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ADHD Brain Science Beyond Appearances

ADHD Is More Measurable Than Ever

It is a very recent disease to mistake the unobserved
for the nonexistent; but some are plagued by the worse
disease of mistaking the unobserved for the unobservable.
Nassim Nicholas Taleb – The Bed of Procrustes

 

"ADHD Going nowhere fast"

ADHD: Going nowhere fast - Nathan Eal Photography via FlickrMost

ADHD Experts Emphatically Agree

Undiagnosed, under-diagnosed, and misdiagnosed ADHD costs the country millions of dollars annually: $13.7 million annually in 2000 for work related medical costs, and an estimated $16 trillion for inmates incarcerated with ADHD.[1] Yet, surprisingly, others still argue that ADHD confusion arises from too liberal diagnostic and treatment interventions, and medications thrown at children “just being children.”

Whatever your personal view of the psychology/biology debate you are well aware of the speculative conundrum that currently exists regarding ADHD diagnosis and treatment at any age.  Concerned citizenry do wonder: just what are the reasons for this unremitting confusion, and what are we missing with this increasingly common childhood and adult malady?[2] Is ADHD a biologic reality or just a defect in character with inattention to socially acceptable boundaries?

One outstanding point is certain:
Far too few regularly witness the abundant downstream pain and suffering attending those who for years have been either missed or incorrectly treated, many completely overlooked during or after childhood. Marriages struggle and end, children drop out of school, families disintegrate under the parental pressures of internal conflicts and lost jobs – and yet the questions pervasively remain: just what is ADHD, what is “Hyperactive” and “Inattentive,” – and how come those pesky stimulants work so unpredictably?  Why does ADHD still appear to be so inordinately confusing and vague, – and just what are we missing medically?

In a word, we’re too often missing function – brain function.
We’re missing the new brain biology. To miss that inherent biology is to perpetuate counterproductive confusion. To understand the new science is to add new treatment options with more predictable outcomes.

Simply stated:
We haven’t been listening to the remarkable evolution in brain science. The biology is there, but many don’t yet recognize that evidence as useful. Brain and body measurement tools bring new biomarker understandings to the activities of brain physiology – from SPECT brain function[3] to neurotransmitter assessments[4] we miss the new biology that connects the dots for improved diagnosis and treatment strategies. Evidence brings more precise treatment targets, and an improved appreciation of the sometimes-unpredictable nature of ADHD medications.

The new brain and body biology has a significant impact on everyday psychiatric practice, from child to adult assessments, to pharmacologic interventions, to new treatment strategies such as neurofeedback, to supplements that improve neurotransmitter function. To appreciate the actual biologic evidence is to significantly add more possibilities to the treatment arsenal.[5] That new science will ultimately improve current treatment strategies, as outlined my eBook, ADHD Medication Rules: Paying Attention To The Meds For Paying Attention,[6] not yet available at Amazon.

The new brain message:
We must move beyond ADHD appearances, the superficial description of hyperactivity and inattention, and look at the person with ADHD as a complexity of issues including both biology and psychology. Both mind and body matter.
cp

[1] Vanderhorst, GK, Costs of ADHD, CHADD Magazine, 2007
[2] CDC: Increasing prevalence ADHD in older children 2003-2007 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5944a3.htm
[3] Single Photon Emission Computed Tomography measures brain function to assess diminished prefrontal cortical [PFC] activity during concentration.
[4] Marc D, Ailts J, Ailts-Campeau D, et al. Neurotransmitters excreted in the urine as biomarkers of nervous system activity: validity and clinical applicability. Neurosci Biobehav Rev. 2011;35:635–644.
[5] For more referenced details see: http://www.corepsychblog.com
[6] ADHD Medication Rules: http://bit.ly/medrules

 

6 Comments
  1. Open to suggestions……….adhd is treated, but obsessive/compulsive traits and anxiety are not

    29 yo, healthy diet, no other health problems (digestion, allergies, sensitivities, etc), aerobic exercise 5+ days/week, good sleep habits, stress management

    current — amphetamine 50mg/daily

    Other medications tried (some before adhd diagnosis – span over years)
    1. Prozac – don’t recall mg, for depression
    2. Wellbutrin – don’t recall mg, prescribed to kick start prozac
    3. Paxil – 10 mg first night = did not sleep, bad somatic anxiety next day; 2.5 mg next night = only mildly better
    4. Abilify – 1 mg first AM = irritable, confused, agitated followed by exhaustion and severe suicidal thoughts
    5. Celexa – 10 mg four days in a row AM = 3rd & 4th AM woke with unusual anxiety, 3rd night did not sleep well but slept, 4th night did not sleep at all

    Any suggestions? Am aware of no-no for prozac/paxil with amphetamines, and possible interaction with wellbutrin

    Seems to me like this is a classic case of needing to balance the serotonin. like the seesaw effect you talked about. NOT depressed or sad much of the time, but I guess it is still an underlying case of depression. In any case. the obsessions/compulsions and anxiety were present before, but made more evident or possibly worse by the amphetamine

    Thanks,
    Mary

    • Mary,
      Interesting, thoughtful and well informed question – shows your spot on about several issues. If your anxiety it encouraged by AMP and, yes, it does sound like a serotonin problem – then as you say what -to-do.
      1. You really should have Neurotransmitter testing to see what is actually going on. If you do have an immune challenge, then IgG testing should follow to remove the offending antigen which could be cranking the serotonin ‘naturally’ or the norepinephrine. The reaction to the Abilify strongly encourages NT testing, and, of course would ask you, not here, about #2 and transit time.
      2. On the try it now side, I’ve had considerable luck with Intuniv for the anxiety, OCD type of ADHD that proves refractory to AMP. I am planning a post soon about it, perhaps can get it off this weekend.
      3. A new article, also ref. for this post, shows good results mixing AMP with Intuniv – even though Intuniv appears to more directly effect glutamate, I can assure you I have seen many with elevated glutamate levels that show anxiety and considerable irritability.
      See what your doc thinks,
      cp

  2. Thank you Dr.P! That’s the ticket> “We must move beyond ADHD appearances, the superficial description of hyperactivity and inattention, and look at the person with ADHD as a complexity of issues including both biology and psychology. Both mind and body matter.”

    In both textbooks I’m studying right now, “Modern Biology” and “Understanding Psychology”, the chapters that explain nuerons are identical somewhat, with drawings, descriptions,etc..”Multitalental Chemical Couries” is quite interesting. The “Modern Biology” is a used book I found at a thrift store, so it’s not so “modern”.. lol. I’m astounded by the new scientific evidenvce that we need to look at here and in your book!

    Scott

    • Scott,
      Just reviewing a new anatomy and physiology book with a student, and the illustrations are awesome – the immune system broken down so well into bite size pieces!

      Thanks – appreciate your being out there – in the best sense of term…
      cp

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