Questions/Answers
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Table of Contents
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(Click on a question below to see the answer)
Can severe anxiety can mimic ADD?
“I am not hyperactive. Can I still have ADD?”
Weak “nearness anxiety” as a way of understanding some ADD symptoms
Is ADHD hereditary (genetic)?
Does the Federal Aviation Administration allow people with ADD to operate an aircraft?
“What are good sites on the internet for finding medical information?”
Is there any relationship between overweight and ADD?
Do women have more problems with ADD than men?
Do patients with ADHD report more sleep problems than those without ADHD?
Can stimulants help other disorders in addition to ADHD?
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Answers
Can Severe Anxiety Mimic ADD?
I saw a middle aged lawyer a few months ago for an ADD evaluation. One of his main problems was memory difficulties. Although these are common with ADD, his seemed a little worse that the usual ones I have seen with ADD. He responded better to long acting methylphenidate (Concerta) than to mixed amphetamine salts (Adderall) but in both cases, the medication helped his ADD symptoms only for a few days at most, then seemed to wear off or made his memory problems worse and sometimes made him feel depressed. After some experimentation with timing of the doses of his medication, including his taking a few drug-free days between short courses of medication, it became clear that the problem was that the stimulant medication was making his anxiety worse, and this was adversely affecting his memory. He responded very well with the addition of an anti-anxiety medication, alprazolam (Xanax) to the long acting methylphenidate. After a month on this treatment, his memory seemed normal and his other ADD symptoms much improved.
“I am not hyperactive. Can I still have ADD?”
Yes, you can. Hyperactive ADD (ADHD) is more common among boys than girls. Girls with ADD often suffer more from distractibility and attention problems then from hyperactivity. Hyperactivity disappears in about 3/4 of children by the time they become young adults. However, inattentive symptoms fade away in only about half of children, though the symptoms in adulthood are often not so severe as they were in childhood.
Weak nearness anxiety as an explanation of some ADD symptoms
As people get nearer to the time or place when a task has to be done, the more likely they are to experience a twinge of anxiety about not having fully prepared for it. (For someone with ADD, the twinge may occur the night before an important presentation, when there is hardly any time to do anything about it.) It seems that people with ADD have to get closer to a task or place for that helpful anxiety to kick in. Having a way to crank up the anxiety sooner can be very helpful. Reminder systems can help. Working with a group can help. Visualizing the task or situation can help if you can imagine it and the consequences of messing up vividly enough. Just getting started on something even if it’s way too early can help. Just stopping before you leave your home each day to check whether you have everything you will need can help. Have you found other methods or techniques that work. Click here to let me know about them.
Is ADHD hereditary (genetic)?
Many studies have strongly established a hereditary cause for over 75% of cases of ADD. At least a dozen different genes can contribute to ADD symptoms, partly explaining why everyone with ADD does not have the same symptom profile and why some people have much worse symptoms than others. There are genes for attention problems, others for hyperactivity, and others for both. To further complicate the picture, some of the genes start having their actions in early childhood and others not till later in life.
And what makes up the other 25% of the cause of ADD? As with most studies of the genetics of psychological disorders, the influence of the home environment seems slight. Most of the 25% of causative influence seems related to the unique life and health experience of each individual. Otherwise identical twins brought up in the same home would have identical symptoms, but it turns out that in about 25% of the time their symptoms are different from each others.
Does the Federal Aviation Administration allow people with ADD to operate an aircraft?
A third class airman who is being successfully treated with Adderall for ADD received a medical certificate allowing him to fly. However, because of his medical history (ADD) and use of Adderall, he was prohibited from operating aircraft if new symptoms or adverse changes occurred or any time his medication required a change. He was requested to promptly notify the Medical Office of the Regional Flight Surgeon of such changes. He was also cautioned to abide by Title 14 of the Code of Federal Regulations, Section 61.53 relating to physical deficiency, medication, or treatment.
What are good sites on the internet for finding medical information?
For medical information : http://www.MedlinePlus.govFor patient assistance paying for drugs: http://www.NeedyMeds.orgFor drug interactions: http://www.Epocrates.comFor information about research projects that are recruiting volunteers for new treatments: http://www.ClinicalTrials.govFor information on drug abuse: http://www.DrugAbuse.gov
For articles in professional journals about ADD: http://www.ncbi.nlm.nih.gov/pubmed/
Is there any relationship between overweight and ADHD?
Treatment of both ADHD and obesity with stimulants can provide considerable relief. For example, it was reported that nearly one third of subjects (32.2%) who were referred to an obesity specialist were subsequently diagnosed with ADHD. Treatment of their ADHD resulted in a weight loss of 15.05 kg (about 36 lb); non-treatment of ADHD in the control group resulted in a weight gain of 3.26 kg (about 7 lb). For more information, see http://cme.medscape.com/viewarticle/708287_2
Women May Have More Problems with ADD Than Men Do
Some research indicates that women with ADD suffer more from temper problems, mood swings, and emotional over-reactivity than do men with ADD (J Clinical Psychiatry 2008:69). This often makes it more difficult for clinicians evaluating them to identify their ADD, which can be overshadowed by their other problems. It is not yet clear whether the ADHD causes these problems or merely co-exists with them. It appears that women benefit more from treatment with stimulants than do men, particularly in the area of social functioning.
Sleep problems in people with ADD
In one study, half experienced daytime sleepiness, and more than two thirds had difficulty falling asleep, going to bed on time, and getting out of bed. In addition, their sleep was less “efficient” – that is, they awakened more often during the night and for longer periods of time and awakenings were more frequent. Methylphenidate had some predictable negative effects: it delayed the onset of sleep and reduced the amount of sleep. On the other hand, it had some surprising positive effects: patients had fewer awakenings during the night, and their average uninterrupted sleep time increased. The overall effect was to improve overall sleep quality and reduce daytime sleepiness.
Can stimulants help people with disorders other than ADHD?
Stimulants have been found to be very helpful to patients with bulimia and with narcolepsy. They can be some value to patients with gastric paresis (slowdown of the bowel) and to some patients with attention problems secondary to traumatic brain injury. They have been reported to augment the effects of SSRI’s on treatment-resistant obsessive compulsive disorder. Using a high dose of stimulants (350 mg per day) I successfully treated one patient who had suffered from a life long depersonalization disorder. Relatively few people can tolerate such a dose with out suffering some adverse effects.
