Daytrana is an ADHD patch – a system that delivers methylphenidate, which is the same standard medication accessible in tablet forms such as Ritalin and Concerta. The uniqueness of this system is the way it’s delivered.

It is a relatively new type of medication to manage ADHD. The patch is applied to skin at the hip area and left on for approximately 9 hours while the medicine is gradually absorbed into the body. It is meant to give relief from ADHD symptoms such as lack of concentration and poor organization skills.

Daytrana first came into the market in 2006, offering an alternative to ADHD medications such as pills. Daytrana lets the medicine to be sent directly to the bloodstream without the need to be digested first. Kids who use the Daytrana patch are probably more likely to feel the positive effects of the patch and help them to complete their school work during the day.

The distinct benefit of the product is its ability to let each patient to find out the duration of action of the medication on a daily basis. The patch is meant to be applied for about two hours prior to the medication’s effect is needed, and the effectiveness goes on for up to three hours after the patch is removed.

The delivery of the medication is easy and simple as the patch can be worn throughout the day while performing normal activities like swimming, bathing, or while performing exercises. As the patch is visible externally, parents can make sure that the medication is on when compared to pills and medicine that do not confirm whether the medication has really been taken. One good thing about the patch is that, once applied, it cannot be removed and re-used by others.

The company recommends the patch to be worn for 9 hours, although it can be taken off before that time. It can be helpful especially when the child’s school schedule is short. The patch can also be taken off earlier to minimise the chances for decreasing the appetite or interfering with sleep pattern.

When it comes to cost, all new medications tend to be expensive in the beginning, especially when they are protected by a patent. At the moment, Daytrana is more expensive than the generic types of oral medication, but it may be less expensive than oral ADHD medications that are still covered by a patent.

How does Daytrana work?

Daytrana releases a small doses of medication on an hourly basis so that kids with ADHD have a constant amount during the school day. It is recommended to be applied 2 hours before the medication is required to begin working.

Daytrana is an adhesive patch that securely sticks to the hip of the ADHD child throughout daily actions. As long as it is applied properly, Daytrana is a convenient medication for controlling ADHD symptoms.

Benefits

Parents who are having problems administering medication to their kids with ADHD, now have a better option, especially when kids refuse to swallow pills or who want to avert the stigma of taking medication at school. The Daytrana patch saves parents the fuss of crushing a tablet, mixing it with food or water, and hope their child will swallow the ADHD medicine.

In the case of pills, the medication is swallowed and released in the digestive system, later to be absorbed into the bloodstream. In the case of the patch, the method is different as the medication goes straight through the skin, and is absorbed into the bloodstream avoiding the digestive system. One good thing about the patch is that the same amount of medication is present right across the patch, although in different doses to be worn for shorter or longer periods of time.

Many children with ADHD are using the Daytrana patch to treat their symptoms during the day and help with attention and focus in school.

How to use and dispose the patch

Before applying the patch, make sure the area of the hip that you apply is clean and dry. Do not put it at the waistline as the patch may be moved away by clothes rubbing against it. While applying the patch, securely press it with your hand for about thirty seconds, making sure the edges are completely stuck. The full surface of the patch must be exposed to the skin for the correct amount of medication to be absorbed.

When correctly applied, the patch will stay on and keep producing medicine. However, exposure to water from bathing or swimming could affect its adhesive properties. If the patch falls off, throw it away and apply a new patch to a different region of the same hip, ensuring the total daily length of time does not go beyond 9 hours. Don’t use tape, bandages, or other home adhesives to re-apply the patch.

Disposing of the patch properly is as important as applying it. To protect kids from coming into contact with the medicine, always remember to fold it in half so that it sticks to itself, and then throw it away safely.

Side effects

Side effects of the Daytrana patch include sleep difficulties, loss of appetite, stomach pains, and headaches. As the patch sticks to the skin, it can also cause a rash or irritation. However, this can dealt with by applying the patch to a different area of the hip every day. Do not apply the patch to irritated or damaged skin as it could increase the amount of medication that gets into your child’s bloodstream.

The side effects of the methylphenidate medication are similar to the oral forms, where a child may get irritated, angry, especially if the dose is too high.

The disadvantages of the system include the need for meticulous application of the patch every day, at a different area on the body, normally the hip region below the waistline, and redness can be expected at the area for up to 2 days after patch removal.

Heat must never be applied to the patch like heating pads, electric blankets, and heated water beds, because this could change the rate of delivery of the medication into the system.

There is a possibility of developing an allergic reaction to the adhesive, or potentially to the medication itself.

The most common reactions related with Daytrana (about 5% and double the rate of placebo-treated patients) in clinical trials among children included decreased appetite, insomnia, nausea, vomiting, and decreased weight. Among a adolescents, there has been decreased appetite, insomnia, decreased weight, dizziness, abdominal pain and anorexia.

And also, most of subjects in these studies had a degree of skin erythema where the patch was applied. Leaving the patch on for more than the stipulated 9 hours resulted in a rise of adverse events.

Conclusion

As with all ADHD medications, the use of the Daytrana patch will have to be cautiously monitored by a doctor. It is advisable to discuss this new system with your child’s doctor and then decide whether it’s the right thing for you and your child.

Some of the most common attention deficit hyperactivity disorder (ADHD) symptoms include inattention, impulsivity or hyperactivity that could play a major part in a child’s capability to learn and live with others.

People often make the assumption that an ADHD child’s behavior stems from indiscipline, a troubled family life, or even watching excess TV. But according to research, ADHD is in principal a genetic disorder.

However, there are a few environmental factors that could affect ADHD. Let us look at the myths and facts that could cause ADHD:

1. Pesticides – Research indicates a potential link between ADHD and pesticides. A 2010 study in Pediatrics established that children with increased urine levels of organophosphate (a pesticide used on produce) revealed high ADHD rates.

In another study in 2010, researchers found that women with high urine levels of organophosphate were expected to have a child with ADHD.

The studies suggest a possible relation, but cannot prove that pesticides are the reason for causing ADHD. Marcy Rosenzweig Leavitt, PsyD, who works with ADHD patients in Los Angeles, recommends consuming organic fruits and vegetables as inorganic ones contain high levels of pesticides.

2. Smoking and drinking during pregnancy – Fetal exposure to alcohol and tobacco is believed to play a part in ADHD. According to research, kids exposed to tobacco smoke prenatally are twice as much likely to have ADHD compared to those who are not.

Mark L. Wolraich, MD, chief of the section of developmental and behavioral pediatrics at the University of Oklahoma Health Sciences Center, believes that fetuses exposed to alcohol are affected by fetal alcohol syndrome, and the symptoms are expressed in ADHD.

3. Exposure to lead – Although lead, a neurotoxin, is removed from almost all homes and schools, but you can still find small quantities of it everywhere.

A study conducted in 2009 suggested that children with ADHD are prone to have increased blood-lead levels compared to other children. The research found that although lead can be toxic to the development of brain tissue and could have continuous effects on the behavior of children exposed to these substances, but it is farfetched to conclude that such exposure could have an impact in the majority of children and teenagers with ADHD.

4. Food preservatives – Most EU countries have banned particular preservatives after a study found evidence of hyperactivity in kids who consumed food that contained mixtures of artificial food colors and sodium benzoate, which is a widely used preservative,

The FDA has stated that food additives are safe only when used properly, and most additives are not needed to be visibly labeled on packaging.

Experts like Marcy Rosenzweig Leavitt consider only a minority of kids could benefit by staying away from brightly colored processed foods that are prone to contain more additives. Cutting down on these additives may or may not aid hyperactive behavior, but many factors play a part in ADHD.

5. Sugar – Parents have often assumed that sugar could cause hyperactive behavior, but it’s so wrong. There have been many studies, but none have been able to demonstrate behavior changes due to sugar consumption in kids.

A study in the Journal of Abnormal Child Psychology found that mothers who believed their kids were given sugar rated their kids’ behavior to be more hyperactive compared to mothers who were told their kids were given a sugar substitute, despite of whether their kids actually consumed real sugar. Cut down on sugar if you are concerned about calorie consumption or dental cavities, but not due to ADHD.

6. Watching Television – There’s no evidence that watching excess TV or playing video games will cause ADHD, while research states that teenagers who spend a lot of time watching TV were prone to more attention problems compared to those who did not. In theory, regular stimulation of television and video games might make it difficult for young people to stay attentive.

7. Poor parenting – Rebellious attitude and bad behavior is often confused with ADHD symptoms and usually it’s the parents who are blamed for their kids’ conduct. However according to the National Resource Center on ADHD (1), there is no hard proof to suggest parenting style could lead to ADHD.

Marcy Rosenzweig Leavitt believes that parents who make use of reward and consequence behavior tools, and provide simple set of expectations could help reduce ADHD symptoms.

8. Brain injury – According to the National Institute of Mental Health (NIMH) (2), children who have undergone particular types of brain trauma may display symptoms parallel to ADHD. As only a small minority of children with ADHD has faced a traumatic brain injury, it is not deemed to be a crucial risk factor.

9. Diet – In the past, food allergies were popularly believed to be the cause of ADHD, but research so far has found no evidence that diet plays a substantial role in ADHD.

However, according to a recent Australian study, particular dietary blocks could affect behavior among adolescents who consumed foods high in fat, refined sugar, and sodium. They were two times as likely to be diagnosed with ADHD compared to other children. Further studies have also associated diets lacking in omega-3 fatty acids could lead to ADHD symptoms as they are helpful for brain development,.

10. Genes – There is strong evidence to prove that ADHD is inherited from parents, but not parenting style. Experts say this heritable psychiatric disorder can affect a child with ADHD, especially if a relative has been diagnosed with ADHD. Research among multiple twins also shows that ADHD often runs in families.

A new study by researchers at Cardiff University in Wales established that kids with ADHD are more likely to have missing or duplicated segments of DNA.

Sources:
1) National Resource Center on ADHD
2) National Institute of Mental Health (NIMH)

The ratio of children and teenagers in America who have a developmental disability such as autism, learning disorders or attention-deficit/hyperactivity disorder (ADHD) has grown 17% since the late 1990s, according to a new study conducted by the U.S. Centers for Disease Control and Prevention.

In 1997-1999, around 12.8 percent of kids were known to have a developmental disability. That figure increased to 15% in 2006-2008, with an additional 1.8 million American children.

This upward drift has been propelled mostly by increase in the number of children with autism and attention deficit hyperactivity disorder. Occurrence of stuttering and learning disabilities has also grown.

The study is published in the June 2011 issue of the journal Pediatrics.

Sheree Boulet, Dr.P.H., one of the study’s authors and an epidemiologist at the CDC’s National Center on Birth Defects and Developmental Disabilities (1) states that it is the first time representative data on developmental disabilities has been gathered on a nationwide basis since 1988.

There seems to be no clear explanations for the increases, but a wider acceptance of developmental disabilities has played a vital role. Boulet explains that with the accessibility to early treatments for conditions such as ADHD has prompted more parents to get their kids screened for the disorder.

According to the researchers, the occurrence of disabilities may be really increasing. Some of the contributing risk factors could be couples opting to have children later in life, premature births, and rise in the use of fertility treatments. Boulet is confident that the findings could pave way for prevention strategies that could help in the long run.

The study was conducted on nationwide basis, involving interviews with about 120,000 children.

Some of the questions the researchers asked parents was whether their children had been diagnosed with autism, ADHD, learning disabilities, cerebral palsy, seizures, stuttering or stammering, hearing loss, blindness, or intellectual disability.

Boulet states that there were striking variations in diagnosis rates across economic, ethnic, and gender perspectives.

The study also found that boys were more probable to have a developmental disability compared to girls. When compared with white and black kids, Hispanic kids were less likely to be diagnosed with disabilities. Children with public insurance like Medicaid were more likely to have disabilities than children on private insurance programmes.

Boulet proclaims that the increase in disabilities as seen in the study is a wake-up call for a revamp of the health-care system, which needs to bolstered with specialized health, mental health services and therapists. Only then can children be provided with specialized treatment and preventative care.

More awareness needed

Lead study author Coleen Boyle, director of the U.S. National Center on Birth Defects and Developmental Disabilities (2) stressed on the need to invest in programs to assist and facilitate a child’s health-care and their overall development. He suggested that progressive maternal and paternal age, aided reproductive technology and large numbers of premature or late-preterm births, could all play a part in influencing developmental disabilities.

Dr. Nancy Murphy, chair of the American Academy of Pediatrics’ Council (3) on Children with Disabilities considers the increases in these conditions may indicate a greater awareness on the part of parents, teachers and health care professionals to identify children with developing disabilities such as autism and ADHD early in life.

The growth in medical science and technology has helped children born with severe developmental disabilities like neuromuscular or chromosomal disorders increase survival rates when compared to in the past, according to Dr Murphy.

The study concluded that although the proportion of autism and ADHD were on the rise, other developmental conditions stayed the same including blindness and intellectual disability, whereas moderate to profound hearing loss showed a noteworthy decline.

Sources:
1) The U.S. National Institute of Child Health & Human Development
2) U.S. National Center on Birth Defects and Developmental Disabilities
3) American Academy of Pediatrics’ Council

Ritalin, or methylphenidate, is the most popular medication used to treat attention deficit disorder, with or without hyperactivity (ADD & ADHD).  It works by activating pathways in the brain associated with attention, focus and motivation and is extremely effective for treating ADD/ADHD.

But as a Schedule II medication, Ritalin is a potent stimulant with potentially serious side effects.

How well does Ritalin work?

Ritalin is a stimulant and the stimulants in general work to significantly treat ADHD symptoms in roughly 70-80% of those who take them.  That number, however, is in combination with therapy – without therapy, the response rate is only about 50%.

But why is there such a big difference in efficacy between medication alone and medication with therapy?

The reason is likely because Ritalin makes it possible for you to behave in a less “ADHD fashion” but that you still have to learn to do so.  You may take Ritalin, for instance, and still forget to pack an important item before a meeting because you weren’t organized.

How does Ritalin work?

Let’s first explain the biochemical action then explain what it actually means.

Biochemically, Ritalin has a few effects.  Mainly, it works on the dopamine transporter in the brain, inhibiting it.  This prevents it from removing dopamine from the space outside cells.  Since dopamine remains longer outside cells, it has more time to activate receptors.  This treats ADHD symptoms because dopamine is associated with focus and motivation.

But what does that mean?

When your brain experiences a stimulus, it has to decide whether or not it is important.  If it is important, you pay attention to it.  In ADD/ADHD, an increasing amount of research shows that this attention pathway is dysregulated.

Paying attention to something boring for someone with ADHD is a lot like trying to lift a weight after someone injected a tranquilizer into your arm.  It takes something being very, very important or interesting to achieve the same “this is important” decision that someone’s brain without ADD easily makes.

Ritalin helps your brain process signals and decide which ones are important.  And beyond helping your brain do that, it helps you keep focused on whatever it is for longer than you could otherwise.

Is instant release or extended release better?

A lot of research is starting to indicate that extended release forms of stimulants for ADHD are a lot better than instant release.  It makes a lot of sense!  Would you rather take 2-3 pills a day or just one? 

Beyond the once-daily dosing, extended release formulations provide smooth drug release.  Taking instant release forms of Ritalin is a lot more intense, with drug levels spiking up then shooting down – several times in one day.

Supporting this claim are studies which show that more people experience ADD/ADHD symptom remission on extended release Ritalin (Concerta) than instant release.  In one study, 44% of those on Concerta had complete symptom remission versus only 16% of those on instant release.

Because of these advantages, clinicians tend to prefer extended release forms over instant release.

What are the side effects of Ritalin?

The most common side effects of Ritalin include dry mouth, decreased appetite, moodiness, mood changes including increased sadness or anxiety, decrease in appetite and weight.  This list is not complete; see manufacturer’s insert for more.

In one study, about 10% of adults taking Ritalin and 5% of adolescents stopped taking Ritalin due to side effects.

Does Ritalin work if you take it daily for a long time?

There is limited research into whether or not tolerance into stimulants like Ritalin develops.  That said, most researchers and clinicians believe that tolerance is quite rare – but possible.  In most cases, once you find a dose that works for you, you can take it daily for years without tolerance developing.

ADHD and ADD Online Diagnostic Test

ADHD/ADD Natural Remedy Report

Overcoming ADHD: A Guide for Parents

What does it feel like to take Ritalin or Adderall in a therapeutic way for ADHD?  To answer that question, we’ll provide a story.

The following stories both start the same exact way.  An 18 year old freshman in college has just come to the library to get some studying done.

Version A:  Not medicated, normal ADHD

Looks at watch.  Okay, it’s 3pm, time to study some chemistry.  Soo boring!

Pulls out books, starts reading, taking notes. This is so boring.  Darn, it’s just so hard.  Looks at paper, blankly.  Didn’t I just read that paragraph?

Rereads paragraph, tries to take some notes on it.  Notices two people who just walked by and that they’re talking about the College band. This is driving me crazy!  The text is just so dense – who writes this stuff?

Tries again to read the first few pages.

Version B: Took an ADHD medication

Looks at watch.  Okay, it’s 3pm, time to study some chemistry.  Soo boring!

Pulls out books, start reading, taking notes. This is so boring.  Darn, it’s just so hard.  Look at clock – only 5 minutes?  Is the Ritalin doing anything?

Okay, I just have to focus.  Now what are the main classes of chemical bond?  Starts drawing a neat flowchart that summarizes the material quickly but thoroughly.

Looks at watch.  30 minutes have passed.

30 minutes?  That went by so fast!  And I don’t feel like ripping the book into pieces, running out the library, and doing something completely different!

What it should not feel like:

Just took a high dose of Ritalin to get some studying done, enter room, see clothes on the floor.  Wow, that’s so messy.  I have to clean it up.

2 hours later, lots of stuff cleaned but no work done.

Remember

When taken at the proper dose, medications like Ritalin and Adderall can make life a lot better for people with ADHD. It is true and can not be denied that they also are popular as drugs of abuse.  But that doesn’t change the fact that for people with ADHD they improve the quality of life consistently, effectively, and – in general – safely.

Many medications used therapeutically can be abused.

ADHD and ADD Online Diagnostic Test

ADHD/ADD Natural Remedy Report

Overcoming ADHD: A Guide for Parents

Concerta vs Adderall XR

Concerta and Adderall XR are two very common and popular treatments for ADHD.

They are both long acting forms of two similar yet different medications: one Ritalin, and one Adderall.

How well do they work?  And how do they compare?

If you want to learn more about what Ritalin is and how it works, see here.

Concerta

Concerta is a long acting form of Ritalin, also known as methylphenidate.  On a biochemical level, it acts on dopamine and norepinephrine receptors.  It temporarily blocks their ability to remove those neurotransmitters from the space in between cells.

And since dopamine and norepinephrine stay around for a longer time, they have a stronger effect.  This leads to better focus concentration and motivation.

Adderall XR

Adderall XR is a long acting form of Adderall.  Adderall is a mix of different amphetamines, including both the l and the d form.  Amphetamines, like Ritalin, also act to prevent the removal of dopamine and norepinephrine from the space inbetween cells.

Unlike Ritalin, however, Adderall may also cause the cell to pump out dopamine.

Efficacy: Concerta vs Adderall XR

About the same percentage of people will get benefit from Concerta as will from Adderall XR.  They work at almost the exact same rates.  Around 70% of those who use either medication along with therapy will have very significant improvement in ADHD symptoms.

We recommend that you read our analysis of Ritalin vs Adderall to learn more about the specific differences between the two.

That said, it is possible that someone will respond better to Concerta than to Adderall.  Dr. Tuckman, a clinician with significant ADHD experience, reports that roughly 1/3 of patients will respond best to a Ritalin type medication, 1/3 best to an amphetamine, and 1/3 will respond equally to both.

Long lasting form

It is important to note that both Concerta and Adderall XR are long lasting forms of stimulant medication.  They both last for an extended period of time, roughly 10-12 hours.

This is important because clinicians report superior treatment results with long lasting forms as opposed to the instant release.  Studies are also starting to strongly support the superiority of long lasting treatment versus short lasting.

In one study of 70 patients, for instance, 97% preferred the long acting form of Ritalin over the short acting.  In another, 44% of those on long lasting form of medication had ADHD symptom remission, as opposed to only 16% of those on short acting.

Side Effects

Both Concerta and Adderall XR have similar rates and similar types of side effects.

The most common side effects from both include anxiety, insomnia, and trouble eating.  Some studies have indicated that side effects for the medications tend to diminish over time.  This may be due to the body becoming used to the med.  It may also be because those for whom it is a significant issue, discontinue use.

It is possible that long term use of either medication is associated with slight decreases in weight and/or height in children.

Related Articles:

1. The 4 Secrets to Success with ADHD
2. A Full List of ADHD Medications – Explained

ADHD and ADD Online Diagnostic Test

ADHD/ADD Natural Remedy Report

Overcoming ADHD: A Guide for Parents

Dr. Ari Tuckman is the author of “More Attention, Less Deficit: Success Strategies for Adults with ADHD” and “Integrative Treatment for Adult ADHD: A Practical, Easy-to-Use Guide for Clinicians”.

He has treated hundreds, if not thousands, of adults with ADHD.  He generously took the time to answer questions that readers of mine have submitted over time.

What attracted you to ADHD?

I actually fell into it around 1998/99.  I was starting out and was approached about working with some patients who were adults and had ADHD.  They needed help dealing with their condition and with life management.  I took the opportunity and it was a good fit.

At that point, things were different.  If you knew three things about ADHD – than you were an expert on it.  It’s better now, but still not good enough.

What kind of experience do you have with adult ADHD?

I’ve been focused on that area for 10 years now and a significant percentage of my clients have ADHD.  If I had to put a number, I’d say I’ve treated hundreds if not thousands of patients with adult ADHD.

Why do we not know enough about Adult ADHD?

The problem is that doctors, especially primary care physicians, aren’t good at recognizing it.  And even if they are, they’re not in a good position to do something about it because they simply don’t have the time for a thorough evaluation, which can take a couple hours.

Very often people have ADHD and their doctor just doesn’t notice.  It’s tough for the doctor, of course, because clinicians have to know a million things.  But when it’s your life, you expect them to get things right.

Why is this a problem?

Very often a doctor will notice that someone with ADHD has anxiety or depression and treats only that.  They are then surprised when there isn’t such a good response and think “I guess this person just doesn’t respond well to treatment.”

And it’s unfortunate.  Untreated ADHD is a big set-up for a lot of problems.  We have hundreds of studies that show the kind of bad impact it has on your life.

Can you elaborate on the problems ADHD causes?

It’s a big misconception that having ADHD is no big deal.  It has severe consequences on people’s lives.  ADHD has measurable effects in all areas of functioning.  Everything is affected by it – social life, work performance and more.  Its effects can even go as far as your credit rating!

ADHD has the most impact of almost all psychiatric diagnoses because it is always present and always causing problems.

If you could tell a Doctor two things about ADHD, what would they be?

First, that even if someone was hyper as a kid, they don’t have to be hyper now to have ADHD.  And they might not be restless or overactive in your office.

Second, that having ADHD doesn’t mean you’re not successful.  On the contrary, there are some really successful people who have it.  But it comes at a great cost and they have to work harder to achieve their success.

Remember, I’m a psychologist.  That means that I prefer talking to people.  But for ADHD, I am a big fan of medication because it works.  And it works well.  Proper use of medication sets people up for success so that other strategies will be more successful.

Medications for ADHD like Ritalin and Adderall have their fair share of controversy.  What’s your opinion on that?

I’m certainly not advocating that everyone has ADHD or should take ADHD medications.  Everything stems from a proper diagnosis.  Once that’s done, choosing to use an ADHD medication is a lot like choosing to use painkillers.  You do it if you need to, and otherwise don’t.  I had surgery, for instance, and for a short time, needed to use strong painkillers.

It’s not a matter of good or bad, but rather how medication fits into your overall treatment plan.  Medications for ADHD tend to be very effective.

What are your thoughts on the proper use of medications like Ritalin and Adderall?

First, I’ll repeat that it’s absolutely essential that a proper diagnosis be made before using any medication. I have a saying that accurate diagnosis guides effective treatment.

It’s also important to have realistic expectations.  You can take a pound of medication and still not do any work.  The fact is, you still have to choose to put in the effort.  Medication puts you in the ballpark, but you still have to swing the bat.

How do you choose a medication?

Typically, I recommend an extended release.  That means either Adderall XR, Concerta, Vyvanse, or Focalin XR.

To choose between them, I find the rule of thirds to be quite useful.  Roughly one third of patients will respond best to Adderall or Vyvanse, one third to Ritalin/Concerta/Focalin, and one third will respond equally to both.

You can’t point at a hundred people and say that for everyone Adderall or Ritalin would work best, but for any one person there may be a better or worse response.

For my patients, it can be hard, but they have to realize that it can take some time to figure out the right dose.  It’s not a magic pill, and you have to be somewhat lucky to get the right dose on the first try.

Doctors sometimes are too cautious and might use a child-sized dose in an adult.  Then they’re surprised when they don’t get good results.  That’s like wondering why half an aspirin doesn’t help an adult with a headache. It doesn’t mean that a larger dose wouldn’t be more effective–up to a point, obviously.

What are some issues you see in treating adults?

Adults who are diagnosed or deal with ADHD are different from kids because they’ve been dealing with their situation undiagnosed for most of their lives.  They’ve had to come up with explanations for why things are not going so well in their lives.  And they’ve constantly been telling themselves, “Now it’s going to be different.  I’m going to get that report in on time, listen more when people talk, spend my money better, etc.”

They’ve had a lot of failures.

For a kid, there aren’t those years and years of struggle.

Most adults when diagnosed have a tremendous sense of relief.  It puts things in place.  And it’s an explanation that isn’t pejorative or judges them badly.  They’ve probably heard way too many times things like, “you’re irresponsible,” or, “you’re lazy.” A diagnosis of ADHD is much better than that.

How do you diagnose ADHD?

I typically do a 2 hour interview.  If possible, I have a parent or romantic partner come along to give additional input.  I try to get as much data as possible, including old report cards which can be particularly telling.  Of course doing so is often hard in someone over 25.

We look at how the person is doing now and at prior points across a broad range of situations.  Looking at just one area can be misleading – how are they performing overall?  And does ADHD fit the pattern of data?

How would you respond to critics of diagnosing ADHD?

For most psychiatric – and even a lot of medical – diagnoses you look at symptoms and history.  Blood tests can’t tell you everything.  The best diagnosis, of course, has to be thorough.  If you do a good job, you’ll look for the right things while not asking leading questions.

Some symptoms are more obviously associated with ADHD.  What are some of the more unusual or harder to notice things?

A lot of people with ADHD have difficulty retaining what they’ve read, and may not actually read books that often.  Magazines and websites are easier to digest.  It’s common to have to reread things.

Other areas include careless mistakes in math.  They know how to do something, but mess up on the small details.  Everyone has brain glitches like that but they are more common in people with ADHD.

A really interesting phenomenon I see is that sometimes people with ADHD will have done homework assignments but forget to hand them in.  This is particularly telling because there isn’t an alternative explanation.  If someone doesn’t do their homework, for instance, you could say that they just don’t want to do it.  Blame it on motivation.  But there’s really no reason you’d choose not to hand in an assignment that you did.

Another area is losing things, both in the house and out in the world.  There’s really no advantage to losing your cell phone, for instance, so doing so is an indication that ADHD may be an issue.

Some psychoanalysts might say losing your phone is a sign of subconscious conflict?

That just doesn’t seem very likely.  Remember, that psychoanalytically based treatments have not been shown to work that well for treating ADHD.  That’s not to say it can’t help with other issues that folks with ADHD or other people might have, but it won’t change the underlying condition.

Some research has shown that low levels of iron in the blood has been associated with ADHD.  What do you have to say to that, or claims that bad diet causes ADHD?

I’ve heard things like that often.  Parts of those claims may be true, but you have to remember that correlation does not mean causation.  While it is true that men in general are taller than women in general, being tall, for instance, doesn’t make you a man.

A possible explanation, however, could be that people with ADHD may not have as healthy diets.  It’s important to remember, however, that dietary treatments have not been shown to a valid treatment for ADHD.

How do you decide to use a medication or not?

It’s a question of weighing the demands of things going on in your life against your abilities to manage them without medication.  What other strategies, for instance, could you useto handle your life?  If the demands of your life outweigh your ability to handle them, that’s an indication that medication might help.

Of course, if someone shows up in my office, they’re probably not doing as well as they would like!

And of course there are different situations.  You may need to take medication during the week but not so much over the weekend.

One of the biggest fears people have is that their ADHD medication will stop working.  In your experience, does tolerance to, say, Ritalin or Adderall develop?

Not usually.  It is my experience that, once you find the right dose, you can keep taking it for years, even on a daily basis.

That said, there are some factors that may change the right dose.  Sometimes there is significant weight change which can change how effective a dose is.  Also, someone may find that their lives require them to perform at a higher level when  they might get a promotion with more responsibility and really have to be on their game.  Or when they have a new baby.

What are some thoughts you have on ADHD in general?

Getting diagnosed with ADHD can be really life changing.  Suddenly things make sense.  I have to tell my clients that I understand how hard things have been in the past.  But now they’re in a new situation.

With medication, things can be quite different.  And, although they’ve already heard a million suggestions, in therapy we look at new strategies that are based on a solid understanding of how people with ADHD tend to process information, so we can create strategies that are more likely to be helpful.

Anything else?

Today I’m having a client who is living out of the country and coming back home here in America to visit his family.  He’s driving four and a half hours here and another four and a half hours back, a total of nine hours driving, just so we can spend two hours to officially diagnose him with ADHD.

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Strattera or Atomoxetine is a new treatment for ADHD that was approved in 2002 and the first medication approved for treating ADHD in adults.

It is a norepinephrine reuptake inhibitor, which means that, like Ritalin and the stimulants, Strattera increases the level of norepinephrine that cells are exposed to.

This hopefully results in increased attention, focus and motivation – reducing the symptoms of ADHD.

Unlike the stimulants, however, Strattera takes up to 8 weeks to work.  The exact reason for this delay is unclear, but it is reminiscent of behavior more typical of an antidepressant.

The main benefits: Strattera provides full day coverage with one or two doses, is not a stimulant, and is hard to abuse.  May work when stimulants don’t or are not a good idea.

The main disadvantages: Strattera isn’t as effective as the stimulants, is expensive, and takes a while to start working.  Plus it has its own array of side effects.

Efficacy:

Strattera is definitely better than placebo at treating the symptoms of ADHD.  Beyond that, however, the studies have been modestly positive.  In one study, for instance, of several hundred people treated for 10 weeks, scores on the AISR scale went from an average of 38.5 to 24.5 for those treated with Strattera.

The AISR scale consists of 18 questions each rated on a scale of 0-3, where 3 is most severe and 0 is not significant.  The max score is 54.  As such, a reduction from 38.5 to 24.5 is fairly impressive.

Unfortunately, the placebo treated group went from an average of around 39.2 to 28.9.

The difference between Strattera and placebo of 4.4 means that a few questions were answered as less severe than originally.  So there is an effect, and it is positive, but it is not as significant as with the stimulants.  Strattera shows similar if slightly better efficacy in other studies.

Roughly 25% of people who use Strattera stop specifically because they feel it does not work well.

Dosing:

Strattera is typically started at .5mg/kg and raised to 1.2mg/kg for a maximum of 100mg per day in adults.

As it is digested by the CP 450 system, medications such as Prozac may interfere with Strattera.

Strattera Side effects:

Anywhere from 10-25% of people report side effects as a reason for stopping Strattera.  They are mostly mild.  That said, over several years of use, the risk of having some sort of serious side effect becomes not insignificant.

People who use Strattera typically lose a small amount of weight.

Most common:

>50% report headaches, some issues with digestion, nausea or upset stomach, and sleepiness

~13% report abdominal pain

Some studies report increased rates of vomiting and constipation on Strattera.

~5% report dry mouth, urinary hesitation, erectile dysfunction

Less common side effects:

Low but possibly increased rates of sinusitis, impaired digestion,

Depression, thoughts of suicide (in one study, 11/714 had suicidal thoughts, or 1.5%), appendicitis.  New aggression or irritability is not common but not uncommon side effect of Strattera.

Rarest side effects:

Heart murmur, prolonged QT on ECG, liver issues, upper abdominal pain, diabetic ketoacidosis

This list is not complete; see manufacturers insert for more.

Use:

Most people who use Strattera have tried stimulants in the past and had adverse reactions or preferred to try a different medication.  Stimulants generally don’t work in about 30% of people with ADHD who try them.  Additionally, in some groups, stimulants are contraindicated.

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Adderall is a popular stimulant treatment for ADHD and is used illicitly as a drug for its energy inducing effects.

What are the long term effects of Adderall?  Does it keep working, or do you develop tolerance if you have ADHD?

Please note that this piece is written assuming use is within therapeutic range for ADHD and not at the high doses typical with abuse.

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Summary of long term effects of Adderall

Mental: Increased focus, attention, motivation.  Reduction of ADHD symptoms.

Heart: Use of Adderall or related stimulants for more than a year increases your diastolic blood pressure by ~ 3-5mm HG, systolic blood pressure by ~ 2-5mm HG and your heart rate ~ 3-5 beats per minute.  Additionally, it is possible that ECG testing will show slight electrical activity differences.

This is almost always not good (except possible in someone with initial low blood pressure), but is it bad?  Some argue that these increases don’t have any direct health implications, while others argue that they can show a 20% increase in emergency room use for heart issues in kids who use stimulants.

Before using stimulants, it may make sense to get some basic cardiac testing.

Brain: Some studies have shown that stimulant use in people with ADHD may increase the size of certain parts related to controlling focus, motivation and attention.  This is very positive.  Some studies we’ve looked at of students on long term use of stimulants showed improvement in overall academic performance as well.

On the other hand, some animal models have hinted at the possibility that use of stimulants can increase the build up of free radicals in the brain.  Even if this is the case, it might be amenable by healthy consumption of anti-oxidants.

Appeptite/weight: Amphetamines like Adderall are among the best appetite suppressers.  This led to their wide abuse as diet pills and may cause unwanted weight reduction in people who use them.  Long term use in kids has been shown to be associated with slight weight loss and even possibly slight height reduction.

ADHD Treatment Effect: Many people taking stimulants ask the question – will they stop working?  The news seems to be good, however.

Researcher Doctor Biederman reports that in a study of several hundred patients over 1-2 years, for most, stimulant medications continued to work well at a steady dose.

Doctor Hallowell, coauther of Driven to Distraction, reports that in almost all cases, tolerance to ADHD medication does not develop, but is possible.  Dr. Paul Wender, a noted researcher into ADHD, reports that tolerance is rare, and most patients can take stimulants for many years without problem.

Dr. Ari Tuckman, a clinician who has treated hundreds if not thousands of people with ADHD, reports in an interview with us that most often, ADHD meds can be used at therapeutic dose daily for years without losing efficacy.

Of the dozens of research papers reviewed, very few mentioned that developing long term tolerance was a limiting factor in treating ADHD.  Even then, it is almost always the case that tolerance can be reduced or removed by temporarily stopping treatment.

That said, there could be more research and data on this subject.

What does that mean?

With the increasing use of amphetamines to treat ADHD and as recreational drugs, more and more people want to know – are they safe for long term use?  What potential side effects come with use over time?  And, this is exceptionally important, do they continue to treat ADHD over time or does drug tolerance develop?

There have not been that many studies into the long term effects of Adderall.  One thing we know is that stimulants do have some cardiovascular effects which can be serious for at risk people.  That said, one study of several hundred people over 2 years of mixed amphetamine salt treatment (the generic for Adderall), showed no clinically relevant heart effects – at least according to the doctors and researchers who did the trial.  A few people did drop out because of heart related concerns like palpitations and excessive heart rate.

Additionally, a retrospective analysis of about 2,000,000 kids treated over time with stimulant medications showed that 456 went to the emergency room with heart related issues.  When you control for how many kids would normally go to the ER in a sample that large, this represents a 20% increase in risk for heart problems.

Remember, there is a black box warning on stimulants because of their potential for heart complications.

In terms of developing tolerance to the therapeutic effect in treating ADD/ADHD: the data seems to very strongly suggest that tolerance does not develop over a year or two year period, and that use of extended release formulations may increase efficacy due to smoother release.

Attenuation of side effects?

It is possible that with time, the side effects of stimulants become attenuated, or less significant.  For instance, one study showed that a significant amount of people experienced insomnia, depression or weight loss at start of use of stimulant medication.

But near the end of a year, only 1% still had a reduction in appetite that would lead to weight loss, and no one reported insomnia (which sounds a little over-optimistic.  Everyone has insomnia sometimes.)  This may be, however, because those who had serious difficulty with those issues stopped using the medication.

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Control Your Add/adhd, Control Your Life!

If you think or know you have ADHD, you’re probably a little confused.  You may not feel like you have a “deficit” but you may not be entirely happy with how things are going in your life.

Let’s be honest.  Here’s some stuff that you just have to know.

1) First, if you have ADHD, you’re different.  Your brain works differently.  You can’t do anything about it directly (as far as I know, there isn’t a brain exchange program – yet), and, whether you like it or not, it has a major impact on your life.  Most people aren’t like you.

There’s a reason you’ve been having all the issues you’ve been having – it’s not your fault.

2) There are amazing things about you that you don’t appreciate.  Other people simply aren’t as energetic, friendly, interested in biofuels or spontaneous as you.  By focusing on your strengths, you will achieve great success and the respect, admiration and even envy of other people (“why can’t I start my own art agency/legal practice?” and, “why can’t I get that promotion?”)

3) Life will make it near impossible for you to focus on your strengths.

You will instead focus on the fact that you can’t sit still.  That you have trouble having “normal” conversations about small, boring things.  That you drive really fast, blasting music.  Whatever the symptoms the ADHD causes – those are the things that will hurt and depress you.

And when you focus on the bad things, other people will too.  People instinctively look to other people for social guidance, how to judge things, even more so than you might think.  (People with ADHD can be quite resistant to group think because they can’t ignore that nasty voice inside of them saying, “this is stupid!”)

If you are down and unhappy about your flaws, other people will see and judge them the same way you do.  They’ll think, “wow, that guy’s not normal.”

If you focus all your energy on doing things that you feel you have to, but are excruciatingly hard, you’ll never be happy.  And you won’t do them that well anyways!

Your gift is in certain areas, certain things, certain strengths.  You are AMAZING at those things but don’t realize it.  And trying to do the things you can’t, that people without ADHD can do easily, is a sure fire way to fail and be unhappy.

Would you expect a great and passionate painter to spend his time filling tax forms?  Or the CEO of the company to mop the floor?

The Hunter/Farmer model proposed by Hartmann is very empowering and just makes sense to a lot of people.  What it says, basically, is that people with ADHD are more like hunters – they need constant stimulation, variety, excitement and change.  Other people are like farmers – focused, able to do boring things for long times, and conventional.

Now, remember, ADHD isn’t just a matter of feeling, or personality types, or lifestyle.  (Although based on how many executives I know have ADHD, it can actually be an advantage at some jobs).  It’s a neurological condition that we have pretty much proven is a physical condition.

If you have ADHD, your brain has different wave patterns and activity than people without it.  Your basic energy processing system is different, as well as the way that you respond to stimulation.  For you to maintain focus on something, it has to be very, very interesting.

We’re starting to be able to prove that by pointing at specific brain activity and abnormalities.

4) If you have ADHD, you are still fully responsible for your life.  But treatment can change everything.  That’s not just hyperbole.  We’re talking about a complete change in everything – for the better.  Even so, and even though ADHD is a real problem that can make your life hell at times, you’re still responsible for everything you do.

If you have ADHD and you run a traffic light – you still get a ticket.  If you don’t do your homework and miss the final, you’ll get an F.

Remember, most other people are simply too busy to care about whether or not you have ADHD.  They care about what you do, whether they enjoy spending time with you, doing business, or whatever.  You are the only one ultimately responsible for your life.

And, ADHD or not – how can you make it great?

Wow, that really helped!

Some people read this article and are amazed at how accurate the advice it gives seems.

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