Search for tag: "adhd"

It seems there has been a big increase in the number of children being diagnosed with sensory disorders. One reason may be that kids with sensory issues actually have other diagnoses, such as ADHD, anxiety, PTSD from abuse, and autism, just to name a few examples. Other times, some kids may just be sensitive to some things but not others and don't actually meet the full criteria. It has only recently been added to the psychiatry diagnosis textbook, the DSM-5.

Sensory processing disorders are basically where kids are sensitive to sounds, textures, or other stimuli to the point where it is beyond normal childhood behavior and causing a disruption in the child's life and also in the life of the family. Any of the five senses, taste, touch, smell, sight, and sound can be affected. Often children with sensory issues also have poor fine motor skills or have a hard time with social cues and interactions. They have a hard time regulating their emotions.

One study shows that sensory processing disorders affect 5% to 15% of school-aged children. Another study showed that there may be a biological cause with abnormalities in the white matter of a child's brain that could explain sensory issues.

Some children are hypersensitive to things and may think everything is too loud or too bright. They are the ones who are covering their ears often or have a low pain threshold or are super picky with eating certain textures. They have a hard time focusing and controlling their emotions, and they don't like to be touched. Other children are hyposensitive and they crave input, trying to get more sensory input. They're more likely to have a high pain threshold, put things in their mouths, hug too tightly, invade other people's personal space, or rock and sway.

One big issue is that there is still so much to be learned about sensory processing disorders. Your pediatrician can suspect your child has a sensory processing disorder but cannot actually make the diagnosis. Again, there are so many other brain issues that can present with similar symptoms so it takes a developmental or a behavioral specialist or even a neuropsychologist to get an official diagnosis. Your pediatrician will refer your child to someone who can help do a full and complete evaluation to get the correct diagnosis. The mainstay of treatment for sensory processing disorders is occupational therapy. Occupational therapists can help kids and parents learn ways to manage their sensory needs.

If you have concerns that your child may have a sensory issue, please talk to your child's pediatrician and ask them for a referral to a specialist who can get them the right diagnosis and treatment.

Interviewer: What should you do if you suspect your child is doing drugs? It's a scary moment for any parent. I mean, how do you know for sure? What's the best strategy for talking to them about it? How much can you do on your own and when should you see a professional?

I'm going to answer those questions with our expert today, Dr. Mary Steinmann. She's a psychiatrist who specializes in child and adolescent psychiatry.

Dr. Steinmann, let's start at the beginning here. We're going to cover a lot of ground today. But what is the first thing a parent should consider if they have a reason to believe that their child may be using some sort of a substance?

Dr. Steinmann: So I think there's definitely a difference between experimenting with substances and actually developing a substance use disorder. And so it can actually be fairly normative or expected behavior in children and adolescents to be curious about or experiment with substances. But we also know that using substances can really place individuals at risk of developing later substance use disorders. So it's something that we want to take very seriously and be able to help parents identify signs in their own children that may warrant additional questioning or additional evaluation or perhaps even getting additional help and support and resources.

Interviewer: Yeah. So if experimentation can be normal . . . I would imagine as a parent, as soon as I saw my kids or had the idea my kids were using drugs at all, I would be like, "Oh, they've got a problem." But you're saying that that's not always the case?

Dr. Steinmann: That's right. It's definitely concerning behavior. It's not something that parents need to be complacent with. I think it's important to actually dissuade substance use and to talk to kids about the dangers of substance use and the potential consequences of substance use, because there are a lot of them.

Kids don't tend to think about long-term risks very much. Their brains aren't hardwired to think about long-term consequences until, honestly, sometimes their 20s. And so that's where I think it's helpful for parents to kind of take a role of, "These are the rules in our house. This is what our views are. These are what our values are. Here's what's acceptable and unacceptable behavior for our house. But I am also here and open to answer questions or listen to what you have to say. Or if you find yourself in trouble, intentionally or unintentionally, I am here for you."

Interviewer: So I'm a little confused. If you suspect that your child is using a substance and maybe . . . I don't know. Do parents generally have a good idea if it's early on? When you said, "Don't be complacent," do you just kind of sit back until you start seeing a problem develop, or do you jump right in as soon as there's some sort of substance use and say, "I understand this is just a natural thing. If you ever want to talk about it, we should"? I mean, I don't quite understand that differentiation.

Dr. Steinmann: I think a lot of the differentiation depends on families, right? So there are some families where even alcohol use or smoking is not a practice in the home, and so there might be a different baseline for a family addressing substance use and experimentation and how they approach that topic in their children, versus maybe a family where there is recreational alcohol use, or occasional nicotine use, or what have you. And so there are some baseline cultural differences that I think go into play.

We certainly want to educate our kids up front about what the dangers are, and say, even if you're comfortable as a parent, "This is kind of my own experience with using substances," talking about responsible use, if that is a value in your home. And in other homes, that might not be acceptable at all.

But kind of laying down, "This is what our family values here, our baseline. I understand you may be tempted to experiment with things. Here are my concerns about that."

And then also knowing your child and knowing their baseline and being able to identify if they're starting to behave differently, if they're starting to hang out with a different peer group, knowing what their peer group is and who their friends are. Having those consistent expectations is really important, but then also providing that guidance, that education, "This is what we value in our family."

That may be no substance use whatsoever. That may be, "This is the concern I have about you using substances right now as an adolescent." And that's the stance I tend to take as a child and adolescent psychiatrist. It's, "I'm concerned about the effect that any substance has on your developing brain. I understand you might be tempted to use. I discourage that, but I am also here if you have questions," and not to shut down that conversation prematurely.

If curiosity develops, if they're like, "Well, I see you drink all the time. Why can't I?" being prepared to kind of have those discussions so that then that increases your chances of having your child actually be honest with you if and when they start down that path, and being available to support and guide and eventually seek help, if needed.

Interviewer: So it sounds like if you suspect your child is using substances, and maybe they're just at the point where they're just kind of experimenting, that's a great invitation to have a conversation at that point?

Dr. Steinmann: Exactly. And even before use. I think sometimes we overestimate the age at which kids may actually be exposed to substances in schools, but we may be having these conversations too late sometimes and setting those expectations too late sometimes.

And so being aware that a lot of times, by middle school, kids are already exposed to peer groups or other folks who use, and maybe thinking about this for themselves. We may be wanting to even have those conversations earlier, depending on the environments in which our kids socialize.

Interviewer: And it sounds like a parent's kind of mindset is super important for this first conversation from the standpoint that I think . . . Well, first of all, what are some of the reactions that you see parents have when they find out their kids are using drugs? I can imagine there could be some anger that is probably born out of fear, because drugs can be detrimental to somebody's life. There's probably the thought that only bad kids do drugs. Are there some other reactions you see? Or what do you see?

Dr. Steinmann: Fear is a big one. And I love what you just said as far as anger often being born out of fear. Anger is a very reactive emotion. We all get angry over a lot of things. But if we dig deep, a lot of times it does come from that fear, either because we're terrified of . . . We just want the best for our child. We want them to grow up to be the best version of themselves that they can be, and there are serious consequences to problematic and ongoing substance use. There can be dangers to even intermittent substance use. And so fear is a very, very common and normal response to parents.

Also, that anger component of fear or fear that gets manifested as anger tends to be the emotion that then puts our kids on the defensive and shuts them down.

And so even though it's a completely valid emotion and an understandable one as a knee-jerk response on the parents' end, it may be the one that we want to kind of work on our own response to continue to invite that conversation instead of making the child feel that they're a bad kid because they thought of going to a party with their friends or even tried to ask a question or to get clarification for themselves or to seek help. Very often it's that fear of anger and punishment that keeps kids from seeking help.

Other common responses I get are often, "Only bad kids do that." And I think probably what parents often mean by that is the behavior is certainly concerning and undesirable, but that doesn't mean our child is a bad kid. There's a difference between the behavior and who someone is as a person, and sometimes kids can overly internalize that.

And so, if a parent's response is, "Well, only bad kids do that," or, "My kid possibly can't do that," that's a form of denial that probably needs to be addressed, especially if you're starting to see telltale signs of substance use or behavior changes. And we can talk about that in a little bit.

Or it can be, "Well, why are you judging my friends? They're not bad people. I know who they are. You don't," which can also raise defensiveness and unwillingness on the part of the child to engage more in that conversation.

Interviewer: Let's say a parent has suspected that their child is using a substance. They've had the conversation, they followed your advice, but then they start noticing, like you mentioned, some personality changes or they start becoming more concerned that it is escalating to a different level. Is that the point that you would get your child help, or is there another intervention that a parent would do first?

Dr. Steinmann: I think there are a couple different routes to go. So we have that conversation. Maybe we were lucky enough to have that conversation upfront before use even started, and the conversation had exactly the effect that we intended to have, which is to deter use. That's kind of the best possible scenario. "Hey, let's talk about the dangers of this." The kid acknowledges, "Yep, that's not a behavior that is good for me," and we move on.

Maybe experimentation happened, and then I think it's important to have the conversation potentially of, "What was that like for you?"

Understand what drives a behavior. We don't tend, as human beings, to engage in behaviors that don't work for us, especially in the short term in teenagers.

And so some may admit, "Hey, I've been really stressed out and I tried alcohol," for example, "and it helped me to feel better." Wow. As a parent, I would want to know, "Well, what's been stressing you out? Is there something else that's healthier that we can kind of engage in? Because, once again, I have my concerns about kind of going this route to address stress and manage stress. Are there different things that we can work together on to help you out with?" and seeing if we can get to the underlying driver of that behavior.

If the behavior continues despite, "Hey, we have a house rule we don't smoke, we don't engage in underage drinking, we don't engage in any forms of substance use" . . . which again is my stance, really, as a physician, because I'm concerned about that brain development . . . and the use continues, then we might need to consider additional types of interventions and understanding what's underlying that continued substance use.

I'm also going to be keeping a close eye on function. Function is really, in psychiatry and in medicine and mental health, what we look for to really start to make that distinction of, "What's the difference between substance use and a substance use disorder?"

And when we say the word "disorder," what we really mean is there is some impairment in academic functioning, in relationships, and that could be friends, family, etc. Are we engaging in additional risk-taking behaviors? Are we putting ourselves in safety risk by result of use? Are there legal consequences? Are we carrying vape to school, for example? All of those things would be red flags for more serious problematic use and possible disorder that might warrant additional treatment.

Interviewer: When a child is using a substance, is there generally some other underlying cause? Is it really truly just kind of a symptom of something else going on? I mean, either experimentation out of curiosity or an underlying condition, or are there other reasons?

Dr. Steinmann: It can be all of the above, honestly. What can start as experimentation can then kind of just spiral out into use for other reasons.

Some people may never engage in use but may find themselves starting with symptoms of anxiety or depression and then are just trying to find a way out of feeling that way. And they may have tried other things or talking to friends or things like that, or hear that, "Well, taking this has helped for me. Maybe it would help you too." And so it can sometimes be a chicken-and-the-egg type of scenario, honestly.

Interviewer: All right. Sounds like we have two steps so far. A parent suspects their child is using a substance, they have a conversation because it's just experimentation. Then that behavior continues, they have another conversation again asking this time, "Is there something else going on?" or, "Why are you using it?" or, "How does it make you feel?" reiterating the rules or the policies in the household. What would be the third step if it continues on past that point?

Dr. Steinmann: I would say then it's probably time to get some external support and some help. And honestly, it's never too early to get external help and support. Again, if this is just a conversation that, for any reason, a parent might struggle to have with their child or not know how to approach it, it is perfectly fine to seek out professional help to help learn how to have that conversation.

And there are a lot of other internet resources that are available if you don't have the ability to talk to somebody.

But I would seriously then consider looking at other resources, including a therapist or a primary care physician.

Not all cases of substance use disorder have to go directly to a psychiatrist, just like not all cases of depression and anxiety need to go to a psychiatrist. Sometimes talking with external supports, such as your child's pediatrician or primary care provider, someone that has an established relationship with them and knows them, can be a good middle-ground next step to get additional support before jumping into subspecialty options, although those are definitely certainly available.

Interviewer: Is there a negative message given to a child when you say . . . because there's a certain weight to saying, "All right. We've got to go to the psychiatrist now." You know what I'm saying? For this problem. That comes with a whole bunch of other stigmas.

Dr. Steinmann: It can. And unfortunately, getting mental health care and having mental illness needs is still really stigmatized in our society. I think that's why I generally recommend starting out with primary care if someone is having questions.

Now, granted, there are times where you would want to bypass primary care. For example, if your child has been absolutely refusing to go to school or you're noticing that they're skipping school a lot or they're getting suspended or even expelled for issues related to substance use, or you're concerned that there's an imminent safety risk, such as heavy use or heavy binge use or physical consequences from that, or you suspect a really severe underlying driver for substance use, including depression or anxiety, perhaps even things like suicidal thoughts, or if you suspect another serious mental illness, those would be things that would be quite appropriate to go up to a higher, more specialized level of care.

It can take a while to access the mental health system as well, and you don't want to get stuck in the lurch while your child is really struggling, especially if their imminent safety is on the line.

Interviewer: When you talk about substances, drug use, what does that entail for you as a physician and a psychiatrist?

Dr. Steinmann: That's a great question. I think a lot of times, when we talk about substance use, our minds automatically go to the hard stuff like heroin or cocaine or methamphetamine. We also think about alcohol and nicotine and marijuana, which are a little more readily available.

But there are also, especially with teenagers . . . Think about access and what you're more likely to be able to get a hold of or afford. Or what are the underlying concerns that might be problematic in teenagers, such as anxiety or depression?

This is another great example of a misperception, actually. Sometimes we think, "Well, my child is very high functioning and they do great in school. They can't possibly have issues with substance use." But I work with a lot of teenagers and young adults who may have some mild ADHD or anxiety who are very high performers and may feel compelled to be even higher performing. And so they may actually get wrapped up in overuse or misuse of cognitive enhancers, like caffeine or prescription stimulant medication.

And so having an idea of kind of the breadth of things that can be misused or abused is important.

It's scary and it can be overwhelming to think about, but it's important to, again, think about those underlying drivers of behavior and the type of direction that might lead even into substances we might not typically think about as being abusable.

Interviewer: And some of these ways of talking to the children about substance abuse might be kind of against a particular parent's parenting philosophy. We are all raised in our own ways by our own parents, and a lot of times, that's the way we raise our children. Is this evidence-backed stuff? Should somebody just go ahead and use their instincts instead going into this conversation? What are your thoughts on that?

Dr. Steinmann: I think that parents are the experts on their children, and so using your instinct can be a very powerful tool.

If you are noticing that your child is not acting like themselves, I do think it's important to ask more questions and probe. And again, by asking, you're kind of almost opening the door to, "I'm interested, I'm curious about you. I care about you."

Sometimes the hardest thing we can do, as parents, is to open the door to conversations that we might not be comfortable having, but by doing that, we're actually modeling for our kids that it's okay to talk about these things, that maybe their assumption that we're going to blow our stack or over-assume might be unfounded, that we want to be and try to be safe people to talk to because we have their well-being at hand.

I liken it in some ways to talking about suicide, for example, and suicide prevention. There's significant data that shows that simply asking about suicide does not increase the risk of suicidal behavior. And I think the same is very true for substance use.

Just because you're asking doesn't mean that you are giving permission or suggesting that they should engage in that behavior. All asking does is signaling your child that, "Hey, I'm aware that this is a problem and I want to be a person that you can rely on and trust to talk to about it."

Interviewer: For a parent listening to this interview that wants to go on to get some more information, what are some good reliable sources that they could go to online to get some help framing this or figuring out the approach or whether or not they should be concerned at this point? What do you recommend?

Dr. Steinmann: For reputable sources on the internet . . . because you're right, there are a lot out there and it can be really overwhelming to kind of weed through and find the best sort of reputable information. I really like the Substance Use Resource Center through the American Academy of Child and Adolescent Psychiatry. The Substance Abuse and Mental Health Administration, or SAMHSA, also has a lot of good resources.

And something that I found fairly recently as a resource, that I thought was very parent-friendly type of language, is through the Child Mind Institute. And they have various questions about how to talk to your teen about substance use for parents who may not be sure on how to start that conversation.

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Scot: This is "Who Cares About Men's Health," giving you inspiration, information, and a different interpretation to better understand and engage in your health so you can have the life you want today and into the future.

My name is Scot. I'm the manager of thescoperadio.com. And I care about men's health.

Troy: And I'm Dr. Troy Madsen. I'm an emergency physician at the University of Utah, and I care about men's health.

Dr. Weir: I'm Dr. Rachel Weir. I'm a psychiatrist at the University of Utah, and I care about men's health as well.

Scot: So we're going to talk today about adult ADD or ADHD. One of the things I do want to clarify right away is . . . I mean, are those the same? Are they different? I've always used them interchangeably.

Dr. Weir: A lot of people say ADD, attention deficit disorder, versus ADHD, attention deficit and hyperactivity disorder, because they don't feel like they have hyperactivity, especially for adults. Kids, you see the hyperactivity symptoms much more frequently than you do in adults.

But if you wanted to be strict in terms of the definition, it all is ADHD. So you would say ADHD predominantly inattentive type or ADHD predominantly hyperactive type or a combination of the two.

Troy: See, Scot, I didn't actually know that, so I'm glad we clarified that. But you're right. I had heard years ago ADD, and then now I always just use the term ADHD, but I did not understand the reasoning for that.

But it sounds like, Dr. Weir, you're saying if we're . . . basically, we don't use the term ADD anymore. It's ADHD, and then there are different subtypes within that.

Dr: Weir: Yeah, exactly.

Scot: So I'm going to make an admission here that's not going to make me look like a great person nowadays. And I think a lot of people out there do this as well. Joke at one time or another when they're having trouble focusing on something, or they get easily distracted, "Oh, man, I really got some ADD today." But just because I can't focus at any particular given time doesn't mean that I have ADHD, right?

Dr. Weir: No, absolutely not. And most of the time, it's not going to be ADHD in adults, especially adults who . . . if you're presenting with new symptoms in your 30s, 40s, 50s, that's not going to be ADHD. ADHD is a diagnosis originally of childhood. It can span the whole lifespan. It doesn't for everybody. But you do have to have symptoms present before the age of 12.

Troy: Scot, we're talking about adult ADHD today. But, Dr. Weir, it sounds like you're saying that it's not something that an adult would develop. Like, this has been a pattern and maybe it just wasn't diagnosed until they were an adult.

Dr. Weir: So it is possible that . . . sometimes I see people for an assessment that tell me, "Oh, gosh, I always struggled in school. My teachers, their comments always said I was hyperactive or always out of my chair or blurting answers out. And my parents didn't really believe in mental health and never really got me treatment."

So if you hear a story like that, even though someone didn't have a diagnosis at a young age, they still can have the diagnosis, of course. It's just that it wasn't picked up on when they were younger.

But if you're in your 40s and 50s and you're having symptoms of inattention, distractibility for the first time, it's very likely something else.

Scot: How many adults do you encounter that have the symptoms but just weren't diagnosed when they were younger? Is that something you encounter often?

Dr. Weir: That that does happen frequently, yeah. It also happens probably just as frequently that it's something else that's causing the problems now.

Scot: Oh, okay. On your definition, you kind of focused in on that example you told of the child. The hyperactivity part was kind of the theme I got there. Is that generally the case? So am I incorrect in thinking it's just kind of lack of attention even in a child? It's more about the hyper?

Dr. Weir: It can be both in kids. It is much easier to identify in kids who are hyperactive in a school setting. For the kids that don't have hyperactivity, if they're just distracted, they're kind of daydreaming, gazing out the window, they're not picked up on nearly as frequently as someone who's causing a lot of commotion in a classroom setting.

Troy: As we're talking about this, like I said, sometimes I joke that if I didn't have ADHD when I started my job, I do now. But it sounds like you're saying I don't have ADHD. I was a focused student. I was not hyperactive as a kid in elementary school, junior high, high school. Not an issue.

But I'll tell you, I struggle with just paying attention. If I'm in a lecture, 15 minutes in, I zone out. You've got to do something to keep my attention. Is that abnormal, or if someone has this experience, is this something abnormal where they should seek attention? Or is that just kind of typical for most people?

Dr. Weir: The key to really making a diagnosis, other than some of the things that we'll go into and, like I said, the symptoms presenting in childhood, would be, "Is this impacting your life? Is this interfering with your functioning day to day, in multiple settings too, not just in a work environment, but at home? Is it somehow affecting your relationships? Have you had repeated school failure, maybe legal problems, car accidents, job losses?" Those types of things that really, obviously, can contribute to a lot of impairment and functioning for people versus just, "Sometimes I'm not quite as on task and as sharp as I could be."

Troy: And that's a great point, because I think we all look at ourselves, and like you said, sometimes you feel down, sometimes you're depressed, you're sad, but it doesn't meet that clinical definition, or distractibility or tough time focusing. But it's not really a clinical thing unless . . . We all experience that, but it's not necessarily an issue where you need to be on medication or have treatment unless it really does affect function and personal relationships, jobs, etc. So yeah, I think it's helpful for all of us to know that.

Dr. Weir: Yeah, absolutely. A lot of the screeners if you just Google . . . because everyone does Dr. Google now, right?

Troy: Yeah.

Dr. Weir: Like, "Do I have . . ."

Troy: Such a bad, bad doctor.

Scot: Everything is going to kill you according to Dr. Google.

Troy: That's why people come to the ER, Dr. Google.

Dr. Weir:But if you Google, "Do I have adult ADHD?" it's probably going to guide you towards a rating scale that's based on symptoms. So it's not going to be very sensitive in terms of actually giving you a diagnosis and saying, "Do you have some functional impairment?" It's just looking at symptoms. So I've seen a lot of people bring those kinds of screeners to me saying, "I'm pretty sure I have ADHD."

Scot: I understand you developed a protocol to help diagnose people that may have adult ADHD. Can you talk about that a little bit? What are some of the things that you do look for?

Dr. Weir: Yeah, that's part of my work. I supervise psychiatry residents who rotate through our university community clinic system in primary care clinics. The first year we did it, I was expecting to see a lot of depression, anxiety, possibly bipolar disorder. And we were really surprised at the number of requests we got for adult ADHD assessments.

So we really had to come up with a protocol that was thorough but reasonable to kind of help our primary care colleagues in how to really make this diagnosis.

So one thing I would say is if, as a patient, you're wondering about this, and you're going to a provider, and you're just saying, "Oh, I can't really focus, and I filled out this scale," and there's not really much of a discussion of, "Is this lifelong? Is there collateral information maybe from a school or a parent?" and screening for other mental health conditions or other medical conditions, and you're leaving that appointment with a diagnosis and a prescription, that probably wasn't an adequate assessment.

So we developed . . . it's still shorter than doing a full neuropsych testing and neuropsych battery. But it is a two-part evaluation. At that first appointment, what we can focus on is screening for possible comorbidity, other mental health problems, substance abuse problems, underlying medical problems that could be contributors, giving the patient some scales to take home and fill out and maybe have a spouse or a parent fill out.

And then coming back and kind of looking at all that information together in the second appointment, and going through if an ADHD diagnosis looks like it's likely.

Troy: So what's the downside then of . . . let's say someone takes a scale in, they see their doctor, and their doctor says, "Yeah, it looks like on this scale you have ADHD." What's the downside of going on treatment? Is that a detrimental thing for these patients? Does it help them function better?

Dr. Weir: That's a . . .

Scot: Well, there are two questions, if it was a misdiagnosis and if it's a proper diagnosis. Right?

Troy: Yeah. It sounds like what you've seen is maybe a lot of potentially overdiagnoses, where people are maybe just going in and saying, "Hey, I did this scale." Obviously, a lot of primary care physicians are very busy and sometimes the easiest thing is to say, "Here's a prescription."

Dr. Weir: Yes.

Troy: I guess, number one, are you seeing that quite often? And number two, what's the what's the downside of that?

Dr. Weir: I'll try to remember all the parts to that question.

Troy: I'll ask you first, does that happen often?

Dr. Weir: Yeah, it certainly does. And that's kind of why we wanted to come up with a good way to really screen people and make sure we were treating comorbidities.

There was one very good study done that was published in the last few years. And this had actually been a longitudinal study of kids with ADHD, and then they had kids without ADHD in the control group, and they followed them over time.

In fact, the length of time that they followed them was into . . . the average was about 14 years. So this was long-term follow-up.

Now, of the children that they followed who were in the control group, we knew at age 10 that they did not have ADHD because they had very good assessments at that time. When they did screeners as they became adolescents and adults, almost half of them had what would be considered a positive screen for possible ADHD.

Now, when they went back with that group and they did a really thorough assessment looking at all those things, impairment in functioning, multiple settings, not just self-report but parent report as well, psychiatric comorbidities, substance abuse, 95% of that group did not have a diagnosis of ADHD.

Troy: Oh, wow.

Dr. Weir: Yeah. So very, very high. It's not going to be that high in the real world, because like I said, they knew these kids didn't have ADHD, and obviously, we're treating people who most of them haven't had any kind of assessment, let alone a thorough assessment at age 10.

But usually, the symptoms they were experiencing were due to another condition. So trauma was one. Depression. That can affect concentration. Cognitive effects of marijuana use was one, and alcohol use as well.

So that is one thing. You want to make sure you're getting your diagnosis right.

Now, if you're not getting your diagnosis right . . . and let's say you do get an ADHD diagnosis, and you start a medication. Let's say it's a stimulant, because that's what most people get prescribed. So methylphenidate, or the common name would be Ritalin, or amphetamine salts, or Adderall would be the common name there. That can be very helpful for symptoms of concentration, but that's not diagnostic.

If all three of us took Adderall right now, it would help us focus better. That doesn't mean that we have ADHD, right?

So what would be the downside of doing something like that? Well, first of all, just improving your concentration alone doesn't inherently fix a lot of the problems that people with ADHD have around planning and being less impulsive, improving executive functioning. You still need some skill-based treatment for that.

And then if you're prescribed a stimulant, you might feel like, "Wow, this isn't really affecting me." But it could make anxiety worse. It could make you not sleep as well.

And then sometimes what we see is people get into these prescription cascades where they didn't really need that original prescription, and then they're prescribed something for sleep. Then they're feeling groggy the next morning from that, and then they want their stimulant dose increased.

You can see you can kind of get down these paths where you're treating more side effects than you are really treating a condition.

And then, of course, there can be some concerns about stimulant use, especially in men, especially as you get older. Blood pressure increases. Pulse increases.

Now, it's not that significant, but if you're talking about taking these medications for 10 or 20 years, then that can be a significant strain on your heart.

So those are just some things to think about.

Scot: That's interesting. But it sounds like that study . . . my takeaway from that study is if I go online and I do one of these self-assessments for ADHD, it's pretty much a coin flip as to whether I will be diagnosed based on that with ADHD versus not, and I probably don't have it even if I'm diagnosed by that.

Dr. Weir: Yes. There was actually a good "New York Times" article several years ago, where they had 1,100 adults take an online ADHD quiz, and almost 50% scored in that range that told them ADHD was possible or likely.

Troy: And of those, it sounds like the large majority, once they undergo a more rigorous assessment, don't have ADHD.

Dr. Weir: That would be correct, yeah.

Troy: Wow. Interesting.

Scot: So this is interesting. It's always interesting when we go into these conversations on "Who Cares About Men's Health," because when I came in, I . . . here's the way I thought it was going to go in my brain. We were going to talk about all these people that are adults and were misdiagnosed or undiagnosed for ADHD. Not misdiagnosed. Let me rephrase. That were undiagnosed. They are struggling in their life, they finally get the proper diagnosis, they get the proper treatment and medication, the . . . I can't remember what you referred to those as, impulse control, that sort of thing. Those exercises?

Dr. Weir: Oh, yeah. Mindfulness and skill-based therapy.

Scot: But what I'm hearing instead is it's a lot more likely that you're going to go in with some symptoms of something completely different, perhaps get a misdiagnosis, end up on some medication you don't really need to be on, and you're not really even solving the problem that you had in the first place. Which one is the bigger risk for an adult here?

Dr. Weir: Well, there's a reason that we've seen the number of stimulant prescriptions increase threefold in just a five-year time period. And at this point, adults make up the majority of those prescriptions. It's no longer that a majority of prescription stimulants are prescribed to children. Now, it's to adults.

Yeah, a lot of people wonder, "Well, if this helps my concentration and my focus, and I feel like I'm functioning better, what's the harm?" I think these medicines . . . I mean, we have to remember they are controlled substances. They are addictive, but they don't have the same . . . there hasn't been the same concern about them like you've seen with the opioid epidemic, with people overdosing and dying.

These medicines are very, very commonly misused, but most people are not getting addicted to them. So high misuse, high rate of diversion or sharing medication, especially when you get to college students, but low in terms of actual addiction.

Troy: You mentioned that increase in the last five years. Just in the last year with the pandemic, are you seeing kind of anecdotally significant increases in the number of stimulant prescriptions and diagnoses of ADHD?

Dr. Weir: I am not aware of that. I don't know. Certainly, the effects of the pandemic I think are going to be very long lasting. Typically, mental health sequelae of something like this, it develops a little bit more after the fact. But people are very concerned about that, especially with depression, anxiety, and post-traumatic stress disorder.

But I do think there are some things going on related to the pandemic that might make more people think that they have ADHD. So one is a lot of us started working from home. That can be much more distracting than being in your office. And just kind of dealing with those distractions, especially if you have kids at home, you have other things you look up and see and think, "I have to go do that right now instead of focusing on work."

And alcohol use has increased as well. So any time you have an increase in alcohol use, people might think, "Oh, gosh, this isn't really affecting me. I'm just having a couple extra glasses of wine a night," or whatever. But it is likely impairing sleep, which if you're not getting great sleep, you're not going to be very focused and energetic. And then that can kind of carry over into a sluggish feeling the next day.

And then just depression and loneliness as well. So one of the core symptoms of major depressive disorder is impairment in concentration. That is also one of the core symptoms of anxiety, generalized anxiety disorder, is impairment in concentration.

So it makes sense that we might see more people presenting with this concern than we already do. But yeah, I think those are some reasons.

Troy: That's what I wondered. We talked to Dr. Ben Chan as well, who I'm sure you know . . .

Dr. Weir:Yeah.

Troy:. . . who works at Primary Children's. He talked about that same thing, how we're all experiencing that, distractions and difficulty concentrating. And I've wondered how many of us have thought to ourselves, "Wow, I must have ADHD. I just can't focus. It's so difficult to get tasks done." And then potentially doing online assessments and potentially being diagnosed and prescribed medications.

Yeah, it's interesting, but sounds like maybe that is something we might see as more data comes out in the next couple of years in terms of prescriptions and diagnoses during this time.

Scot: It also seems as though that distraction could be a symptom of a lot of different things.

Dr. Weir: Absolutely.

Scot: I'm kind of understanding that just because you're distracted and can't focus, you think, "Well, I've got ADHD." Probably not. It's probably something else. So go see somebody who can help you sort through some of those things if they are actually impacting your life in a negative way.

Dr. Weir: Yeah, absolutely.

Scot: Dr. Weir, help me sum up what we've learned today. We set out on this journey talking about adult ADHD. Is that something that somebody could have? Would they want to seek treatment for that? We kind of ended up someplace else. What would your ultimate summary be of what we should take away from this?

Dr. Weir: Well, I'd say that ADHD in children and adults is a very real condition, and it can cause some very significant problems for people. So it is important to get it assessed and treated if you think that you suffer from it, or if you know you do, if you've had the diagnosis or testing in the past, but maybe you kind of stopped getting treated and now you're noticing some problems again, especially when we get to that kind of functional impairment.

I think it would be worth noting that medication is very helpful for this condition. It's very helpful. However, it can't really help with some of the skills that people need in terms of being able to plan, multitask, think about future, planning things like that. So it is important to do some skill-based work as well, and maybe mindfulness too, being able to learn how to stay in the moment, stay on one task. That can be very helpful as well.

And then I think just reiterating that this is a diagnosis that originates in childhood. So if you're noticing something now, if no one ever noticed any problems when you were younger, a parent, a teacher, yourself, and you don't really have that functional impairment, you're noticing things like, "Oh, my work performance isn't top notch. I'm not at the top of my game. I forget what I'm doing," you probably don't really meet the criteria, even though you might have some symptoms.

And then I just always think it's important to think about what some other underlying conditions are that could be contributors. We talked about depression, anxiety. Sleep problems, for sure. We didn't get to that too much. But especially in men, thinking about sleep apnea, and what that can do to your thinking and concentration throughout the day. That's all very important.

Scot: Troy, do you have any final questions you'd like to throw out there?

Troy: I mean, my takeaway from this is if you have concentration difficulty that's affecting your function, relationships, work, etc., you should really talk to someone. But again, it sounds like you're saying it probably is something else. Maybe adult ADHD, but probably not.

Dr. Weir: It's probably something else. And if it's a new problem, it is definitely something else.

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