• yes, with some rules and controls and long acting medication

Yes, it is possible. It usually involves shorter prescriptions, more carful monitoring, sometimes getting someone else to hold the medication for you.

We use the longer lasting medications like Vyvanse, Concerta and Foquest over shorter acting medications that risk getting a buzz on treatment.

Remember, people with combined type ADHD often have addictive tendencies and come from families with a lot of addiction and that treating the ADHD reduces addiction potential, so with a few provisos and controls, yes we can treat you.

Some doctors will insist on only using or first using Non stimulants in someone who has abused stimulants (wether prescribed or not) but the problem here is their effect is often dramatically less, and lets face it, many patients with ADHD are impatient.

• the extremely rapid peak and short bloodlife of crystal meth and cocaine make them MUCH more habit forming

In theory the answer is sort of, but that’s a bit like saying that an over the counter tylenol #1 is the same as mainlining heroin. The difference is in the details. Cocaine and crystal meth have an extremely high peak blood level that lasts an extremely short time. Prescribed stimulants might have a peak level of stimulant effect 1 /100 of that of the recreational drugs, and of course it’s duration is several hours at least.

Addictiveness happens both because of the intensity of the effect but also because of the rapid crash after the street drug wears off, often within minutes. This is a powerful inducement to take another hit. That just doesn’t happen with longer acting prescribed stimulants.

• careful treatment including stimulants can reduce addictive behaviours

We know that when we treat ADHD with stimulants, people smoke less, drink less, gamble less and yes, use less cocaine a trouvé. If we know that someone is using cocaine, it does not stop us from prescribing ADHD medication and in fact we will taylor the medication to effectively deal with the drive to use and when it is strongest. For example, many users increase use of cocaine in the evening and so we adjust the timing of medication to be more helpful in the evenings.

ADHD medication is definitely not the whole answer, but it can be an important part if you are ADHD and a user.

• not often and a lot less than many doctors and pharmacists fear

I have an entire section dedicated to this question but the short answer is there is some risk of medication addiction but it’s much less than the internet would have you believe and in fact addictive behaviours go down when you treat ADHD with stimulants.

• several times a day something is forgotten, misplaced or delayed, or someone is offended, or ignored

After we’d asked about all the different ways that a patient struggles, we ask about how often one of the symptoms they were famous for actually rears its ugly head. Almost universally ADHD patients either say daily or ask do I mean hourly or daily, or if they say once or twice a week and I then rephrase the question ‘how long can you go without one of the ‘famous’ symptoms showing up, they then say they can’t make it 24 hours.

People without ADHD do genuinely have symptoms a few times a week at most and usually less often than that.

Even ADHD patients who swear they only have problems in school or only at work, or only at home, tend to have symptoms in all areas of their lives. The person who is overwhelmed at work, can’t find their vehicle in a large parking lot, or procrastinates on bill paying so has lots of late fees.

• higher intelligence, greater creativity, the ability to mulitask, inventiveness are more common in people with ADHD

There is a movement at the moment to talk of the ‘gift’ of adhd, like it’s a blessing, that it does more good than bad, and that you should celebrate your ADHDness and skip treating it.

A lot of us who work with ADHD patients feel this is a disservice. It ignores the huge cost to having ADHD and underplays the important role treatment has in managing ADHD. The patient may feel there’s no cost to being ADHD, but those around them heartily disagree.

We can tell you that people with ADHD on average have a 10 point higher IQ than the general population – and that’s significant. Many with ADHD are very creative. Often people with ADHD are good with their hands and seem to have a better than expected understanding of mechanical things. They’re often good at sports, and seem to understand computers and programming better than most.

The problem is, not everyone with ADHD is creative, or an athlete. So I don’t couch it in terms of being a good thing to be adhd, but especially with kids, do suggest they learn about great people who have adhd and to at least explore whether they might have a creative streak as yet undiscovered. I steer young people into education and careers that work well for people with ADHD while never discouraging anyone who does have dreams of a specific goal.

People with ADHD are rarely boring, often have a great sense of humour, are very positive and fun people to be around, and can be very caring when they aren’t distracted.

ADHD is sometimes associated with the ability to integrate a lot of information (looking at the big picture) when it comes to making decisions and this can be a real strength compared to someone who is very linear and only sees the one path ahead.

People with ADHD are often idea people, coming up with inventions and songs and fixes that ordinary people struggle with. This strength may not be seen till the ADHD gets under control.

Treating the ADHD does not seem to harm the positives of ADHD unless we’re talking over-medicated.

• short answer NO, or at least a heck of a lot less often

For someone born with ADHD and never knowing any other way of being, it is normal to assume that this is how everyone else is too. Studies, however; show that symptoms occur MUCH more often in people with ADHD. The book Taking Charge Of Adult ADHD – by Barkley has an appendix in which they spell out how common symptoms are in the normal (or as prefer to call it ORDINARY population) vs. those with ADHD and the percentages are dramatically different, as is the frequency of symptoms.

It’s about the frequency of symptoms and the impact they have on quality of life.

• several times a day something is forgotten, misplaced or delayed, or someone is offended, or ignored

After we’d asked about all the different ways that a patient struggles, we ask about how often one of the symptoms they were famous for actually rears its ugly head. Almost universally ADHD patients either say daily or ask do I mean hourly or daily, or if they say once or twice a week and I then rephrase the question ‘how long can you go without one of the ‘famous’ symptoms showing up, they then say they can’t make it 24 hours.

People without ADHD do genuinely have symptoms a few times a week at most and usually less often than that.

Even ADHD patients who swear they only have problems in school or only at work, or only at home, tend to have symptoms in all areas of their lives. The person who is overwhelmed at work, can’t find their vehicle in a large parking lot, or procrastinates on bill paying so has lots of late fees.

1. I learn more about you by doing the assessment.
2. I sometimes pick up on other diagnoses besides ADHD.
3. I use the assessment later to evaluate effectiveness of medication.
4. Sometimes universities need a more recent assessment, or ask about specific symptoms when patients apply for extra time for exams, or some grant that applies to people with a ‘disabiilty’.
5. It’s a reality check for you – just how much impact is there with this ADHD stuff?
6. When a partner is involved in the assessment, it helps them feel heard, and they see that the patient is making an effort.
7. I learn so much more when a partner, friend, ex, or room mate is there during the assessment.

• I can be wrong, you can be wrong, we can have biases that affect accuracy of assessment

OK, what you really mean, is can I be wrong in my conclusions after doing the assessment? Absolutely, I can only work with the information I’m given. Sometimes patients have a strong desire not to be diagnosed – perhaps because they’ve been sent here by a spouse, or they don’t believe the counsellor and aren’t invested in the assessment effort.

Some patients simply aren’t aware of symptoms and deny them all. Later, when the partner comes in, we get radically different answers to my questions.

I find that partners can give examples which then help the patient recognize that yes, they really are famous. Other times they fundamentally disagree, and I have to determine who’s right. Most of the time I can tell based on what the partner tells me, but I’m not clairvoyant – I can get it wrong.

Sometimes the conclusion is borderline – the number of symptoms is lowish or the impact of symptoms doesn’t seem to be great – and yet some time later the patient may report that after thinking about it, they realize the impact was a lot greater than they’d thought, or hoped.

Definitely the biggest reason for wrong conclusions is lack of a second person at the assessment to help with answers.

• yes, because we learn a lot about you by doing the assessment
• it checks for other diagnoses
• we use the information to later assess progress
• sometimes someone in the family has doubts
• it gives all of us, you and me a sense of how significant is the ADHD

Well, if your family doctor is like most, they probably didn’t have an hour to spend doing the assessment, so good chance we’ll learn more about you if I repeat the assessment.

One of the ways we determine if the medication is working well is to review the symptoms you had before treatment, and I like to print out that assessment and have the patient and family review it to see if we really have solved the problem or are some of the presenting symptoms still an issue.

Can’t do this if there wasn’t a formal assessment in the first place, and my assessments are covered by Alberta Health, and one hour is not a huge investment of your time or mine.

Also, in repeating the assessment, sometimes we get surprises, other diagnoses, issues with medication, etc.

It may be obvious to your family doctor, knowing you well as they do, that you’re very adhd, but that won’t cut it if we are looking for accomodations for your adhd at university.

• its useful in assessing progress
• you might need a current assessment for university or for a grant

If we’re talking about my assessment, then the answer is maybe. I find three reasons to revisit the diagnosis. Sometimes someone in the family has doubts about the diagnosis. It might be the young man who thinks it was all a plot against him, or the parent who isn’t comfortable with their child carrying a lifelong label, never mind being on medication.

Sometimes the original assessment was made quite quickly, perhaps by a busy family physician. Doesn’t mean they were wrong, just that we might learn more in doing a more detailed assessment.

Other times the assessment was a long time ago and lost to the winds, and a current assessment outlining the particular symptoms the patient has can be useful, especially in followup when we ask ourselves, is the ADHD now under control, have we got the dose right, or is it the best medicine for the patient. I often print out the initial assessment for the patient and family to review when trying to figure out if we are where we need to be.

Lastly, the assessment can point me to other issues and diagnoses that can impact how I treat the patient.

Sometimes patients come with a specific problem related to treatment and medication and we just need to solve the current problem. The patient would much rather spend the hour discussing how to solve the current problem and I’m usually ok with that. We can always revisit the assessment.

When I’m doing an assessment on a patient who is already on medication, it’s essential to work out current symptoms on what might be partially treated ADHD, or symptoms before medication.

• you can come see me

In Calgary, Psychiatric Adult Services at Foothills hospital sees patients for assessment. Dr. Sarah Binder in particular is known for her work with adults having ADHD cz-lekarna.com. Access is through Access Mental Health at 403 943-1500

Dr. Sam Chang is world renowned for his work in ADHD and in educating doctors about ADHD in adolescents and dealing with addiction. While he’s near impossible to get to see, his department, Adolescent ADHD and Addictions services at Foothills can see patients and they share his expertise.

CANLEARN Society is a non profit organization with psychologists, social workers and physicians available to counsel, asses and treat ADHD. there are fees for their non physician services.

I do accept referrals for ADHD assessment. It is my preference to work with a referring family doctor but I don’t insist on a referral so yes, patients can self refer. More often they come to me because of someone they know who has seen me. See ‘about me‘ in the site menu for more information and remember that I am not an expert, not a specialist, simply someone with many years experience.

• you remain responsible for your behaviour – both legally and in terms of school performance, and parenting

ADHD may make some things harder but it doesn’t take away responsibility. Get a speeding ticket, and you’re still going to have to pay. Not bother to hand in assignments and a letter from your doctor isn’t going to keep you from failing or being expelled. Universities may give you extra time to write an exam, but not to complete assignments.

It is your responsibility to work around your limitations. Revenue Canada is not going to be sympathetic. The courts aren’t going to ignore you getting distracted while driving and then hurting someone.

Thing is, You may get distracted, and bored, and be prone to procrastination, but we know from the military and very strict private schools and involved parents, that you can do the work, you can be responsible a trouvé.

• diet, supplements, sugar, and food colourings have nothing to do with ADHD
• caffeine plus stimulants increases risk of agitation, especially at the beginning

It may be ‘common wisdom’ that sugar makes kids hyper but there is no evidence to support ADHD being caused or made worse by junk food, sugar, food colourings etc.

There is also no evidence to support the many alternative treatments for ADHD. Biofeedback can produce a limited and narrow scope of improvement, while it’s being done, at vast expense, but shows no residual benefit after it’s stopped. To be fair, neither does medication, but at least medication is a lot cheaper.

Meditation can help but if you are restless and unfocused, it’s really hard to learn a trouvé. Better to combine medication and meditation or medication and counselling, or medication and strategies – it’s so much easier to remember and apply strategies if your ADHD is already being helped by medication.

There are chiropractors who want to manipulate your spine to fix ADHD, optometrists who claim that eye exercises and special glasses will help, and doctors who deal with addiction and think that there is no such thing as ADHD. I can only say that there is zero evidence to support these theories, but unfortunately the internet is democratic – any crackpot, any one with an agenda, anyone with a lot of knowledge in a very limited area can espouse their ideas, and looking impressive and being persuasive have little to do with the validity of the ideas.

• exercise is good for ADHD, even the innatentive type

There’s good evidence in kids for lots of activity helping focus during the rest of the day and I’m sure it’s still true for adults. And this seems to be not just wearing down the hyperactive but helping anyone with ADHD focus better.

ADHD gets worse when kids no longer have recess and physed programmes are no more.

Exercise helps ADHD and depression and anxiety, at all ages and not just in the hyperactive.

1. Any job you love – that does a lot to help you focus.
2. A job that involves many short tasks and few prolonged tasks.
3. a job that is unpredictable – not knowing what will come at you next keeps you alert and focused.
4. a job that lets you move around, get outdoors, be physical, especially if you’re the hyperactive type.
5. sales – people with ADHD often excel in sales. They get bored with the same old approach, and use their sense of humour and ‘funness’ to get and keep customers. The last thing you want in a salesman is to be boring. People with ADHD are NOT boring.
6. Mechanical things – not sure I can explain it but often people with ADHD are good with their hands and with machinery, making great repair people, service technicians and mechanics.
7. Teaching – who’s better to help kids perform than the person who WAS the class clown. Teachers with ADHD tend not to be boring, and can help kids by using lots of strategies to get information across, instead of the standard one only louder. Remember Not being boring – kids engage better with teachers who have ADHD, whether they have ADHD or not.
8. Anything creative – broadcasting, video, art, design, architecture etc.
9. Computers – programming and web designing and IT support. It seems creativity and inventiveness trump obsession for detail, and that can be learned, inventiveness not so much.
10. medicine and law – yes, really. While obsessing with details seems like a strength for a doctor, the ability to look at the big picture and to think outside the box are huge strengths for a doctor to have. To practice effectively, they do need to establish strategies that get used and do work, and have good staff to back them up.

• start them off with something like the CBC Nature Of Things Episode on Adult ADHD
• next have them at least flip through ‘Taking Charge Of Adult ADHD’ by Barkley

The book, ‘Is It You, Me Or Adult ADHD’ by Cera is entirely about this issue. It’s a book for the partner, not the patient, though patients could read short sections. The book has strategies for reaching the patient and persuading them to seek assessment and to get treatment.

Motivating someone to seek treatment is largely about what is it costing them to not treat the adhd, and to a lesser extent, how hard it is on their loved ones to put up with the symptoms. Even getting them to wander through this site might be enough to motivate. Typically pressure from the partner to get help is not well received, even when it’s well meaning.

It’s common for adults to first recognize they are adhd when they witness the assessment of their child or partner – so you sure want them to be there.

Leaving a book like ‘Taking Charge Of Adult ADHD’ in the bathroom can be a great idea. Or have them watch the CBC Nature Of Things episode on adult ADHD with you – see resources for the link.

Sometimes, people won’t be willing to do it for their partner, but they might for their kids, and they might be open to suggestion from just about anyone but their partner – so a friend or other family member could make a suggestion.

• if you love learning and are good at reading, school can be easy, the rest of life not so much

If you really enjoy your courses and like your profs, you may excel. I had a student who in fourth year, had a perfect 4.0 grade average. Yet, her personal life was a disaster, her apartment a pig sty, her friends frustrated with her, and she was unable to manage a relationship – quickly getting bored if the partner didn’t get frustrated first.

Doing well academically may be because somewhere you had good habits drilled into you – parents who made sure homework was done on time, school programmes that taught you how to study.

I talk elsewhere about the ways that some patients with ADHD are very organized, either naturally or to manage their adhd or because anxiety drives them to be organized.

I sometimes see teenagers who have few symptoms of ADHD but it’s because of helicopter parents, who watch them like a hawk, who stand over them as they go out the door, checking that they have the right books, and their lunch, and bus money, and the homework the parent helped them complete last night. These often turn out to be students who want to go away for university, far, far away. You can guess how well it works when the supports all disappear.

• boys with hyperactivity and impulsivity show symptoms around age 2 or even earlier
• girls may not show symptoms till junior high
• those with only inattentive symptoms may not be noticed till much later

Most often, boys develop symptoms of ADHD early in life, showing symptoms before starting school if we’re talking combined type with restlessness and impulsivity. Inattentive is usually there at this age but not picked up until much later – often in university or after. I’ve had a number of mums tell me they knew which child had adhd in utero. Some girls follow the same pattern but we also see a pattern of girls who show few ADHD symptoms till adolescence, somewhere in Junior High. We don’t know if this is hormonal or inherent differences between boys and girls or exactly what. Dr. Patricia Quin is famous for taking an interest in this area of ADHD, doing research, lecturing and writing on the subject.

Sometimes it doesn’t occur to anyone that there might be adhd until much later in life. Lots of parents were first diagnosed when their kids were going through assessments and the parents realized they had all the same symptoms. I this case, the symptoms were always there, just no one had picked up on it. In other cases, focus seems fine until a certain threshold or load is reached versuchen sie diese seite. That might be a promotion at work, or a change in job to something that is more linear, or a job that involves a lot o desk or paper work. It might be the distraction of having to be responsible for people under you while dealing with the pressures of bosses above you. It can be the birth of a child and now you have to be a parent, a partner, a bread winner and a maid. Of course, diagnosis and onset are separate issues.

Occasionally I’ll see someone with a few ADHD symptoms till, say, two years ago and now they are severe. In the absence of changes like the above, this is more likely to be depression than underlying ADHD and treating the depression is the way to go.

• there’s no upper age limit – it depends on goals, stresses, frustrations and effects on family

If ADHD was only about work, then I suppose possibly not, but it’s also about enjoying reading, listening to your partner, following through on intended tasks, managing money, avoiding impulsive decisions that don’t tend to work out. It’s about learning new things and exploring new opportunities. You may be retired but your’e not dead!

It’s about being less anxious, being resistant to depression, and improving quality of life, so yes, there’s definitely value in exploring possible ADHD.

There is no contraindication to treating ADHD at any age, although some health problems that are more common in people 65+ could be an issue, for example atrial fib.

Interestingly coronary artery disease is not a contraindication and while we need to be more cautious when there’s hypertension, it’s not a contraindication.

I do start treatment for people in their 70’s and the highest I’ve heard of was someone who was 97.

• grow out NO, cope with MAYBE

There are lots of adults for whom ADHD isn’t a problem, but it’s debatable whether they truly grew out of it. More likely is a combination of coping strategies, the right job, and the right partner. Sometimes coping with ADHD as an adult is very successful but comes at a high price in terms of anxiety and treatment can be very helpful.

When young adults who had adhd as children are surveyed, some 20% think they still have adhd. When their parents and partners are surveyed, they think that 80% of the patients still have ADHD – quite the discrepancy.

Care to bet on which group is right?

• it’s all ADHD

What we now call Attention Deficit Hyperactivity Disorder has had many names over the years, and ADD happens to be about the easiest to say, so even though it’s out of date, we still use the term for convenience.

Officially it’s all ADHD and it can be inattentive type or combined type, the latter including restlessness and impulsivity. Some refer to a third type in which there isn’t inattentiveness.

• smoking during pregnancy turns genes on and off that affect not only the offspring but are then inherited by their kids

We used to think genes were written in stone – immutable, unchanging – you either have the gene for freckles or you don’t a trouvé.

In the last ten years, we have discovered Epigenetics. Turns out genes can be turned on and off by environmental conditions. Then the turn-on can be inherited for a few generations before reverting back to off.

Turns out smoking in pregnancy predisposes to ADHD, not only in the offspring but through modifying gene expression, is then passed onto the next generation. It eventually fades out as genes reset, but it can take three generations to do so. Pretty scary stuff.

About 50% for each child. The only thing we are aware of that can reduce risk to offspring is to not be a smoker.

• 70% inherited

At least 70% of ADHD is inherited, although it can be complicated and skip generations and the type of ADHD can vary between parents and kids.

Other causes include high fever in pregnancy, viral illnesses, pregnancy and delivery complications like breach or cord round the neck etc.

Concussion can leave someone looking like they have ADHD and it responds to ADHD medication.

• not unless you have a personal or family history of serious arrhythmia

Most patients dont need one. There was a time when we worried about stimulants causing kids to drop dead. Fortunately good research showed this was not the case. We still worry that if there is a family history of dropping dead from a fatal arrhythmia, it might be genetic and safer to get a bailine EKG before starting treatment.

Some medications pose a risk for altering heart electrical function slightly and we worry that adding a second medication that can cause palpitations could be dangerous – so an EKG within a few weeks of starting treatment is a good idea.

• NO

Evidence and experience both say no, that treating a child for ADHD with medication means that as an adult (not on medication), they have a higher education, make more money, have more stable relationships, fewer problems with the law and are generally more happy than those who were not treated as children.

It’s true that we can’t cure ADHD and symptoms will return if you go off medication, but not any more than if you’d never been on medication in the first place and in fact more likely to be a bit less as you have learned good habits while on medication.

Patients commonly report that ADHD medication isn’t working any more. While tolerance (weakening of effect) is fairly common in the first few months, it doesn’t tend to happen after that and if we do see that medication is less effective, we look for a good reason – a change in job to something more linear, involving more paper work, or with more distractions from doing what you are good at. Sometimes it’s going back to school, or having a family or being in a long term relationship with requires better focus.

A common scenario is that the medication is still effective but it wears off way too early in the day and a top up later in the day is both needed and very effective.

Depression can make adhd look a whole lot worse and make medication less effective.

• no, they are safe to take for the rest of your life

In the past we could only rely on our experience which was suggestive of safety but hardly proof. We do now have the scientific evidence to show long term safety. At last year’s CADDRA meeting, one researcher was able to show us that long term stimulant use does not lead to premature death, or heart attacks, something we had worried about in the past. This evidence is based on 30 years of detailed records collected in Norway which has a centralized medical record system, and surprisingly, in the US, where health insurance companies keep detailed records of outcomes. Kiaser Permanente existed 40 years ago and we can follow patients long term cz-lekarna.com.

• no, but we might advise a reduction, treating the ADHD can make that easier
• if under 25, stopping marijuana/cannabis is urgent to prevent long term brain damage, not to mention impact on offspring.

While stopping should be the long term goal, realistically lots of patients find it difficult or are using it to sleep or manage anxiety. I find that patients naturally reduce dose as the ADHD medication starts to work.

there are better ways to manage sleep and anxiety so talk to your doctor.

In the past, I didn’t see problems with occasional use of marijuana but recent evidence of significant brain damage and impact on offspring and their risk of ADHD has made me rethink this, especially in those under 25. Get off, get off soon, and while working on getting off, reduce the dose as much as possible, but with the definite plan of eventually stopping if you are under 25.

For those over 25, the message remains that less is better, that medication is significantly more effective and marijuana may slow the brain down but doesn’t improve focus so at best is a partial solution with significant concerns, especially if you are a woman who may have children in the future.

• medication is a lot better
• anyone under 25 has to stop using marijuana/cannabis urgently

ADHD patients with racing minds do find that marijuana slows them down and this is helpful. Unfortunately, it actually makes focusing even more difficult, especially for anything more than basic, so most patients find that stimulant medication works much better impotenzastop.it. Add in the risk of addiction, weight gain, and laziness sometimes seen in marijuana use, it’s not a great solution.

More scarily, there is evidence that in young people, under 25, there can be permanent brain damage from use of modern day potent cannabinoids, and use of cannabis in women, can have a dramatic increased risk of offspring having ADHD, and their children too, through a mechanism called epigenetic, were genes are turned on and off and it is heritable. Creepy!

• not unless you have a personal or family history of serious arrhythmia

Most patients dont need one. There was a time when we worried about stimulants causing kids to drop dead. Fortunately good research showed this was not the case. We still worry that if there is a family history of dropping dead from a fatal arrhythmia, it might be genetic and safer to get a bailine EKG before starting treatment.

Some medications pose a risk for altering heart electrical function slightly and we worry that adding a second medication that can cause palpitations could be dangerous – so an EKG within a few weeks of starting treatment is a good idea.

• good chance you can reduce the dose but uncertain if you can go off
• 30% of ADHD patients have another diagnosis in addition

Comes down to do you have depression secondary to living with untreated ADHD, or are you one of the 30% who have anxiety or depression in addition to ADHD. If the former, you might well get off antidepressants but if the latter, then perhaps not.

From a practical point of view, many people are able to reduce the doses of antidepressant – which reduces side effects.

If someone is already on a high dose of antidepressant, we may want to reduce the dose simply because adding a stimulant can raise the blood level of the antidepressant and risk serious side effects.

• antidepressants are entirely compatible with ADHD meds
• sometimes ADHD meds will raise the antidepressant level so if it is already high dose, then we might need to reduce it

Yes, we don’t want you going off your antidepressant, at least in the early stages of ADHD treatment. That said, research shows there can be modest increases in antidepressant blood levels when you start stimulants so if you are already at max. dose antidepressant, we might drop it a notch.

Don’t forget that serotonin acting antidepressants can cause dizziness and ‘brain zaps’ when stopped suddenly.

Bottom line is it’s just fine to be on antidepressants and ADHD medication.

• tics are not caused by ADHD medication but they might make them worse

Tics are vocal spasms or muscle twitches that occur more commonly in kids with ADHD. It tends to reduce as they reach adulthood. It used to be felt that stimulants actually caused tics, but that’s been disproven. It is probably true though that occasionally stimulants will make tics worse.

Lots of kids with ADHD do have funny mannerisms, from blinking to shrugging to doing repetitive movements but that is largely voluntary and patients have at least partial control over it – being busy tends to make those things disappear where true tics won’t go away when busy.

Tic’s might limit how much medication we can use but rarely stops us from using stimulants and for the most part, without making things worse.

Some patients have what look like tics as a part of obsessive compulsive disorder. If a ‘tic’ can be suppressed by some sort of action – touching surfaces for example, it might be OCD and that can be treated and doesn’t prevent us from treating ADHD.

There is no specific medication for tics, but over the years a number of medications have been used with some benefit, but many of them have significant potential side effects.

True tic’s are very uncommon after age 25, both because fewer people still have them and those that do, have them a lot less often than when they were kids.

• typical cost is $100-200/month

Cost varies depending on doses and frequency of medication, whether they are available as generic and which medication it is, but realistically, typical costs run between $60 and $200 per month.

It varies between pharmacies. Costco and Walmart are two of the cheapest, while small independent pharmacies tend to be expensive and oddly, Shoppers is fairly expensive.

Older meds and especially those in generic form are typically cheaper, but expect that with one of the long acting medications like Vyvanse or Concerta to pay about $200 per month for medication. Ouch. Good reason to get a job with a good drug plan.

Some of my patients get paid based on how hard they work and how good they are – sales for example. In this case, we find frequently that treating the ADHD can double sales and the cost of the drugs is minor compared to the increased income. I remember a waiter who was already best in his large restaurant, but he doubled his tips when we treated the ADHD. Now he was more attentive, more alert, more organized, and knew when to back off. It was appreciated and customers rewarded that great service.

If you’re stuck on a fixed wage, being on medication might make the difference in getting a promotion, or simply a better job, but that won’t help you today at the pharmacist. While Vyvanse is one of my more commonly written prescriptions, generic Dexedrine Spansules is exactly the same drug, just a bit shorter acting and even when taking it twice a day, is almost half as expensive, say $120 per month. Of course, you have to remember that second dose.

Bottom line is it’s sure nice to have a job or significant other who comes with a drug plan. Perhaps that’s what you should ask on a first date.

• private Blue Cross and Alberta Works and AISH cover vyvanse, Dexedrine and Ritalin

I can’t give you a detailed list. Pharmacists often know more about this than I do and if they don’t, they have a mechanism to find out for you. What I can say is:

Private and Seniors Blue Cross in Alberta covers Ritalin, Dexedrine, and Vyvanse, but not Concerta or Foquest or Adderall XR plus. It also doesn’t cover Strattera or Intuniv XR.

Social services uses the same drug list and coverage as private Blue Cross so if someone is on social assistance, Alberta Works, or AISH this is what you can expect.

Private insurance companies are hard to fathom, one will cover Vyvanse but not Adderall, and the next company does exactly the opposite. So check with your pharmacist.

Likewise the military, and Native Affairs have their own rules.

Sometimes you can get exceptions if you apply and in other cases, you have to have used something that is covered before you’re allowed to try what we wanted in the first place. It’s easy enough to do a one week trial of the covered drug – heck, you might even like it, but if not, you can then apply for the drug we wanted in the first place.

• most of the time generics are ok

Talking about stimulants, the short answer is maybe. By law, the amount of actual drug has to be the same, but that doesn’t mean it will work the same. It might dissolve faster, or slower, or not at all. It might hit you fast and cause side effects, or hit you slow and it isn’t nearly as effective. In my experience, these kinds of problems are fairly common.

So, effectiveness, onset, duration and side effects can be issues, but sometimes that’s just a matter of a small adjustment to timing or dose and if your drug plan won’t pay for brand names when generics are available, it’s definitely worth giving it a shot.

I encourage patients to at least try generics and if we need to make adjustments to the dose or timing of top-ups later in the day, well that’s not a big deal to save what’s often a lot of money.

• Ritalin and generic Concert need the triplicate/duplicate RX
• Triplicate/Duplicate Rxes must be handed in within three days.

Dextroamphetamine came out in the late 1930’s, Ritalin in the 1950’s. As Ritalin was new, and patented and valuable, it was hugely promoted. IN the 50’s there was a well established drug rep programme visiting doctors and offering them trips and handouts and free stuff, and unfortunately they were very influential. There was backlash, and recognition that Ritalin wasn’t perfect and that it could be abused. But it was popular.

As a result it was Ritalin and methylphenidate products that the College Of Physicians And Surgeons Of Alberta decided must be better controlled, just like as was being done with strong narcotics.

It would require a special prescription pad, with serial numbers, and hard to alter surface, and three parts, one for the physician to keep, one for the pharmacy and the last to be sent to the College. They would monitor prescriptions and have a little talk with physicians who seemed to be stepping out of the usual practice, in terms of numbers of pills, frequency and dosage.

It didn’t seem to occur to them that dextroamphetamine had all the same issues as Ritalin, and so Dexedrine and it’s derivatives never entered what’s called the Triplicate programme.

So what does this mean to the patient? Well, some doctors won’t use triplicates at all so forget asking them for a Ritalin refill. As new methylphenidate products come on market, they are automatically triplicate till the college decides they aren’t at great risk of abuse. Most recently this happened with Foquest, which fortunately is no longer on the triplicate programme.

It means prescriptions cannot be phoned in, though oddly, they can be faxed, if from a doctors office but I can’t fax them from home and don’t even keep triplicate prescriptions at home or in my vehicle.

The triplicate prescription expires after only three days, so it must be handed in promptly. Now, it doesn’t have to be picked up immediately, or paid for immediately if you didn’t pick it up, but if you hang onto it for a few days before going to the pharmacy, they have to contact the doctor and there will be a delay before you can get your medication, and frankly, it pisses off your doctor as they have to then deal with your forgetfulness. DO you really want to piss off the person who holds your life in their hands? Mmmm cz-lekarna.com?

When you pick up the triplicate prescription, you have to show identification and sign for it, complicating and slowing the process.

The college has recently announced switching to a two part prescription but everything else will stay the same.

Products that require a triplicate include Ritalin, Ritalin SR, and generic Concerta (but not the brand).

• Forget drug holidays
• going off to see if medication is really doing something is reasonable and you go back on as soon as you have your answer

while drug holidays were commonly recommended in the past, it wasn’t based on science and simply has no merit. It might be reasonable to go of to see if the medication really is helping, but as soon as you determine that it is, then you go right back on – this could be in as little as one day.

Generally if an adult has enough symptoms to warrant a diagnosis of ADHD, they usually have sufficient symptoms in all aspects of their life that whether they are at work or on holiday they benefit from being on medication, as do the people around them.

IN kids, it can be a bit more complicated. With concerns about appetite and weight and even growth, we sometimes need the child off medication as often as possible.

Some adults go off their medication on weekends but apart from pissing off their family, it means they are less organized, less efficient, misplace things more and are more short tempered. In addition, while kids don’t seem to notice any issues stopping stimulants, adults often find they are really tired for the first day or so of being off.

I recommend adults continue their medication on weekends, though they might use a shorter acting medication if they are lucky enough to be able to sleep in (ie. no kids) a trouvé.

• teenagers go off because they don’t like being told what to do, or it messes with appetite, or sleep, or the medication makes them too serious, not any fun any more

Going off medication just when high school is starting seems like such an obviously bad idea, but it happens all the time. Sometimes kids are simply asserting their indepenence or resent their parents nagging them about taking their medication.

Sometimes, though, the teenager has legitimate concerns. On medication they feel rather flat, losing their personality, sense of humour or spontaneity.

There are ways to fix this so it’s a pity that they don’t consult before going off. Usually we catch them again when they are struggling in grade 12, but not always. Sometimes they have to learn the hard way. If you are a teenager reading this, do you really love high school so much you want to take another year to complete it?

Fixing a lack of sense of humour might be a matter of a smaller dose that lasts longer, or adding a non stimulant to the current medication, or switching stimulants.

Occasionally what the student really means is that they miss being the class clown, disruptive and silly. They don’t always recognize the difference between being laughed at or laughed with. This can take some support and encouragement and education.

• meds don’t always work, but that’s less than 3% of patients

Unfortunately not, though it’s pretty uncommon. In a few percent of patients they either don’t respond to medication or do so only very briefly.

Far more often patients complain medication is no longer working. While this may be tolerance developing it is often that the medication doesn’t last as long as expected, wearing off as early as 1 PM. It can be particularly frustrating for partners who only see the patient in the evenings and by then the patient is essentially not on treatment any more – the medication having long since worn off. This is an easier problem to fix.

Occasionally the problem is the delivery mechanism of the medication. It’s assumed that all patients metabolize the medications at the same rate and have the same sensitivity to medication but nothing could be further from the truth. Some patients need more than the maximum recommended daily dose of stimulant. Uusally those doses were determined in the original research that got the drug licensed, and more experience since then has shown that higher doses or more frequent doses are often needed.

It’s very common for those early studies to show that there is no advantage to higher doses, and yet within a few years, we have learned the value of much higher doses.

How high a doctor is willing to push medication is based on experience, subsequent teaching, nerve, and some might say recklessness.

I not only need to justify a certain dose to myself, I need to know that I have evidence to support such decisions or I put myself and my patient at considerable risk.

Sometimes ADHD medication fails because of underlying depression or severe anxiety, but if you hate your job, it’s doubtful there is any dose of stimulant that is going to make you focus. And if you hate your boss…

I have had patients be issued with a different and usually generic form of their medication and that explains why it’s no longer working.

If we missed borderline personality disorder or bipolar disorder, that might well explain why the ADHD medication isn’t working. Doesn’t necessesarily mean they aren’t ADHD, just that they have bipolar in addition.

Addictions can prevent ADHD medication from working. A very toxic relationship may trump medication effect but on the other hand, might have been caused by the ADHD in the first place.

• Bipolar Disorder
• Obsessive Compulsive Disorder

Bipolar and Obsessive Compulsive Disorder but the first step is to get an accurate diagnosis. Sometimes Bipolar can be mistaken for ADHD versuchen sie diese seite.

Using stimulants when bipolar or OCD are not well controlled can be a disaster – in the bipolar, resulting in manic behaviours that can cause a lot of damage in the way of physical safety, destroying relationships and reputations, and losing trust, not to mention ending up in a locked room in hospital against your will because you’ve gone psychotic as part of your mania triggered by the stimulants. In OCD, stimulants can be very poorly tolerated because of massive increases in agitation and anxiety.

Get these conditions under decent control then we can definitely proceed with ADHD treatment including the use of stimulants.

• dry mouth
• edginess/agitation
• decreased appetite
• difficulty getting to sleep
• irritability
• headache
• sweating
• depresssion
• palpitations
• elevated BP
• upset stomach

Here’s a list of the common side effects, as well as some that are much less likely but potentially more serious.

Dry mouth – happens to almost everyone but some don’t find it a problem, many find it gets less after a couple of months and a few find it intolerable.

Saliva protects teeth and anything that produced dry mouth results in greater risk for cavities. It’s essential that anyone on a medication that can cause dry mouth have excellent oral care, brushing twice a day and flossing as well as going for fluoride treatments and teeth cleaning.

Edginess – more of a physical sensation than actual worrying more. Many patients feel calmer and happier on medication but edginess or agitation often happens when you first go on a new dose of medication. Often it settles in a matter of a few days but if it doesn’t, there are ways to work around the problem.

Decreased Appetite – more of a problem in kids but occasionally an issue in adults. Most patients report it settles within a few weeks. For those in whom it’s a problem, we try to have medication wear off shortly before supper, medicating in the evening only when really needed.

Difficulty getting to sleep – not for most patients but for the patients who do find this, they REALLY don’t like it. It may settle over several days but can persist and requires a change in medication duration or type if so.

More often stimulants in small doses can actually help sleep. Very occasionally we’ll see difficulty staying asleep and that seems to relate to running out of stimulant and can be helped by a small evening dose of long acting stimulant – odd, I know, but it often works.

Irritability – can happen as a side effect of medication in which case it is present when the medication is strongest, usually mid morning, or it can happen as a withdrawal symptom end of day in which case it’s easy to top up even once a day medications with modest dose at lunch time, or switch to an even longer acting medication like Foquest.

Irritability can also be too much medication. When focus goes beyond the normal we get the ‘ritalin made my kid a zombie’ syndrome in which a person hyper focuses even on the boring, but also gets irritable when pressed to pay attention to other matters.

Headache – can happen as the medication kicks in in the morning, or can be a withdrawal symptom at end of day. The former needs a switch in medication, the latter a top up later in the day.

Sweating – not very common, perhaps 1 out of 10 patients but frustrating when it happens. A matter of working the dose and timing and sometimes which medication. Antidepressants are often associated with sweating so it may be a matter of reducing those rather than messing with the ADHD meds.

Depression – can happen in the first few weeks or it can sneak up over a few months, Usually grounds to do something about it, but again if is end of day only, easy to treat with a top up.

Palpitations – this can be a rapid heart beat or an irregular heart beat from what are called extrasystoles. It’s almost always harmless, though in someone over 50, it warrants investigation if it happens. Some of my patients report already having these symptoms related to anxiety or even caffeine. If a patient has recurrent atrial fibrillation, it’s possible that stimulant medication could increase risk of episodes – after all we know that caffeine can.

Other symptoms are less common, occurring less than 1% of the time. That doesn’t make them unimportant, just unexpected.

BP Elevation – while well described, isn’t in fact very common. However, it seems we are poor at predicting who it can be problem for – the person who is already on four blood pressure medications and still not well controlled turns out to be fine on stimulants, while the 16 year old skinny girl has a significant jump in bp.

Whether to treat the adhd anyway, knowing that you might have to add a bp medication comes down to the risks/benefits balance. If the alternative to controlling adhd is a car accident, then it’s a no brainer. If someone is going to get fired, or divorced, it’s probably worth it even if we do have to treat the bp.

Psychosis – It’s well documented that stimulants can cause psychosis. Whether it’s true is a whole other matter. A recent study indicated that no, methylphenidate does not cause psychosis in children. Whether that generalizes to adults and dexedrine based stimulants remains to be seen.

Personally I have never seen psychosis from stimulant use but that doesn’t guarantee anything – just means it’s very unlikely.

We know that marijuana can cause psychosis, as can bipolar disorder, and antidepressants, and even cold remedies and gravel – so I don’t think it should factor in anyone’s decision to treat or not treat, just information to be filed away just in case.

Upset Stomach – is often listed as a common side effect but my experience suggests it is not common at all. I almost never see it except occasionally on Vyvanse specifically, and is usually solved by taking the medication with food.

Things ADHD medications don’t cause:

seizures and heart attacks – yes, we now have solid long term evidence in hundreds of thousands of patients to say this with confidence.

It doesn’t make ADHD worse in the long run and addiction to ADHD medication is uncommon. It is not normal for ADHD medications to stop working severe months to years after being started, if your circumstances have not changed – eg. marriage, kids, promotions, different job or returning to school.

• a dramatic response is very suggestive of ADHD, but not proof

Not necessarily. An ordinary person will feel more alert and focus longer, especially if they are tired – too many late nights or whatever. Dramatic responses to medication are suggestive but hardly proof of a diagnosis – grounds to investigate further.

We don’t use stimulants as a trial to see if someone has ADHD unless we already have a strong suspicion – but very occasionally there remains some uncertainty after a good workup and at that point I do sometimes trial the patient on stimulant medication, but this is AFTER the workup, never instead of it.

• it all comes down to the impact of the adhd, on performance, stress, and school ‘burnout’

It’s all about the impact of not treating ADHD in kids. You have to consider the safety issues – do they run out between parked cars, even at 8 years old? You have to look at the social skills part – frankly, do they piss off friends because of hurtful comments, or not knowing when to shut up, or how to get along and keep their temper. It’s about the joy of reading and learning and whether NOT medicating will either turn them off of school or result in such anxiety that life is miserable.

You have to ask yourself, what would I have been willing to do to NOT have been like that as a child myself a trouvé?

The bigger issue is when should I look at treatment for my child? That answer depends on the severity of the ADHD and whether there is restlessness or impulsivity. It can also depend on the skills of the teacher and whether they ‘get’ kids with adhd and know how to help them.

Medicating just for work is usually a big mistake . I suppose if you are single, not in a relationship, don’t have too much trouble organizing and running your home life, then maybe you can forego medication when home, but most patients benefit from being on medication all the time.

• treatment is usually lifelong

It depends cz-lekarna.com. For someone whose adhd is mild and they are in school, it’s possible they may not need medication after graduation. They then might have to go back on medication after a promotion or change in responsibilities or when they are in a relationship or have children.

The idea that somehow if you go on medication for a few years, that you won’t be adhd after is unfortunately not true. That said, with maturity and experience of being on medication, you might manage your adhd a bit better when you go off than you did before going on in the first place.

For many people diagnosed as adults, they really are looking at a lifetime of treatment and fortunately evidence suggests this is safe. There is no upper limit to age for ADHD treatment.

• yes, but they are much less effective

The answer is a definite maybe. Non stimulants push one button in the brain while stimulants push two, and as a result are at least 3X more effective. Some patients don’t need a sledge hammer to help and a gentle nudge in the right direction can be effective. More often though, we use a combination of stimulant and non-stimulant to gain effect without the problems of using only stimulants.

Stimulants work the day you take them while non stimulants build up over 2 – 6 weeks, but that also means that they work 24 hours a day without messing up sleep – a distinct advantage.

• many adults do well on the same stimulants that were poorly tolerated as a kid

We still use basically the same drugs now, even if brands and durations of effect are different, but some side effects are much less of a problem in adults – for example the loss of appetite that can really limit treatment in many kids. Other side effects we have learned to work around – like rebound irritability, anxiety and moodiness at end of medication effect in the afternoon (by adding a top up at lunch or switching to a longer lasting medication). We know more about the use of combinations of stimulants and non stimulants to reduce side effects, and frankly, we often get lucky and patients don’t have the same problems, even with the same medications. Bottom line, there’s a good chance you can do a lot better on medication as an adult.

The ‘need’ to be the class clown is less attractive to adults.

Adults are more aware of the need for strategies to remember medication which often makes it easier to get used to it. And adults are more likely to come back in and complain if things aren’t going smoothly.

In practice, patients often do well with the same medication that was a disaster for them as a child so it sure doesn’t prevent me from trying the same medication, albeit with some caution.

• usually, but sometimes there are big differences in either effect or side effects

Sort of. In Canada, there are only two main medications, methylphenidate and amphetamine (usually dexedrine). About 70% of patients find they have a similar effect and side effects, but in the other 30% there can be huge differences in effectiveness or in side effect profile.

the actual number of milligrams per pill does vary hugely, methylphenidate needing about 2.5 times more milligrams for a similar effect to the equivalent dexedrine.

One exception in the dexedrine family is Vyvanse which is made slow release by binding it to lysine – an amino acid that is in out diet anyway so is safe, but that breaks apart in the body slowly, making it slow release. Turns out the lysine weighs more than the dexedrine and you need bout 2.5 times the milligrams – so similar to methylphenidate.

This means that Vyvanse and Concerta doses are roughly the same, while Adderall which is amphetamine and dexedrine spansules need a lot less.

Short answer is yes, till you get a sense of how sensitive you are to the caffeine, and then you can cautiously reintroduce it. Often people with ADHD were self medicating with caffeine before going on treatment and often those kinds of levels will not sit well versuchen sie diese seite.

• if you are an adult, then no
• if you are a kid with mild inattentive type ADHD then possibly

If someone is young, and not in a relationship and not in school, and not impulsive and not severely ADHD, then it’s not unreasonable to be off medication on weekends. On the other hand girls off medication date ‘bad boys’ and it doesn’t end well. Guys seek out risky sports and injuries are common. And yes, it could just as easily be boys dating bad girls or boys etc.

Also, while kids seem to be able to go on and off their stimulants without problem, adults often find that the first day or two off of stimulants they are extremely tired (like with cafeine but more so).

As many of my patients don’t appreciate the full range of their ADHD symptoms it may well be that the impact of being off is more of a problem than they think.

• no, if you have good strategies and not too much stress

Definitely not. If you are successful and not too stressed, and if those around you are not frustrated by your symptoms, then there’s nothing wrong with knowing you’re ADHD but choosing not to treat. That said, those who choose not to, really are already treating their ADHD, by making lists and having systems in place and learning to be very organized, or having people in their lives to do it for them. I do see a lot of patients who only think of medication in terms of work, and discount the need for treatment to manage homelife, live with loved ones, be a parent, manage money or to avoid rash decisions versuchen sie diese seite.

Treatment doesn’t have to be medication. There is more and more evidence to support the use of counselling, and in particular cognitive behavioural therapy.

Just as coaches can help you stick to an exercise or weight loss programme, they can motivate you to do the things to make your life run more smoothly when you’re ADHD.

Don’t discount the concept of ‘getting your shit together’. We know that when patients are motivated – by money, interest, self preservation, bribery or anxiety, they CAN manage procrastination and organization, and set up strategies to manage focus. Whether doing all of that will prove a bit much and lead to more stress is the question that determines whether medication should be considered.

• usually it’s pretty obvious once we get the dose right

Most patients have no difficulty telling that the medication is working when the dose is right. In practice, any of the symptoms reported in the assessment, or even on a screening test will likely improve to some degree, often dramatically. It’s not usually necessary to keep a diary or dither about whether it’s real or placebo – when we get the dose right, life should be a lot easier.
Some people expect the medication to change them but it doesn’t other than they don’t have the adhd symptoms they had previously. Other people (more severe ADHD, anxiety, depression) do feel fundamentally different on medication because the ADHD impact was huge and getting it under control is a giant relief.

In patients who will be in school but aren’t currently, I have them test focus by doing some reading, or taking one online course and testing the waters or deliberately paying attention to how they’re doing in terms of procrastination, listening, misplacing things and being impulsive.

Stimulants work the day you take them. Unlike antidepressants that build up over time, if you get the dose right, they work today. Now, in real life if we started everyone on the dose we thought would be right for them, many wouldn’t tolerate it at first, so we sneak up over several weeks. That said, lots of patients can see a significant difference by the end of a two week trial.

• NO

In the first few weeks, tolerance or a lessening of effect happens in half of all patients. It is less common between 3 and 6 weeks, only occasional before three months and if it happens after that, there’s usually a good or bad reason for it happening. It might be going back to school, or a promotion or change to a job that is more linear and more detail oriented, or it might be the birth of one extra child than you can cope with effectively. On the other hand it might be depression, anxiety, marijuana, alcohol or other substances – but in my experience there is almost always a good explanation and we need to take that into consideration when planning treatment.

• I see kids 10 and up

If I see you already, then I’m happy to see your child at whatever age. If I don’t already see you, then I do see kids 10 and up, preferring the younger children to see one of the city’s paediatricians who work with ADHD.

I know it can take several months or longer to get into a paediatrician who does much work with ADHD so if I can be of help in the interim…

Yes. Its best if a referral comes from your family doctor but it isn’t essential. It’s much better if you can bring someone with you to the initial appointment – a partner, ex, roommate, parent, sibling or whoever.

#10, 6449 Crowchild Trail SW, 403 455-2550, see contact me for a map.

I do see patients without Alberta Health. If from another province, it typically won’t pay for the assessment visit and that’s $250 for a one hour assessment. Often out of province WILL pay for the followup visits or at least most of them, but absent any insurance, cost for a followup visit is $50

• I see children 10 and up

I used to see kids of all ages but as I worked more with adults, I saw fewer children and usually prefer to pass kids under 10 to one of several paediatricians who work with ADHD. If your child is getting a bit old to fit in the paediatrician’s chairs, I’m happy to take over and in the past, a number of paediatricians have referred their graduating patients to me, usually around age 16 or so.

On a practical basis, if I already see a parent, I’m happy to help with the offspring, especially knowing how long it can take to get into one of the paediatricians so I still work with several younger kids.

Sometimes there are difficulties in seeing the pediatrician – in terms of getting in quickly or being able to ask questions as easily as you’d like, or dealing with them after hours. I give my patients my email address so you can contact me almost any time and I’ll respond within 24 hours.

Sometimes kids just don’t get along with a particular doctor and if you’ve found me easy to approach (I hope) and think this could be helpful for your child, then perhaps I can help.

I recently had a situation where I see mum, the children see a paediatrician, but it would be a lot easier for mum if most of the visits were with me. The paediatrician pointed out that he has a close working relationship with the teachers and that’s important and we’ve agree that he’ll see the kids once a year and when we need him, but in-between times I will see them and adjust medication as needed and monitor for side effects and growth.

Short answer is no. Remember though that it can be difficult to sort out borderline from impulsive type ADHD. That can take skill and time.

Looking like you are borderline can be Bipolar disorder, or impulsive ADHD.

• maybe but treating the ADHD can be really helpful

It’s often thought of as a separate condition but my experience suggests that it often responds very well to ADHD treatment, rather implying that it is part of the ADHD. That said, there are ADHD patients who love to read and have no difficulty remembering what they read, and people who struggle to read but aren’t ADHD and some with ADHD who’s struggle with reading isn’t helped by medication – but not often versuchen sie diese seite.

• Foetal alcohol can have ADHD symptoms but also a lot more problems

Alcohol affects the foetus in different ways at different times of foetal development, meaning that while sometimes it can look like ADHD, there are usually additional problems that make it much more challenging to treat, including often an inability to learn from experience.