Dilemmas of ADHD in Teen & Adults ADHD 2010 A

so let's talk specifically now about adolescents with ADHD and then I'm going to talk specifically about adults with ADHD although some of this stuff of course overlaps the first thing to keep in mind when we're talking about adolescents with ADHD is they're adolescents and so all those things that any adolescents are going to be struggling with are things that adolescents with a DD are going to be struggling with having a DD doesn't make you a completely different person and so they have all the usual range of limitations and frustrations and challenges as the Friends of the same age and yet often they're a DD makes it harder for them to manage that stuff that's not so easy for anybody to manage what are some of the tasks that come up more during adolescence well a big one is managing time and homework because there are a lot more things to do particularly if you're involved in a sport or you're in clubs or you've got a dating relationship and you're driving you're taking driving lessons you and then you get your license and you drive developing relationships finding out who you want to hang out with and maybe finding somebody you want to date driving a car and then eventually leaving home and modifying your connections to your parents those are just a few of them so the question then becomes or how does all this affect a DD let's talk a little bit about a couple particular examples this is a kid I saw just a few weeks ago 16 year old boy in 10th grade really bright kid you know you'd expect if you look at his IQ which is in the superior range you'd expect to be getting mostly A's and B's and he's actually getting mostly C's once in a while a B once in a while a D and it was clear that he had a DD but he said you know I I really don't think I want to take any medicine for this I don't like the idea of putting other things into unnatural things into my body what became clear when we spoke a little bit further was that he was already putting quite a bit of THC in his body but he thought of that as a natural substance he was a kid who aren't quizzes and tests did quite well because he was able to listen to what was going on but the problem is he didn't read the assign materials and he would getting a lot of zeros into his average because he wasn't getting his homework in that was why the grades were you know sort of stuck at that level and what he had discovered was worlds of warcraft a computer game which is extremely challenging and complex and fascinating for a lot of kids particularly really bright kids it's referred to colloquially and this boy was playing on average about 6 hours a day of this game which has played not just with you in this game and not just with you and a couple of year friends there's a whole network all around the world playing this game and the fact is he had begun to get so involved in this that he who had cared quite a bit more about his schoolwork and his friends wasn't very interested in either one of those things and he began to talk about how a question that he raised with me he said can a person become addicted to a videogame and then we went on with the discussion about wow now the thing was that he was not only addicted to wow he was also addicted to getting high and he was smoking every day before he went to school he was smoking every day just before bedtime in order to get himself to sleep and what had precipitated the conversation his parents bringing him into my office was he was demanding that now that he was 16 he should have his license and a car and his parents said we don't know what to do about this and I offer this as an example of how sometimes people can sort of get themselves into a bind and expect that they can go on and do everything that everybody else is doing but the fact is kid getting high as much as he was was going to be a risk in driving particularly the first year or two as the incidence of motor vehicle accidents with kids who are getting high plus having ADHD plus being an adolescent and an experienced driver that doesn't look very good on the actuary charts for the insurance company you know and so what had happened in what brought him to the office was his parents are saying oh you want to drive do you and he said yeah and they said well we'd like to see a few changes in terms of your being able to get your schoolwork done better and in terms of reducing the amount of time you're spending it Wow to something which is a little more manager we're not asking to quit it we're just asking you to reduce your consumption of both the weed and the videogames led to some interesting discussions there's a 17 year old girl she'd been on the honor roll in ninth and tenth grade she's now in 11 and the grades were starting to take a nosedive and she was not addicted to wow but she was addicted to her boyfriend she had gotten the guy interested in her that she was really interested in and as a result they were spending almost every waking hour together that they could and then when he left at night they would spend a couple three hours more on the phone as she was lying in bed trying to get ready to go to sleep and often wasn't getting asleep until about two o'clock in the morning and she had to get up at 6:15 in order to get ready to go to school homework often was later it just wasn't done pretty smart kid and she was diagnosed with a DD several years earlier and she was taking medicine which was supposed to last all day in this case concerta to help her but when she came home every day they were having a lot of trouble with arguments with her parents and really nasty snotty attitude with her siblings and the question is what's going on now when you begin to look at these facts you can say well she shouldn't be spending so much time with her boyfriend maybe she should be getting her homework done she knew all that but the problem in this case was she was on an all day medicine where people didn't understand that the term all day with reference to a DD medicine means all school day most of them don't last much more than three or four o'clock in the afternoon some people it does work later these are averages we're talking about but what was happening with her was she was having rebound every afternoon after school from that medicine where it was dropping off she was crashing and she was in a lousy mood which then intensified her need to interact more with the boyfriend and which left her with absolutely no help from the medicine for being able to get her homework done so I'm just offering this is a couple of typical examples of just a few weeks ago the kinds of things that you see often with adolescents and then there's the transition that's involved in getting ready to go to college I'd like to read you I remember reading some case examples this is out of the book I published which is in fact available it's one of the goldfish on it there's a bunch of case material and this particular guy letting he was 18 and he was referred in to see me after he had been taken to the hospital senior year of high school and they had got it was like January or so they had just gotten the applications for college done and here's the way he explained what happened he said you know my girlfriend and I were with a few other seniors at this one kid's house we got in a pizza and coke to celebrate that all of us had finally finished up our college applications it was the last day for us to hand them in to the guidance counselor for mailing just after we got to the house with the pizza I got this huge pain in my chest and I couldn't catch my breath I'm a good athlete I'm in good condition I've pushed hard and tough competitions I had never had anything like this I felt like I was going to die my friends got the ambulance and they took me to the hospital I was there for about five hours having tests and after that the parents the doctors said I was just having a panic attack not a heart attack I guess that was a relief but I don't know how that could be because I didn't feel worried about anything well we spent quite a bit of time talking about it and as we spoke about what was going on the precipitance of this panic attack became a bit less mysterious even though he wasn't consciously aware of any worries specifically what he gradually realized was the act of completing his college university applications and sending them off was a milestone that had triggered a lot of fears most of all he wasn't afraid to leave his parents he was afraid to leave his girlfriend here's what he said he said I just can't imagine being without her we've been going together for almost three years and we do everything together all the colleges I've applied to her just a couple of hours away but she's just a junior so she'll be here after I go even though we say we'll never break up I've seen a lot of other junior senior couples at our schools say that and then they ended it before Thanksgiving because they couldn't handle being the part in two different worlds they're so separate I just couldn't take the idea of her dating anybody else besides I don't know if I can get my work done without her she's smarter than I am and she's always helping me study for tests and helping me write my papers and reminding me to get my reading done she gets mad at me if I don't get decent grades on everything and every night I talked to her on the phone for at least an hour while I'm home in bed even if we've been together all the time from when practice ended until we have to get home it's almost like we're married see I think what this does is give an example of how sometimes the relationships which are helping to keep people afloat aren't necessarily the relationships with the parents they may be with a boyfriend or a girlfriend or a teacher or a buddy you know this is you know the picture that I drew when after I do an evaluation often in the first session I'll take a blank piece of paper and draw a square like you see the middle square and this is that same kid and what you see for what I draw first are the bark down some of the strengths this kid was you know a very good athlete and that was he was in three sports he was excellent he was a great keyboard player and singer he's saying with a group where they did gigs it a lot of parties a lot of good friends he worked pretty hard to keep his BC grades but he also had some problems and the circles you see in the middle in that Venn diagram are I draw those to represent the difficulties that the person is presenting and he'd been diagnosed as having ADHD plus a reading problem plus a disorder written expression which means difficulty in being able to get your ideas out on a piece of paper in sentences and paragraphs and then of course there was this acute anxiety problem but then after I've talked with the Fant with the patient and the family and got them to help me figure out how big each one of these circles should be I draw another rectangle around that and in there make reference to various stressors and supports that the person has he was waiting for college acceptance he just gotten his application in that was a problem and he was thinking about when I get to college I know how good I am on our teams here at the high school I don't know how good I'm going to be compared to the other college athletes he had very supportive parents and sisters he felt bad about leaving his teammates and his coaches he was worried about his grandmother who had cancer and he wasn't sure she was going to live through this first year of college but the big thing he was worried about is in the lower right corner losing Lauren's companionship the girlfriend and her daily help with schoolwork think about how big a change this kid was facing when he was going off to university and you can realize that particularly for somebody who's not much into talking about what's going on in his life when that morals a milestone was crossed of setting those applications in all of a sudden in the back of his head you start getting the intensity of the worry about what's going to be happening how's it going to be it's a big transition it's probably one of the biggest transitions that any of us ever make how often do you ever have without any precedent a situation where you're leaving where you spend most of your day for your job school where you're leaving the place where you've been living most your life family where you're leaving the neighborhood that you've been accustomed to where you know where to go to get a pizza and a late-night burger or something like that and where you're very familiar and suddenly you have to go into new environment where all those things are going to change that is a big change particularly when you've never done it before so that you have these structures that are changing and you'll lose the day-to-day contact you know the kids as they're getting ready to graduate from high school I said we'll stay together we'll keep in touch and they will by email and Facebook but it's not the same as living day by day in the same place and they know that and having to learn a new social matrix a new community and encountering these unknown zones of social academic and athletic competition how am I going to stack up big change now what are some of the things that then become a problem when a person makes that transition into university well one thing is keeping in mind the big picture of time and priorities for assignments because when you get into a university the professor is not going to be saying okay are you guys getting your notecards done you know has everybody got their list of references for the term paper now remember we're going to have a quiz next week you know in a week after that we're going to be having the exam most professors are going to come in they're going to talk content and they are not going to be holding people's hands to help them figure out what they should keep in mind given the fact they've got four or five classes they're all supposed to be taking at the same time you know a lot of students when they move to university have not yet developed an efficient system either paper electronic to keep track of their workflow and their daily priorities not an easy task and then there are some students who are too perfectionistic just as there some who are way too casual and they waste too much time working on some tasks and not being able to take care of the others I had one student who came in a university student he came in and he said he'd gotten a lousy grade in this course that is actually two courses he was taking and he said I just didn't have enough time to study for those midterms and I said why was that and he said well I just spent too much time taking my notes for my reading for my psych course and I said how much time are you spending and so my god I must have spent about 20 hours last week working on my notes for my read for my psych course I said how many chapters he said that was I guess three chapters I said bring in your notes in your new psych book and he handed me a set of notes that looked like they could have been bound and published you know he had actually gone through and rewritten paragraphs about all the key points and a lot of not key points from the textbook and then had gone on on the on the net and had downloaded illustrations that were not in the book that he could use to illustrate those points for himself and it would have been a perfectly good textbook for people to use in another school but in the meantime of spending those 20 hours he had not gotten the work done for these other courses where he was now in big trouble you know being able to manage that stuff out in a way that you can weigh the priorities is not an easy thing another thing which is a problem a lot of folks when they get to university suddenly discover that professors assigned more reading that is humanly possible for anybody to do if they're going to get any sleep at night and often what happens is that the reading gets pushed aside because nobody is asking you about it every day and you suddenly realize oh my god we're having a test and I have five chapters I'm supposed to have read that are going to be covered in this and how am I going to be able to get it done and then problems and being able to decide which things you have to decide which things you read very very carefully which things you read sort of which fridge things you skim and which things you just blow off and those are not easy decisions to make but if on top of that you have a problem that a lot of folks with a DD have with reading it's doubly difficult think about whether you have a TD or you don't think about what it's like if you read when you're dead tired you've been working all day you've done whatever you have to do all day and then you may be going to the gym and you have been hanging out with some friends or prepared meals for family or whatever maybe you got to get some laundry done and you got some paperwork to do and then you're just about ready to go to bed and you realize that there's something you need to read now because you're going to have to do something with it first thing in the morning and so you matter a couple of obscenities and grab it out of your book bag or your briefcase sit down and you read it you understand it perfectly well as you read through the thing and then you stop you finish it and you realize your eyes have gone over every word and you do not have the foggiest idea of what you just read if you ever read like that when you're tired and you read and you think you understand it at the time but you just can't remember that's the way most people with a DD read all the time and so as a result often they've got to go back and read it again and read it again yesterday I mentioned one student who said to me when I asked him about this he's he said you know when I read something that I'm not that interested in that that's a very important point if the person's reading something that really is interesting to them they don't have that problem they can retain it but if it's not something that's really interesting to them it's something just assigned and required and they have no special interest in it students said it's sort of like I'm licking the words and not chewing them you know I'm not able to get them really into my head so that I can get them later and a lot of people don't understand how to mark and highlight what they read I had somebody the other day I was talking with about this and I said do you mark your books when you read them they said oh yeah I highlight them so let me see and he opened up a textbook and both sides every bit of the page covered with yellow highlighter he didn't need a highlighting pen he needed a roller a paint roller and he could just highlight it that way this has nothing to do with being able to read and remember what you're doing you know it's a paint job you know and what he hadn't learned was how to use the highlighting as a way of indicating which things in this book that is chapter that I'm reading are important that I'm going to want to be able to go back to so I don't have to read the whole damn thing over again when it's time to review for the test some of those study skills are not adequately taught in high school and they're a big problem for a lot of university students but think about problems another one is that being able to manage sleep now having problems regulating alertness is not n sleep is not part of what's listed in the symptoms of ADHD but I can tell you most of the patients I've seen particularly University students although a lot of high school kids and a lot of adults particularly single adults who are living alone who do not have somebody who's going to go through the bother of dragging them out of bed in the morning report that they have a problem with this and the problem often takes two forms one is that they'll say I often stay up a lot later than I really want to or should because I have found if I try to go to bed before I'm absolutely exhausted I can't shut my head off I just keep thinking of stuff it doesn't mean I'm worried just I think it's tough and so I usually busy myself by staying online or reading or watching TV or whatever until I'm absolutely exhausted often until 2:00 or 3:00 in the morning and then I'll crash but then I fall asleep okay but when I fall asleep at that point I sleep like a dead person and I'll have several alarm clocks and I've gotten pretty loud alarm clocks much to the annoyance of other people and women in my dorm but the fact is I always keep hitting the snooze button and I really can't awaken with that and sometimes people come in and wake me up and I say yeah yeah I'll be there and then I'll fall asleep some parents told me the other day that they this is a big kid about six for a high school student senior in high school basketball player who had this difficulty and they were laughing because we're I was asking questions about this in the evaluation and they said I'll tell you what happened this morning it took us a half an hour and six tries to get him out of bed which is not at all unusual but then we came back upstairs after we were trying to get breakfast ready and he didn't show up and he was out of bed we heard the shower running and he's sitting on the floor of the shower stark naked water running over him absolutely sound asleep and snoring you know that there are a lot of folks with a DD they have trouble being able to let their mind settle into sleep and relax but then they also have trouble when it's time to wake up in being able to come conscious again and then of course the other problem that comes with that often is they're fine when they are on their feet moving around or if they're talking a lot but if they have to sit still for very long to listen or to read or do paperwork their eyelids start getting kind of heavy I had one student had this kind of difficulty that I wrote about in the book and he said you know I had a terrible time I wasn't it I had this 8 o'clock class in the morning and it was a [ __ ] I just couldn't get to these classes and so it was coming up on final exam time and the instructor had announced that he my friends told me that he had announced that he was going to give the review for everything we needed to do I got myself to sleep early that night and I got up early and I went and I had breakfast and then I went over and I was one of the first kids in that lecture hall and there about 300 us in the in a lecture hall and I sat down and I had my notebook open and I was all set to take notes and I started he came in I started writing and I was getting detailed notes because I wanted to be able make up for what I hadn't been able to hear before and he said the next thing I knew there was that banging of these desks that you know they had to pull up desks and that were falling back and the thing in the class was over they said I looked at my notebook and I had notes for about the first five to seven minutes of the class and then I'd fallen asleep he said I had had eight hours of sleep that night but he said that happens to me all the time there are problems with regulating alertness that are an aspect of a TD for a lot of folks with a TD and of course the other problems that come with that are people decide they're going to help themselves get to sleep by having a few more drinks or by getting baked that night and then of course it's harder to get up the next day and often then you get university students and young adults and older adults who end up reversing their days and nights and there are not they become nocturnal creatures and there's nothing wrong with that except for the fact that the rest of the world is not operating on the same schedule keeping up effort going to university is a very difficult task because there's not much to encourage the persistence of effort very often there are just a few assignments that are going to be collected and graded or a few tests and you don't get much feedback a lot of professors are not wonderful about handing back your papers promptly and giving you a lot of response in terms of what you're doing some are but not or not and often a big long term paper counts really heavily but the problem is it's hard for anybody but particularly people with a TD remember the reward motivation thing I was talking about before to work on them over time without getting any feedback and these longer-term threats or rewards don't you know if you if you get a good grade on that term paper that's going to count 75% of your of your term grade or even 50% of your term grade and then you've got two exams 25% each those are not big reinforces for persons with ADHD because people with ADHD because of that reward system thing I was talking about before often have difficulty in being able to stay up in their level of motivation for a task where the reward doesn't come until later anybody see the issue last week of Time magazine or maybe two weeks ago where they had a question on the cover of it should schools pay cash to reward people for learning well there's something to that I'm not advocating that we can't went out and about to change the schools to do that we're lucky we can pay teachers these days in the States anyhow but the point is the payoff for work there are many people whom I see who do very well at jobs where they get paid every day or they get paid every week every Friday you collect a paycheck and they have a very different feeling about doing their work they're compared to doing their work when they're just going to get a grade at the end of the semester you know there's a difference in how those things operate with the chemistry of motivation a lot of people with ADHD also struggle with processing speed that's a measure we've got a couple sim tests on IQ tests are not wonderful but they often correlate pretty well with ability to take notes in class and to get an essay written but the processing speed is like having a slow modem you may have a very good computer but a very slow modem in terms of being able to crank out the work particularly when you have to take notes or when you've got to write an essay and that's one of the reasons that a lot of folks with ADHD need extended time when they're taking tests the Komet think about the combination if it takes you longer to read and you've got to go back and read that material a couple of times on the test to be sure what the paragraph says about what the question is and then it takes you longer to write the sentences and to figure out what you're going to say it makes it very difficult to be able to do this within some of the standard times that are allocated for it particularly when it's high-stakes testing and you've got a lot of anxiety as well and of course one of the key problems in a DD is working memory being able to keep things in mind students often complain that they will study for an exam it'll be often being a group of people studying for exam when they're in college or university or they're at home and they'll study and study with one of their friends or with one of their parents and they'll go over the stuff and they've got you quiz them what are the answers to this this this and this and they've got it they go into class the next day thinking they're going to get a good grade in this and all of a sudden a big chunk of what they knew the night before is just evaporated it's like you've got a file in your computer where you've forgotten the file name and you know the stuff is in there but you can't pop it up when you need it and then a few hours or a few days later something jogs your memory it's all back again it's not they didn't have it as they couldn't retrieve it you see working memory is the search engine for the brain and in a DD working memory is one of the primary problems you know and of course within this working memory is important not only for reading being able to remember what it's said in the last paragraph and the previous page but also for listening and taking notes I've see a lot of folks with a DD who will say I have to make a decision when I'm in a lecture as to whether I'm going to listen to the lecture or write notes I cannot do both at the same time because what is working memory it's the ability to hold one thing in mind while doing something else and then if particularly if you happen to have a professor who lectures very fast and on top of that some of them we have a thick accent which is not a language that you're accustomed to listening to that makes it very very difficult to be able to get this stuff down and then of course with writing papers one of the most difficult things for most people with a DD is is getting essays and term papers written being able to keep in mind what in the world you were talking about and how is this point related to that point rather than just sort of going off on some tangent now when you talk with university students and high school students about medication there are many of them who say I don't like putting unnatural substances in my body you know I don't see any need for that I think we should do with what we have you know and they don't want to believe that there is a chemistry to motivation which is not much under their control but one of the first things that needs to happen if a clinician is going to be of any help at all to somebody like this is to do some education which is credible about what ADHD is and its causes so they can understand the relevant science a lot of discussion about ADHD is so superficial so lacking in any scientific basis that people don't take it seriously they're still thinking these are just misbehaving kids so we now know there are a lot of folks with ATD who've never had any significant behavior problems and that even for those who do that's usually the least of it you know and so the first thing we need to do is to be able to provide people with AD D some compelling education about what this is not because we're trying to sell them something but so they can make informed decisions but then even if they make a decision say okay well I'll try the medicine then trying to find a doctor who understands this and is able to work with them and fine tuning that making a good choice about the drugs and the doses one of the things that I've learned to say to people with a DD adolescents and adults alike is I cannot promise you that medicine will help all I can tell you is your odds are eight for 10 you know there were some people in those eight out of ten who are lucky enough that the medicine works for some of them it's huge how much it helps them others it's substantial but it's not huge others it helps a little not that much and two out of ten it doesn't do a damn thing the other thing that's important for people to know is a DD is not cured by the medicines we use it's much more like my glasses I have a problem with my eyes I can't read typewriter sized print without my glasses you just look brewery to me put these on I can read it about as well as anybody can take them off I'm right back where I started the glasses don't fix my eyes they just help me see when I've got them on and a lot of people will have problems in in taking medicine when they're living in dormitories in the university or if they're living in a rented house where a bunch of other students are in and out and the problem with this is that these medicines have street value particularly the short acting versions of them you know and so with college students I generally have a little talk I give about this saying look if you're going to take this medicine to school do not leave it out on your desk or on your dresser don't keep a whole supply your whole supply in your backpack take only one week's supply out at a time and put it in your sock drawer or your underwear drawer or someplace where it's not going to be obvious don't put it in your shaving kit or in the little bucket you use to carry your shampoo into the bathroom if you're sharing the bathroom with a bunch of other people because otherwise you're standing there all lathered up and you come out you've got your pills there so you remember to take them and you find the bottle of pills is gone and you have no clue where they went and that's the end of your month's supply of Medicine and you're not going to get another supply for the end of the month that's one problem the other problem is that there are there's a lot of data that suggests that a lot of university students and some high school students will borrow or sell medication their medication for a TD to other students now there's some who try and crush it and get high it's not a real good way to get high but most of them are taking it because they're using it to try and pull an all-nighter so they can make up for all the work they didn't do in the preceding five weeks all in one night good planning but the thing that it's important for people to know about this is that if you give medicine to somebody and somebody comes down and says hey I understand you've got some ATT medicine can I have a couple year pills the tendencies want to be a nice guy and say okay sure I'll lend them to you or sell them to you by the way they often do it but there are a couple of problems with that one is that if you give it to Jim then two weeks later Joe is going to be down knocking on your door asking for the same thing and pretty soon you're going to run out of pills and you're not going to be able to get a refill until it month is up and the other problem is if you decide you're going to say no it's very hard to say no to one friend after you've said yes to several others but there's another problem I think the laws in Canada are similar to what they are in the States on this and that is if you give us a schedule to drug a controlled drug like the stimulants we use for ADHD to someone else even if you don't get a penny for it you're dealing and you can do it a hundred times and nothing happens or you could do it once and that's the night that that kid takes the pill and goes out and gets drunk and walks in front of a speeding car or falls off a balcony and pretty soon you have any answer questions from the police you'd rather not have to answer you know so managing medicine is a problem a lot of kids with a DD come with a whole month supply when they come into University they've got it they're used to their parents getting a Murray field they run out of medicine and then it's mañana mañana mañana for getting it refilled and pretty soon we have a month in which no homework is being done you know so the other thing is that there it's important to understand are we giving a medicines actually helping this person and not causing trouble for them and are they getting adequate sleep and not getting drunk too much and not getting stoned too much to mitigate the effects this slide is just an example of a little drawing I do for most people when I'm starting on stimulants to talk about the question of how do you tell when you're getting too much of them of stimula medicine and the way it works is like this that if this represents the point at which you take the medicine it kicks in and maybe an hour or an hour and a half and then it does its thing for whatever the length of time is depending on the formulation and then it comes down if during that time the person is feeling or acting they're excessively wired like they've had way too many cups of coffee and kind of jittery the dose is too high or it's not a good met for them or if during this period they're feeling really crabby where every little thing is pissing them off way more than it would normally and then it gets better when it wears off dose is too high or it's not a good medicine for them or if during this time they get too serious and they sort of lose their sparkle they lose their sense of humor they don't feel much like interacting with other people and then that gets better as the medicine wears off the dose is too high or it's not a good medicine for them but if they're not having any of this as a problem during this timeframe and they begin to get any of these things during this time when it's supposed to be wearing off late afternoon or early evening that is a completely separate problem that's a rebound and what it means is not that the dose is too high because that you would have seen here it means it's dropping too fast and the person's crashing and so what we have to do then is jump in a little bit ahead of that and give a small dose of the short acting version of the same medicine so that as this one's coming down we've got this one coming up but not coming up so high so we can smooth that curve so it can come down more slowly one simple thing like that can make the difference between a person's being able to use these medicines successfully and they're feeling like it's messing them up that kind of fine-tuning is critically important and you need a doctor who's willing to ask the questions and listen to the answers to the questions in order to do that kind of tweaking and fine-tuning for the medication you know I've had so many patients who have come in and said oh yeah I stopped taking that stuff it was making me too crabby my first question then is when which of those two timeframes is it because that's what tells us what to do and there's some people who say well you know I don't feel very social on it I feel depressed and then you ask some questions about when the amount of stimulant a person needs this is true whether you're talking about methylphenidate based compounds or amphetamines has nothing to do with how old you are how much you weigh or how severe the symptoms are it's how sensitive is your body to it I treat little kids teenagers and adults most of the little kids are taking small doses most of the adults are taking big doses but there are some of the little kids who are the same size same weight same symptom severity as all the other little kids we've got to go to the top of the dosing range to touch them their bodies just are not that sensitive to the medicine and we've got to crank it up in order to reach them there are some adults taller and fatter than I am who are taking baby sized doses even though most of the other adults are taking big doses go figure it's a fine-tuning job and it's critically important for people to have that kind of help to be able to get it and with students we've got a problem high school students and elementary school students most of them do better if you give them a long-acting medicine like concerta or extended-release adderall because that'll get them through the school day and it often will leave a little bit for getting homework done in the afternoon or evening and some people that last too long and you've got to worry about sleep but most of those long-acting medicines rarely last more than ten hours and there are some people who do just fine on that and it will cover them for the whole day but there are a lot of people where that'll get them through the school day but they've got no coverage for their homework or anything they're doing late afternoon or early evening and so we often sixty percent of the people I've seen unconcerned in one of the studies I ran needed a short-acting methylphenidate booster late afternoon early evening to get their homework done or to manage the stuff they have to do with the family and the pharmacy companies don't tell you about this stuff in university because the schedules are so changing from one day to the next where one day you may have morning classes next day nothing till mid-afternoon and they're often a lot of the work is being done after sundown some of those students are better off with short-acting medicine where they've got easier control of it in terms of being able to move it around or some will take a short-acting in the morning and then a long err acting in order to cover things late afternoon and early evening as well that's the kind of fine-tuning which is particularly important for being able to get students through college and university in high school

Channel: CADDAC Centre for ADHD Awareness Canada

Views: 113,382

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Id: 1LkZguH9o7o

Length: 39min 33sec (2373 seconds)

Published: Thu Nov 19 2015