|Posted on 26 October, 2015 at 20:00||comments (0)|
ADHD is one of the most diagnosed conditions in children, yet it is one of the most underdiagnosed conditions in adulthood. There is a lot of confusion as to what ADHD is and is not. There are also a lot of myths regarding ADHD.
First of all, we need to clarify a few terms. ADHD is the common diagnostic term. The older term ADD, is still used by many people although it is not the official medical diagnosis anymore. ADD is now diagnostically called ADHD, inattentive subtype. There is a myth that ADHD is overdiagnosed with a recent study showing that only one in five people with ADHD are adequately diagnosed and treated. I suspect the overdiagnosis myth comes from the query of ADHD in young boys usually under the age of 10 who prefer to be active rather than sit in a classroom. To be diagnosed with ADHD, it must be shown that the level of hyperactivity or inattention is outside of the normal range for a child of that gender, of that age. Diagnosis under the age of six is difficult and the vast majority of professionals that I have worked with our reluctant to diagnose or provide medications that young unless there is a severe impairment in social functioning. In these cases, regular appointments are made so the professionals can track growth as a decreased appetite is the most common side effect of the commonly used ADHD medications.
The most commonly recognized form of ADHD is the hyperactive subtype. Unfortunately, many people with the inattentive subtype go undiagnosed and the difficulties are not recognized. Additionally, many times behavior problems in children are diagnosed as ADHD when ADHD may not be present. I have seen both extremes of this particular problem over the years, where child who apparently has very clear behavior problems is treated for ADHD and behavior problems disappear, and other times were kids appeared to have ADHD medical treatment has no impact on the problems.
Mammoth hunting: ADHD is a medical/psychiatric disorder and it does have significant impact on individuals ability to be successful and their relationships. There are benefits to being ADHD which are often overlooked. People with ADHD tend to do better under stress. The leading theory as to why ADHD exists is that people with ADHD have a baseline arousal level much lower than the average person. To feel motivated to pay attention or to get going, they require high levels of external pressure. In the Hunter gatherer society, it is easy to see how these traits would be beneficial for a hunter or a warrior. The difference between a hunter gatherer society and modern society is they did not have a Monday to Friday workweek with a 7.75 hour workday. Nobody would expect a hunter warrior to perform routine tasks daily. When they were needed, when the pressure rose, they came into their own and performed well. Modern-day equivalents would be occupations such as being a paramedic, a firefighter, a trial lawyer, or an emergency room nurse or doctor.
An additional strength associated with ADHD is heightened creativity. We see these traits in actors, artists and musicians. There is some controversy regarding creativity and its association with ADHD, with some studies finding no such link. Many other studies do confirm the association with creativity and ADHD, so I will leave it for each person to assess the evidence for themselves and come to their own conclusions. I personally have noticed heightened creativity in the clients I work with who do have ADHD, but that in itself is not conclusive.
A couple decades ago, it was commonly thought that children outgrew ADHD as they moved into adulthood. We now know that about two thirds of children with ADHD will continue to have symptoms as an adult. The overt hyperactivity is often replaced with a sense of restlessness that is felt internally. We have also learned that emotional dysregulation is a core symptom of ADHD for many people. Many people are misdiagnosed as having personality disorders, mood disorders, or anxiety and often feel little relief from the treatments prescribed for those conditions. Making this even more confusing, is the high rates of comorbidities between anxiety, mood disorders and ADHD. A recent study has shown that over 90% of people who were diagnosed with one will also be a diagnosed with one of the other two and 60% of people will meet the diagnostic criteria for all three.
My experience has been that people often report experiences with depression and anxiety as those are often changes from the individuals normal functioning. With ADHD, it is always there and many people with ADHD do not realize that other people experience the world differently from them. Boredom and procrastination are almost universally reported by people with ADHD when asked about it. If the client is being treated for depression or anxiety, and they are experiencing minimal relief, it is usually a good idea to screen for ADHD as accurately identifying ADHD can mean the difference between barely functioning and remission of symptoms.
I will do a follow-up blog on ADHD looking at specific subpopulations such as women with ADHD, ADHD and bipolar II, and ADHD and SAD. It is becoming clear through the research of mental health conditions do not fit neatly in one category or another. It seems to make more sense when work backwards from which neurotransmitters appear to be impacted and in the case of ADHD, dopamine plays a central role. It makes sense that ADHD often occurs alongside seasonal affective disorder, bipolar II and atypical depression. Those disorders are rooted in dopamine as well.
|Posted on 14 September, 2015 at 14:15||comments (1)|
Depression is the most commonly diagnosed mental health condition, and the majority of cases are diagnosed by a family physician. It seems straightfrorward; you feel depressed, have a hard time accomplishing what you want to, and your relationships suffer. Your doctor has given you an antidepressant, and it doesn't seem to do much for you, so you try another. This time you feel worse. Your doctor refers you for counseling, which helps a bit, but you are still struggling.
This story is all too familiar. Depression isn't just depression. The trouble is, many people diagnosed with depression aren't depressed, at least not in the way that an antidepressant would help with. One of my pet peeves as a therapist is the confusion regarding depression, because of an issue called "Symptom Overlap." This means that symptoms in different disorders can be the same as symptoms in other disorders. Unfortunately, diagnostic tests are not available to identify the causes of the symptoms, so we play a game of trial and error.
There are several categories of depression in the DSM (Diagnostic and Statistical Manual), the guide used by most practitioners in North America to diagnose. There is much critique with how depression is dealt with in the DSM. People who feel depressed can actually experience a number of different "disorders" such as Major Depressive Disorder, Atypical Depression, Seasonal Affective Disorder, and Bipolar II. The root cause of these labels differs with three general causes. Serotonin, Dopamine, and Light.
Serotonin is in play when you feel sad, have trouble staying asleep, lose your appetite, and consistently stay depressed even if something good happens. This type of depression usually responds well to a SSRI (Sustained Release, Serotonin Reuptake Inhibitor) antidepressant.
However, if you have trouble getting out of bed in the morning, feel irritable, have an increased appetite, experience sensitivity to rejection, and experience mood improvement, briefly, when good things happen, you are likely experiencing Atypical Depression, which is related to the neurotransmitter Dopamine. An antidepressant will usually not help as it is working on a different neurotransmitter. None of the antidepressants on the market focus primarily on Dopamine. An older class of drugs, not commonly used, MAOIs (Mono-Amineoxidase Inhibitor) do effect dopamine, but there are serious potential side effects and dietary restrictions due to a reaction with tyramine, present in aged cheeses and wine, for example.
To make this more complicated, the frequency and timing of these "atypical" symptoms changes the diagnosis. If they happen only in winter, we call it SAD (Seasonal Affective Disorder). Treatment is with natural light, but there is very high comorbidity with ADHD, another Dopamine based disorder. If the symptoms are episodic, any time of the year, we call it Atypical Depression. If the symptoms are cyclical, with occasional hypomanic symptoms, we call it Bipolar II. Confused yet? Many of us are, with good reason. Adding confusion is the fact that we now know that anxiety and ADHD are highly comorbid with depression, as are issues with substance abuse.
So where do we start? We need to look bigger, rather than right in the moment. We need family history, as these conditions run in families, and other family members experiences with what does and does not work helps guide us. Secondly, onset of symptoms, and the number of, and pattern of relapses helps narrow down diagnosis. Onset in childhood or adolescence separate from trauma suggests Dopamine, rather than Serotonin. Third, we need to be open to trial and error. A combination of counseling and medications are often needed. We can effect our Serotonin levels through lifestyle changes much more easily than we can effect Dopamine levels. Therapy is a key component in recovery, regardless of the diagnosis.
I will go into more detail in subsequent blogs, as there is a lot of detail to clear up, but this gives an overview of one of the biggest areas of confusion in Mental Health diagnosis. When you meet with us, and you tell me things didn't work, I believe you! There is plenty of reason to see why people struggle with recovery.