Jud, The problem with the education thing is that nobody will fund those programs these days with the bad economy at this time which leaves us as individules which have the disorders or providing care for those with the the same do the research our selves which it sucks. The awsome people on here sharing there info are those who that have ADHD and do there own research and for myself i do research for my son who is ADHD and i also share my info.. just a thought... thanks yall
As per your request in the WAIS-IV discussion thread, I will drop a note in here regarding practice and ADHD recovery.
As you so often, and very succinctly put it, neurons that fire together, wire together. This is completely true regarding skills performance, not only in ADHD individuals, but in everyone. Practice makes perfect, and skills unused absolutely atrophy, just like muscles. As a result of this fact, anyone that wants to see improvement in anything from general cognition to specific skills has to practice.
Practice can take various forms. These new 'brain training' programs that you see out there these days have their basis in real science. While they seem on their face to be pointless games and puzzles, practice of them, over time, has been shown to lead to real improvements in general cognition, working memory, general memory and problem solving skills. These programs will prove helpful if general progress is what you're looking for.
Should you be looking for progress in specific areas, and in specific skills, however, the only thing that's going to lead to improvement is practice of those actual skills. Reading, writing, arithmetic, spelling, vocabulary or any other practical skills will only improve through specific practice.
It's often spelled out here that the point of medication is to give us the focus to learn and practice the skills that we failed to learn as children. Some of us will, sadly, be medicated for life. Other's of us, however, can eventually stop taking meds, if we work hard enough at learning the skills that we're deficient in. So practice, practice, practice, and when you're done, practice. It may well be that meds will not be required lifelong.
Bob, I hope that's along the lines of what you were looking for. If it doesn't work out for you, let me know and I'll edit what's here, or clarify in a subsequent post.
The Following User Says Thank You to Thunor For This Useful Post: addprogrammer (02-08-2011)
I definitely agree with the "brain training" thing. And medication can help overcome both cognitive difficulties and fear-based difficulties, the things you have a mental block about because you've messed them up so many times before.
When I went on meds at 19, I had serious difficulties putting a paragraph together in writing. My grammar skills were fine, I could type, I just couldn't figure out what to say. This was the biggest reason I failed out of college the first time, I couldn't write history papers. Or lab reports. Or term papers for my music history class, etc. The only time I could write was under the most intensive deadline pressure, when fear and stress brought my neurotransmitters up to where they should have been and it all came together.
Depending on adrenaline to accomplish normal tasks is NOT a recipe for an orderly lifestyle. Sometimes I'd wait too long. Sometimes something would get in the way, or the adrenaline surge just wouldn't come, no matter how hard I tried.
They talk about long-time addicts having to learn skills all over again while sober. I was a lifelong adrenaline addict, learning to write sober.
And I did. I wrote a number of papers while entirely calm, on Dexedrine. And it taught me how to do it, and it helped me dismantle the mental blocks I'd built up around the task. And now, well, see post count. Got no issues with writing.
So writing was a skill I learned on the meds and can now do without them. Paying attention in a lecture-type setting? Still can't do it unless I take Adderall. But at this point in my life, I kinda don't care.
The Following User Says Thank You to janewhite1 For This Useful Post: addprogrammer (02-08-2011)
Practice makes perfect, and skills unused absolutely atrophy, just like muscles. As a result of this fact, anyone that wants to see improvement in anything from general cognition to specific skills has to practice.
Bob, I hope that's along the lines of what you were looking for.
Thu,
The progress you have made is "through the roof." I'm amazed. I'm in awe of you.
Yes, it is exactly along the lines I am looking for.
Scope creep has taken my study of the "neural correlates" well past ADHD.ed.v.1.000 specs for its intended purpose. I tried my dangest to avoid scope creep knowing how it can derail any project into a perpetual state of incompletion.
The creep snuck in while I was searching for neurological evidence pro or con for ADHD's genetic connection. I had to search so deep I ended up jamming my head with volumes of neuro correlates I never intended to research.
Let me do a quick and dirty summary so I can call the "Neural Correletes" section complete.
My composite summary of two research reports that follow define a "working model" that explains the many symptom variations that we observe among us.
The ADHD phenotype results from the interaction of the person's genetic makeup and his or her environment. Several lines of evidence suggests that the ADHD genome is produced by the interaction of several genes each of a minor effect.
Phenotype can be expressed as ...
genotype + environment → phenotype
Phenotype can be described as the resultant observable characteristic or trait.
The bottom line:
Can the results from laboratory tests capable of detecting variant genes be used to correctly choose the appropriate medication for ADHD patients ON THE FIRST TRY?
The answer, my friend, is the subject of an in-progress study being conducted by the University of British Columbia.
Based on what I got jammed in my head, I'm optimistic that this study will yield positive findings. Certainly many more studies will be needed. I'm optimistic that the combined research along these lines will produce a set of diagnostic laboratory tests similar to those used by doctors that treat organic illness. The shrink will have his nurse take a blood sample, send it to the lab, the lab reports back "deletion variant found in SNAP25 gene and mutations found in the dopamine genes DRD1, 2, 4, 5."
Shrink reads the lab report and prescribes an amphetamine based medication. He knows this patient will not respond well to MPH based meds.
25% of all ADHD patients do NOT respond to any type of stimulant med. The lab reports "multiple abc gene variants, mutated norepi system genes."
The shrink prescribes "a non-stimulant med" that turns the trick on first try.
I call that progress. And it effectively summarizes all the stuff that got jammed in my head that resulted in near project death scoop creep.
It is done.
Now, I want to build on your "atrophied skills" remediation base. "Atrophied Skills" is the PERFECT description of what ADHD causes. Perfect, I said.
I definitely agree with the "brain training" thing. And medication can help overcome both cognitive difficulties and fear-based difficulties, the things you have a mental block about because you've messed them up so many times before.
So writing was a skill I learned on the meds and can now do without them. Paying attention in a lecture-type setting? Still can't do it unless I take Adderall. But at this point in my life, I kinda don't care.
You are adding bark up the tree where I think I see the "ADHD fix coon."
ADHD medications should be primarily used to learn the skills atrophied by ADHD caused disuse. Secondarily the medications can be and should be used to function during the interim.
I love your LADD fix. (Lexture Attention Deficit Disorder). To hell with it. Perfect. Why fix any skillset we do not need? I think determining which to fix important to the overall success of our remediation. I've always hated "lextures."
Not to bust your bubble, but right now genetic testing is an awful lot more expensive than just going through a few medication trials.
Of course, the expansion in basic science of ADHD is very exciting.
(They do sometimes do genetic testing prior to chemo, where picking the wrong med or wrong dose can cause death.)
Jane,
You did not burst my bubble, you set off a 50 megaton H-bomb at bubble dead center.
Money is the problem.
Let's look at the best ADHD diagnostic tools available.
1. Patient History. Why the hell doesn't every psych/shrink work up a thorough history on each patient? It takes too long. Managed health care dictates how much the doctor is going to get paid. The ins. provider dictates doctor fees. "You are going to get a buck and half and not one cent more to dx ADHD." Working up a history can take hours. I am a big fan of ROI - Return On Investment. A shrink has a minimum of 1 million dollars invested.
Frankly, I'd like to see a minimum of $500/hr return if I made an investment of that magnitude.
The shrink can't afford to delegate the history to a physician's assistant for the little he's going to paid from the managed health "insurance" provider. So our doctor takes the 5 minutes he is paid on, asks a couple good questions, makes a few good observations, then makes the diagnoses.
2. Two diagnostic tools that can be useful for complex cases.
a) qEGG (quantitative electro-encephalograph). The test can detect ADHD's abnormally high beta/theta brain wave power ratio. qEGG are 90% accurate. They suck as primary ADHD diagnostic tools. qEGG are very helpful in finding "a better explanation" for ADHD look-alike symptoms. The qEGG can help the doctor NOT to prescribe an ADHD therapy doomed to fail from the get-go to a therapy likely to help the patient.
b) SPECT scans - absolutely rule in detecting comorbidities. SPECT's are brutally accurate in detecting brain injuries and substance abuse. Hmn, the boy ain't ADHD, the coke he has been snorting is causing ADHD like symptoms. Best therapy, this case, is to "stop snorting coke."
There is NO WAY in hell managed health care is going to pay for a) or b).
History + qEGG + SPECT are not enough for the physician to choose the correct med on the first try.
None of this is relevant to those of us fortunate enough to be prescribed the best med on the first try.
The medication trial and error process for those not so fortunate can be worse than the damn disorder. I see a lot of us including myself that fall into the not-so-fortunate group.
Well, now, Janey, who blew me up with reality. There is NO WAY in hell managed hell care is going to pay for my genetic testing that could make ADHD medication management so much more patient friendly.
I fell like I wasted a lot of time on nothing. The whole freaking problem is money. Neuroscience advancements will only add to the costs that insurance providers will refuse to pay.
Bob
Edit: My typo, "managed hell care" == more accurate description of what we get for our money.
Last edited by addprogrammer; 02-10-2011 at 10:10 AM.
Reason: emphasis on typo
True, Bob, managed care isn't going to pay for genetic testing, today. The hope is that if we can establish rules that are relatively hard and fast regarding genetic variance and ADHD, it may be possible that such testing may be available to our children, or perhaps to their children. After all, I'm running programs on my $250 phone today that I couldn't have imagined running on my $2500 desktop computer 20 years ago, and 20 years before that, those same programs would have required million dollar NASA computers.
It's unfortunate that we have to find our medication via trial and error, and that we have to be the guinea pigs in the search for a better way, but the thought that my kids, or my nieces, or the kid next door might not have to endure this frustrating process makes me feel better about the whole thing.
The Following User Says Thank You to Thunor For This Useful Post: addprogrammer (02-09-2011)
(addressed to last 2 posts, my mouse is too cranky to quote partial replies properly.)
I think you're both right. Bob, you're approaching a fundamental problem with entire health care systems: New technology makes health care more expensive. A couple generations ago, advanced cancer meant a few months of morphine and nursing care. Now we can (sometimes) fix it, for a cost high in the six figure range.
Back in the day, people with ADHD or other moderately severe mental health issues would either learn to get by on their own, or live a life of personal and financial instability, contributing far less to society, but not costing the health care system. Now we use up psychiatric, pharmaceutical and educational resources, but society gets more productive adults. It's a trade off.
But, Thunor has a good point, sometimes the costs of a particular technology do come down to the point that it can be more widely used. Genetic testing used to be a lot more expensive than it is--and once you know the exact marker you're looking for, and large numbers of people are being tested for it, the price comes down further.
The Following User Says Thank You to janewhite1 For This Useful Post: addprogrammer (02-10-2011)
I'm brand new to this board and like what you have to say, and your extensive knowledge and research. I am seeking out support for my 10 year old son. I've never heard of guafanice? Does it go under a 'generic' name? My son is fairly mild but has developed tics/ocd type behavior. We began medication last year (lowest dose of concerta). The rebound is awful, he lost weight, and he's not a big kid to begin with. We've had him off meds sine beginning of June but definitely impulse issues, negativity, can't stay on track, etc... the usual suspects. I would welcome and appreciate your opinion. Best, hwc.
Wow! Thank you. I have a prescription for that for my son. We went to a pharmapsychiatrist who gave him adderall first (I read about it and refused to give it to him), then she gave intuniv (but I read negative stuff so never tried it) and went with Concerta. I like the sound of intuniv, based on the neurotransmitter uptakes vs. being like a zombie. Do you think I should try it for him? I just found this board and have already gotten more from 'it' than the doctors. Thank you very much. Best,
Got no issues with writing.
