If you worry about headlines reporting new research findings, look at the facts before making a decision. Headlines are written to get your attention. They never tell the whole story and even statistics can be used inappropriately.
Headlines are designed to grab your attention. Recent headlines about Adderall and other ADHD medications are scary. This is another example of media misinterpreting a study with the headline. I’ve written before about Adderall being misrepresented by headlines.
In this post I will generally refer to stimulants by their common names. Adderall is in the amphetamine family and as used here could include other named medications in that family. Ritalin is in the methylphenidate family and as used here includes other medications in its family.
That sounds like a typical headline. It’s eye-catching, right? It won’t be something you forget if you take Adderall or are considering starting it.
If these medicines have been working well for you and you aren’t hearing or seeing things, you don’t need to stop them.
How can I say that? Am I not worried about someone becoming psychotic?
We always need to look at studies critically. The title of an article, or even the summary, can be misleading. Attempt to read the study itself, but if you are unable to, find a summary by an expert in the field.
Limitations in the study
This study actually fares well in many of the above things to consider when evaluating a study. It’s a respected journal and there’s a large sample size, but it’s not a double blind controlled study. It’s a review of insurance codes. This can be fraught with many problems.
The study was a review of codes from national insurance claim data. It included teens and young adults who were starting these medicines for the first time. They reviewed codes for diagnoses as well as prescriptions. They did not have any direct study of the patients. Anyone who was doing well on these medications already was excluded.
Unable to accurately assess disqualifiers
Anyone who had filled a prescription for a stimulant in the year prior to the study was disqualified. That means the many, many people who use stimulants with great benefit for years were not included. There is no comparison to total number of prescriptions for this.
We know that many people will self medicate with someone else’s medicine. There was no way to assess if they used someone else’s prescription medication, so there could be misrepresentation of new medication starts in the study population. This means even one of their qualifying conditions cannot be verified.
Inability to assess if patients accurately took medicine
We all know that people will fill prescriptions that they don’t take as directed.
There is no way to tell from this study design if the patients took their medicine regularly, or even at all.
Adderall has a larger street value than ritalin, so if more of the patients who were prescribed adderall diverted their medicine to someone else, they were still included in the psychosis number. This could sway the numbers making adderall look more problematic than ritalin because they weren’t being medicated. Said in another way: if people are more likely to take their medicine, they’re less likely to have psychosis.
This is just a thought. I have no way of knowing this information based on the study design. I include it because this is the way we must evaluate study results. We need to consider the results and other possibilities and explanations critically.
What does double the risk really mean?
The age range studied is one at which schizophrenia and other psychoses tend to develop.
They compared psychosis rates to people treated with methylphenidates versus amphetamines and found the risk was double in those starting amphetamines. Double sounds huge, but it was still very small numbers.
One big problem is that there was not a comparison to a baseline development of psychosis in people of the same age not on medication.
We would expect a small number of study participants to develop psychosis, whether they start the medicine or not. They did not attempt to compare this with their study population.
We also know that people with ADHD struggle more with mental health.
Their overall risk of psychosis may be higher, but since they didn’t compare the same age range of people (with and without ADHD) who did not start any new medications during the same time frame, we do not know that baseline.
The age groups in the studies are slightly different. We know that risk increases with age, so it should be further studied if the age range contributed to this difference.
Closer follow up matters
It is also possible that people who are starting a new medicine are more likely to be identified early in their psychosis.
Many adolescents and young adults rarely see physicians or other medical providers since they’re generally healthy. If they aren’t seeing someone who could identify psychosis, they would not get a diagnosis.
People who see someone who is prescribing stimulant medications are hopefully being assessed for mental health in general. It is expected that they are more likely to have problems identified.
This wouldn’t explain the difference between medicated groups, but could raise the incidence overall identified.
This study doesn’t convince me that the risk of psychosis is enough to avoid using it for the management of ADHD. Both amphetamines and methylphenidates have been used successfully in many people over the years.
Are you struggling to control side effects from your ADHD treatment? Learn some tips to help manage them effectively so you can thrive with ADHD!
With everything we do, we must weigh risks and benefits. Many people with ADHD need help managing their symptoms, and that often includes medications. Unfortunately this treatment can lead to side effects. If we can manage the ADHD medication side effects, the risk to benefit ratio tips toward the benefit side.
1. Appetite suppression
A decreased appetite is common when stimulants, such as methylphenidates or amphetamines, are used. I have seen kids who gain weight better on their medicine because they can actually sit long enough to finish lunch, but most will lose a few pounds when they first start their medication. After the initial drop, most can maintain a healthy weight with some simple adjustments.
Make the most of non-medicine times
I often say that kids on stimulants don’t have eating disorders, but they have disordered eating. They eat at unconventional times.
Before meds kick in
Start your day with a healthy breakfast that includes protein, whole grains and fats. The typical American diet of cereal for breakfast is mostly carbs, which gives quick – but non-sustaining – energy.
Protein, fiber and healthy fats can provide longer-lasting energy.
Don’t limit yourself to “breakfast” foods. If a sandwich or leftovers sound good to you, eat that for breakfast.
As meds wear off
Before hanger sets in, grab a healthy snack at the time you start to feel hungry in the afternoon or evening.
If your parents try to make you wait for dinner, talk to them about how your hunger affects your mood and behavior.
Eating a healthy snack (or call it an appetizer) can help keep those under control. You should still be able to eat dinner, but if it affects your appetite, warm up last night’s dinner as your appetizer each day. You’ll still eat what the family eats, but it will be timed differently. Still sit with your family for the conversation if your hunger doesn’t coincide with the family dinner. Family meals are important!
After school if you’re hungry, grab a mini-meal. Heat up leftovers, make a sandwich, or grab a plant and protein pair.
apple slices, grapes, or berries with cheese
bell peppers with cream cheese
berries and yogurt
cucumbers, carrots, bell peppers or snap peas with hummus
apple, banana or celery with peanut butter
smoothie made with fruits, vegetables, and yogurt
broccoli, carrots, cauliflower, snap peas or celery with a yogurt dip
If you’re hungry after dinner, again grab a mini-meal type snack, not junk food.
Don’t waste empty calories
If you’re able to eat, pick the healthiest part of the meal first. Don’t start with the side dish or roll. Eat plants and proteins. Plants are fruits and vegetables, and most of us fail to get the recommended amount of these daily.
People with ADHD tend to be very sensitive and emotional in general, but medications can increase moodiness at times. Look for patterns about when the moodiness is the worst to help identify why it happens.
Some people get more irritable when their medicine is working, others as it wears off. This can be due to a medicine that’s not the best fit or at the wrong dose. Be sure to talk to your prescriber about how your medicine is affecting your mood.
Many people experience a rebound of symptoms as the dose wears off. If this happens, some people can use non-medication changes, others require a medication adjustment.
If you can be alone during this time frame, that may be all you need.
Listen to music. Exercise. Read. Whatever helps you adjust.
If this isn’t sufficient, discuss adjusting the dose or adding a short acting dose in the afternoon with your prescriber.
When these medication adjustments aren’t sufficient, adding a non-stimulant medicine can help buffer the rebound. Again, talk to your prescriber.
Sometimes stimulants can can trigger an underlying anxiety.
Anxiety can look like anger or increase irritability.
It can lead to headaches, stomach aches and other physical symptoms.
Anxiety is a common cause of insomnia. Lack of sleep makes anxiety worse. It’s a hard cycle to break sometimes. Talk to your prescriber if you’re experiencing this.
When anxiety distracts, it can look like poor focus, which can be misintrepreted as too little stimulant. Increasing the stimulant makes it worse.
Anxiety often leads to avoidance, negativity, over planning and trouble with patience.
Help for anxiety
Therapy is the first line treatment for anxiety, but if it is caused by medication, adjusting the medication can help.
Sometimes adding another medication to help with the anxiety may be needed.
It is very important that you talk to your prescriber about any anxiety you have, whether it’s medication related or not. No one should suffer in silence.
Other causes of moodiness
Moodiness can be related to chronic sleep deprivation or hunger – see the related sections of this post to help manage those issues.
If you think your medicine keeps you up, talk to your prescriber about changes that could help.
4. Stomachaches and headaches
If stomachaches or headaches seem to happen due to the medication, taking the medicine with food can help.
These symptoms sometimes only happen at the start of a new medication, when the dose is increased, or when resuming after being off of it for awhile. If this is the case, you should notice these side effects go away after consistent use.
When the stomachaches or headaches are persistent and not tolerable, talk to your prescriber to discuss changing medicine or changing the dose.
Repeated movements or sounds are known as tics.
Tic disorders are common in kids with ADHD:
About 20% of kids with ADHD have chronic tics.
Around half of all children with chronic tics have ADHD.
Tics can come and go. They often change over time, so an eye blink can go away and be replaced by a nose twitch or shoulder shrug.
Because of this natural cycle it can be difficult to decide if they’re on their normal cycle or worse due to medication.
Some people will even notice that their tics are less common when they’re on medication for ADHD, especially with guanfacine or clonidine.
If you note that tics increase with the start of a new medicine or an increase in dose, evaluate how these tics affect you. If they are minor, such as an eye blink, it is okay to ride it out. The tic will most likely continue to come and go and it’s not causing distress. If it causes you distress, talk to your presciber about behavioral therapy or a medication change.
Recent headlines have put psychosis and stimulants in the news.
In short, if you’re doing well on a stimulant, either amphetamines or methylphenidates, there’s no need to worry.
The study being reported is about new starts on these medications.
As is often the case, headlines are overestimating the risk. They are designed to make you want to read the article.
I am writing a whole post on this, so tune in next time… if you don’t want to miss it, sign up in the pop up or the right sidebar so you’ll get each new post in your in box. I promise to never use your email for any other purpose!
This presentation will be of interest for all ages living with ADHD. It will include experiential activities, and guidelines for using ADHD strengths in order to follow your passion from childhood to the workplace!
This will be a combined group of the parents and students. We appreciate your RSVP so we can plan seating, but if you decide to come at the last minute, you’re welcome to show up! All meetings are free and open to the public. RSVP here
Does rumination and negative thinking keep you from finding appropriate solutions and moving forward? Learn how to overcome negative thinking with ABCs.
We all have negative thoughts, but when we get stuck in a rut about them, it’s called rumination. When we ruminate, we can’t stop thinking the negative thought, which keeps us from finding appropriate solutions and moving forward. Cognitive Behavioral Therapy (CBT) teaches how to break this cycle of rumination. One way to use CBT is to think of your ABCs. Use the handout linked below to stop thinking negative thoughts.
A is for Adversity
When there’s a problem, we need to identify the trigger, or what is causing the adverse situation.
Check out the following examples to see how the process works.
Situation 1: Your BFF hasn’t answered your important text.
A: Your friend is usually quick to reply and you’re worried that there’s something wrong that’s kept her from replying.
B: You don’t know if she’s mad at you or dead on the side of the road after an accident.
C: You are worried that you did something to anger your friend or that something catastrophic is keeping her from answering.
D: There was no indication that she was upset with you last time you spoke. She is a safe driver and the road conditions are fine. It is possible that she could have forgotten to charge her phone (again). She could have the ringer off. Sometimes texts don’t go through. She might be busy doing something and unable to check messages.
E: Do you feel less anxious realizing there are other reasons that your text has gone unanswered? What about these new thoughts can help you problem solve? Is there another way to reach your friend, such as through her parent or another friend? Should you call instead of text?
Situation 2: Too much to do!
A: Last week you missed a couple days of school so you got behind and can’t quite get back on track. You have a paper due, a huge test this week, and practice every night after school.
B: There’s so much to do, you’re overwhelmed and can’t even start on any of the schoolwork. After practice you want to just relax and watch YouTube videos. You need time to relax to feel better, but then you realize hours later that no work has been done, so you’re going to be up all night working. This leaves you too tired to focus at school so you get confused on even simple concepts and questions.
C: Anxiety is keeping you from initiating what needs to be done. While relaxing is important, you are not using your time efficiently, which is adding to the problem. You’re sleep deprived, which increases anxiety.
D: Take a look at how much time you’re spending on everything. What can be pushed off until later? Where are the priorities? How can you moderate your down time so you can be productive but still have time to relax?
Mindset: This is a situation I have the capacity to deal with. I’ve developed a pattern of avoidant coping but I can get better at non-avoidant coping through the right kind of practice. This is an opportunity for that.
E: Does realizing how much down time you waste help you regroup and use time more efficiently? Are you motivated to set timers to help limit your free time? Can you grab a friend to study together to keep you on track? Are there things you need to change in your schedule so you can devote appropriate time to tasks? Are any of your teachers willing to extend the deadline since you were sick? What can you learn from this to do it better next time?
Most of us want to be happy, but true happiness remains elusive. What’s the big secret? I don’t think there’s a single secret. There are many things that can add to our happiness. I don’t mean making millions of dollars, having the latest model cell phone or having the cutest prom date. Those can bring temporary happiness, but they miss on true happiness. Sometimes they actually can make us unhappy.
Have you heard the title quote before?
Live is a marathon, not a sprint. ~Unknown
I think it holds some of the best ideas about true happiness. Life is a marathon, not a sprint. Let’s break down what that means. I’ll start with a bit about what goes into running a marathon. Then I’ll give several examples of how we’re sprinting along and how this can lead to burnout. I’ll end with tips on how to turn this into a marathon. Pace yourself. You’ve got a long life ahead!
Running a marathon isn’t easy.
People must train for long periods of time. It takes dedication and consistency.
There is a big time commitment – and it’s not all running. It’s coming up with the time to run regularly. And eating enough healthy calories to sustain your body.
Not to mention preparing yourself mentally.
Only after months of hard training can you actually run the marathon.
Sometimes injuries delay things unexpectedly.
Excitement builds as the date approaches.
During the marathon, you might feel on top of things as you run past others, but then there will be some who pass you. There are moments a runner may feel like there’s no way to go on because you have nothing left to give. It takes grit and resilience to keep going.
After finishing, you might even spend time wondering what you could have done differently to shave off time.
And you need to take time to rest so your body can recover.
Then maybe you start the cycle all over again.
Society of here and now.
We’ve become a society that has access to everything right here. Right now. While it seems like this is a good thing on the surface, this can lead to impatience, anxiety, and entitlement. All of these lead directly to unhappiness.
It’s not uncommon to hear how busy people are. They complain, yet they often seem to be bragging of all the things they have to do. Being busy isn’t something to brag about.
It is seen as a negative thing when we take time to relax. We’ve become a society that doesn’t value balance, despite everyone talking about finding work-life balance.
Being constantly busy and expecting everything when we want it has become our general expectation. We don’t learn resilience when we’re able to get what we want when we want it. Resilience is when someone is able to pick up and move on when something doesn’t go their way. If we never learn resilience, we’ll be unhappy in life.
The good news is you can learn resilience at any age!
Instant access to friends and family
When I was growing up, we had no cell phones. (I’m a dinosaur, I know.)
I didn’t even get voice mail or caller ID until my mid to late teens. If a friend called and no one was home, we didn’t even know they called. Sometimes that caused frustrations because we had to keep calling to find someone to answer if it was important, but it also was a lot more freeing in many ways than being constantly attached to a cell phone.
We looked forward to talking at school and activities. There were fewer distractions when we were with people because it was rare that someone had to take a call. It took planning to arrange to meet friends, but that itself helped us learn an important skill!
In today’s world if want to tell a friend something, I text them. This is impersonal and doesn’t build communication.
Sadly, we often impatiently wait for an answer. Some people even start to worry when the text remains unanswered for a few minutes.
~ Did I do something to make them upset?
~ Are they having fun with someone else and ignoring me?
The facts can be very different.
Maybe the text is delayed. Their ringer could be off. If they’re driving they shouldn’t answer. Maybe they’re practicing self regulation and it’s not a time they are using their phone – they’re doing something else. The phone can be in another room – or taken away by parents.
So many things can interfere with a quick response, yet we often get upset when the reply isn’t instantaneous.
Isolation of online
There are so many things to do online. Some of these are required for school or work. Sometimes we simply want to relax and check up on things or watch a video.
That keeps you away from actually living life and self care.
Set limits for yourself. You will find that you have more time to do other things that bring more joy. Less time online also means less time to get upset with what others post.
If we are in need of things, we can order online and Amazon will deliver it tomorrow. There are even food delivery services that will deliver from any restaurant in the area, so we can order online and never leave the house.
While this seems convenient, there’s something to the action of going shopping or out to eat. Planning a day and time to be able to shop (or eat out). Actually looking through the store and possibly running into someone you know or having a simple conversation with the store clerk are becoming lost skills. We are isolating ourselves by taking the convenient road.
Fear of the great outdoors
In years past kids would play outside until it got dark outside. They’d walk to school and back unsupervised. A great memory is shared in The Summer of No TV.
Today parents are afraid that kids will get hurt or abducted, so they won’t allow them to roam alone.
Parents of today tend to schedule kids in sports, music lessons, dance classes, scouts, and more.
They structure a child’s time so much that kids of today don’t learn how to fill their time with fun things to do. They don’t learn to work through problems and differences with friends on their own. The fear of injury and abduction overshadows the real dangers of kids not learning how to become independent and resilient.
This over-structured lifestyle leads to teens who don’t know how to find things to do other than screen time or scheduled activities. Kids don’t learn to use boredom as a door to discovery. They don’t discover their own interests and talents. It can lead to feelings of inadequacy and sadness.
Our society is growing adults who have no idea how to organize their own time and succeed in life.
If you’re a teen reading this, talk to your parents about how you can gain independence and be accountable for yourself. If you’re a parent, think about ways you can let go and let your kids figure things out themselves.
Want to know the secret to happiness?
Make it a marathon
You can’t get away from many of the busy activities in life.
The key is to use balance. Balance can lead to the secret to happiness.
Spend time with others
Find ways to be with friends and family on a regular basis in real life.
Go beyond your regular practice and game time and schedule unstructured time. When we are in class or at practice, we have rules to follow and things to do. Unstructured time is when we’re able to be creative with our time, find new interests, and learn more about one another.
Make time for yourself.
Yes, I know I just said to be with other people, and that is still important. When we’re alone too much, we start to feel self doubts. Anxiety grows. Depression can set in.
What I mean by making time for yourself is that we all need to practice self cares.
Here’s another self care necessity. I know you hear this all the time, but it’s important.
It’s easy to spend most of the day sitting. Failure to get daily exercise can lead to lifelong problems.
Find something you enjoy doing, such as a sport or dance. If it’s nice outside, invite a friend to take a walk or bike ride. Walk a dog. Play frisbee. Have fun! This directly and indirectly can increase your lifetime happiness.
Expand your horizon
We tend to get stuck in our daily routines, which can get boring and doesn’t allow us to find our true passions.
Explore other cultures.
Learn about other people and cultures through books, movies, music and cultural events. Visit a museum or historical site.
Talk to people outside your social circle. I know that can be intimidating for some and difficult if you’re in a small town, but it can be very rewarding to learn about other people and their culture.
If you don’t have time to read, or just don’t like reading, try an audiobook. You can listen while exercising or doing chores around the house.
Take up a new hobby
When we’re young our parents sign us up for things to do or buy our toys and games.
As we get older, we need to explore other interests to help find ourselves. There are many things out there that you might not even know about. Think about what characters in books and movies have done. Does any of that interest you?
You can try new things at school by taking an elective that you know nothing about.
Take an art class or learn to rock climb. If you think you can’t dance, sign up for lessons. If competitive sports aren’t your thing, check out a non-competitive league or an individual sport.
Join a new club at school.
Give to others
Community service is becoming required for many teens, but it should be something we do with a giving heart.
Doing things for others is one of the biggest secrets to happiness.
Don’t simply sign up for a service project because you need the hours. Find something that suits your personality and interests.
If you love the great outdoors, find ways to help others outside.
Love animals? Check out the animal shelters.
If you’re good in a subject and see a friend struggling, offer to tutor. (Be careful how you propose this… you don’t want to offend them or come off as a know – it- all.)
Is your neighbor aging? Offer to help with yard work or house work without charging. Leave a pot of flowers on their porch just because.
Do you love kids? See if you can volunteer at a summer camp or respite care.
If you’re interested in healthcare, look at hospitals and other healthcare settings to see if they offer volunteer opportunities.
We often associate spirituality with religion, but they are not the same. We can learn about our own spirituality through meditation and prayer. Spirituality involves a deeper understanding of yourself and the world around you. It is about loving yourself, others, and our planet.
Spirituality also involves mindfulness, philosophy, and more. Learn from books and other people to develop a deeper understanding of love and life. Attend a conference or retreat. Continue this learning life long.
Certainly religion is important to many people, and exploring your faith can be very rewarding towards overall happiness. Teen years are a common time to question, so it’s a great time to reflect, read, and learn. Learn about your own religion and others. This isn’t to change your belief, but it often reinforces it. If you do find that another religion is appealing to you, find people from that faith to talk to so you can continue learning.
Enrich your spiritual life by taking time each day for reflection. Keep a gratitude journal. Help others.
Check out your senses
Sights, sounds, touch, and taste are all important senses, but smell is especially helpful in our emotions and memory.
Certain smells can bring me back to my grandmother’s kitchen. Smells have a way of solidifying memories and then bringing them back. Some, like my grandmother’s kitchen are very positive, happy memories. Others can bring negative emotion. We can use this powerful sense to help us bring happy feelings or a sense of calm and peace.
Certain smells tend to lead to happiness. Citrus smells, such as lemon and orange, and peppermint can serve to pick up your mood. This doesn’t make you find happiness for life, but it can be a pick me up when needed.
Learn to be aware of all 5 senses. This is part of mindfulness and helps us in our awareness. There are many ways to learn mindfulness. Take some time and try some out.
Neurotransmitters are the messengers that bring information from one neuron to another. An imbalance in their levels can cause many problems. Medicines can help bring levels back to normal.
There’s a commonly held belief that people with ADHD should just try harder, but this doesn’t usually work. The symptoms of ADHD are caused in part by imbalances of neurotransmitters in the brain. Low norepinephrine levels lead to symptoms of ADHD. More and more evidence is showing the differences in the brains of people with ADHD compared to neurotypical (“normal”) people.
ADHD is real. You can’t just will it away.
What if no meds are used for ADHD?
Not everyone with ADHD is treated with medication. There are many reasons.
Some have never been diagnosed. Others don’t like medicine for whatever reason.
Many teens want to come off their medications. Some don’t like side effects. Others don’t want to be different.
Some people simply forget to take it and then struggle with the consequences of being unmedicated.
Many families have a hard time affording the medicine or taking the time to do the required follow up with their physician.
I’m sure there are many more reasons people stop (or never start) medicine.
Before discussing how the medicines work, it’s important to learn about neurotransmitters.
Our brain is of course very complicated in structure and function. There are millions of neurons that make up our brains. Between each neuron is a synapse, or space. Different areas of the brain serve different functions, and they all interact with each other. They also interact with other parts of our body and the outside world.
There are many pathways or circuits that bring information from one part of our brain to another. Neurotransmitters are the messengers that bring information from one neuron to another. They are made from amino acids.
Neurotransmitters each have a unique function but can be broadly classified into two categories: excitatory and inhibitory. Some neurotransmitters can serve both functions.
Excitatory neurotransmitters regulate motor movement, thought processes, anxiety, and more.
They can help us stay alert, but when they aren’t moderated by an inhibitory system, things can get out of control.
Inhibitory neurotransmitters act like brakes.
We need brakes so we don’t feel restless, irritable, and out of focus. When our brakes work, we can excel! Without brakes, we’re out of control.
Lock and key
Neurotransmitters act as messengers between different neurons. They are released from one neuron into the space between neurons called the synapse. They enter a neuron that has the proper shaped structure for it to fit.
It works like a lock and key.
Each neurotransmitter is like a different key. They each fit certain locks, and often can fit more than one type of lock.
Neurotransmitter levels and ADHD
When neurotransmitter levels are too high or too low, we can develop anxiety, depression, and executive functioning disruptions.
It is important to understand that to some extent we can control our actions, but neurotransmitters are important in the aspects that are beyond our control. Sometimes we just feel anxious or sad. Focusing can be very difficult. Executive functions, such as time management, working memory, and more, can be hard to manage.
Norepinephrine is an excitatory neurotransmitter. It is primarily made and stored in neurons but is also found in the blood and a small amount is stored in the adrenal glands, which sit on top of our kidneys.
Norepinephrine is involved in focus, emotions, sleeping, dreaming, and learning. Too much norepinephrine can cause anxiety, but too little can lead to problems with focus and motivation.
It can raise our heart rate, increase blood flow to muscles, and increase our blood sugar level – all symptoms we experience in times of anxiety. These are helpful responses when stress is caused by physical danger and we need to run away, but not so much when we worry about a test or other common anxieties.
These symptoms can lead to distraction, self-consciousness, and poor focus and performance. This can look a lot like when norepinephrine levels are too low, which is one reason why anxiety and ADHD can mimic one another as well as exacerbate one another.
Dopamine makes us feel happy. Getting a bump in dopamine feels good.
I often joke that we get a dopamine hit every time we check social media or win a game. One of the reasons depressed people overeat comfort foods is that eating rises our dopamine levels, which makes us feel better. (At least until the heartburn sets in or we notice we’ve gained a few too many pounds to be healthy.)
Dopamine is one of the neurotransmitters that can be both excitatory and inhibitory.
Drugs like nicotine (yes, even from electronic cigarettes), opiates, and alcohol all increase dopamine levels. Eating foods can have the same dopamine increase, as can winning a game or doing anything else pleasurable.
We can all choose healthy options to get dopamine hits. Exercise. Playing games. Enjoying the company of friends and family. Helping others. All of these are healthy things that bring us happiness.
Negative things, such as drugs and alcohol or too much screen time, can lead to more problems than they’re worth. Even though they bring temporary feelings of happiness, they cause more problems in the end. Avoid these dopamine hits.
Dopamine can increase our alertness and help with memory and motor control in addition to giving us pleasure.
Dopamine can be converted into norepinephrine and epinephrine.
Low levels of dopamine are associated with problems focusing, depression, the inclination to abuse drugs and alcohol, excessively playing games online or gambling , and overeating.
If the levels are low in motor areas of the brain, it can lead to the tremors commonly seen in Parkinson’s disease.
Low levels in other parts of the brain can lead to learning and memory problems, lack of energy and motivation, and a loss of happiness and interest in things that used to bring pleasure.
Low levels in the prefrontal cortex are associated with ADHD.
High levels of dopamine can cause overexcitement and disrupted thoughts. They can even lead to anxiety and paranoia.
Serotonin is important in the regulation of anger and aggression, body temperature, mood, sleep, sexuality, appetite and metabolism. It can help us relax when serotonin is available in proper amounts. Stress can lower our serotonin levels as we use it up trying to relax.
Low levels of serotonin can result in depression, anxiety, anger, panic attacks, low energy, migraines, insomnia, obsessions, irritability, craving sweets or loss of appetite, focus and memory problems, aggressive behavior, slowed muscle movement and speech, and having a decreased interest in sex.
High levels of serotonin cause diarrhea, headache, confusion, sweatiness, twitching muscles or stiff muscles, fever, high heart rate and blood pressure, seizures, and even death.
How do ADHD medicines work?
Stimulant medicines are considered the first line medical treatment for ADHD. The two types of stimulants are methylphenidates and amphetamines.
The differences in how these two groups of stimulant types work may explain why some people with ADHD respond to one type better than another.
Methylphenidates include prescription medicines such as Ritalin, Metadate, Concerta, Focalin, Aptensio, Quillivant and others.
The methylphenidates block the reuptake of dopamine and norepinephrine. This leaves more of these neurotransmitters in the synapse. Methylphenidates also help release these neurotransmitters from the neuron, again allowing more to be in the synapse.
Amphetamines include Adderall and Vyvanse. They increase the release of dopamine and norepinephrine from their storage sites into the synapse. They also slow the reuptake of the neurotransmitters, but not to a large extent.
How do medicines affect neurotransmitters?
Medicines that affect neurotransmitters are used to treat ADHD, anxiety, depression, and low blood pressure.
Stimulant medicines (methylphenidates and amphetamines) increase norepinephrine and dopamine.
Atomoxetine (Strattera) affects only norepinephrine.
Serotonin norepinephrine reuptake inhibitors (SNRIs) are antidepressants that work by increasing serotonin and norepinephrine.
Tricyclic antidepressants also increase norepinephrine and serotonin, but are not often used anymore since there are many safer options available.
Selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat anxiety and depression. They block the reabsorption of serotonin, which leaves more available in the synapse.
MAOIs prevent the breakdown of serotonin (and other neurotransmitters) but are rarely used due to significant adverse reactions.
In addition to the resources hyperlinked throughout this post, check out the following:
Did you know that while stimulants that are used to treat ADHD can help people with ADHD, they can cause imbalances to neurotransmitters to those without ADHD? Learn how stimulants can make focus, attention, mood and more worse in Stimulants decrease brain function. Say What?
A lot of people worry about medication side effects, want to be all natural, or just plain forget to take their medicines. What’s the harm in that? Is it really a big deal if we don’t treat ADHD? Dr. Russell Barkley has data to show why it’s a big deal!
A lot of people worry about medication side effects, want to be all natural, or just plain forget to take their medicines. What’s the harm in that? Is it really a big deal if we don’t treat ADHD? Is there risk of not treating ADHD?
I have had the privilege of hearing Dr. Russell Barkley, an internationally acclaimed expert on ADHD, speak three times about his research results showing the long term impact of ADHD on our lifespan. He came to Kansas City to present at a Grand Rounds at Children’s Mercy Hospital and again at the Midwest ADHD Conference in April 2018. He presented the same information at the 2018 International ADHD Conference in St. Louis this past November. During each of the the three talks he made big impressions in audience members.
Unfortunately, not everyone outgrows ADHD and many people suffer from untreated problems, especially when they’re young and haven’t learned to adequately manage the frustrations that ADHD can cause.
Dr. Barkley’s long term study has shown some very distressing results. Children with ADHD have a shortened life expectancy of over 9 years. Adults with persistent ADHD symptoms have an even more significantly shortened life expectancy of nearly 13 years.
Dr. Barkley has found that many risks associated with ADHD can lead to life problems, including premature death.
We all know that kids with ADHD struggle in school without proper supports. This is linked to lower educational success, lower paying jobs, and more family stress.
Many people with ADHD get anxious and depressed due to circumstances created by their ADHD. This can lead to more problems in school, interpersonal relationships, self medicating with drugs and alcohol, legal problems, and even death by suicide.
Inattention and impulsivity increase the risk of accidental injury and death. Other risky behaviors can lead to unplanned pregnancies.
Problems with executive functioning can lead to problems at home with significant others and in parenting. Many adults with ADHD show problems at work and in maintaining a consistent job.
Impulsive eating can lead to obesity, and all the long term health consequences associated with that. These include diabetes, heart disease, orthopedic problems, and more.
A public health problem
Dr. Barkley asserts that we should approach ADHD as a public health problem.
During his talk in St. Louis, one of Dr. Barkley’s slides proposed that “ADHD is a serious public health problem; it accounts for greater reductions is ELE [expected life expectancy] than any single risk factor of concern to public health and medical professionals, such as smoking, excess alcohol use, obesity, or risky driving among other widely accepted health risks.”
The good news
The good news is that many of these risks can be minimized with proper management.
If we support our students to help them succeed in school, they are more likely to continue in their education. When people attain a higher education level, they are able to get more fulfilling jobs and earn better incomes.
Proper management of ADHD and executive function problems can help prevent and treat depression and anxiety. With less depression and anxiety, parents can be better parents, workers better workers, and partners better partners. Self medication with drugs and alcohol will be less, resulting in fewer problems that are linked to those issues: less crime, healthier bodies, less risky behaviors and fewer accidents.
Encouraging healthy habits, such as regular exercise and proper nutrition, helps everyone live a longer, healthier life. This is no different for those with ADHD, so it is important to help them overcome poor dietary habits and inadequate exercise to improve their overall lifespan.
What can be done?
We can use behavioral interventions, training for patients and parents of children with ADHD, educational support, and medication to optimize management of ADHD.
When properly diagnosed and treated, individuals with ADHD can be very successful in life. That’s why ADHDKC was started… to help those with ADHD learn to thrive!
What have others enjoyed reading on ADHDKCTeen that you may have missed?
I know it seems like I’m jumping on the bandwagon, but posting the top 10 blog posts at the end of the year serves several purposes. First, it might help someone find a post about a subject that’s important to them but they hadn’t seen yet. Second, it is a way for me to look at what people are reading, which can help me plan future group meeting topics as well as new posts. Third, it’s self-preservation. It’s a busy time of the year and I only have so much time like everyone else. This is an easy to write post!
10: Screen Time Limits
Setting Screen Time Limits is important to everyone. We all waste time on our screens, but we can’t simply get rid of them. They are a fantastic resource for information and a way to communicate with people we can’t talk to directly. Unfortunately, it’s all too easy to fall into the trap of checking one more app or playing one more game when we should be doing other things. People with ADHD are at risk due to their executive management issues with time management, impulsivity, and more. Learn some practical strategies on regulating your screen time so you have more time for other things!
9: What does brain imaging tell us about ADHD?
We’re able to look at the brain in many novel ways that are helping us to better understand its function and development. Studies have shown that kids with ADHD have smaller brains than kids without ADHD. Learn what brain imaging can tell us about ADHD and what the limitations are in What does brain imaging tell us about ADHD?
8: Genetics of ADHD
If you know people who doubt that ADHD is a real condition, you can share new research that has located 12 specific areas in our genes that link directly to the symptoms of ADHD. Learn more in Genetics of ADHD.
7: Stimulants decrease brain function? Say what?
Yes, I was going for a click bait title with this one, but only in response to the headlines that made mainstream news about a study showing Adderall decreased brain function. The study was done in neurotypical (“normal”) people. There’s a big difference in what these drugs do in a brain that has imbalances of neurotransmitters (such as in those with ADHD) and in a brain that does not, so don’t freak out. Read Stimulants decrease brain function? Say What? to learn more!
One of the disappointing aspects of ADHD is that children are made to feel that they are bad and inferior. Most societies want children to do as they’re told in the way they’ve been shown. School in particular is difficult for kids with brains that work differently. The truth is that we should cultivate the characteristics that individuals have. If given the opportunity to learn in ways they learn best and to express their creativity and problem solving, people who think differently can excel. Many adults with ADHD finally find their purpose later in life when they can use the way their brains work to their advantage. Learn more in Celebrate ADHD.
4: 5 Self-Confidence Boosters Part 1: Stop Negativity
I’m surprised this is the most popular in the series of Self Confidence Boosters because it’s rather negative and the others are positive. I suppose it’s because if we recognize that we have a problem with negativity, we want to fix it.
3: How To Get A Growth Mindset
This is my personal favorite because I love this topic. A growth mindset is associated with success more than intelligence. Let that soak in… our perspective on life can help us be more successful. Learn How to Get A Growth Mindset.
2: Watch Out for Rejection Sensitivity
This is a topic that is a relatively new idea to me, but in hindsight I feel like I’ve always known of it. Kids with ADHD are particularly sensitive to criticism. They tend to have low self esteem and are often easily upset by things that wouldn’t bother others. Learn more about Rejection Sensitivity and what you can do to protect yourself against it.
1: What is ADHD? Why do some develop it?
The most read post is What is ADHD? Why do some develop it? It helps to introduce the basics of what causes ADHD and, sometimes more importantly, what does not cause it. If you know people who blame poor parenting or bad teachers, share this with them.
As we hear holiday songs of joy and cheer, it’s a great time to talk about the Joy of Missing Out: JOMO. This winter break don’t waste your time looking at all the great photos of what your friends are doing. Fear of missing out, FOMO, leads to depression and feelings of insecurity. Find your own fun. Learn to appreciate the joy of missing out.
FOMO is everywhere
We’re able to see what our friends are up to at all hours of the day and night. People tend to post pics of what they do when they’re having fun. It’s great to see them enjoying whatever that is, but a part of us tends to be jealous.
When we see peers over and over again having a blast and getting lots of likes, it appears that they’re always having fun and they’re very popular. We forget that they have moments when they’re sitting alone bored and scrolling through social media wishing they were the one in the photo. They also have times that they feel all alone.
The grass is always greener on the other side. Believe me. Everyone has down moments. We just don’t post to say we’re doing nothing. Unless we want attention – and there’s a problem there too!
FOMO is a big problem
FOMO leads to more time online checking and rechecking to be sure you’re not missing the latest and greatest.
Excessive social media use can lead to less sleep – which in turn increases anxiety, depression, risk of accidental injury or death, and more.
The drive to know what’s going on at all times can lead to checking in at inappropriate times:
In class. How many have had phones taken away?
While driving. This puts not only your life in danger, but also the lives of others. Not to mention that it’s illegal in many states – including when you’re at a stop light.
While in the presence of others. It’s rude to check your phone when others are trying to talk to you! You can make your friend feel insignificant if it’s more important to play on your phone when you’re spending time with them.
When you should be sleeping. Being on a screen suppresses your melatonin so you don’t feel tired. If you have to get up in 8 hours, you should be sleeping.
When you should be studying or working. How often do you stay up late to finish homework? Think about how much time you wasted while doing your homework and checking in. And how many hours you spend procrastinating doing what you should be doing.
When you could be exercising. Obesity is a real risk of too much sitting around looking at your phone. Get out there and move!
Today’s teen culture is built around how people appear online. The number of followers and likes seem to indicate how good or popular you are.
But it doesn’t have to be like that. Generations of people were happy and satisfied, popular and self fulfilled without shouting to the world what they were doing.
Friends often have insomnia so reach out online. Don’t feel like you need to see their post immediately. It will be there tomorrow – you can see it when you have scheduled social media time.
What can you do to learn JOMO?
You might think it’s too hard to stay off line. How will you possibly keep up with the gossip and know what’s going on?
That’s the point… you don’t need to! Your real friends and family will talk to you about what’s important to them. You can share with them everything that’s important to you by talking with them and being with them.
FOMO is strong. Fear is a big driver of what we do and how we feel.
Find a passion
If you love a sport, art, music, or other activity, schedule regular time to do that activity.
Being with others who share the same passion will encourage you do do it even more and build strong connections with people.
Enjoy the moment
There’s a lot of research that show mindfulness helps to lower our anxiety and fight depression.
Keep track of how much time you spend online. Break that time into essential school and work related things and non-essential time.
Think about how much time you really should be spending online. Where can you cut back to give yourself more time to be with friends and family or to practice self-care tasks? Wouldn’t it be great to have more time for sleep?
For more on managing screen time, see Screen Time Limits. There are even some examples for apps that can help you track your time.
If you recognize that certain people trigger FOMO, unfollow them.
By unfollowing certain people you can still check on your friends and family who live out of town and stay in touch with them. But the people you don’t really care about won’t bother you. And you can look forward to catching up with friends who actually tell you what’s going on in their lives.
You won’t see all the people you don’t need to see, so you’ll not feel like you’re left out, but you can spend less time scrolling and more time doing other stuff.
Make connections IRL
Stop building your self image based on your online image.
If you feel compelled to check on your posts to see how many have liked it, you have a problem.
Be yourself. Don’t worry about how many likes you get. Think about what matters to you can get involved in that.
Enjoy friends when you spend time with them in real life. It’s okay to like their posts, but it’s even better to share time doing fun things together.
Let friends know you really care by asking them to do things. They’ll appreciate the effort because they’re probably suffering from FOMO too! Of course they could have conflicts, so don’t be offended if they can’t always be available.
Take a break
I’ve seen several people over the years share a “see you later” post on their social sites. They let friends know they’re going off line for a day, a weekend, or more.
While I don’t really think you need to publicize it, I do think taking a break and not checking any social sites for a specified time can help you find what you’re missing by being online all the time. It can take time away from our screens to appreciate all the other stuff life has to offer. This extra time forces us to think about what we can do with our time. Boredom can lead to finding ourselves and our passions.
Publicizing going off line has pros and cons. It can seem to be a way to draw attention to yourself, but it also can let people know that you’re not hurt or in trouble. Some friends might be offended if you don’t reply quickly to a post. This will let you know you’re not mad at them or ignoring them. If this is the only way you feel like you don’t need to check in, then let people know you’re checking out. That also might stimulate them to do the same!
Make yourself, not companies, happy
Social sites, such as Instagram, Facebook, Snapchat, and Twitter are businesses. They’re in it to make money.
The more you check your social sites, the happier those businesses are. They’re doing their job if they get you to spend time on their products. They make more money if you see their ads. The more time spent on their app, the better investment they are to their sponsors, which brings in more money to them. They use psychology to get users to use their platform more. They don’t care if it makes you less mentally and physically healthy.
Stop playing into their game. Resist the urge to hop online.
Make yourself happy by finding a passion off the screen and doing it. Don’t make your life about the right photo op. If you live life to its fullest, you’ll have the memories… which is infinitely better than the likes from people you don’t really care about!
A new study shows 12 distinct areas in our DNA that link to ADHD.
I have recently written What is ADHD? Why do some develop it? and What does brain imaging tell us about ADHD? Both of these help to show that ADHD is NOT caused by bad parents, bad kids, or many of the other things that are blamed. It is a disorder of brain development that has a genetic basis. Today we’ll go into some of the genetics of ADHD. My hope is that by learning how and why ADHD develops, we can stop blaming people for acting the way they do and treat the symptoms to help individuals thrive.
It has been thought that a range of small and hard to identify differences in the sequence of nucleotides, which are components of DNA, combine to increase the likelihood of ADHD. These single nucleotide polymorphisms are referred to as SNPs. Environmental factors play a greater or lesser role (or sometimes none at all) depending on exactly which genetic variations are present.
What are SNPs?
SNPs are commonly pronounced like the word “snips”.
They are the most common type of genetic variation among people. Each SNP represents a difference in a single nucleotide in our DNA strands.
SNPs occur normally throughout a person’s DNA. They occur once in every 300 nucleotides on average. There are about 10 million SNPs in the human genome. They can act as biological markers, helping scientists locate genes that are associated with disease. When SNPs occur within a gene or in a regulatory region near a gene, they may play a more direct role in disease by affecting the gene’s function.
Does this cause a problem?
Most SNPs have no effect on health or development.
Some of these genetic differences have been shown to be very important in the study of human health. SNPs that may help predict an individual’s response to certain drugs, susceptibility to environmental factors, and risk of developing particular diseases. SNPs can also be used to track the inheritance of disease genes within families.
Twelve SNPs were identified that are linked to ADHD, but we must still learn what this means in terms of development of ADHD. Much like some people have a genetic predisposition to cancer but never develop cancer and others without a genetic risk still develop cancer, some people can have the SNPs without ADHD and some people without these SNPs can develop ADHD.
How can this help us?
ADHD is real
One important thing that genetic studies can do is to help people understand that ADHD is a real condition. It is not made up. Yes, it can be over diagnosed in some people and missed in others, but it is real either way.
Learning about symptoms
Comparing this study with similar ones of related conditions can lead to new understandings of relationships of the conditions.
For example, one SNP pattern found overlaps with those discovered in a similar study of insomnia. Many people with ADHD suffer from sleep problems, so this might lead to specific treatments of sleep disturbances.
Limitations of the study
This is not a study that will help us diagnose ADHD.
Specific ways that the genes lead to symptoms are not yet known.
How other factors, such as prematurity, nutrition, and life experiences, interact with the genetic predisposition must be further investigated.
How is ADHD diagnosed?
Diagnosis of ADHD requires that symptoms exist in at least two settings, such as home and school.
Standardized assessment scales should be used to assess risk of ADHD. These scales are commonly done by parents, teachers, and others close to a child. Adult rating scales are available for adults with suspected ADHD.
Evaluation to assess for other disorders and conditions that can mimic ADHD, such as learning disorders, sleep deprivation and anxiety, should be completed.
Blood tests and brain imaging are not required to diagnose or treat ADHD.
Future research may help us learn to manage the symptoms of ADHD in new ways.
My hope is that learning the causes of ADHD will not only help us manage the non-desired symptoms, but also cultivate the beneficial attributes and decrease the stigma and misunderstanding so we can help people with ADHD learn to thrive.