ADHD Fact Sheet
24 Points you shoud know about UADHD and neurostimulant treatment
Uncomplicated ADHD [UADHD] & NeuroStimulant Fact Sheet
1. Uncomplicated ADHD Combined Type needs to be differentiated from other forms of ADHD, and other disorders that look like ADHD, to ensure proper treatment and resulting good long term prognosis. This discussion is on Classical Uncomplicated ADHD only, that is usually stimulant responsive.
2. UADHD has a very high genetic, biological, heredity correlation, estimated to be 80%, one of the only things that is higher is height, about 90%. This diagnois should be considered to be a more purely neurobiological disorder in the realm of neurological medicine , rather than a classical psychiatric disorder.
What is its theoretical cause? It’s a brain chemistry disorder of dopamine/norepinephine imbalance treated, in an almost lock and key manner, with neurostimulants improving both general mindfulness & all aspects of concentration.
3. UADHD because of its biological nature & lack of psychiatric complications make psycho education and medication management with a stimulant the first line treatment of choice & is often all that is needed.
Treatment [RX] has remarkably sustained effectiveness, rapidity, safety , with minimal side effects, compared to the treatment of other forms of ADHD and other like diagnoses [DX]. If this treatment response does not occur the diagnosis should be suspect.
4. Stimulants work by stimulating selectively in UADHD brain the brakes rather than the gas pedal, having the effect of helping the person show down ,stop& think ,slow down, stop and focus and to sustain concentration. In the non UADHD brain the stimulants have a non specific effect and may be helpful initially, but in the long run will start stimulating the gas pedal causing increased physical & mental activity, increased anxiety& mood instability, resulting in poorer concentration and increased impulsivity.
5. Medication of UADHD not only has life changing effects almost immediately but prevents long-term complications, discussed below, but you must have the right diagnosis !!!
6. If ADHD core symptoms occur exclusively in the course of another DX or are better accounted for by another DX then the diagnosis is not ADHD. In this case other symptoms will continuously or episodically always be present, persistent & pervasive, e.g. worry, fears, panic, sadness, mood swings, rage, illogical thinking, bizarre or unusual way of relating to people, poor eye contact, motor movements around eye, nose, tongue, psychosomatic symptoms like headaches & sleep problems. These symptoms may be hidden by what appears to be ADHD. Core ADHD symptoms of other DX will improve on the right medicine for the other DX, & ADHD meds may worsen symptoms, though not initially.
7. Uncomplicated ADHD primarily presents with the core DSM symptoms : inattention/poor concentration, making careless mistakes, doesn’t seem to listen when spoken to , or complete activities, difficulty organizing, avoids things that require sustained attention & mental effort, looses things, forgetful, easily distracted hyperactivity, fidgets, squirms, trouble staying seated, inappropriate running/climbing, trouble working/ playing quietly, talks excessively, feels restless, on the go, as driven by motor, impulsivity[x3 that is socially, behaviorally and cognitively], blurts out answers, difficulty awaiting turn, intrudes, interrupts, butts into activities, conversation, at work and play.
Not core but usually present are excitably , short fuse, discipline problems, not learning from mistakes and life’s experiences, making the same mistakes over and over, some Oppositional Defiant syndromes. Specific to ages; preschooler: difficulty completing developmental tasks like toilet training, language delays, too vigorous play; school age: perception of immaturity , wont complete chores /homework; adolescent: restless rather than hyperactive, risky behaviors, poor self esteem and peer relations; adults: disorganized, forgetful, poor time management, problems with money, work and relationship instability based on impulsivity and over emotional .
At its core are defects in 1. initiation of attention 2.sustaining attention 3. concentration and deepening focus & 4. changing focus. All of these including the hyperactivity, and the three kinds of impulsivity should improve with adequate medication management. the two non core symptoms of excitability with a short fuse and not learning from mistakes, usually improve also, but may require counseling and "re education".
8. Other criterion are the symptoms must a. be inconsistent with the developmental age, b. cause significant impairment in at least 2 domains, such as home, work, school, social situations. c. some symptoms be present before 7 years of age, d, be present for at least 6 months
9. Symptoms, distress & impairment should be sustained & continuous[4M‘s?], Motivation, milieux, mood, and meaningfulness of an activity must be factored in to get a true diagnostic picture and rule out other disorders like an unstable mood or anxiety states.
If there are intermittent lapses or episodes, if the symptoms come and go, consider another DX e.g. Tic or Mood Disorder, or OCD rather than uncomplicated ADHD.
An adequate treatment response also should be sustained and continuous.
10. Long term prevention with RX: less tobacco, drug, alcohol abuse, school detentions, suspensions, and failures, decreased incidence of auto accidents, pregnancy, sexually transmitted diseases, less anxiety, sadness, physical complaints like headaches stomach aches, less risky behaviors, job instability and marriage/ relationship conflicts, better performance, success at school, work, relationships.
11.Medicine may not be for a life time, though if needed there are no serious long term side effects for most, and usually the benifits out weigh the risks, short and long term.
The best guarantee to be the 50% of treated ADHD that can do without medication in the future is adequate medication as the earliest age.
Benefits of stimulant medication in Uncomplicated ADHD far outweigh the risks!!!
12. The specific medicine used for UADHD should be based on track record, safety, effectiveness, side effects and ease of use, i.e. stimulants, no other medication class comes close.
Generally and statistically all the neurostimulants are equally effective, though individual differnces in the preparations and because of unique brain chemistry, make trials of more than one worth while if results are not adequate or optimal.
13. Neurostimulants were first used successfully 1938 for brain disorders marked by hyperactivity, poor concentration, and impulsivity, the core symptoms of UADHD, and nothing has been safer or better.
14. Being equally effective, the individual product picked is based on crucial compliance issues of tolerably, side effects, duration of action[ 3 to 12 hours], and ease of use e.g. tablet, sprinkle, patch, liquid.
Generally a longer acting prepartion works better, but there is a subgroup perhaps less than 5% that do better on the shorter acting products.
15. Because of the uniqueness of individual brain chemistry one preparation may be vastly better , and can only be determined by a separate medication trial, though individual response to other medications and family history of response may be helpful.
16. Immediate effects can be seen within one hour of the right medicine at the right dose on all core symptoms, which are improved ability to slow down, stop and think and focus for 3 to 12 hours, better anger control, improved ability to follow directions, better performance at home , school, at work, and in relationships.
17. The right dose is found by starting with the smallest dose and increasing as needed every 3 - 7 days depending on urgency, environment, family/patient variables and response.
Slower titration may be appropriate for some espcially if one is dealing with an uncertain diagnosis or the person may have "atypical" brain chemistry.
18. Short term side effect are less appetite, stomach and head ache, insomnia and irritability. Insomnia may be improved with pm dose.
Irritability if it occurs is a special case of side effects and requires differential diagnosis; is it the med, is it UADHD, another DX, rebound, med unresponsive trait like some forms of ODD, Oppositional Defiant Disorder?
19. Long term side effects are non statistically significant include concerns about growth deceleration, shorter stature, abuse, dependence, addiction, these and others need to be discussed with your health care professional. On the positive side long term RX may increase brain mass, and may "heal" and normalize the UADHD brain.
20. Few contraindications, except for allergy/unique sensitivities most are relative, tics, compulsions, cardiac defects, blood pressure issues, psychosis, addiction and abuse.
Tics, compulsive behior, and moodyness may represent side effects of the meds, or may indicate other diagnoses requiring other medication approaches best evaluated and treated by a skillful experieced practioner of clinical psychiatry, neurology wiht expertise in clincal pharmcology.
21. If there is a lack or inadequate response to treatment, or it is not sustained, or unexpected side effects occur, the diagnosis of Uncomplicated ADHD should be suspect and re evaluation is necessary, and a trial with lower or higher doses or with another medication may be indicated.
22. An unrecognized cause of a negative response is low end responders who have such sensitivity to both the good and bad effects of medicine ; the beginning dose may have to be extremely small, use micro dosing.
23 A common cause of lack of adequate optimal response is the medicine is not titrated to the highest tolerable dose, which can be done as long as there is no significant side effects and significant symptoms are still present .
Often micro diagnosis is needed, that is recognizing the less troubling symptoms and their variable response to treatment, e.g. sustained attention and social impulsivity respond last.
24. Adequate treatment occurs with Fine tuning of DX & RX and is necessary to ensure compliance & effectiveness, and until all major and minor symptoms are optimally treated with minimal to no side effects.