Opposites Attract

Opposites attract

After my inaugural blog post, my BFF Cathy Morrow posed the question of how do I find the time to write. She's well aware of the fact that I work for 5 employers so I can have the flexibility to work primarily from home in order to earn an income to support a family, manage (and micro manage) my kids, run a household, and still have somewhat of a social life. I consider myself to be the polar opposite of a person with ADD. I'm highly organized, rarely procrastinate & if I ignore my kids, husband, needy dogs, random texts, calls from students, and calls from nursing homes regarding my patients, I am able to maintain focus for extended lengths of time and tackle a large amount of work. Sounds great, doesn't it? Well, for my own personal sanity & success, yes.  However, it has proved to be my downfall in caring for my daughter. I believed if I shared with her organizational skills and abilities based off of personal experience and research into organization, she could overcome her disorganization (a VERY common symptom with ADHD). Yeah, not so much. All it did was lead to frustration on her part, as well as mine. I'm giving you the tools to be successful! How can you NOT do this? Well, because she can't. Her brain doesn't work that way. The hardwiring of her brain is different than mine. The chemical composition of her brain varies as well. Not that she can't be organized, but without medication, her brain can't organize the way mine can. Even with medication she may not find success in following Mom's Tips for Leading a Highly Organized Life.  She has to organize by her own set of guidelines. Not mine.

Oh, believe me, I’ve done all the basics; charts, graphs, lists of responsibilities, schedules, and the list goes on and on. But keeping up with it all is quite the challenge for this overworked mom. I've always led the way in this organization with little input from Nevia, primarily because when she was younger, she didn’t know how to organize anything! Now as a teen, she has some of the basic skills to organize. Maybe some of Mom’s Organizational Tips did rub off on her.  Developing this plan can be time consuming, but is something we will have to do!

Remember I mentioned how the chemical composition in the ADHD brain is a bit different than us neurotypical (non-ADHD) individuals? Well, here’s a basic discussion on what I mean. There are three primary chemical neurotransmitters out of balance with ADD.  What are neurotransmitters you ask? Neurotransmitters are chemicals in the brain that transmit information along pathways in our brain. Simply put, it is how one part of our brain communicates with another part of our brain. While there may be as many as 200 neurotransmitters in our brain, only 50 have been identified. Research has determined that many common psychiatric disorders result from deficiencies in specific neurotransmitters. Disorders such as anxiety, depression, anger-control problems, obsessive compulsive disorder, and yep, you guessed it, even ADHD/ADD.

So of the 50 identified neurotransmitters, the three main culprits involved in ADD are: norepinephrine, dopamine, and serotonin. ADHD was the first psychiatric disorder found to be caused by a deficiency in norepinephrine. It was also the first disorder to respond to medications to correct this neurotransmitter imbalance. Research on these neurotransmitters suggests that different characteristics occur with certain chemical imbalances;
         Distractibility: too much norepinephrine in relation to the amount of dopamine activity
         Impulsivity: too much norepinephrine or too little dopamine
         Obsessiveness: too much dopamine in relation to the amount of serotonin

So while these psychiatric disorders are literally “all in your head”, rest assured that you cannot control the symptoms related to these disorders without the help of medication (some may find alternative therapy or diet works well enough, but this is not the case for many).  A kid with diabetes can’t control his glucose level without the medication called insulin. Well, just because a disorder occurs in our brain doesn’t mean we can ‘control’ it without medication. We consciously control merely a minute amount of what goes on in our brain. But, if you don’t believe me, then the next time your ADHD kid acts impulsive, tell him to decrease the norepinephrine release in his brain or up his dopamine. Let me know if it works.

Glad you asked about neurotransmitters, aren't you? I could go all scientific on your ass and discuss more, but I will cut you some slack.

Whew! So hopefully I have helped to open some minds to a starting point to understanding ADHD. And trust me, this is only a starting point in understanding this complex disease process. Some people expect these kids to be able to control their symptoms WITHOUT medication. I know I did. Again, my self-directed education has paid off. Hopefully it’s paying off for you all as well. I realize I was all wrong about the management of my child with this disease process. So now we move forward.

How, you ask? Well how the heck do I know? Don't you remember me saying I'm the polar opposite of my child? I know MY way of organization. Not hers. Perhaps I haven’t taken enough time recently to learn her ways. I’ve always tried to stuff her into MY organizational mold. She'll fit. Well, no. She didn't fit in that mold.

Thankfully, opposites attract. We can look for a day when our neurotransmitters are best aligned and come up with an organizational plan that works. One that works on her pole, not on mine.

Dr. Donna Poma Fife DNP, MS-ARNP

Disclaimer: The purpose of this blog is to provide information on ADHD/ADD. It is an informal platform in which I can share experiences and education regarding this disease process. It includes a lot of generalizations of the disease. If you don’t fall into those generalizations, don’t stress it! This blog in no way is providing you with medical advice. Please see your medical professional for medical advice, since you pay them, not me.

She puts the H in ADHD

She puts the H in ADHD

I often try to get my friend Sheri to run with Michelle & I by enticing her with the thought of achieving a ‘runner’s high’. You know, that release of endorphins you get when you run, which makes running feel easier and makes you feel somewhat euphoric? Well, I guess I have achieved a writer’s high!  Because I’m excited to write some more! Remember guys, my blogs are personal commentary, filled with my experiences and knowledge gained through my self-directed education on the topics. Generalizations will be made. Keep in mind, there will always be atypical cases and outliers who vary from the majority. Also, keep in mind this is meant for me to share ideas and experiences and not to be taken as medical advice. Unless you want to pay me.   

Anyone who knew Nevia when she was an elementary aged child could easily see the hyperactive component of this disease process. The child could NOT sit still. Her school agenda was FILLED with comments from her teachers stating Nevia was; disruptive, couldn’t sit still, got out of her chair, blurted out answers, wouldn’t follow in the line as they walked to lunch, was talking to other kids when she was supposed to be paying attention, disrupting class, blah, blah, blah, the list goes on. I tried everything I could to address this issue in a naturopathic manner. I gave her supplements found to help in some kids with ADHD. Chewable supplements that she found disgusting. As you can imagine, it was not easy to get her to take these!  I fed her a breakfast of eggs, bacon, and toast nearly every day. Quite the challenge for the vegetarian mom who nearly pukes at the smell and sight of eggs.  No sugar, high protein was my mantra. I walked her over a mile to school (while pregnant with Oscar, and for quite some time after he was born) as a way to ‘wear her down’ before she got to school with the hope that these measures would help her behavior. Well, of course, it didn’t work.

I made an appointment for her to go to her pediatrician. I marched in his office with her school agenda in my hands, sure that he would want to see the teacher’s comments, which would lead him to a swift diagnosis of ADHD. He never even looked at the agenda. He asked me a few questions, examined Nevia, and said ‘no, she doesn’t have ADHD.’ Seriously? Yep, you guessed it. I fired that pediatrician and found another.  

I recall one of the many times Nevia was put in time out for her behavior. I observed her trying to stand still while facing the corner of the wall. She seemed to struggle so badly when trying to do the right thing and keep still. She was trying so hard to be good. It looked physically painful and mentally draining for her to do such a simple task as standing still. But it was only viewed as bad behavior because she couldn’t follow directions and hold still. I now know better. My how differently I view things with 20/20 hindsight.

Dr. Ned Hallowell (I misspelled his name in a previous post) describes that those with ADHD have an internal ‘itch’. This proverbial itch contributes to this inability to sit still. It can be the basis for the hyperactivity component of ADHD. Kids with hyperactivity can’t turn it off like a switch. They can’t control it. Discipline and punishment have not been found to be effective ‘treatments’ for this symptom. So if your child has this symptom, medication often helps, but do both of you a favor and do your best to limit the amount of frustration and annoyance that you may feel about this hyperactivity (remember in my previous post I mentioned by the time a kid with ADHD reaches the age of 12 he/she has received more than 20,000 negative messages than the neurotypical (non-ADHD) child?).  Find ways to make it a positive. Instead of expecting a hyperactive child to sit still in a chair when doing homework, have them sit on an exercise ball that they can gently bounce on as they work.  They may actually accomplish more this way. It would be in the best interest of all involved if we would break the cycle of expecting ADHD kids to adapt to the traditional ways of doing things. Stop trying to shove the ADHD kid into a mold they don't fit in. It will never work. Be creative and find what works for your kid.

Fast forward a few years after our wasted pediatrician visit in which her diagnosis was ‘missed’. I noticed in the middle school years that Nevia wasn’t as hyperactive. She was off and on medication, but even when off the medication, the hyperactivity seemed to wane. In my recent description of Nevia in relation to the hyperactivity I commented that the hyperactivity was gone. Now she’s just a lazy teenager, I said in jest. Well, my mom-diagnosis was quite off. Hyperactivity doesn’t really go away in the kids who have this presenting sign/symptom of disease. It may diminish to a restlessness, but remains as primarily an internalized issue. This internal hyperactivity or restlessness often manifests itself as sleep issues. Insomnia is a common complaint by those with ADHD. About 85-90% of adults with ADHD experience a burst of energy at sunset or nighttime. The average person with ADHD may spend about 2 hours at night trying to fall asleep. They can’t turn off their body or brain and lie there wide awake. Sleep deprivation may cause as much impairment in people as the ADHD symptoms do.

I’ve had difficulty in finding much research or scholarly literature discussing the hyperactivity component of ADHD. I do know that this component is not present in all people with ADHD. Those without this symptom may be given the abbreviation ADD as a diagnosis. In listening to the ADHD Experts podcasts, I have heard many esteemed professionals discussing how this disorder was not effectively named. Labeling the disorder ADD doesn’t address the hyperactivity component. Calling it ADHD may classify those without hyperactivity as hyperactive. Some also address the ‘deficit’ component of the label. Those with ADD/ADHD don’t have a deficit in attention. They have what one professional I heard describe as a ‘wandering’ of attention, not a deficit. No matter what the label is or what a person’s presenting symptoms are, there is certainly a deficit in the education of many Americans (myself included) on this disorder. Hopefully with time this will change.  

Dr. Donna Poma Fife DNP, MS-ARNP

The gift of ADD

I've been wanting to start a blog for quite some time now. I finally have a few minutes it get the ball rolling! This is a blog with medical information, but is meant for informational & entertainment purposes only and is not intended as medical advice. Please contact your doctor, or better yet, your nurse practitioner, for medical advice, because after all, you pay them, not me.

My inaugural blog is not in my practice specialty area, but is something I have learned a lot about through personal experience. Attention Deficit Disorder (ADD) is a disease process I never imagined I would have to learn so much about. After all, I practice geriatric dermatology & work as a nurse educator. However, it is my lovely, sweet daughter that has led to my need to acquire a vast amount of knowledge on this disease process. It would be time wasted if I did not try to impart this knowledge on to others. So here we go...

It is a common misconception that the only issue or the most significant issue of those with ADD is inattention. There are five main presenting symptoms with ADD. They are; short attention span, poor impulse control, disorganization, procrastination, and distractibility. We'll discuss more about these in future blogs.

The disease process would actually be quite easy to manage if the problem stopped with these symptoms. But as those with ADD can tell you, these symptoms are only the tip of the iceberg.

Did you know that kids with ADD are 30% developmentally behind their peers? This obviously makes school an incredibly complex situation since they are expected to learn at the same pace & the same material as their non-ADD peers (forget about excelling, these kids struggle to keep up!). Additionally, they are about 1 1/2 years behind peers socially as well, which can lead to social issues & isolation.  They have a deficit in higher level functioning and struggle day to day because of this.

What about the high incidence of overwhelming anxiety those with ADD struggle with? There is an extremely high rate of substance abuse in these individuals, not so they can feel 'high' but so they can feel 'normal'. Let us not forget to discuss depression these ADD individuals deal with as well. We're not talking 'I've got the blues today' type of depression, but the 'I can't stop thinking about killing myself and I don't know why' type of depression. Let that thought resonate in your mind for a few minutes.

In addition to the suicidal thoughts and ideations a person with ADD may have, there's also often an issue with nonsuicidal self-injurious behavior common in particular in girls with ADD. You know, cutting, eating disorders, burning her own skin, the list goes on and on. If only inattention were these young ladies' biggest issue.

Did you know that by the time a child with ADD reaches the age of 12, he/she has experienced more than 20,000 additional negative messages than their non-ADD counterparts? I wonder what this does to the child's fragile self-esteem. No wonder they want to hurt themselves.

What about the incidence of other learning differences those with ADD experience? Dyslexia, dyscalculia, dyspraxia, dysgraphia, just to name a few! We've already touched on comorbid conditions associated with ADD, such as anxiety and depression, but did you know that about 20% or so of males with ADD also have Oppositional Defiant Disorder? More on that later...

If a child with ADD is lucky, they will have a parent who learns as much about the disease process as possible and will work hard to ensure the best care for their child. A parent can spend countless hours looking for psychologists, psychiatrists, neurologists, and pediatricians who ‘treat’ the disease. There will be countless calls and emails to the school of the child ensuring the child's learning differences and needs are close to being met (which let me tell you, doesn't happen in a public school system). The hours spent researching alternative therapies, gluten free diet, elimination diet (who on Earth can do that?!?) disease pathology and evidence based medical treatments. Supplements, supplements & more supplements!!!  I once had Nevia trying 6 different supplements at a time. I figured with that and a little bit of prayer she'd find relief of her symptoms without having to take a controlled substance. Unfortunately, neither the supplements nor the prayers worked.

What about the hours a child spends in tutoring, in therapy, at doctor's visits? Time (and money) one hopes is well spent, but realistically one often finds is not.

Oh, and we haven't even scratched the surface on medication! I'm sure every parent finds it easy to put their kid on a controlled substance that is HIGHLY abused by those who don't need it! Yes, after experiencing my child being on medication and not on medication, I can certainly see the benefit. Through researching medications I have found that meds like Focalin have been found to have a neuroprotective effect on those with ADD. Good news for them! Their symptoms may lessen years later after struggling through the side effects! I guess that is something to look forward to. But what about those kids with variations of ADD who react negatively to stimulants? Treatment needs to be individualized, but how often does this happen?

Through all of my reading of books, journal articles, websites, blogs, community forums, etc. the most useful information I have found about ADHD/ADD is from the ADHD Experts podcasts. In particular, listen to any podcast in which Dr. Ned Hollaway is speaking. He is a psychiatrist who has ADD & considers it a gift. He helped me see my daughter's ADD as a gift as well. Those with ADD are often the most creative, most loving people out there. They have bigger hearts than anyone can ever imagine. I've learned more about love, kindness, and generosity through my sweet daughter than I could have ever imagined possible.

I wish the 'lack of focus' issue was all a person with ADD dealt with. It sure does make the disease process seem a breeze! But any person with ADD & any parent of a child with ADD will tell you, that isn’t even the beginning. 

Remember, we all lose focus and can be easily distracted at times. Merely exhibiting these symptoms does not equate to an ADD diagnosis. It’s a much more complex disease process. One I hope to continue to educate others on as I continue to educate myself.

Dr. Donna Poma Fife DNP, MS-ARNP