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Is ADHD a fairytale?

What a blessed couple of weeks! Although having loads of the usual pressures, our dream to launch Goldilocks and The Bear Foundation became a reality (see our splash page http://www.gb4adhd.co.za/, or Facebook page https://www.facebook.com/gb4adhd/ . This led to extensive media coverage and also radio interviews!

During these interviews I became once again aware of the amount of stigma, misconceptions, and myths surrounding the diagnosis of Attention-deficit/Hyperactivity Disorder (ADHD) and the treatment thereof – the cause being either a lack of information and knowledge, or misinformation.

 

So let me address some of these myths:

 

  • Myth 1: ADHD is a new invention of modern society

The facts:

“Mental Restlessness” was first described by Sir Alexander Crichton in 1798, while “Fidgety Philip” (a popular storybook character and now also an allegory for children with ADHD) was created by Heinrich Hoffmann in 1844. Sir George Still (in 1902) was the first to describe the symptoms of restlessness, inattention and impulsiveness in children – the starting point of the description ADHD as we know it.

 

  • Myth 2: ADHD is not a real disorder

The facts:

Since the first descriptions of ADHD, more than 10 000 clinical and scientific publications have been published on ADHD and there are clear differences between children (and adults) with and without ADHD. ADHD has been recognised as a legitimate diagnosis by major international medical, psychological, and educational organisations. ADHD is best understood as a bio-psychosocial condition: it is medical in origin but is affected and influenced by the environment, social and emotional aspects of the person and situation. However, research shows that genetic (hereditary) and neurological factors (such as pregnancy and birth complications, brain damage, toxins and infections) are the main causes of ADHD rather than social factors (such as poor parenting and diet).

ADHD is one of the most genetic conditions – it runs in families, with a heritability chance of almost 60% for a child if a parent has ADHD, and a 70%–80% chance for a twin if the other twin has ADHD. Research demonstrated imbalances of chemical messengers (neurotransmitters such as dopamine and noradrenalin) within the brain, as well as differences in the development of self-management systems in the brains of individuals with ADHD (e.g. changes in areas of the brain responsible for concentration, regulation, organisation, planning, time-management, decision-making, etc.).

 

  • Myth 3: ADHD is over diagnosed

The facts:

ADHD is the most common psychiatric disorder in children – affecting an average of 5% of school-aged children – irrespective of in which countries or cultural groups these prevalence studies were conducted! The seeming “explosion” of ADHD diagnoses and prescriptions for treatment in recent years has led to accusations that doctors, teachers, and parents are labelling ordinary, energetic children with a disease and medicating them to control normal, but unwelcome, behaviour.

Although the rate of diagnosed ADHD in children has increased over the past two decades, this is not due to “over  diagnosis”, but rather improved awareness about ADHD amongst healthcare practitioners and parents and therefore increased help-seeking behaviour and screenings. Also, because we are now more aware that ADHD persists through adolescence and into adulthood, children often continue to be treated for longer – resulting in an increase in prescriptions for ADHD treatment. Unfortunately, despite this, many children (and adults) suffering from ADHD remain undiagnosed, misdiagnosed, or if diagnosed, do not receive optimal treatment.

 

  • Myth 4: Any child who is naughty, fidgety or talkative is diagnosed with ADHD

The facts:

Many children with ADHD are not hyperactive – but rather quiet daydreamers! ADHD is a clinical diagnosis, which should only be made by a specialist psychiatrist, paediatrician or other healthcare professional with training and expertise in the diagnosis of ADHD. Although screening children for the presence of ADHD is very important, the final diagnosis will always be confirmed by a thorough clinical assessment – which will also exclude conditions that mimic ADHD (e.g. depression, anxiety, visual problems, and certain medical conditions). In South Africa, psychiatrists use very well-researched diagnostic criteria (the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders) which describes the core and associated symptoms of ADHD.

 

  • Myth 5: ADHD is due to the “junk” we eat

The facts:

There is no scientific evidence to prove that eating sugar or junk food will cause ADHD. Although some children (both those with and those without ADHD) are particularly sensitive to certain food components (such as artificial colourants, additives, and refined sugar), and others benefit from specific food supplements (such as omegas), dietary intervention alone does not “prevent” or “cure” ADHD. If ADHD was due to foodstuff alone, then surely the prevalence would have been much higher and “everyone” would have ADHD!

However, we know that various factors are at play (see myth 2). There is little scientific evidence to show that dietary changes help with ADHD symptoms or academic functioning. However, a healthy balanced diet and regular physical exercise do form part of the ideal integrated treatment approach of children (and adults) with ADHD. It is important to treat each child as an individual and work with an appropriate professional to test what, if any, dietary changes might help improve the child’s symptoms.

 

  • Myth 6: Pharmaceutical companies and psychiatrists are colluding for financial gain

The facts:

When a cardiologist assess a patient, discover the patient’s blood pressure is high, and start him on treatment – is he colluding with pharmaceutical companies “just to sell more medication”? I prefer to belief that healthcare providers (read: psychiatrists) always have the patient’s best interest at heart. Why would they want to do something which is bad for a child? Pharmaceutical companies and medical professionals are both bounded to strict ethical codes (and personal values) we adhere to.

 

  • Myth 7: ADHD medication is dangerous

The facts:

It is true that any substance or medication (including herbal remedies) has the potential for risks and side effects. When it comes to medication, it is never a decision to be taken lightly. Always carefully consider the benefits of treating the child versus the potential harm of withholding treatment.

The medications used to treat ADHD have been proven safe and effective over more than 50 years of use, and has been researched in more than 200 successful clinical trials. The most famous and often cited study is the “MTA” or “Multisite Multimodal Treatment Study of Children with ADHD” conducted in 1999 (http://jamanetwork.com/journals/jamapsychiatry/fullarticle/205525). This 14-month randomised clinical trial of treatments in almost 600 school-aged children found medication to be superior to behaviour therapy or community care. Combined medication and behaviour therapy was found most effective, however, this was attributed to its effects on non-ADHD symptoms (e.g., oppositional / aggression, internalising, teacher rated social skills, parent-child relations, and reading achievement).

The most common side-effects children experience are a decreased appetite (and sometimes weight loss), dry mouth, headaches, stomach ache, and problems sleeping. However, most of these side-effects are mild and transient. The goal of treatment is not to subdue children or to “change their personality”! Medication does not “calm the brain down” – effective medication stimulates and improves the brain’s management system. It is important that medication should be carefully monitored and adjusted for every individual – to enhance the child’s functioning by sharpening their focus and increasing his or her ability to control their own behaviour.

Medication does not cure ADHD, but they are highly effective at easing symptoms of the disorder and enabling a child to learn better coping strategies. Also remember that treatment should always include therapy (e.g. parental guidance, addressing issues with self-esteem), educational support (e.g. learning support and strategies, and coping skills), addressing potential stressors (e.g. parental conflict, and bullying), and lifestyle changes (e.g. physical exercise and a healthy diet).

Untreated or inadequately treated ADHD can cause significant personal, interpersonal and social burdens, impacting negatively on overall quality of life. A child (and adult) with (untreated) ADHD is six times more likely to have another psychiatric disorder (such as depression, anxiety, or substance abuse) or learning disorders and self-esteem problems. Research has also shown that those diagnosed with ADHD completed on average two years less of formal schooling and attained a lesser employment status than those without. The risks of using appropriate medications to treat ADHD are minimal, whereas the risks of not using medication to treat ADHD are significant.

 

  • Myth 8: ADHD medication is addictive and create addicts

The facts:

It is actually the opposite: treating children with ADHD protects them against becoming addicts! In a ten year follow up study of a sample of 140 boys originally aged between 6-17 years, 73% had received some level of treated with stimulants at some stage during childhood (some also continued this into adulthood). The researchers found no association between treatment with ADHD medication and alcohol, drug, or nicotine use disorders in later life. Other studies also clearly showed that untreated ADHD increased the risk to develop substance abuse problems during teenage years or later life. This may be due to impulsivity, self-medication, or failure in the educational system and getting involved in destructive friendships and behavioural patterns.

 

 

We are scared of things we do not understand or know.  Be careful of what you read – especially in the popular media and online (read: “Google”) – and believe. These sources can strengthen misperceptions and stigmatising beliefs about patients suffering from ADHD. Always discuss your concerns with a trained healthcare professional. The media is also our potential biggest allies (with a big responsibility) to create public awareness and education – and we are very grateful for the support we are experiencing. Knowledge is power – it can dispel myths, help you to have an informed opinion and to take informed decisions, with regard to ADHD.  Knowledge give wings – it helps your child to fly!

Finding the blue bird of happiness

Early during 2016 I read the book “The happiness project” (Rubin, 2009) in which the author went in active pursuit of happiness. In this book she chronicles her adventures over the course of a year in which she “tested” the wisdom of ages, current scientific research, and lessons from popular culture about being happier.

 

According to current research, in the determination of a person’s level of happiness, genetics account for about 50%; life circumstances (e.g. age, gender, ethnicity, marital status, income, health, occupation and religion) account for 10% to 20%; and the remainder is a product of how a person thinks and acts.

 

Should “being happier” be a New Year’s resolution? Perhaps not. We all know that New Year’s resolutions seldom stick. Research showed that only 8% of people who make resolutions succeed in keeping them, with 75% of resolutions being kept during the first week of the year, but with only 46% making it past the first half of the year.

 

Seven reasons why New Years’ resolutions do not last:

  • They are often based on what you think you should do (such as other people’s expectations or opinions expressed in magazines) and not what you really want to do.
  • They lack meaning and personal relevance you. You might start out all eager, but your interest will quickly dwindle. If you do not have confidence in your resolution, you will struggle to keep the motivation and commitment going, and will not be prepared to do the hard work to keep them.
  • They are often focused on changing behaviour and objects outside of ourselves, instead of focussing on inner change and lasting transformation.
  • They are unrealistic. It is far better to succeed at a smaller, more manageable resolution (e.g. to exercise 30 minutes a day) than to fail at a larger, loftier one (e.g. to lose 30kg in 6 months).
  • The timing is wrong. Returning from holiday and being confronted with the realities of “real life”, our resolutions may suddenly appear irrelevant or mundane. Why decide on something on the first day of the year, when 364 other equally important fertile days for decision-making lay ahead?
  • You make too many resolutions. This will cause you to feel unsure as to where to start, will lead to procrastination, inaction, or even to quit.
  • You embark on your journey without support. Verbalising your resolutions to others creates accountability which enhances your chance for success.
  • You have no action plan. People set themselves up for failure because they commit to a resolution, fully knowing they have no plan in the first place to actually achieve it.

So instead of merely setting resolutions, such as “to be happier”, first reflect on the past year. Some of us are naturally inclined toward introspection and reflection, especially during this time of year. We need to step back, press “pause” and consider where you have been, where you are, and where you want to go. Our years may be filled with losses and challenges, but we are often also more blessed, with many more reasons to be grateful and to celebrate. In the Japanese Naikan method of reflection, you ask three simple questions to yourself about your relationships, your travels, objects, the environment, difficult situations, and accomplishment: What have I received from…?, What have I given…?, And what troubles and difficulties have I caused…? This reflection will increase your awareness, which can then help you to take responsibility, and then, the most important, to set realistic resolutions with an actionable plan to achieve them. So now you are able to identify what brings you joy, satisfaction, and engagement, and also what brings about negative emotions such as guilt, anger, boredom and remorse.

 

Now is the time to make your resolutions towards “happiness” – i.e. concrete actions that boost your happiness. You cannot expect to experience joy, if you do not do something that has the potential to give you joy! Your resolutions should be based on what you have learned from your reflections. Be careful to avoid the eight resolution-busters mentioned above!

 

Six resolutions to boost your happiness:

  • Boost your vitality and physical well-being through regular exercise, a healthy diet, a good sleeping routine, and acting more energetically (even though you are feeling drained).
  • Invest in your relationships. Quit nagging, give proof of love, do not expect praise or appreciation, and always avoid Gottman’s “Four Horsemen of the Apocalypse” (i.e. stonewalling, defensiveness, criticism, and contempt). Do not neglect your friends (research has proven that each deep meaningful relationship you have with someone of the same gender, increases your happiness by 9% – plateauing to 40% with four friends). Remember small acts of kindness!
  • Advance your career and professional life. Challenge yourself, continue to learn, ask for help, do not fear failure and work smarter.
  • Don’t take yourself too seriously and be serious about play. Lighten up, and have fun. Laugh, sing, and dance! Create, treasure and celebrate happy memories. Pursue your passion!
  • Buy some happiness: a modest “splurge” on something useful, joyful, or beautiful to treat yourself, or someone else, can create some happy moments.
  • Be mindful, grateful and nurture acontented heart. Gratitude is important in the pursuit of happiness and has many benefits such as leading to  improved relationships, better physical health, increased happiness and amplified coping skills. People who experience gratitude, it seems, experience more positive emotion and are better equipped to deal with negative situations. Gratitude brings freedom from envy, because when you’re grateful for what you have, you’re not consumed with wanting something different or something more.

The feeling of control and autonomy, i.e. being able to choose what happens in your life, or how you spend your time, is crucial for happiness. Identifying and following through on resolutions make you feel far more in control. However, the real challenging part about resolutions is keeping them. It takes a huge amount of mental discipline, self-control and time! People are more likely to make progress on goals that are broken into concrete, measurable actions, with some kind of structured accountability and positive reinforcement.

 

Six tips for sustainable resolutions:

  • Instead of making a resolution for the entire year or proclaiming a major life change from here to eternity, name a change you will make for a specific period of time. Keep it short, specific, and realistic. Write down you specific, simple and actionable plan!
  • Get support. For certain resolutions a buddy system works well (e.g. a gym partner). Verbalising your intent to a friend or family member and asking them to check in with you regularly increases the chances of you sticking to your resolution. Life change is easier and happens best in groups.
  • Sometimes you realise your resolution is a bigger time or emotional commitment than you’d originally intended. Instead of trying to accomplish it all in one day, break it up into small steps. Take a small step EVERY day. A series of small steps constitutes a journey.
  • Never say never. Giving up the things we love and enjoy is punishment. Why give up entirely the things we enjoy and bring us pleasure if it’s not harmful to others or ourselves? When we make resolutions containing the words “never” or “forever,” we are more likely to fall short of our goals and expectations. This leaves no room for balance and flexibility, and will make us discouraged.
  • Belief alone doesn’t make things happen, but dreams become reality in our lives when we believe in a possibility and work toward it. When we keep our intentions as our focus and take action from a place of gratitude, we open ourselves up to the people and opportunities to bring us to the change and intentions we desire.
  • Don’t let the perfect be the enemy of the good. A small slip is not a failure. Breaking a resolution does not mean you need to abandon it. Rather acknowledge the effort you have been putting in, be kind to yourself, and get back on track!

Working towards happiness is not a selfish goal. One of the best ways to make yourself happy is to make other people happy.  And the only way you can  make other people happy is to be happy yourself. Be mindful and grateful. You will not be happy unless you think you are happy – and by pushing yourself to be mindful of your happiness, you can truly experience it. You will find the bluebirds nesting on your doorstep.

 

Wishing you much success for a happy, healthy, and prosperous New Year!

 

Fat pharms: does your medication make you fat?

Not a day in my practice goes by without a patient complaining about their weight gain. So often the antidepressants are blamed. The simple answer is that weight is a straightforward mathematical calculation: you can only gain weight if you consume more kilojoules than what you burn, and vice versa. But is it really so simple?

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