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Frequently Asked Questions For ADDults

The following FAQs are reproduced with the kind permission of Dr Cosgrove, Bristol Priority Clinic

Q. I've been told that AD/HD doesn't occur in adults. Is this true?

A. No! It is not true! Between 25% - 50% of all children with AD/HD will take it into adulthood - beyond 25 years of age.

Q. That's a large figure ! Why, then, do so many doctors tell patients that AD/HD only occurs in children?

A. Ignorance! Poor medical education! Prejudice against behavioural problems being made into a medical diagnosis! Fear of using medication like Ritalin and Dexamphetamine in adult patients! There may be other reasons.

Q. So, you can treat AD/HD in adults.? Don't they react differently to medication compared to children?

A. No, they don't! They respond just as well and just as comfortably as children do.

The four major characteristics of AD/HD (poor concentration; impulsiveness; poor motivation; and residual hyperactivity) are very effectively treated in adults using dopaminergic medication. Self-esteem rises; personal relationships improve, and the job goes more smoothly.

Q. That's impressive, especially if you've never felt quite right.' This "Dopa-min-ergic "! What does it mean?

A. It means that the tablet (such as Ritalin and Dexamphetamine) makes more dopamine available for active duty in that part of the brain just behind the forehead. Instead of the dopamine sloping off to put its feet up in a brain cell, it has to stay around in the area of activity between brain cells. The dopamine has to put in longer shifts of work as a result of the tablets.

Q. But it's a difficult word to pronounce.' I thought they were called "stimulants"?

A. "Stimulant" is a bad description! "Stimulant" has long since passed its sell-by-date! Ritalin and Dexamphetamine do not stimulate a patient with AD/HD. Instead, they reduce the impulsiveness and the hyperactivity - that's not stimulation! True, they increase concentration and motivation, but they bring it into the normal range and no more.

Q. OK! What is dopamine?

A. Dopamine is a chemical, a molecule which is manufactured by brain cells. The amount a brain cell produces is ordered, so to speak, by the genes in the nucleus of the brain cell.

Q. Does that mean that AD/HD is due to the genes? It's not another genetic disorder, is it?

A. Yes, I'm afraid it is! It's not a psychological disorder, it's not caused by bad parenting nor by a bad environment or life-style. It's due to the genes (responsible for ensuring that dopamine is manufactured inside the brain cell)

Q. Is it inherited?

A. Yes, AD/HD is inherited; it runs in families. Other members of a family, which has a diagnosed member, are some 5-6 times more likely to have AD/HD than those in families clear of the disorder.

Q. So, I suppose some so-called "bad" parents of an AD/HD child have AD/HD themselves. But no-one realises this and just blames them for being incompetent, "bad" parents.

A. Absolutely right! And anyhow, even adults without AD/HD will find parenting an AD/HD child next to impossible. AD/HD in children makes anyone out to be a "bad" parent.

Q. Can AD/HD adults become depressed?

A. Yes! Almost always they experience depression. But they usually realise that their depression is not the whole problem nor even the major problem.

Q. Does that mean that adults with AD/HD can be misdiagnosed as having depression or even a depressive illness?

A. All too frequently, I'm afraid! You see adult psychiatrists do not believe that AD/HD occurs in adults, so they see the depression but fail to recognise the AD/HD

Q. Then they get put on Prozac?

A. Yes, one of the many orthodox anti-depressants which are useless for AD/HD because they do nothing for the dopamine.

Q. So, AD/HD adults put on Prozac or the like by the psychiatrist because they are deemed to be depressed, don't get any better?

A. That's right! Usually, they don't feel better in any way, let alone less depressed. But they do experience the misery of side-effects like sleepiness and lethargy to no purpose. They stop taking these anti-depressants and are then labelled as uncooperative! Sometimes the depression does lift to some degree, but the adult with the unrecognised AD/HD is still left unable to concentrate and remains without motivation and drive. They're still crippled by their untreated AD/HD

Q. That's not fair! Why don't psychiatrists use these Dopa-min-ergics " if the depression in the AD/HD needs them?

A. Quite simply because they think that Ritalin and Dexamphetamine are addictive!

Q. But aren't they? Everyone seems to believe they are! And the leaflets we get in the boxes of pills say they might be.

A. Ritalin and Dexamphetamine tablets take too long to get from the mouth to the brain to make anyone addicted to them. Consider alcohol, nicotine and cocaine, for examples. They produce their effects in the brain within a short enough time to addict someone. But not so Ritalin and Dexamphetamine!

Q. So the pill makers should change their blurb to fit the facts, then!

A. Yes, they should but they won't! It would cost them thousands of pounds, dollars and euros to alter their product licence, and they won't get round to it!

Q. But psychiatrists should know better, shouldn't they?

A. I agree! They should and maybe they will one day! They get confused between addiction and tolerance. When a patient is tolerating Ritalin or Dexamphetamine, they think he or she is getting more and more addicted.

Q. Tolerance.' Why do you have to introduce another technical word? Dopa-min-ergic is enough!

A. Sorry! But addiction is a technical word too, and it is often misunderstood. So introducing tolerance might be helpful.

Q. OK then! What do you mean by "tolerance "? Make it simple, please!

A. Tolerance is when a person on Ritalin or Dexamphetamine needs progressively increasing numbers of tablets to keep the beneficial effect of the treatment the same. This happens because the enzymes in the liver and in the gut inactivate a greater and greater percentage of what you swallow over the weeks and months. It's the body's defence against foreign chemicals taken by mouth.

Q. Well, that's not too difficult! You need an increasing dose over time to stay where you are! And this is not addiction.' Does this go on for ever and ever so you end up shovelling tablets into you mouth?

A. No! This tolerance, this inactivation of the tablets swallowed has a ceiling. There comes a point where the gut and the liver stop trying to compete with the doctor, and the tolerance stops. The tolerance is capped!

Q. It's what?

A. It's capped! The tolerance is capped i.e. it has a ceiling so you never get anywhere near having to shovel tablets in.

Q. All right, doc! Is there anything else you really feel should he said?

A. Yes! Anxiety, worry and panic attacks are almost always present in adults with AD/HD. People often self-medicate with alcohol, for example, to try to feel calmer or they hide away from others socially or in their houses. Now, these dopaminergic tablets such as Ritalin and Dexamphetamine are simply superb at making a person feel calmer. They reduce the worrying and remove the panic attacks. They also help an adult to get on top of their alcohol problem.

A. Well, that's a positive note to end on! Where can an adult who thinks he or she might have AD/HD get help and treatment? replies:

The best place to start is to get in touch with a local support group, they will know about the services in your local area and how to access them.

There are only 2 NHS Adult ADD/ADHD Clinics in the UK so getting a referral to one of these is different in each area. However there are a number of private consultants who will be known to the local groups.

There is also a lot of information for adults on these Information pages.

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