This is a transcript of the podcast Distraction, your survival guide to our crazy-busy, ever-connected modern world hosted by Dr. Edward Hallowell, ADHD expert. Dr. Hallowell and John Ratey answer listener’s ADHD Questions.
Episode 17: Tackling ADHD Questions Head-On
DR. HALLOWELL: Hello, and welcome to Distraction, I’m your host Dr. Ned Hallowell. We have a real treat for you today, my dear friend and colleague John Ratey is joining us live on the program.
John: I’m delighted to be here with you Ned, it sounds like it’s going to be fun.
DR. HALLOWELL: It will be. We’re devoting today’s show to ADHD; the diagnosis, the treatment, the good parts, the bad parts, while talking about it all and answering questions from our listeners.
John and I co-authored 3 books, Driven to Distraction, Answers to Distraction and Delivered from Distraction. In addition to being an author, John is associate clinical professor of psychiatry at the Harvard Medical School. Really this is great treat to have you join our podcast today. John, welcome.
John: I’m really glad to be with you Ed, we’re such old friends and this is such an important area to educate people and get people on board with the right thinking.
ADHD Questions Answered
DR. HALLOWELL: Okay, let’s welcome our first listener question. Hello Mercedes, do you have a question for us?
Mercedes: Yes, I do. I’m an actuary, so I take exams on top of working. For example the one that I’m taking now requires 400 hours of studying. You get some time at work to study, about 115 hours, but still there’s 285 hours to get in outside of work and I work 9-5.
DR. HALLOWELL: Well, you’re obviously extremely smart.
Mercedes: Yes, it’s very difficult and then they have about a 30% pass rate, so I’ve definitely failed them a lot before I passed. My question, I take Adderall, I’ve been taking it for 9 years now and I have a lot of trouble managing it while I’m studying, because if I take it in the morning, it will run out by the end of the work day and then I have to study after work, and a lot of times I will take more and then I won’t sleep and I’ll just get in this really terrible cycle of taking more the next day and getting less and less sleep.
Long Acting Stimulant Combined with a Homework Pill
DR. HALLOWELL: Mercedes, this is a common problem that we see with children all the time and the way I solve it with my patients and I’m sure John does the same, is you want to take a long acting stimulant in the morning, right after breakfast.
Mercedes: Right after breakfast?
DR. HALLOWELL: Yeah, and then a second pill, what I call the homework pill of a short acting stimulant around 4:00pm in the afternoon and then you want to time it so it doesn’t interfere with sleep. A typical regimen would be let’s say Vyvanse is your long acting pill, take 30 or 40 milligrams of that in the morning and then say use 10 milligrams of Adderall around 3:30pm in the afternoon for your homework pill, for your evening pill.
Mercedes: Okay, Vyvanse apparently.
John: I prefer using Focalin, actually you can take it a little later, for the homework, for the nighttime. It’s not as long lasting as short acting Adderall.
Mercedes: Is that prescription, or is that over the counter?
John: No, that is definitely a prescription pill, it’s a form of Ritalin, but that’s what I usually do. It just gives a little more control over when you’re going to be focused and also make you drop off easier.
DR. HALLOWELL: 10 milligrams, John?
John: Yeah, I would, that’s what I would do if she were my patient.
Mercedes: What is it again?
John: Focalin, it’s a form of methylphenidate, so you know, they are all in the same class. I mean, they are all amphetamines basically.
Mercedes: Still take Adderall in the morning?
John: Oh, yeah.
DR. HALLOWELL: The long acting, Mercedes, either Vyvanse or Adderall XR, right? I prefer Vyvanse, I think it works better, but either one of those. Adderall XR or Vyvanse for your morning dose.
Mercedes: Actually, I have 30 milligram extended release Adderall and then the 10 milligram not extended release.
Vyvanse Versus Adderall
DR. HALLOWELL: You might ask your doctor to just try Vyvanse, because it usually works better than Adderall. Insurance won’t pay for it until you try Adderall first, but then it will pay for it and for most people Vyvanse works better.
John: I find that as well, it lasts a bit longer and you can titrate it, you can adjust it a little better than you can with Adderall. You can increase or decrease. It’s something you should learn about. You go on Google and you learn about Vyvanse, because I think you can dissolve it and take a little bit here and a little bit there.
Mercedes: Great, this is wonderful, easier solution than I expected.
DR. HALLOWELL: Well, a lot of people, a lot of doctors don’t think about this homework pill idea, the notion that it wears off and so you’re left for the late afternoon and evening with no coverage.
Mercedes: It’s really tough then, getting to sleep is a struggle.
DR. HALLOWELL: Yeah, so let’s hope this regimen carries you through to pass the rest of these devilishly difficult exams. Congratulations Mercedes, you deserve a lot of credit. It’s one of the toughest professions to enter, an actuary.
Mercedes: I don’t want to give it up. I want to be a good example.
DR. HALLOWELL: No, don’t give it up, just get the most mileage you can out of medication. Thanks a lot for your call.
Mercedes: Thank you so much, have a great day, bye bye.
How Do You Know if You Have ADD?
DR. HALLOWELL: Let’s hear our second question. Hi Scott, you’re on with Ned Hallowell and John Ratey.
Scott: Hello sir, thank you very much, nice to meet you.
DR. HALLOWELL: Tell us about yourself, Scott.
Scott: I love that question, but I was told we only had a short time. In specific context, I’m soon to be 56 and last year came right up close to, I don’t think I can use the word diagnosis, but an awareness certainly of ADD and for the last year I’ve been what I think to be successfully on and with Adderall to help with those traits and I learned of calling it traits. Now, my question that I bring to you today, is what is necessary for me or one officially to be considered now as having ADD and that’s me right now this morning. What it takes for someone to be officially considered as having ADD.
DR. HALLOWELL: John, why don’t you take that.
John: Yeah, officially it means what? When you’re younger we might recommend that you get a neuropsychological battery to see if there are other learning issues that you might address, but if you’re 56 you’ve already had a diagnosis, or they wouldn’t be putting you on Adderall, so that’s pretty official.
DR. HALLOWELL: Did you say you were taking Adderall?
John: He said he was taking Adderall and it helped his traits.
Looking at ADD at a Deeper Level
Scott: Yes, a small part of the back story is after years, I could say safely a decade of really looking at taking medication for something like Attention Deficit Disorder and hyperactivity was really a bad thing. All of the kids and families that I dealt with looked at it as bad, broken, dysfunctional, that cannot be me, so no, I was a hater in that sense. When I learned of the condition and the traits at a deeper level, for me it was a big thing to turn and say, hey, this could be me and medication might help.
To make that shift was a big turn and I went and spoke with a counselor and then with my doctor with a long history of what I think to be quite accurate. They said, hey, let’s try this and we did and within I cannot say minutes, but that day I knew that there was a night and day difference of how I was responding to distractions and now. Then finding if you want to go further, here’s a $1,400 assessment that we would do. I said, I don’t have $1,400 dollars for an out of pocket test for you to tell me what I am or am not. I have spoken with these professionals and that’s just a little more of the back story and a little bit more of me.
Your History is the Test
John: Again, I think if the doctor who prescribed it felt that your symptoms were enough to being interfering with your life, then that is the diagnosis. There’s a lot of ways to get a diagnosis. You could do anything from neuropsychological testing to other kind of measures, but if you have the symptoms and you obviously listed them quite well enough to convince one MD, then you had the diagnosis and you had the medicine and wallah, you’ve confirmed it. I don’t know why you cannot say you’re not officially diagnosed.
DR. HALLOWELL: He wouldn’t have prescribed the medication for you unless he diagnosed you, but really Scott, the diagnosis of this condition, like most conditions in psychiatry is done by your history. I’m glad you didn’t spend the $1,400 dollars because you don’t need it, your history is where the diagnosis lies or doesn’t lie and the doctor who prescribed for you, you said he took a careful history, that’s the gold standard. That’s the closest thing we have to a definitive test, is your history.
John: Right and if you’ve listed it out for 50 some years, then it’s pretty certain that you have it.
DR. HALLOWELL: What you should do to really embrace it is spend instead of $1,400, spend $14.00 dollars and buy our book Delivered from Distraction to read and learn about it. You don’t have to read the book all the way through, pick and choose the chapters that interest you and seem to apply to you. As you see yourself and learn about yourself, you can really embrace it, as you spend most of your life fearing it, now you can embrace it and make friends with it and then you can manage it must more successfully.
Scott: Thank you, both of you and your team for your work.
DR. HALLOWELL: Thank you, thanks for calling in. Okay, welcome to our next caller. Jim you’re on the air with Ned Hallowell and John Ratey, welcome.
Alternative Treatments to Medication
Jim: Thank you, I’m very happy to be on the line with you. My name is Jim from Chicago, Illinois and I’ve done a few different alternative therapies introducing to medication and I heard a bit about the transcranial magnetic stimulation. I don’t know how deep that research is, but I just wanted to throw out that question if that is something that you guys have been involved in as far as the research and what your thoughts are on that?
John: I have not been involved in it, nor am I up on the latest and aware there’s been any studies on TMS and ADHD. Ned, do you know?
DR. HALLOWELL: No, not for ADHD, it’s mostly for other conditions, so Jim I don’t think you want to bark up that tree. You’d also like John and me to talk about alternative treatments in general, is that correct?
Jim: That would be great, yeah, if you could talk about that and whatever the latest is with the effectiveness of new things that are happening.
DR. HALLOWELL: I know Johns favorite non-treatment medication is, so take it away, John.
Alternative Treatment – Exercise
John: Okay, my favorite is exercise daily. The best kind of exercise is the one that keeps you coming back to it. The biggest problem for people is that they stop. You want to get involved in something that you’ll continue on your own or continue with the group. That is probably the best to get your heart rate up, your brain activated and moving and maintain your focus.
That is acutely for that day, but then over time you get better. Your focus gets better, even if you’re on medicine, you expand your working memory, which is a big part of what the problem with ADD is. You improve your executive function, both that day and if you’re getting fitter, then that gets better over time on its own. Then if you’re challenged by certain periods of time like a test or getting a report in, then to have a what I call a bolus of exercise, like a bolus of medicine, before you tackle it, because that can help you do that much better on whatever tasks before that has been difficult or befuddling. That’s one of the things that we certainly recommend.
DR. HALLOWELL: You know, the door program itself, which is now defunct, none the less continues to have narrative. It is a specialized form of exercise that stimulates the cerebellum. Someone who wants to do this at home, can try standing on one leg with your eyes closed, juggling, or sitting on an exercise ball. Anything that challenges balance and coordination will stimulate the cerebellum and it turns out because of connections between the cerebellum and the frontal lobes, that this is good for both reading problems, dyslexia, as well as ADD.
Alternative Treatment – Connection
My favorite non-medication treatment and John is well aware of this, Johns favorite is exercise, my favorite is human connection. My plea and trumpet call is go connect. Make time for a friend, and for the people in your life that you love. Forgive that sibling that you’ve been feuding with. Go back to the club you dropped out of. Rejoin the religion you grew up in. Just take mega doses of connection. Again, it doesn’t have to be connection to a person. It can be a connection to a pet, to nature, to beauty, to a favorite place, to a favorite piece of music. Everybody, but particularly people with ADD thrive when they are living in a matrix of connection and they wither and wilt when they’re living in a matrix of disconnection.
Jim: Thank you guys, it certainly has been a pleasure being on the line with you.
DR. HALLOWELL: Thanks so much, good luck to you.
Jim: Okay, take care.
DR. HALLOWELL: We’ll be back next week with the second part of our 2-part series on ADHD. If you have an issue, question, or suggestion, call us toll free at 844-55-connect or email at [email protected], or go to our website at distractionpodcast.com. To hear more mini and full length episodes, subscribe to Distraction on iTunes and thanks so much for listening. Distraction is produced by Collisions, the podcast division of CRN International. Collisions, podcasts for curious people.
This is a transcript of the podcast Distraction, “Tackling ADHD Questions Head On” Distraction is available on iTunes.