Understanding the Nuances of ADHD | Michael Manos, PhD

hi thank you for joining us I'm your host Matt I user and you're listening to health essentials podcast by Cleveland Clinic today we're broadcasting from Cleveland Clinic main campus here in Cleveland Ohio and we're here with dr. Michael Munoz dr. mouth is a psychologist at Cleveland Clinic's Children's Hospital and we'll be talking about ADHD thank you so much for being here today my pleasure No thank you for having me and please remember this is for informational purposes only and it's not intended to replace your own physicians advice let's talk about ADHD let's just talk about definition what is ADHD there's a formal definition and the formal definition that it is a biological disorder and it's associated with particular symptoms and a particular network in the brain and the core symptoms are inattention distractibility and hyperactive impulsive behavior that is a typically useless definition for most people and the way it has been defined is that ADHD is like having a Ferrari engine for a brain but with bicycle breaks it's it's actually somewhat of a misnomer to call it an attention deficit because what it actually is is attention to too much the thing is that the brain is always active it's always putting its attention on something and the difficulty comes in when the person can't select the object to put attention on and keep it there because the attention wants to go where it wants to go sure sure so you're saying it's not trouble paying attention it's being attention to too many things at once yes exactly that's well said ok so how common is it nowadays that is a question that keeps changing but the current prevalence data in the United States from the Centers for Disease Control is 11 percent worldwide present prevalence is 7.2 percent which is huge when you consider that evolution biologists say that natural selection selects for a particular condition if it's 1% of the population this is very very high yeah that is very high so is it considered a learning disability no learning disabilities are associated with difficulty in manipulating or managing the symbols of language so there are reading disabilities there are math disabilities we call dyslexia or dyscalculia ADHD is a matter of placing attention to sustained attention for task completion associated with doing that the way you do that is to use executive functions now most of us especially those of us who have work that requires it and it's especially needed in school we have to self-regulate so in an adult example for example if it's if it's 2014 and you have your taxes due and it's April 14th and taxes are due the next day and it's a beautiful day outside and you haven't done your taxes you have to regulate yourself to sit down and get your taxes done rather than go outside and enjoy the day we use executive functions for to do that the self regulation that is available to most neurotypical individuals not available to an individual with ADHD the individual with ADHD tends to live a different sort of life they're attracted to the world around them using language which is how most of us get things done it's how I got here to talk with you it's how you got here originally it's how our administrative assistants manage people we use language language to manage personal behavior in a person with ADHD is not very powerful so we might go to the store we might have in mind I have to get milk eggs and cheese and you get to the chuck store you buy what you buy and you walk out and you have bread and you have Havarti cheese and you have one of the broiled chickens that are and you walk out with five things and not one of them is one of the things that you said you were gonna get so you see language is not as particularly potent that's why you don't treat ADHD by consoling constantly that's useless I mean I know how to say brilliant things I can have golden words come out of my mouth when I'm talking to a child and by the time the child ends the session and walks out the door of the hospital at the rehab hospital walks through the green awning whatever I say is gone it's why parents and managing children with ADHD they do all this talking and a child does something like spills the milk the child gives a five-minute lecture on how you're supposed to hold the glass with two hands and you're supposed to whatever it happens to be and the next day the child sitting down spills the milk again you get the idea okay so language is not it's not the appropriate way to communicate with a child with ADHD well appropriate it's not I'll use a different word it's not the effective way of making a difference for ADHD I've given lectures in a lot of places I and I went out to Stanford and gave a presentation there and I told him at the very beginning look I'm an expert in ADHD by the time this conversation is over in the hour later after we're all finished I will know exactly who in this room is ADHD come up and talk to me afterwards Wow for example you can often tell people who have ADHD not because of overt symptoms but because they seem just to notice everything there are some adult jobs for example that are perfect for the ADHD brain but when you have ADHD your attention is on the world around you your attention is drawn to any change in the world around you and if the world around you is not particularly fascinating or interesting or attention-getting guess what the brain generates thoughts and conditions it can ruminate on things that happen years ago the brain will always be attending to something that's the difficulty of ADHD it's the nature of it now when you consider adult positions adult jobs consider a policeman what does a policeman have to do what's good policeman goes to a crime scene what does he have to do or she have to do to notice everything there are certain professions David Neil Amon for example was the former CEO of JetBlue now those people who follow airlines and stocks JetBlue was the most successful Airlines for a long time I think now it's second to Alaskan air but you know what he said he said I wanted to make the airlines suitable for me I want things fast simple and efficient he created it that way and created a very successful errand in fact you might be too young to remember when we used to use paper tickets for flying the airplane so David Neil Elman used to use paper tickets what do you think happened to his paper ticket given that he's ADHD he lost it of course so he was the one who invented feel like trying to ticket so what is the difference between ADHD and ATT because I heard that a lot so you're a DD is that similar to ADHD or is it reduce anymore in the professional field it's all called ADHD there are three types of ADHD there's what's called ADHD predominantly inattentive presentation and to diagnose ADHD there are nine symptoms associated with inattention and nine symptoms associated with hyperactive impulsive behavior an adult has to have at least five in either one or both of those categories a child needs to have at least six so it's not enough however just to show those symptoms because everybody shows those symptoms from time to time people who don't get enough sleep are often forgetful people who are depressed or anxious and have actual anxiety depressive disorders often forget things or often overlooked something or often seem scattered there are certain conditions so let's say you have a child who is inattentive shows eight of nine symptoms for inattention there have to be certain conditions there first of all they have to have been there for a long time they have to happen a lot so much so that it's intrusive usually the measure that we use for intrusiveness is that the child's behavior is compromised at home and in school in an adult you might consider home and work you can consider relationships I had a truly remarkable guy married and inattentive type ADHD he told his wife honey I'm gonna accept your request and I'm gonna put up paneling in the basement just like you've asked me for the past two years he went out and he bought the paneling on a Saturday put it in the basement and another year went by finally after all of his excuses and all of the disruption that his wife had and all of his her upset when are you gonna do it all of his promises that he ultimately broke he called up a friend of his and he said can you come on over I know you know how to put up paneling will you come over and do it I'm going to get a keg of beer you and I are gonna go put up the panel in the basement I'll pay you for it he had it done in four days after virtually three years of not keeping his promise to his wife so what changed well what do you think what changed experience maybe the alcohol no I actually got nothing to do with the alcohol it had to do with the context within which he did it to do it himself is a characteristic of ADHD that is difficult people with ADHD tend to have significant difficulty self-directing saying I am going to write that paper or I am going to clean that room they say it to themselves what's the consequence they can forever say oh I'll do it tomorrow and there's no serious consequence okay but if you change the context of the situation and make the person obligated to another person who's going to come over and who's there to complete the task then things change completely that's where the real mistake is I shouldn't call it a mistake actually that's where the real ineffectiveness is in what most people think they're supposed to do with ADHD if you have ADHD I'll sit and talk with you and help you through it sutter nonsense if you have ADHD what I'm going to do is actually have you alter your circumstances if you have difficulty studying then go join a study group if you have difficulty remembering written material then have somebody read to you or use books on tape or alike it's to do things differently is the way you treat ADHD now you ask me a question a long time ago about what sit in between a DD and ADHD nobody professionally uses the term a DD it's all ADHD the three types are inattentive type hyperactive-impulsive type and combined type which is both of those things okay so what you were saying earlier right before you answer this is it the outside factors or environment that we're changing to help the person with ADHD again that's well said you don't treat ADHD in the therapists office it's it's an illusion that I don't know how it got propagated but you treat it at the point of contact so for example our summer treatment program at Cleveland Clinic it is the most advanced sophisticated behavioral program for ADHD in the world there's one in Japan there's five in this country of the research type that we use now by the way I'm not self grande izing I didn't invent this programs this belongs to a person named William Pelham dr. Pelham is at Florida International University I've known him for years and in fact he used to be at the University of Buffalo and that's how we started our program here the STP came to Cleveland Clinic in 1999 and you were seeing the program itself is very effective what is going on with the summer program tell me more you are an excellent listener thank you the you treat ADHD at the point of contact and the most sophisticated program there is behaviorally for ADHD is the summer treatment program we target for example 13 negative behaviors we reduce their frequency during the day and then we target nine positive behaviors like pro-social intervention or cooperating with another person or responding to a directive these nine positive behaviors we increase and then we also train parents to do exactly the same so what's very interesting in our world today especially for parents is that you probably remember Hillary Clinton's venture into it takes a village way back in the 90s our world has advanced to a place where the village like most of us grew up in where you'd run down the street and do something you weren't supposed to do and the mom down the street called your mom when you got in trouble when you got home it's not there anymore there are no norms to behavior and the village has actually it's shrunk to a household so behavior management has to occur in the household but there's no consistency of it across households and parents are left with not knowing what to do what is appropriate behavior so a tendency is to fall back on how my own parents raised me I turned out okay now sometimes that's a question but not to the person themselves okay so you start using the things that worked at a different time in a different context with different people and it doesn't work now yeah got a customized it's our new lifestyle yes well I'm gonna say in an alley a little more harsh way we're going through life looking at a history rather than facing a future we're looking at what's already been as opposed to what we're building it's a problem that occurs in almost every facet of life it's a problem that occurs in relationships for example my mom used to treat me like this my wife should treat me like that too or some version of this so it's like high expectation based on what we went through based on memories versus how our life is changed I wouldn't even call it high expectation I would call it an expectation from our history whatever that happens to be and you can see ramifications of that in all different kinds of family dysfunction sure sure now I want to ask you about adult ADHD versus children when an adult is diagnosed with ADHD were they diagnosed as a child or were they just did they kind of like miss out on that part of their life and weren't diagnosed and something new lifestyle changed them later on or how does adult ADHD usually get diagnosed adults with ADHD are generally referred to our lifespan clinic the ADHD center for evaluation and treatment because somebody mentioned it to them you know you might have ADHD or they've had their child diagnosed with ADHD or they just have always known that something is off I just had a young woman today 21 years old absolutely clearly needs symptom criteria for ADHD combined presentation and she described to me the things that she does she described for example that she ditches her friends she'll make an agreement to meet her friend at 4 o'clock but then 4 o'clock in the afternoon comes and what she really wants to do is to go for a hike in the woods by herself so she doesn't show up now of course she has to go clean it up with her friend but it happens again and again and now her friends just say oh that's just Julia not her real name language she has consistent difficulty with procrastination the conversation that she has with herself is I have two weeks to do this thing I don't have to work on it today I can I got plenty of time to get it done later that conversation rolls right up into the day before the assignment to do yeah and when she decides to do something she described for example several different art projects that she really enjoys and she'll start the thing there will be a lot of enthusiasm at the beginning but then when the project gets to be more of a task she loses interest and doesn't initiate or put enough effort and energy to complete the thing so with adults I will tell you the primary difficulty adults lead lives of incompletions now William James was probably considered the father of Western psychology he wrote in 1890 there is nothing so fatigued as the eternal hanging on of an uncompleted task now that is exactly one of the first things that I personally address with a person an adult who comes in to see me and if you look at an uncompleted task as an agreement that's been broken you can consider that the brain never forgets a broken agreement if I sat down with you and I said what things have you gotten incomplete you would tell me a few things and they're incomplete because you said you were gonna do them and you didn't do them at least perhaps not to completion now what does it feel like when you have incompletions when you have broken agreements it's like wearing a backpack and you're constantly putting rocks in the backpack and weighing yourself down everybody has had the experience of saying they're gonna do something students in college for example by agreement they're in college to complete all of the work that they have to do so a paper is due on a particular day on a Monday and they haven't written it and it's Sunday night that feeling of incompletion of breaking the implicit agreement that if you're in college you're gonna do the work weighs on them now and everybody has had the experience of I said I was gonna do this and I didn't do this the brain will never forget a broken agreement I had a person come in mid-40s and we were talking about incompletions and he said you know it strikes me that I promised my high school friends three of them that I was gonna contact him after we graduated went to college and I never contacted him he said my brain reminds me of it all the time and I keep saying I'm gonna do it and then I never do it and if any individual looks to see what broken agreements there are what things they haven't done they've left incomplete it's a burden and what does it feel like when you finally do something that you've been putting off forever I feels great doesn't it of course great I hope you don't get a lot of calls from college kids thinking they don't have ADHD because I feel like a lot of kids are you know pushing the assignments of the very last day or forget forgetting stuff I'm just trying to see the line is thin between when is it actually a problem versus you know just forgetfulness or pushing something back or because we all experience that on a daily basis a very useful observation it's not that a person procrastinates and that makes ADHD you have to have the symptoms six of nine or five of nine of inattention five of nine or six of nine for hyperactive impulsive behavior and you have to have the conditions the conditions have to have been around a long time they need to be intrusive in more than one setting now you mentioned earlier parents could worry if their kids have it that they may have it so is this a genetic disorder professional thinking at present is that it is definitely a genetic condition okay way back in 2000 2001 to there were maybe four genes that were associated with ADHD now I think there's over 29 I haven't done a recent talk so the difficulty of genomically identifying ADHD is pretty significant so now the symptoms of ADHD can make school family just like you said relationships everything very difficult so how how to cope because it sounds like something like an ADHD student that goes to school where it's all about talking and learning and raising your hand and going into that box and some people learn differently how what is the approach that you see fit for these students so there was a major study that was conducted called the multi treatment assessment study or the multi modal treatment group for ADHD it was it was started in 94 went to 96 and then several hundred children participated in this study and they've been collecting data on it ever since so what's fascinating is that from that study we've got very clear notion that a combined approach of using pharmacal therapy and behavioral intervention is the best approach okay now for very young children the American Academy of Pediatrics recommends using behavioral intervention first in our own summer treatment program and any other summer treatment programs in the United States and in Japan investigations have been have indicated that you can use lower doses of medicine and you can use when you use very intensive behavioral intervention yeah and when you use very intensive behavioral intervention first you can use you can start with lower doses of medicine to have things be effective now the real I think the real issue is many people consider that ADHD is over diagnosed I thought that's where you were going in your question before about college students coming in and because they procrastinate they think they got ADHD and they should have adderall well so the truth of the matter is adderall is not hard to get on a college campus it is the most diverted drug that there is you can typically buy a capsule of adderall for five dollars during midterms and finals cost $20 or something to that effect so when you consider what makes ADHD you have to do a thorough assessment you may have seen the study that just came out that described mm-hmm younger children in kindergarten whose birthdays occurred just before August 30th yeah 31st compared to kids born after that date tend to be diagnosed more with ADHD than their peers the ones before school year so the ones before school year got diagnosed more than the ones after because if school is supposed to start on D found somewhere for first and you're born on deception assuming if school starts on September 1st and you're born on September 2nd then by the time you get around to school you're gonna be a whole year older than the one who's born on August 31st right right and the kids who were born in August or audit before August 31st just before the school year starts more of them 30% more of them we're diagnosed with ADHD now automatically people are going to conclude oh we're over diagnosing ADHD the issue is not over diagnosing the issue is miss diagnosing anybody who knows child development is going to be crystal clear about whether or not a child is actually exhibiting symptoms of ADHD or whether this is a developmental issues it's a lot it this is a question that is consistent with exactly what you were bringing up before college students who want an edge we'll go in and tell the therapist I have this symptom but that's it from that symptom yeah it's up to the therapist to be able to tell the diagnostician to be able to tell is this ADHD is this someone who wants to look like their ADHD is this somebody who's just anxious because they're studying a very difficult subject and they can't quite get it and so they think they have ADHD yeah sure and that's actually my next question was how is it diagnosed how so when someone comes in asking for adderall or Ritalin or whatever the treatment is what what kind of steps are taken to make sure that you know it is true ADHD versus just like you said just trying to get you know the pills again that well so I'm gonna simplify it and turn it into a three step process and now I'm going to comment on a three step process and how it's used so the first step in diagnosing ADHD is to determine if the symptoms are there so again we're talking about 9/7 of inattention how many of them are there nine symptoms of hyperactive impulsive behavior how many are there so you have to determine if the symptoms are there so what most people do is to use a rating scale like the Vanderbilt scale or the ADHD rating scale and I would ask a parent and I would ask a teacher so I have two rating scales now and then many times people stop there sorry the symptoms there yes this one says yes and this one says yes high level of the agreement between the two but that's not enough there's a second step and the second step is what can I rule out as the cause of these symptoms being there could it be the child is not getting enough sleep could it be that parents are really aberrant in how they're managing behavior in the household could it be that the child is depressed or anxious what actually can I rule out as causes of these symptoms being present that's the second step now like I said many times when professionals do diagnostics for ADHD they stop at the first step and even that step I mean there are school districts in our country who would some of them count and make sure they have a lot of the symptoms of ADHD because it means they get more federal aid some school districts because they have such an excellent excellent record don't want their kids to have the diagnose ADHD so they under play the symptoms so the if if ADHD is diagnosed and a school has to provide accommodations for that child and sometimes the school is so strapped for money that they do not have the capacity to provide it so there's a subtle pressure not to diagnose ADHD so you see rating scales themselves may not there may be other things that factor them I mean I can't tell you the number of times that children who were in families whose parents are divorced and the mom thinks ADHD is complete nonsense but the dad is very clear that it's ADHD so the mom fills out the rating scale and under plays under represents the symptoms the dad may over represent and the parents are at odds about it so the first step is not enough the second step to rule out other causes of which that might be across yeah and then there's a third step the third step is to determine comorbidity is there something else occurring co-occurring which is what comorbidity is co-occurring with these symptoms and with ADHD it's especially so in adults this it broke my heart the other day that this young man had a family good job very very active he felt all his life that he was stupid very close to his family very responsible risk for his family but never felt like he could do anything else he would look at his classmates when he was in school he would see that they finished their tests sooner than he did they got better grades than he did they could recall the answers to things that just escaped him now when that happens he's not concluding to himself oh I know it's that my network in my brain doesn't use directed attention very well and I'm constantly in the phase of automatic attention which is the default mode of the brain that must be why this is all happening the person doesn't say that what do they conclude well just like you said you would think I'm stupid I can't learn exactly a foresting fundamentally a person says there's something wrong with me and this young woman that I just saw today before I came to talk with you cried when she says I always thought I couldn't do things and when she realized that it had nothing to do with how bright she was or how bright she wasn't how committed to her education she was or how committed she wasn't she constantly referred to herself throughout our conversation as lazy I finally corrected her or intruded on that conversation and I said to her perhaps you're not lazy at all she's not a lazy person at all but she thinks she's lazy when what she's really doing she thinks she's lazy primarily because she procrastinates constantly and it's drawing her grade down she's not doing her best work she thinks she's lazy because she avoids things laziness is a state you can look at somebody and said oh you're just lazy laziness is a state a state a characterization of a person like personality or something people with ADHD are almost never lazy almost never hi at first of all I have never ever met a lazy child never you've met them you've not met them either you probably have the most energetic balls of fire you well you probably have met children who avoid things what do they avoid schoolwork why schoolwork is boring yes I had a little kid for example one of the most fascinating little kids I've ever met on one Saturday he organized five other kids in the neighborhood because on his street they were building new houses he organized five other kids in the neighborhood they all went around they took wood and they went back in the woods and they build a tree for it they had it done by Sunday afternoon and they played in the and until dinnertime in it and then he came in on Monday morning to school and the teacher said children here's a worksheet start doing it right now everybody else did all 30 problems he had to said a lazy child it's not a lazy child at all it's a child who avoids the kinds of tasks that are characteristic of ADHD and I think this is a good point to really give the nature of ADHD you know we think that we have one kind of attention there's not one kind of attention there maybe three but there's two definitely so the kind of attention we use when we're really interested in something or watching a good movie or having a wonderful conversation with somebody or reading a good book that's the default mode of the brain the default mode of the brain if we're very lucky is where we end up having our careers the default mode hijacks attention for a person with ADHD but there's a second kind of attention that we use to self-regulate it's the kind of attention that we use our frontal cortex with language to self-regulate so if you know you have to have a meeting in the a building at four o'clock you'll be there at the a building at four o'clock whether you're hungry or whether you are having a great conversation or whatever you happen to be doing you'll separate yourself from that and place yourself in the a building person with ADHD has difficulty with that kind of attention which is called directed attention and it has its own network of the brain which is called the task mode primary neurotransmitters associated with the task motor dopamine and norepinephrine and that's what pharmacotherapy addresses some people say there's even a third kind of attention and the third kind of attention is an emotional regulator because there are some kids with ADHD who have real difficulty managing their feelings but at any rate there's at least two kinds of attention the default mode in the task mode and the task mode is what's difficult for people with aging that's why an adult who is in a in work that they love primarily engage with default mode so let's talk about the causes or what the causes may be for ADHD genetic genetic it's all genetic its genetic so I know were you about to go to media I'm just wondering if there's anything else I mean screens is just like you said that's a completely different lifestyle that we have nowadays we have you know iPhones or iPads or TV or GPS sir and that car we have everything everywhere does that technology is it making it worse for our children is there anything else that's that could be causing ADHD this is it's the worst that it's ever been correct I don't know that it's the worst that it's ever been it's the worst that we've ever recognized it so ADHD has been in the population since forever there was a study by UC Irvine they followed the genetic patterns of hunter-gatherer tribes going back 30,000 years followed migration patterns to into South America it was a fascinating study I couldn't comprehend it myself how they did things I understood the conclusions but the ADHD symptoms have been around for a long time 30,000 years ago I mean some people make the case that it's these are hunter genes and we lived in hunter-gatherer tribes the hunters were the ones who noticed everything which is what the ADHD brain does so bring any to brain notices everything yeah yeah and when you're over eight if you're living in a dangerous world you want to be around the guy who knows dangers that way we got it that way so some people make the case that we're living in a world dominated by screens and that screens are making the attention span shorter now there's no question that the expectations for some kind of reinforcement some kind of change in the environment is somewhat exacerbated by screens but screens do not cause ADHD ADHD is largely genetic now screens certainly are impacting how children react to directed attention tasks because if you have a worksheet in front of you with 30 math problems on it that worksheet isn't doing anything it's not changing you have to bring your attention to that worksheet in order to interact with it you're the change agent for the worksheet if you're looking at a screen and the screen is having all kinds of action occurring in a war zone the screen is changing and it's actually capturing our attention so the real issue is not that it's changing attention at least as far as we know now there are no clear studies that confirm screens cause ADHD that's a myth at least at present it's that the brain and the person expect things to change now children with ADHD tend to have tend to require a bigger difference in their world to respond to it so greens are perfect for that and when the screen is not there and we're looking around the world to find something to do kids are not looking to say hey let's go to the new houses get some wood and go build a fort back in the woods what they're doing is looking for the next game to play or the next very exciting situation which requires which which actually attracts and draws and lights up their default mode and attention I answer your question yes good thank you okay so now are naturally let's just go on to treatments I know we talked about adderall ritalin is that another one are there so the two compounds are methylphenidate nymphetamine methylphenidate has a variety of there's about 29 maybe even over 30 different compounds or different delivery systems for methylphenidate now fat Amin methylphenidate works in one way and the synapses amphetamine works in three to four ways in the synapses and now I want you to be clear I do not practice medicine I don't give medical advice so nobody can listen to this and say that I'm saying one thing or another about medicine if you want medicine you talk to your physicians the stimulants are highly effective in managing the symptoms of ADHD why because they target dopamine and norepinephrine in the defo in excuse me in the task mode the mode of directed attention and remember if you are going to self-regulate you have to suppress the default mode so the sunny day versus getting the taxes done you have to suppress the sunny day suppress wanting to engage with the sunny day and do the boring task of doing your taxes you do that through executive functions and the stimulants enhanced directed attention so you can self-regulate the stimulants do nothing more than allow a person to do what they ordinarily would want to do you can be as an attentive on stimulants as you are off stimulants so another thing that I've heard a lot from my own friends our parents of kids maybe with ADHD or maybe need something like at all you know like the side effects with maybe sleep or appetite something like that do you think the benefits outweigh these side effects you have just stated exactly what the question is when there are side effects so three primary side effects of the stimulants appetite suppression sleep delay and irritability there is what's called a rebound effect of the medicine that when the medicine is wearing off at the end of the day people can become irritable more easily angered or upset more cry periods more easily agitated so the key question is does the benefit of the medicine outweigh the side effect so let's say a child has appetite suppression so doesn't eat lunch so the parents give a good breakfast in the morning then give medicine and the child doesn't eat Mount lunch or doesn't eat much lots lunch comes home at 3:30 doesn't get hungry until six o'clock well have dinner at six o'clock and then give really good snacks then it's also useful to consider what are called structured treatment interruptions or colloquially called drug holidays the American Academy of Pediatrics does not recommend weekend drug holidays but it does it does endorse longer times like Christmas break or excuse me winter break Spring Break summer times if there are side effects so if the benefit of the medicine outweighs the side effect then you manage the side effect if it doesn't then you either lower the dose or change the medicine yeah how about sleep is there is there something that then they can take for sleep so again many physicians will recommend using melatonin and melatonin can be very very effective for assisting with sleep great how about any natural remedies and when I say natural remedies I'm talking about more mindfulness or meditation does any of that help with ADHD let me say this there are a lot of products out of the market and these products most of them have not been demonstrated to be effective there are three alternative or integrated medicine treatments or I shouldn't even call them treatments they're actually protocols or methods three of them that have been demonstrated to be effective for ADHD the first one is omega 3 so omega 3 is good for any of us actually and it has been demonstrated to have a very very small effect on attention so whereas stimulus may have this much effect Omega 3 is about this much of it you probably wouldn't even notice it actually the second thing is mindfulness so mindfulness is exploding it's exploding in medicine in in education in business in psychology mindfulness practice which we use in our own summer treatment program has been demonstrated actually to be effective for ADHD because it allows the person the moment of separation between responding to a default mode stimulus event and redirecting attention to a task like the boring mashie the third thing is is a computer program called cogmed cogmed has been demonstrated to be effective with working memory we have godmen available here in Cleveland how about nutrition since we're talking about omega-3 those poor nutrition their eating habits cause any ADHD or at least contribute to it you know when I first started working in in this area in the 1970s there was a diet called the Feingold diet the Feingold I was at the University of Hawaii at the time and the Feingold diet was this magical thing it removed salicylates from food so oranges have salicylates processed food has salicylates and the object was to remove those salicylates and supposedly hyperactivity disappeared there have been any number of studies with the Feingold diet and none of them went done in a rigorous scientific design demonstrated effectiveness of the Feingold diet that has been so to date with all of the other diets that have been investigated so removing gluten for example for some people may be effective removing food dyes for some people may be effective because some people have allergic reactions to these things I mean green red and yellow food I can actually generate hyperactivity in some people not everybody and you would know it because the child's behavior is gonna become quite active after they ingest something so there has been no other clearly studied diet that has impacted ADHD now for example the person that I saw today she would get this feeling of being agitated and her she said my thoughts just would be going all over the place much more so than it is when she would wake up in the morning for example that's typically a result of having directed attention getting depleted oh and by the way directed attention and a person with ADHD gets depleted far sooner and in a neurotypical individual but she would describe that when this occurred for her and she knew she couldn't study she would go for hike in the woods and she would want to do it all alone because being in the woods somehow brought back her equanimity and there are even some books that describe that being in nature and doing something that doesn't elicit a lot of response in the brain and when I even think back to when you think to screens some of us older folks probably remember mr. Rogers or mr. Rogers he'd walk gradually to another place and he would say what he said very present in the moment very present and also slow moving and kids were captivated by him hello little neighbor and life would light up its that slowing down of the of the Reese to the world around that has an effect on the brain and that's what mindfulness practice does now the biggest problem of mindfulness practice with people with ADHD is getting bored I mean that's the whole purpose of mindfulness is to manage void well actually it's to manage boards boredom is nothing more than the same thing occurring in the brain as when thoughts are flowing through it so the tolerance for boredom for a person with ADHD is a little more intense and for a neurotypical individual however mindfulness practice is clearly a very useful strategy that any of us can practice we use it in our own summer treatment program so can you outgrow ADHD brilliant question NIDA truly brilliant that's one of the things the findings from the multi treatment assessment study this may astound you but a child who's been diagnosed with ADHD with intrusive symptoms 49.9% of them will show intrusive symptoms as an adult that means 50 percent of them don't know so do you outgrow ADHD I don't know that that's a clinically relevant term outgrowing it typically what people do is to grasp how their brain is actually working and they put in place strategies that work for them like I it's it's rather odd but many adults with ADHD end up marrying someone who's very organised or they end up working for an organization that's highly structured or they end up doing something that's absolutely fascinating to them so I have diagnosed physicians at some of the best institutions in our country with ADHD and yet there are some of the best doctors in the world even surgeons one of the capacities of these people is they can over focus on something and their ability to notice everything makes them some of the best people around but when they have to stop and do a directed attention task as opposed to the default mode tasks of surgery and they have to enter an electronic medical record they have to have they figure out they have to have somebody accompanying them to get the thing done so they can get it done on time now how do medications actually work in the brain for ahd patients many people have misconceptions about what these medicines do some people think they calm a child down some people think they dope the child up it's got nothing to do with that if you consider that the network of the brain that is not as effective it's not working as powerfully called directed attention or the task mode of the brain neurotransmitters dopamine and norepinephrine that that network if it's strengthened allows the person to put their attention where they want it to go as opposed to the attention going where it wants to go controlling it yes it actually allows them to to adapt their attention to the task so that's all it does it doesn't do anything else it strengthens the directed attention needed to self-regulate so child actually can do what they want to do sure ok so we are running out of time but before I let you go now I know you talked quite a bit about the nine symptoms for people to kind of notice when their children are going through maybe ETH ADHD symptoms is there something so our listeners or viewers that you want to tell them are these symptoms is it something that they can just google and find out what these symptoms are if you're sure check out okay so just kind of look them up and justify that in case it sounds like it could be someone they know or yes you go to the American Academy of Pediatrics you could go to the Chad website CH a DD children and adults with ADHD a DD and you can find the symptoms you can find discussions of the treatment the thing to watch out for there there's so much disinformation out there and we for example here at Cleveland Clinic offer shared appointments and then the shared appointments we describe what ADHD actually is from the science of it and you have to be very careful as to what you are going to believe yeah sure well thank you so much for being here today it's been a pleasure well my pleasure not a thank you and for inviting me I appreciate the conversation thank you you're a gracious host and for more information or to make an appointment call

Channel: Cleveland Clinic

Views: 122,772

Keywords: dr. michael manos, adhd

Id: hrjj0EgII1Y

Length: 60min 19sec (3619 seconds)

Published: Fri Feb 22 2019