Concerta

ONE YEAR, I DECIDED TO TEACH YOGA, home-school my son, join a singing group, and remodel the kitchen. These (and other) projects came up just after I'd finished my degree in interior design and certificate in ayurvedic medicine, published a journal, and redesigned my garden. Somehow I managed to get it all done, which is impressive considering my commitment could usually be measured in days or weeks, not months or years.

When taking stock of my 43 years, I see this same pattern repeated again and again: boundless enthusiasm for idea after idea, tempered by a restlessness that keeps me always moving on to the next thing. What a behavioral neurologist would see is Attention Deficit/Hyperactivity Disorder.

In spite of ample intelligence and enthusiasm, someone with ADHD experiences daily life as a constant struggle. Boredom, procrastination, disorganization, and a tendency to say yes to too many projects can be dizzyingly stressful, while emotional intensity, impulsivity, and a tendency to interrupt make for chaotic relationships. But by accepting the diagnosis of ADHD, I've begun to understand the complexities of the condition and the effectiveness of traditional as well as alternative treatments.

nonlinear in a linear world

ORIGINALLY KNOWN AS "minimal brain dysfunction," then "attention deficient disorder," the condition has had one misleading moniker after another. Those of us with ADHD don't suffer from a deficit of attention--if anything, we have a surfeit of it. We're vulnerable to distraction because we perceive too much at once; we're unable to filter out extraneous stimuli and focus on what is most important.

The cause may be a lack of blood flow and electrical stimulation to the frontal cortex--the area of the brain involved in prioritizing, focusing, and choosing words thoughtfully rather than blurting them out. Scans of people with ADHD usually show reduced activity in this decision-making area of the brain, notes Daniel Amen, M.D., assistant clinical professor of psychiatry and human behavior at the University of California, Irvine, and author of Making a Good Brain Great.

Some researchers suggest that "executive functioning disorder" is a better description. "ADHD people think in a tangential, nonlinear, circular way," says Hal Elliott, M.D., director of adult psychiatry inpatient services at Wake Forest University Baptist Medical Center in Winston-Salem, N.C. "One thing reminds them of something else, which reminds them of something else. People with ADHD tend to be writers, musicians, visionaries, inventors, and people who rock the boat at work--they come up with better ways to do things. There's nothing wrong with being a nonlinear person except that it can make you miserable in this linear world we live in."

About 4 percent of American adults suffer from the condition, and they lose between 12 and 56 workdays annually to their symptoms, according to a national screening survey conducted by Harvard Medical School. A history of childhood ADHD--whether or not it was ever diagnosed--is a criterion, and there is evidence that ADHD runs in families. (A study of ADHD genetics is now under way at the UCLA Neuropsychiatric Institute.) "ADHD isn't something that pops up when you're 45, going through a divorce," says Amen. "You see there was evidence of it all along."

Adults with past or current symptoms of ADHD are also at a higher risk for other problems. A 2005 study in The American Journal of Psychiatry found that 59 percent of ADHD patients suffered from major depression at some point, compared with 40 percent of the non-ADHD group; the respective ratio for anxiety disorder was 21 percent versus 8 percent.

trials and treatments

"SINCE WE STILL know so little about ADHD, treatment is very trial and error," says Hailing Zhang, M.D., a psychiatrist who treats many adults with ADHD. "But the gold standard is stimulant medication." Controlled studies show that drugs like methylphenidates (Ritalin, Concerta) and mixed amphetamines (Adderall) increase mental concentration by making the neurotransmitters dopamine and norepinephrine more available to the brain. Drugs related to antidepressants (Wellbutrin, Strattera) can be successful in treating ADHD, too.

But some of these drugs may cause side effects like insomnia, stomach pain, loss of appetite, irritability, anxiety, or heart problems. Canadian authorities banned the use of Adderall for several months in 2005 due to possible sudden deaths, heart-related fatalities, and strokes in children and adults. And while the FDA considers Strattera an "effective drug" with "low risk," the agency is warning doctors to monitor children and adolescents taking it for suicidal thoughts.

There are alternatives that show promise. Naturopath and acupuncturist Trina Seligman, N.D., L.Ac., a guest lecturer at Bastyr University in Seattle, recommends a "foundation" of a broad-spectrum, free-form amino acid supplement taken daily to balance a patient's brain chemistry. To target specific symptoms, Seligman uses specific aminos. She often prescribes twice-daily single doses of dopamine precursor DL-Phenylalanine or norepinephine precursor L-Tyrosine to improve concentration and diminish restlessness; serotonin precursor L-Tryptophan to alleviate depression; or GABA or L-Theanine to reduce anxiety and irritability.

An ayurvedic herb may also help. Two Australian studies published in Neuropsychopharmacology and Psychopharmacology found that 300 milligrams of Bacopa monniera (aka brahmi) daily improved information-processing speed, while slowing the rate at which newly acquired information is forgotten; the herb also reduced anxiety. Meanwhile, a 2004 study in Progress in Neuro-Psychopharmacology & Biological Psychiatry determined that zinc sulfate (150 mg per day) can reduce some ADHD symptoms.

A classic natural therapy may also be beneficial: A 2001 Swiss study showed homeopathic treatment comparing favorably to the use of methylphenidate in children with ADHD. Because the condition is so complex, however, there is no advised standard; an experienced homeopath can determine the best remedy for each individual.

the holistic approach

MEDICATION AND/OR supplementation is only part of proper ADHD management. "Taking a whole-person approach to brain health can make an enormously positive difference," says Amen. The following lifestyle adjustments are recommended:

Feed your focus. Keeping blood sugar stable is vital to leveling out symptoms. "If you have ADHD, it can be hard to function on a good day; but if your blood sugar is low or spiking, it makes it even more difficult," says Wendy Richardson, M.A., M.F.T., author of When Too Much Isn't Enough: Ending the Destructive Cycle of ADHD and Addictive Behavior.

ADHDers need to eat real meals throughout the day and limit simple carbohydrates, sugar, and caffeine. (Caffeine is a stimulant, but it actually decreases blood flow to the brain.) Every breakfast, lunch, and dinner should provide complex carbs, quality protein, and healthy fats in the form of fresh, whole foods. Avoid preservatives and other food additives, as they may exacerbate symptoms.

Pump the blood. Every ADHD expert emphasizes the importance of regular, vigorous movement. "Exercise is not a choice," says Amen. "It boosts blood flow to the brain and helps the brain make new nerve cells." In addition, sustained cardiovascular activity steadies blood sugar, contributes to overall mood, and promotes sound sleep--something patients typically need more of.

"People with ADHD don't do boring, so do what you enjoy," Amen advises. "If you're not sure what to pick, walk briskly--don't stroll." Get a physician's OK, then elevate your heart rate for at least 30 minutes, five days a week.

Seek support. ADHD has nothing to do with laziness or a lack of intelligence, yet people with the condition are often pegged as underachievers. Take advantage of psychotherapy, coaching, and support groups to clarify the emotional factors involved and help restore your self-esteem.

Honor who you are. Personally, I've found that meeting my needs as a whole person--eating wisely, exercising, doing yoga, taking herbs and supplements, and getting support--has enabled me to manage the challenges of ADHD. Indeed, I've begun to realize that many of my ADHD qualities--like flexibility, creativity, and empathy--are strengths I can rely on and even celebrate. Now, if you'll excuse me, I have to compose a symphony, cater a wedding, and add a second story to the house. (Just kidding!)

DO YOU HAVE ADHD?

The principal characteristics of Attention-Deficit/Hyperactivity Disorder are INATTENTION, HYPERACTIVITY, and IMPULSIVITY, according to the National Institute of Mental Health. Behavior can be PREDOMINANTLY INATTENTIVE (loses tools, makes careless mistakes, is easily distracted, leaves tasks uncompleted), PREDOMINANTLY HYPERACTIVE-IMPULSIVE (feels restless and fidgety, interrupts, blurts out comments, has difficulty relaxing or waiting), or both. Everyone exhibits such tendencies once in a while, but most people desist when these actions become inappropriate and detrimental.

The following self-test, developed by the World Health Organization, can help you identify behavior consistent with adult ADHD. Answer these questions never (o points); rarely (1 point); sometimes (2 points); often (3 points); or very often (4 points). A score of 11 points or more indicates the potential benefit of getting an ADHD evaluation by a health-care provider.

IN THE LAST SIX MONTHS:

(1) How often are you distracted by activity or noise around you?

(2) How often do you have difficulty getting things in order when you have to do a task that requires organization.)

(3) How often do you have difficulty waiting your turn in situations when taking turns is required?

(4) When you have a task that requires a lot of thought, how often do you avoid or delay getting started?

(5) How often do you feel restless or fidgety?

(6) How often do you leave your seat in meetings or other situations in which you are expected to remain seated?

Drain Your Brain

Feeling stressed and overwhelmed? "People with ADHD need time each day without stimulation so they can decompress," says Hal Elliott, M.D. Restore yourself with activities that relieve the mental and emotional strain. Like these:

Go green

Spending time outside in "green settings" is a potentially valuable component of treatment, according to a 2004 study published in the American Journal of Public Health.

Play

It's sometimes easier for ADHDers to concentrate on pleasurable activities, and therapeutic to enjoy tangible results."Having a hobby--gardening, woodworking, knitting, any kind of hands-on endeavor--is a great outlet for ADHD energy," says Hailing Zhang, M.D.

Relax

Massage and yoga give busy minds a vacation by drawing awareness back into the body. "The ayurvedic technique known as Shirodhara involves pouring warm herbalized oil over the forehead in a specific pattern--this stills the mind and calms the nervous system," says John Douillard, D.C., National Ayurvedic Medical Association board member and author of Body, Mind, and Sport. Available through ayurvedic practitioners and in some day spas, Shirodhara is sometimes referred to as "bliss therapy."

TRAIN YOUR BRAIN

"The brain is continually adopting to its environment, growing interconnections between nerves and becoming more efficient in response to the stimulation we receive," says Sergio F. Azzolino, D.C., a clinician in San Francisco and vice president of the American Chiropractic Neurology Board. Here are five techniques that can help you Reinforce positive brain function:

1. Coaching

While psychotherapy typically deals with thoughts and emotions related to the past, coaching focuses on building the future by developing strategies to attain life and career goals. "Many individuals with ADHD are creative, intelligent people who are frustrated with their lack of achievement," says Pare Milazzo, an ADHD coach and chair of the ADHD Awareness Campaign for the Attention Deficit Disorder Association. "When they learn strategies that support working memory and executive functioning, they start to see sustained success." (For more information, visit the ADD Coach Academy at addca.com or ADHD Coaching Associates at adhdca.com.)

2. Tai Chi

A tai chi practice may reintroduce the brain and nervous system to a fluid, sustained state of concentration. A University of Miami School of Medicine study found that taking two 30-minute classes a week for five weeks reduced ADHD symptoms like anxiety, daydreaming, and hyperactivity. The benefits continued during a two-week follow-up period without classes.

3. Neurofeedback

In 2005, the Journal of Clinical Psychology published findings showing that neurofeedback had an effect comparable to stimulant medication in helping ADHD adolescents and adults intentionally regulate brain activity. This technique uses monitoring equipment to display a visual representation of your brain state. Working with a specialist--a health-care professional with additional training--you learn to differentiate between different brain wave types, and independently regulate brain wave activity for increased concentration and focus.

4. Interactive Metronome Therapy

A new method for addressing cognitive challenges of many kinds is exhibiting promise for people with ADHD. Interactive Metronome Therapy is a computer-based technology where sensors measure accuracy as you try to synchronize hand and foot movements with a given beat. The immediate audio and visual feedback allows for progressive refinement of the exercise, which helps develop focus, increase stamina, filter out distractions, and improve self-monitoring of mental and physical actions. For a list of resources, visit interactivemetronome.com.

5. E-surfing

Help for people with ADHD is as close as your computer. Visit the Attention Deficit Disorder Association (add.org) and the National Resource Center on AD/HD (help4adhd.org) for information and advice. At Webjillion.com, click "Temptation Blocker" to temporarily lock out distracting software such as browsers and games; it's a free download for Windows users.

COPYRIGHT 2005 Weider Publications
COPYRIGHT 2005 Gale Group