ADHD: A Changing Diagnosis

it's symptoms include impulsivity hyperactivity in attention and distractibility just to name a few it's ADHD attention deficit hyperactivity disorder and recent numbers from the US Centers for Disease Control suggest it is being widely diagnosed in fact the study found 11 percent of school-age kids were identified with the affliction but it's not a new condition it's been around for decades and joining us now to tell us what's behind the surge in diagnosis Rick green producer and director of a DD and loving it Rick also has ADHD dr. Russell Shakur senior scientist in psychiatry at the Hospital for Sick Children dr. David Teplin adult clinical psychologist dr. Albert Wong research scientist at the Centre for Addiction and Mental Health campaign and Ravindra Sidhu she is a clinical psychologist at wings neuro rehab and it's good of all of you to come into TVO today for this discussion I welcome you all but you will forgive me if I welcome you just a little bit extra oh because Rick Green used to do TV programs here at Evo so it's kind of sweet to see me used to do them here I'm trying to give you a sweet you know home sweet home well that's great to see it's lovely that well now that we've got started here when did you know you had ADHD I got the diagnosis around the year 2000 that was my y2k disaster but it was also it was a relief it was like this everything makes sense and so I was able to go this is why I've written 700 episodes of radio and television skit comedy and finish one screenplay and I took all the other screenplays and went not going to do those what happened then was I got such resistance from people around me are you talking about you're successful you're on national television you have ADHD Richard Branson owns an airline he's got ADHD so I was so dismissed and kind of humiliated and angry it's stewed and eventually with a friend of mine Patrick McKenna who plays Harold on the red green show co-star he he decide there I talk to him very quickly because he's impulsive what the heck into doing a documentary about him actually getting diagnosed his wife was not 80 HD was alarmed and they went along with it and it's been seen by denote five or six million people and emails come in all the time see he just saved my life my child is starting to have a dream they could have a life well let me pick up on that because he was an adult when he got diagnosed as were you yeah I was 47 I thought this was the kind of thing that you got diagnosed when you were a kid not in your case no in fact for adults it mine was the classic your kids diagnosed your kids suddenly gifted sprite suddenly struggling they do announce you know testing they suggest ADHD I'm a dad I'm responsible let me see the list what's wrong with this this is oh this is this is and then everything makes sense suddenly you realize why you're really good at starting stuff not finishing why you have so much on the go why you tune out and you start to as I start to learn especially about the drd4 point 7 the first gene that was identified thanks to some work done partly done here at University of Toronto but mostly University of california-irvine that was the first gene that was identified suspect gene and then I went and I could look at my dad I look at my grandfather who was on the vaudeville stage my dad stood wrestled his change in keys as he watched TV change channels go upstairs read a book come back the light went on yeah and he's in sales it was the perfect job is the insurance talking to people they want perfect job and I'm in the perfect job so when you find the right conditions you can soar but if you don't know what's going on and you're tuning out when your own child is pouring their heart out from you you don't think well I wonder if I'm low on norepinephrine and dopamine you think I'm a bad father mmm oh really so the relief the anger the why didn't I know sooner it's a huge toxic mix we're dealing with on our website on totally aadd people who've got the diagnosis and their 70s they get the diagnosis they start treatment suddenly six months later the house is clean all the clutter is gone they're back finishing courses the kids are coming over because they can stand being around they can listen they don't interrupt and then they go oh my god life changing yeah but what if I'd known sooner I wouldn't have gone through three marriages and four bankruptcies and and it's heartbreak just for the record you're not referring to yourself when you say I've been through one divorce and my finances are still a mess I have a woman a wife who does miracles for me and it's it's the perfect match let's find out from David temple and then why this thing seems to be so difficult to diagnose here's Rick getting a diagnosis well into his 40s how come well their number of reasons first off they've done some studies suggesting that the average adult with ADHD takes about 12 and a half years to actually get the diagnosis which means one of a few things either they've been misdiagnosed or the person assessing them hasn't even looked for it in the first place the second thing and again I'm talking as an adult clinical psychologist is that many things can mimic ADHD including other psychiatric disorders medical conditions and also even if the person should have adult ADHD the rule rather than the exception is that if you've got ADHD you have about a 75% chance or even more of having one or more comorbid or coexisting disorders so it's very important that when you do an assessment that it needs to be comprehensive and that you need a lot of data points as it were to collect the data in terms of it being life long and a lifespan disorder and also in terms of how it plays out because ADHD is not we coming to understand that ADHD in fact is not one simple diagnostic term and probably in time I wouldn't be surprised that we start to see ADHD like we did schizophrenia or mood disorders in which they're different into a panoply of things that's right it's like like a spectrum disorder so we might really talk of it as the ADHD s rather than ADHD I see okay riff Inder said oh you're also a clinical psychologist I wonder if you could sort of add to what we just heard about whether you find it also difficult to diagnose right out the gate um it is and I think there are unique challenges to diagnosing it and children and diagnosed needed adults you both both yes so we do get you know like Rick said oftentimes they'll be adults who come in and they end up coming to us because their child is coming in because the teacher thought that they may have ADHD so the child goes through an assessment and then we go and have the feedback and you're talking to the parent and then it just kind of clicks in like I was like that as a kid you know I still have problems like with all these issues and they may not have even picked it up on their child because they think that's normal this is how I was he's just taking after me and then they start to wonder well maybe I have ADHD too and they've gotten through without ever getting diagnosed so this condition that more often than not is inherited from a parent um there is like a big heritability component with it so I like like it with everything there's an interaction between you know the genes and the environment but there is a large inheritability component so oftentimes when you do see children chances are that maybe one of the parents might also have it as well which leads to a whole bunch of other challenges but with children just like how dr. Chaplin said like there are so many conditions that mimic same symptoms of ADHD and it's also comorbid with so many different things that you really need to talk to people in multiple contexts in the child's life so you need to get some information from school staff from parents sometimes if you have the luxury maybe even somebody who's seen the child outside of home and school somewhere else another family member who might know them very well so this is very intensive in their fancy the child as well yeah so often times like I mean mostly assessments I end up doing I'll be called in for a psycho-educational assessment for example because the child's having learning problems so I actually do luckily get to spend an entire day with this kid because we're testing for six to eight hours and so I get to see the child over the course of a school day like starting from nine o'clock how they how do they do so three and the observations become really important right because if in six hours I don't see anything in this child showing that there's any attention problems and issues I might start to get suspicious but um chances are usually you do see some behavioral stuff and you can kind of supplement that with school records and with all kinds of of information but that's not always possible to have such comprehensive alarge numbers of these diagnoses have got some people scratching their heads and and let me go to you on this one Russell Shaq er because a new study as you know by the Centers for Disease Control in the u.s. indicates nearly one in five high school-age boys in the United States have received a medical diagnosis of ADHD at some point in their lives and it's got people asking questions whether or not you know contrary to Rick's background where it was never diagnosed are we overcompensating and over died no Singh now what's your view well I think we're probably over diagnosing ADHD under some circumstances we're probably under diagnosing it under other circumstances and and certainly miss diagnosing it under many circumstances the study from the Center for Disease Control it was really just a study based on the data is based on inquiring about whether or not a person had a diagnosis received a diagnosis it's not clear from that study where they got the diagnosis how valid the diagnosis was and and I dare say there are probably many people who have been told at various times by various people that they have ADHD exactly how that in fact there's a long before I was diagnosed there's an adventure with build the thing I did on the red-green show there's an adventure with Bill where I'd get knocked down I get up I try again I mess up I do something stupid again and again and just keep going forward optimistically and read great and the narration says that looks like bills have on one of his ad D moments and you know I have family members I won't say who but they've said to me yeah I probably am too and they're very successful people so it it's it is a spectrum and the analogy I like to use is at its height we all have height right the question is how much and so you're a tall guy but if I say to you is six foot two tall you'd say not probably not somebody else might say my wife would say yeah six foot two is tall if I say six eight is tall you're going to agree that's tall right so we're all going to agree six eight is tall so if you're in the top four adults it's four percent if you're in that top four percent in terms of height you're six foot five or up so there's nothing wrong with being seven feet tall if you don't know you're seven feet tall and you go through life hitting your head on everything smacking doors you go out in grade three to play with the other kids to play leapfrog and they all get hurt now aggression hurt every other child never invited to a birthday party and ADHD kids are not popular they don't have a lot of friends they're struggling this whole method though these are creative artistic no no these are kids that nobody invites for sleepovers I want to tell dr. Albert Wong that yes you do get to speak on this program and you will situated oh you're enjoying the discussion but we want to put you to work as well and I want to I actually want to get you to react to something that I'm going to read right now because there's a blog written by the director of the National Institute of Mental Health Thomas Insel talking about the new edition of the dsm-5 this is the Diagnostic and Statistical Manual of Mental Disorders this is the Bible for the people in the psychiatric world and here's what he wrote control room if you would let's bring this up unlike our definitions of ischemic heart disease lymphoma or AIDS the DSM diagnosis are based on a consensus about clusters of clinical symptoms not any objective laboratory measure in the rest of Medicine this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever indeed symptom based diagnosis once common in other areas of medicine has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment which raises a bunch of questions should we even think of ADHD as an illness or a disease or a condition or what helped us on that yeah I I agree generally with Tom ensel's ideas you know the the counterpoint to his ideas is that we do need a language to speak about what these behavioral syndromes are clinically so that we can have a common definition so that's a semantic issue and so the issue of whether it's being over an under diagnosed is in some ways I don't think the real question because it depends on how you set the criteria and these criteria do change over time and they're and they're they can be applied differently in different contexts so I think the the more important point is what dr. ensel said which is that we in saqqara to look at clusters of symptoms or behaviors or just things that people do or the way that they act and we call this we give it a label we give them a diagnosis but that doesn't necessarily have anything to do with the way the brain works or if the brain isn't working of course there are there are many control points in the nervous system for all kinds of behaviors and we've picked out of these clusters of behaviors that people have certain ones that we call diagnosis but that changes and that is something that's driven by committee it's not necessarily anchored in neurobiology and I think that's part of the issue one of the examples that Tom Insel makes in that blog is that if we were to approach heart disease say 200 years ago in the same way as we are approaching diagnosis it's country we might look at people with chest pain and if we're looking for a good measure of whether they're actually having a heart attack or not we might try EKGs the problem is that most people with chest pain fortunately aren't having a heart attack so the problem we have in psychiatry is we look at people who have a bunch of behaviors that we can very reliably diagnosed as having a certain syndrome and then when we look to see if there's something that we can measure something biochemical or a brain imaging test or a gene variant or something and we see that a certain proportion of those people who present with that behavioral syndrome don't have that biological abnormality then we say that abnormality is not very good for diagnosing the syndrome so in other areas of Medicine we use the biological marker that as the anchor for the diagnosis in psychiatry we use the syndrome as the anchor and this leads to some sort of circular reasoning and that's part of the problem well let me follow up then given the way you have just laid that out is there a danger in diagnosing people obviously incorrectly with ADHD insofar as these people will start to think of themselves as victims or you're creating a you know a pathology where none exists yeah so I think this is sort of the issue more generally of social constructs of illness as opposed to illness itself and so sometimes for example it's it's helpful to see problems in a medical framework and so because sometimes that believes the person who has that problem from some sort of blame some kind of moral kind of accusation so addiction is a good example of this where over the years addiction has been seen less and less as a moral failing and more and more as a medical condition so there's certainly a utility in helping people who have this problem by giving them a diagnosis so that perhaps more constructive ways of treating their problem can be found or or initiated rather than simply blaming them from a failure of will but that doesn't necessarily mean that the condition is any different it doesn't make it any more or less of an illness whether or not there is or isn't a political or social gain in creating that label or legitimizing it so I think in some ways it's just too bad that we have difficulty in accepting and thinking about and understanding our everyone's variation that people are different they have different tendencies they're good at some things not so good at other things and it seems that sometimes we need to find an explanation for that in order to allow people to be different but perhaps it would be maybe unrealistic that it would be a better idea if we could simply be more taller and understanding of people of their behavior and their patterns of behavior without their necessarily having to be a scientific explanation for why they're different David I hear what you're saying and most of what you're saying makes total sense to me I think as well for the viewers what's important with any DSM diagnosis it's never just the symptoms themselves in a vacuum we need to also take a look at the level of impairment the severity of impairment hard interferes with day-to-day activities and functioning the level of distress because if you just take a look at the symptoms symptom for symptom many folks in the population will say absolutely I did that sometimes I have that sometimes we're not talking about sometimes or occasionally we're talking about often very often and we're talking about untreated unmanaged a very serious impairing disorder they can rule your life yeah can ruin your love these people are showing up and the doctor's office I went in with depression I went through bouts of depression I also had enough anxiety thanks mom - actually amelie ate me from some of the risk-taking that a lot of ADHD people do so I was struggling my marriage was over I you know and I was had all of the success and felt none of it I made seven hundred episodes of television and radio and I watched ten nominated for how many geminis I don't know anybody yeah amount 'less but I never watched the programs because I always had to be on to the next next next night didn't understand why I was suffering and I was successful on some level right the reason why I don't like your metaphor about height is it fails to take into account the issue of impairment and it is absolutely true that one of the reasons why the diagnosis of ADHD can be made when it should not be made is that people have not the people are doing the assessment have not adequately considered the presence and the type of impairment that's associated but the point that was made is completely clear there's very strong evidence that if a preschooler meets this pattern of behavior that are there at increased risk for traumatic brain injury forget for suffering a burn they're at increased risk for for doing badly in school for leaving school high school prematurely for being underemployed compared to their non ADHD peers and the other consequences that you've just described a 10 times the rate of hopeful car accidents according to one study my son got ADHD son got his driver's license and a month later hit a parked car in a Wendy's parking lot a parked car he hit it with his car I've had five or six car accidents all at about 5 miles an hour now when we go to the go-kart track my son and I the ADHD brain wakes up we beat everybody but getting there my wife's gotta drive us right because with when I'm bored I you know I'm sorry I'm it was it bad of me to laugh when you so no it's fine that's what I do that's a that's the whole point of what we've been doing is getting people to laugh at this I don't know if there's another like the other issue partly why you can laugh is every comedian I know has told me yeah I may be HD or their kids are and they're afraid to actually look everybody I know in radio when we ever I do promotion because we talk talk talk talk this is just so I understand this then is this a negative thing you wish you didn't have no it's a it's a thing that completely interfered with my life until I knew what was going on and then I had an opportunity and that's why I use the height analogy the height it's you're right it's not impairing but it is if you live in a world designed for 5-foot people and you don't know why you're hitting your head and you smash grandma's chandelier that that grandpa gave her that was a wedding gift and she is crying and you're not invited back to Grandma's house and when grandma dies you're not invited even to the funeral and then you're 45 and somebody says you're 7 feet tall and you go I never got to say goodbye to Grandma and it's painful to see well I was going to take up the quote from Tom Insel because I think his examples with all due respect to him he's a leading figure in mental health and mental health research but with all due respect to him.the the metaphor is a bit specious the a better metaphor might be hypertension which is not any more reliably assessed than then symptoms of ADHD I mean if you take your blood pressure if a woman takes your blood pressure it's different than if a man takes your blood pressure this is these things have been demonstrated there's white coat phenomena where it's very difficult to get an adequate reading of somebody's blood pressure because they become anxious and it's difficult to get a valid estimate of the symptoms but people who have hypertension and the more hypertension they have they are at increased risk for a variety of serious consequences it is not a single thing with a diagnostic test at the level of some metabolic marker it is a symptom just like restlessness and attentiveness and impulsiveness is a symptom and no more reliable and just like ADHD there are endless debates about exactly where to split nature into could where to place your threshold if all is tall right absolutely the question if you want to can do a public health intervention targeting everybody at risk you set your threshold lower than if you're trying to target people who are most affected for a different kind of intervention and so these thresholds are flexible when you apply that logic to ADHD people become ballistic and very anxious because of the social political and other ramifications which by the way are serious well let's focus on the kids here for a second because we had a suspect you all know him Alan J Francis who's one of the authors behind the dsm-4 I think and he was here up at Hart House at U of T actually a year ago this month and we had him on the program and well let's play a clip of what he had to say then we'll come back and check will take place the diagnosis of attention deficit disorder used to be about three three and a half percent now it's ten percent and four percent of kids in American schools are getting medication now a recent Canadian study really indicates the nature of the problem it was found that and this is a very large number of kids in Canada it was found that one of the strongest predictors for whether you had a DD or not was your birthday if you were born in December you are much more likely to have a DD than if you were born in January the only reason for this could be the school year that the kids who were younger in the classroom less mature instead of being accepted as less mature are being medicalized as having attention deficit disorder and all too frequently are given medication medication he's referring the course there I think remember to Ritalin and I wonder if you could tell us based on your experience how safe is ritalin um well not being a medical expert I can't really speak to like the side effects and the nature of the drug but I do see more and more now just because it's the media attention and the social consciousness people are very wary of putting their children on Medicare wanted your view for I will leave the docs aside for a second I wanted your take on this I did get I get actually both cases so sometimes um I see it actually being very effective with some of the clients who come in and often times I also see children come in who maybe have tried medication not necessarily but Ritalin but some sort of stimulant and then had some sort of adverse reaction and the parents have taken them off of it or are very adamant against it and then when you go and you see the child and you talk to the teachers and you see how much they're struggling being able to see that even though the medication was having some possible side effects without the medication they're clearly having a lot of other impairments so that there there may be some you know benefit or some cost like benefit analysis they can be there to try and see if there be some other drugs that they could use or other kinds of treatments that they can intervene I think at some point we'll talk later about non pharmacological treatment so I won't get into that okay but would you would but ideally these involve success non success rates where would you put the percentage um I'm not sure if I even know how to estimate that but I find that more most children actually on some form or another do actually do fairly well on the medication fruits are not right anyway if you don't have an umbrella right you go to Starbucks everybody's taking stimulant medication and are they bouncing off the walls no they can sit now and actually read every I mean when I worked at Evo people got I can't think straight till I have my coffee and my cigar you know it's first off we know from the actual clinical literature that only about 75 talked about adults now I don't deal with kids about 75% respond favorably just a minute what we don't know from these figures is how well do you respond a lot a little bit connoisseur so the second thing is that again talking about adults ritalin is not as commonly used as once daily dosing time released the interesting thing about Ritalin as we talked before is that it's been around since 1937 so probably one of the longest or the oldest psychiatric drugs are still being used but I do like your point that I'm sure others will mention it as well is that medication for any disorder in DSM is not a panacea pills don't teach skills and we know of a lot of studies in bhakta shocker can probably talk about the sea a lot better than myself there's lots of more research that talks about even with some medication and possibly some treatment there are still residual symptoms that remain impairing and impacting on a day to day basis so I think we need to kind of take a good wholesome look at the role but we're also talking about a multi-modal approach when we talk about treatment of ADHD okay Russell you want to follow it well I think you're quite right I think that first off I think children the it's generally considered that about 75% of children and adolescents achieve a positive response to stimulant medication that does not guarantee a altered trajectory through life that the it is rarely thought of it should rarely be thought of as a treatment all by itself in the absence of other non drug interventions in fact there's reasonable evidence that combined treatments are superior to drug alone and superior to non drug alone as well I might add so those are the the major considerations in terms of site of safety I think that that's a an ongoing issue I think that in clinical practice the most common adverse effects that you notice are headaches stomachaches loss of appetite and trouble falling to sleep and that can make it impossible for about 10 or 15 percent of children to take stimulant medication at all for others they have to have an adjustment in their dose no most people would not consider those serious life-threatening side effects others have pointed to the possibility that is apparently vanishingly small but still has been suggested to be associated with stimulant medication was which is a risk for adverse cardiovascular effects and so it is a black what's called a black box warning which means that every physician when prescribing this medication has to discuss this risk because why while it's extremely rare it is obviously extremely serious instead of risking kids as well yes it is well it to be honest the black box warning came out based on some reports through monitoring of side effects of in an unstructured way and then subsequently there have been multiple studies that fail to find this as an association nevertheless these black the black box warning still remains I think that and there are many position papers some of which I participated in Canadian cardiovascular Association pediatric Association psychiatric association etc that have shown that it's really not a serious risk let me with you Albert follow up on this 1937 you said right there when the ritalin was first diagnosed created and then prescribed is is the ritalin that you your profession uses today essentially the same thing that we've been using since 1937 yeah I think it is and many of the drugs that we use to psychiatry either are very old drugs or target the same neurotransmitter so why have we not come up with something a little different or better in all that time so I think that's that's a good question there's a few answers for that but first I think I just want to comment on the sort of the issues about the use of these medications in general I think one one point I want to make is that our view of psychoactive medications in our society it seems a bit conflicted but on one hand if somebody has a drink before they go to a party so that they can be a little more relaxed or if they smoke a joint before they play the guitar or take some before they go dancing we don't think that's generally okay but if somebody's feeling depressed and they take Prozac that their psychiatrist has prescribed or if they have ADHD and they get a stimulant to help them focus better then we think that's okay so I just want to just kind of point out that I don't see the drugs that psychiatry has that youth that we use in clinical psychiatry as being conceptually any different than the drugs that people use recreationally and they're just as potentially harmful and used improperly and just as much have side effects or be beneficial as well and on the issue of why we haven't been injected in 70 years yeah I think part of it is because all the low-hanging fruit has been picked that the drugs that directly bind to and shut off or stimulate neurotransmitter receptors the main neurotransmitters receptors that are already there to modulate behavior and mood and so on these have already been discovered and now the more complicated task of finding other drug targets it's kind of a categorically different problem than the original set of drugs that were first discovered and I would also say that you know Humanity has been very good at discovering compounds that are psychoactive many of the almost all the drugs that we use today that are psychoactive are Dhiraj shrimpson natural source now of course they've been copied and synthesized but you know all the opiates of course came from opium a lot of the so cocaine comes from a plant so you know many and of course marijuana nicotine tobacco these all come caffeine these all come from plants so you know a humans are very good at finding these kinds of compounds but in terms of actually deliberately synthesizing and refining and making new drugs that hit other targets to modulate certain kinds of behaviors or sort of psychological states we're actually not that good at that so I think it's it's basically it's a new kind of problem that we really don't have a paradigm to solve let me get your take on this because you were on ritalin right oh yeah so when I got diagnosed I'll set this up I've never smoked a joint I've never done drugs I've never smoked a single cigarette my parents smoked like chimneys but I was self-medicating with five or six cans of Cola which was not good for my teeth made my hands shake and actually sorry can tolola okay a day yeah yeah both you know and that's the same as four cups of coffee maybe maybe more chocolate as well I was self-medicating by being in a business that's high-stress and energizing them wakes me up so when the doctor said my doctor suggested you might try this I was are you kidding me I don't even take aspirin whenever headache it was the last person I said I don't want to lose my creativity and he said I have a lot of very creative people they haven't found that what they've reported to me is they can stick with things longer but I'm not interested in making you a busy work or busier worker be theirs so anyway so I tried it Michael John riddle and so I tried to relay it over it this was 2000 so I think the pill home I'm so scared I break it in half waiting for the slide get me one and the nothing happens lunch I take the second half like three days in and such a weenie I finally take a full one nothing so the fifth day I said I'm going to do my taxes because I mean here in a quarter behind in my GST I sat down took the pill half hour later started my taxes at 11:30 I'd done a quarter I'm only a year behind by one I done two quarters I thought I'll take a break and at five o'clock I was only one quarter behind right and the heroin up in my neck I went oh my god I couldn't even do one quarter and I've done a year's worth now here's what's interesting you said pills don't build skills a year later I'm behind again so the medication levels the playing field but you got to go out and play on the field you just got to do the things that you've got to do right I didn't put in place the filing system the organizing was so on now that I know what's going on and now that my wife finally convinced me it all goes to Peter the account and he loves adding numbers okay follow it over though you so now I'm gonna do it so now I want something called concerned okay that's what oh you'd stop taking ritalin yeah either about eight months until I didn't really need it anymore I had enough systems in place and my career kind of worked for it and then I started on concerta which is a slower rate one in the morning because we'll forget and it just there's days when my wife says to just take your conservative this morning what's interesting is when I started taking thyroid medication nobody in my family was upset about that the thyroid double well you know you have the gallbladder out sure you got it but I'm taking HTML blah blah blah they said to me as they smoke in great so and again it worked it was fine I was one of the lucky few where right away first dose first time worked and all it does is it allows me to focus more I mean it may do other things as well clearly it doesn't stop me talking too much which we enjoy here that's okay that's okay as please you were talking with regards to the safety of the medications that are being used that like I think it's a issue generally with any psychiatric medication that it needs to be monitored properly because the effects can be unpredictable and you're changing behavior in some cases and so it takes some time sometimes for the effects even to kind of be apparent and so sometimes when parents come in and talk to us what it sounds like may have happened is that whoever prescribed it it's unclear who prescribed it or in what setting it was prescribed and whether it was being followed up on properly and the other issue too may be more specific to ADHD is that there is a potential there like Rick mentioned to have issues with compliance with medication because you forget to take the doses and maybe you're not taking it properly and on the other hand it sounds like that there might also be potential perhaps for addictive behavior because if you're impulsive and you're not thinking about things and suddenly you start to have great effects with things there might also be a potential for abuse that also needs to be fallenness talking a little bit it's a medication yeah so actually the most of the research the most effective treatments rate II have other than medication really tends to be exercise and lifestyle diet changes they have the most research support so oftentimes it's you know will recommend that you need to have vigorous aerobic exercise for about half hour day just to burn off that excess energy and help them focus better and no five cokes a day and reduce the caffeine and sugar intake because often times you talk to them they're having like 5-10 cups of coffee a day so those are the two biggest things and then in terms of like behavior really a lot of what we use is behavior modification or setting up structure in the person's environment so because the brain can't you know tot manage time or prioritize or organize you put those things in the child's environment so for for children it might be training parents to kind of have a lot of structure routine setup checklists have visual aids and board so that they're kind of on track and know what they're doing the same and coordinate with the school using a lot of like graphic organizers and that kind of thing what's the best exercise anything that gets your heart rate kind of pumping and right now really is walking robic exercise yeah and then the other treatments that are kind of starting to show effect is that either you try to create the structure in the environment so that the leg environment is kind of regulating you or there's some research to start supporting that there are certain treatments that can actually target cognitive skills and executive functioning skills and help the person learn how to better sustain their attention or better self monitor and so things like mindfulness based meditation based programs and also cognitive rehabilitation programs sometimes you might use a someone who has brain injury like and there's websites that do it now to things like where you can log on and play games for it to improve your memory and attention we did on our website we did a webinar with Lydia's of dr. Lydia's Alaska down in California who has written this book on mindful meditation for ADHD and she led however 80 or 90 of us all over the world straily and Europe and everywhere in a mindful meditation exercise and then the comment every bit the comment chat aren't stopped and everybody did this exercise for five seven minutes and then it started Wow different I feel calmer clearer bangbang mindfulness meditation is not the staring at a candle trying you're never going to shut this off right you're just not gonna but what it allows you to do is to go what is my mind going to next what is my so like even here some of the practices I'm able to go shut up Rick you're talking too much or whatever I'm catching and I and then stop looking off at the camera like come on we let your documentary do a bit of the talking can we do that sure okay so you sit tight for a second alright and this is from a DD and loving it Rick greens documentary roll tape without a proper diagnosis a TD can ruin your life we know for sure this is a disorder that will hurt you if you don't look after it okay having said that the tremendous good news is if you get the diagnosis and you get proper treatment not only can you avoid all those disasters you can achieve spectacular success we also know for sure that this disorder when looked after and make someone very functional I mean you can be at the absolute pinnacle not only in terms of success but happiness fulfillment a rich and wonderful life having said that Russell Shakur there are those who now say we've got and I think dr. Russell Barkley is one of them who are saying it's not a gift to have ADHD it is a problem even if you can control it as Rick appears to be successfully doing right now most days most of the time this isn't something you should wish on having no I hear you on this I I find that last clip rather offensive because it makes it sound like you can own your own airline under any circumstances let alone if you are afflicted by ADHD I think or visible range like Terry Bradshaw yes correct I mean I think that from everything that we know first off ADHD is not it does can mean that having diagnosis and childhood means that you will definitely have a terrible outcome in life it's nothing like that but there's a very clear statistically significant relationship between having these kinds of problems in childhood and having difficulties throughout life and to portray it this way really diminishes the difficulties that these individuals have the sir well it's interesting because we saw Halliwell have debated Russell Barkley and they actually what was interesting was at the Chad event a couple of years ago they said actually we're saying the exact same thing Russell Barkley says if you don't deal with this you are screwed and what Halliwell is saying is if you deal with this and manage to succeed that get it handled you can succeed beyond what you because the problem is that so many kids with it and parents especially all the kids are so frightened that there's something seriously wrong so once in here I want to pick up on on what you were saying because I think you're on the money there we know as well from studies that roughly 50 to 65 percent of kids and adolescents go on to exhibit severe ADHD symptoms in adulthood so we know that for a whole bunch of folks this doesn't go into a remission or kind of die down but the other thing I want to say is that because of the rule of thumb there are different kinds of presentations so when I talked earlier about 75% of adults having ADHD plus or minus one other condition to go along with it I think it also depends what your comorbidity is and what your presentation is because the other thing that we haven't talked about to this point is that not everything is accounted for by ADHD because people still have characteristics they have personalities there's culture there's subculture there's all kinds of things that also play into it and to kind of have one size fits all just doesn't seem realistic to me I want to go back to Rick though he just took a shot at your documentary and said you were really misleading people with that and I want you to have a chance to well I think I'm on it no I think he's absolutely right this is a gift but if you it comes with certain if you can turn around like just there's been number Studies on creativity the ones you start at University of Memphis and we score higher for creativity and it's the same whether we're on or off medication thirty people who were not ADHD and thirty who were that said being creative great but if you're divorced you're bankrupt you can't get a job and so on what does creativity matter and so it is hugely painful I mean yeah everybody sees me as the funny comedian I have suffered I suffered I wish I hadn't had this I only succeeded because I managed to compensate for some of the downside and was lucky enough to cope or find career that played to some of the upside of this the ability to be spontaneous to be to quickly move on but if you didn't have it you wouldn't be who you are no but if Stevie Wonder wasn't blind would he be who he is and and he's actually the funny thing is he's actually said he he does he would choose to be blind now that his point in life and dr. Halliwell who is kind of at one extreme end of this is you can turn this around and I think it's a hopeful message but I you're right not everyone can if you've got no didi and other stuff going on you're in raising what so do oppositional defiance disorder and there's I mean not we end up in eighty eight not we ADHD is nine times higher in the prison population something like that now that doesn't mean that you got it you're going to jail no because those people probably also have something else either undiagnosed or untreated or whatever right would you say is that fair yes I mean obviously you know with we all have tremendous number of different traits you can describe each one of us in terms of our intelligence our creativity our ADHD ness our anxiety level etc etc and some of those traits are less adaptive than others and the environment certainly makes a huge difference some individuals are fortunate because of the circumstances that they may be born into the opportunities that they have to channel their traits into something that's constructive and they then can speak about the these traits being positive and others so to use your metaphor there are some people who are very happy that they're nearly seven feet tall like you know like chera on skates anyhow so but not everybody is born into those kinds of circumstances and our healthcare system and our school system and our social safety nets are not apparently capable of responding to all of these kinds of variations and giving kit finding the kids who need the assistance and giving them these kinds of circumstance Albert once were to thrive yeah I think that's a good point that Russell made and also I like the analogy about height actually and I think that you know when you were speaking about the behavioral treatments I mean I think that's great that we're exploring other treatment alternatives but at the same time it also makes me think that this is why people make fun of psychiatry because the idea that some kids should be able to sit for hours and hours in a classroom listening to a teacher mumble about you know British history without fidgeting without fidgeting those are the abnormal kids the kids that need to run around and and can concentrate better after that I mean that to me makes sense and the idea that we have to do all this research and come up with all these labels to finally get back to I think what is a fairly obvious observation that humans have known for hundreds of thousands of years that you know that kids need this kind of outlet I think it just it just speaks to sometimes how we just lose the force with just a few minutes to go here Rick I you do point out in your documentary and I'm going to show another clip in just a second that you can have success as you have with ADHD as long as you understand it you fit the world to you you got the right career the right partner you take care of yourself and let's focus in a little more on those five keys to success well play this clip we'll come back and chat roll tape please many myths about a Dede and I think maybe that's the scariest is that there are so many the amount of misinformation is incredible the experts aren't sure of a lot of things that some I believe separate theories have been shot down we no longer believe that a bhe is an expression of unresolved conflicts but a frank expression of some hardwiring differences what we no longer believe is that people outgrow it it continues on into adulthood what I learned to do in graduate school to treat ADHD I would now consider malpractice yeah our understanding of this has changed that much over the point when he said that interviewed my wife was in the back co-producing and she both of us independently thought that's the opening line the documentary and it actually we decided not to use as the opening but that is it is changing so rapidly the statistic I heard was 95 percent of what we know for sure about the human brain has been learned since 1995 because of MRI and all of the technology but you opened by saying you know this diagnosis has been around for 10 years with this name yes but Google fidgety Phil written in 1844 by a doctor for Judy Phil can't sit still there it is a clinical list go watch The Sound of Music and listen to how do you handle a problem like Maria it's a list she runs with Jane she whistles she laughs she makes us laugh and then we find her annoying and it is a list of and she was shouldn't have been a nun she should have been with surrounded by kids leaving MIT singing and dancing in the Hills house she ultimately did and she did and she soared and she won probably five or six Oscars as did the movie it's figuring out who you are now that said the doctors see people who are struggling in ways that I can't imagine I mean I've met people who can barely who can't finish a sentence their mind is going so this is a spectrum there are people who are seven foot six and they're not you know and height people that don't live as long and when you've got ADHD you are really struggling it's our understanding of this changing fast enough to give you satisfaction on how to make people's lives better it's interesting your comment because back in the day I was taught like a lot of other folks around here that you outgrow it and basically that's the end of it and by the time they got to adulthood if there was a diagnosis we call them something else I'd sort of pick up on one thing if I can early that let my car made around treatment working with adults and not kids I do want to say that there's some nice evidence coming out all the time about the efficacy of cognitive behavioral therapy for adult ADHD and the two things to note there is that when we treat ADHD in adulthood we're looking at two things we're looking at the level of impairment and goodness-of-fit and how much buffering and compensation etc have you done where and how you might kind of you know look at all of those things but we're also taking a look at issues that pertain to the fallout of having ADD ADHD your whole life and some of the resentments some of the grief some of the feeling of blame expectations etc etc and that that seems to be where we're also kind of heading to the other big thing is that because of the high rates of comorbidity oftentimes in the clinicians office in the trenches we're treating more than one disorder at the same time so typically I'm going to see folks who have got depression anxiety adult ADHD and they're hooked on marijuana cocaine and so there really is a multi-modal approach that is needed of course you have to decide what do you tackle first of all you do concurrently and that's a discussion for another day but that's oftentimes the reality in the trenches well I know one of the things you recommend is something that is really not consistent with somebody who wants to do well in television turn the television off yeah you've suggested that well not that we're going to do that right now with an alpha state that it puts you into it puts you into a state of pacifist and a THC that the names wrong attention deficit is not a deficit when I'm working on my model railroad my wife has to come and yell at me to come to bed and it's 1:30 in the morning suddenly when we're in a video game if that's what we do then we are locked in some of the ADHD doctors we interviewed once said she everybody else took six breaks on their final medical exams over the full day she took two so we can hyper focus right you watch in hockey there's ADHD in sports and athletics there's a lot of in Fire and Rescue I mean the cops get into trouble when they're not on duty when they're hanging around when there's top action and everyone else is running away in a panic and alarm they are laser beam I walk out on stage in front Massey Massey Hall in front of 2,000 people calm and clear I have to sit down and add up my receipts I'm like Superman with whatever tonight what is turning the TV so turning a TV obvious TV does not help TV it just puts you in this neutral state and it doesn't improve anything there's one study that said every hour of watching TV lowers your happiness by three percent and that's not even a CH D that's just a general I say turn off the TV get the kid magic tricks or a Diablo or dance lessons or exercise class something participatory martial arts focus movement all of those things that so that rather than this having to constantly move and yet Russell is am I right about this developing a video game to assist yes I think it was hurry to what he's just suggested no no no video game video games actually work acted rather yeah right that's okay that's the distinction well there are number of distinctions I mean I'm not as anti television because and well yes I think that a lot of times children who are not well behaved and compliant and when I get stuck in front of a television as an alternative form of parenting to give the parents a much-needed break sometimes what's the gist of your video game the video game well I think the idea is to to start with an analysis of the kinds of cognitive deficits that kids with ADHD have have and to build strategies to help them overcome those that is very different than just giving them a any kind of computer game to play because those games tend to be highly arousing and not focused on the kinds of cognitive deficits that children with ADHD have and we know about so that's the the goal is to construct the games in that way Rick you host television programs you know how to take account I got 30 seconds left thank everybody well hang on here's the question oh okay and let the camera and say next week yes my quick he remembers I'm impressed are you cured I am struggling less there is less disorder in my life I still have bad days I could still sink into it sink into it or get lost or get overwhelmed or get worked myself into a marvelous ugly-looking frenzy but no it's the level that I met it was like this and it's now like this your edges are more beveled yeah and I just have more power around it have more access around it there there are diagnosis that you can get a mental health where it's just take the pill this one is the pills really going to help but you're going to have to develop a bunch of skills and you want to have people around you supporting you and not afraid and my mission is to get rid of the stigma so people at least are willing to look that's Rick green you can learn more about him and what he's been dealing with for the last many years at totally a didi calm he's also producer and director of a DD and loving it Rick great to have you back here it is so much dr. Russell Shakur senior scientist psychiatry Hospital for Sick Children dr. David Teplin adult clinical psychologist dr. Albert Wong research scientist at CAMH assistant professor of psychology and pharmacology at U of T Ravinder Sidhu clinical psychologist wings neuro rehab great of all of you to join us today for this discussion thanks so much thank you support Ontario's public television donate at t v-- org

Channel: The Agenda with Steve Paikin

Views: 204,773

Rating: 4.8497338 out of 5

Keywords: TVO, TVOntario, The Agenda with Steve Paikin, current affairs, analysis, debate, politics, policy, brain, child development, mental health

Id: CJ94RFdctH0

Length: 54min 10sec (3250 seconds)

Published: Wed May 22 2013