up with work in your home school (which was sent with you the Friday prior) which, not being on medication, I failed to EVER remember to do.
In Fourth Grade I was re-diagnosed, again to be prescribed ritalin, which I defined as "putting me in a fog," even at the low dose I was on. My work was well done and I tended to stay in my seat and not talk out of turn, which I am sure was appreciated by all - but I remember thinking that I just felt tired. After a couple months of taking it fairly regularly, I must have been out of my seat and/or talking when my teacher (again, who I adored, and initiated my continued love of LaCoste) Mr. Gross, yelled crossly, "Did you take your medication, young lady?" The other kids laughed at me, and I remember being stunned and embarrassed, more by the tone than by what he said. Though I had never considered it a bad thing - or even worth mentioning to anyone- that I took Ritalin, either the look on my face or what he said had all the kids asking at recess "You take medicine? For what? Are you retarded? I didn't know you were retarded!! You should be a nerd then!"
This resulted in two reactions: 1.) I became incredibly reluctant to take any medications or tell anyone I had ADHD and 2.) I became suddenly terrified of being a "nerd."
I refused any other meds until Jr. High school, when taking AP history classes and getting bumped in math from the normal 7th grade math to 8th grade algebra HALFWAY through the year (note: don't ever do that to ANY kid... Despite the fact that I am actually made to do math it made me hate it for years!) I was struggling! I was, once again, diagnosed (because there were so many years in between, and so much research, every doctor those first few years wanted to re-diagnose me just in case the new research revealed that I Wasn't really ADHD. The only one who didn't was the doctor who diagnosed me in 4th grade who said he didn't need to after watching me sit down, get up, walk around, go outside and fidget in the waiting room for 15 minutes from his office dark-window) This time, now in 7th grade, I was diagnosed for the third (possibly forth?) time, prescribed Ritalin for a month, and then stopped when my doctor died or was killed on the day of our follow-up appointment.
Diagnosed yet AGAIN in 9th or 10th grade, the appointment initiated of my own will. I believe I stayed on Ritalin for a few months, but eventually just stopped remembering to take it. My grades were never as good as they could be - I NEVER did homework until the night before, and pulled almost straight B averages... the drive for perfection had not yet begun.
The Drive For Perfection
No... Changes in my focus didn't surface until my return to college.. I had a 1-year hiatus between my first two years on scholarship and 2nd two where I joined the Marine Corps Reserve. I was still not on meds, but ADD was no excuse for anything... I was to get my thoughts organized or be defeated, and Lord knows I don't handle defeat very well.
That year I suddenly and rapidly began learning coping skills for my ADHD. I learned how to organize my thoughts, identified and mitigated my greatest weaknesses by leveraging my strengths against them, and got really honest about who I am and what I am made of. I didn't start meds again until I attended grad school in 1999-2000, and then I went through trying ritalin (still to sleepy), Dexedrine (which FELT like crack even on a low dose,) Straterra (when it came out, but it made me incredibly sleepy AND I never remember to take anything regularly) and finally adderall - which was adjusted a few times, and settled on. Since then I have taken low doses (my body is easily affected by meds, so it doesn't take much) about 50% of the time, with the exception of 2001-02 when I was recalled for the war. I do not (usually) take meds on the weekend, and frequently forget even on the weekdays. However, the coping skills I developed during college, combined with my compulsive perfectionist tendencies allow me to perform at close to the rate of an average person (bills, work, school) even when I am not on meds - and despite my handicap. However, it does take me longer, and there are lots of ways I manage that.
I will cover that in the next blog though... I just got off a phone call and now realize that its actually 9am already - so I must start on the PowerPoint before I go to the picnic this afternoon. Otherwise, I will be doing it in my head and not having any fun at all. :(
~Psyche
posted by Psyche at 5:04 AM
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