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Attention Deficit Hyperactivity Disorder

Adult ADHD

05/19/2010

Question:

I`m 55 and was told that I had "minimal brain damage" (MBD) as a teenager. They didn`t call it ADHD then, but I had all of the symptoms and they were wrecking my life, although I did learn to work around some of them. I hated the term "minimal brain damage" because I always thought of myself as being at least average IQ; I saw a psychiatrist because I thought I had a sleep disorder and she sent me for a sleep study (showed fragmented sleep, pretty severe daytime sleepiness, some REM onsent but not as severe as onarcolepsy which was the wrking diagnosis since I was also having sleep attacks, bad but not severe. Going on ritalin changed my life; I went from being a disorganized idiot unable to finish anything, doing terrible in school to doing great (almost flunking to mostly B`s). I has more comfortable with a sleep disorder (which was sort of untrue) than being MBD so I just continued ritalin for "excessive daytime sleepiness" for 30+ years..life has been great, marriage, 30 years of a great job, advanced degree and then retired several years ago. My neuro doc had me do a sleep study for apnea (had it) , went on CPAP, lost a ton of weight and took myself off the ritalin. I did this because I needed to buy health insurance and being on ritalin would have been problematic. I hoped that having the apnea fixed would "fix" the problems of ADHD and daytime sleepiness, the daytime sleepiness is gone, but the ADHD is back with a vengence. I now have all of the original symptoms of the ADHD;I feel quilty that I let my neuro treat me for basically narcolepsy for over 20 years the I just told her "I`m o.k. now since the apnea is gone"..all because I needed to buy insurance. Now I have the insurance, I`m retired and would like to restart treatment for the ADHD. My records show treatment for narcolepsy; was it possible that I had both? I`m seeing a new psychiatrist; should I be honest about accepting treatment for narcolepsy when I knew I really had ADHD? Going thru my old records is heartbreaking; prior to starting ritalin, I has almost flunking out of high school. Then with ritalin, I made amazing progress (even got appointed to the US Military Academy at West Point); finished an advanced degree and even did a stint in the military reserves as an aviator (the drug tests were unsophisticated). I`m frustrated that I didn`t admit that I didn`t have the daytime sleep disorder adn should have just accepted the ADHD diagnosis. Should I be honest with the new doc I have a pile of documentation) or just try to restart the ritalin for a disorder that I don`t really have? I`m in great health: why does taking ritalin not make me jittery or hyped up? It makes me feel organized and able to finish tasks. I was on 20mg twice a day for many years and took myself off for months at a time without problems (except for return of ADHD symptoms). Also, when I went off the ritalin, my memory went to heck and I couldn`t finish tasks. Any suggestions? I`m frustrated and feel really, really stupid. I had great providers and was a lousy patient.

Answer:

This question raises many issues important to those with several disorders.

1. The term "minimal brain damage" was abandoned because in most cases it is not possible to demonstrate any brain damage. For a while "minimal brain dysfunction" (MBD) was used, but the more descriptive non-causal term ADHD or ADD seems preferable without causing the angst this writer went through. However, the MBD does not imply intellectual disability (low IQ).

2. Stimulants such as methylphenidate (Ritalin, Concerta, Metadate, Daytrana) and amphetamine are good for both ADHD and narcolepsy. As long as it helps, it is not critical which diagnosis is made. Daytime sleepiness is not typical of ADHD, but can result from either sleep apnea or narcolepsy. The distinction between the two sleep disorders is critical, because the treatments are different. It is not unusual to have a sleep disorder along with ADHD. Another sleep disorder often linked to ADHD is restless legs syndrome.

3. The correct dose of stimulant should not make a person with ADHD (or narcolepsy) jittery or hyped up. It should just normalize attention, memory, ability to finish things, impulse control, and other executive function. However, it does not work for everyone with ADHD.

4. Forgetfullness is one of the DSM-IV symptoms of ADHD, so that self-observation is not surprising.

5. The excessive amount of guilt expression over things that most people (including the past and current providers) would not worry about suggests the possibility of depression or anxiety (not unusual along with ADHD), for which an evaluation might be useful. All past information should be shared with the current provider so that he or she can make the most informed recommendation for current treatment.

6. Finally, this vignette presents a wonderful example of what a person with ADHD, sleep disorder, or other manageable handicap can accomplish: A useful, productive, successful, and (I hope) satisfying life despite the disorder(s). I hope that you will get involved in the work of inspiring adolescents with a handicap to "be all that they can be," to borrow a military term from your past. You may wish to consult with ChADD (Children and Adults with ADD) about how you could get involved. Their web sites are www.help4adhd.org and www.chadd.org. Their CEO's name and email address is Clarke Ross clarke_ross@CHADD.ORG

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Response by:

L Eugene Arnold, MD, MEd L Eugene Arnold, MD, MEd
Professor Emeritus of Psychiatry
College of Medicine
The Ohio State University