ADHD is a term that’s thrown around so frequently these days, we all assume we know what it means. Used to apply to everyone from a kid who misbehaves in school to an adult who has trouble focusing on a single TV or computer screen at a time, ADHD is actually a clinical diagnosis. Learning more about what ADHD is – and isn’t – can help you determine if you or someone you love warrants further testing

ADHD stands for “attention deficit-hyperactivity disorder.” In common parlance, it’s used interchangeably with ADD, which stands for “attention deficit disorder.” However, this term refers to cases where there’s attention deficit, but no hyperactivity involved.
From a layperson’s point of view, ADHD means the person – often a child — has problems concentrating and paying attention.

Of course, that can be applied to pretty much any child over the course of a typical day. What sets people with ADHD apart is that the area of the brain responsible for clarity, mental focus and activity is actually wired differently. What that means is that even when you try to “settle down,” your mind just doesn’t want to comply. You can tell yourself to relax, focus, and pay attention, but you just can’t make your mind and body comply.

So from an outsider’s perspective, how do you tell if your child is just suffering from normal “wigglies,” or really has ADHD? Let’s take a look more closely.

Signs and Symptoms of ADHD

There are three main components of ADHD: hyperactivity, inattention and impulsivity. Each has similar symptoms but they can be distinguished enough to determine if your child has one, two or all of the components.

Hyperactivity
Signs of hyperactivity include:
• difficulty sitting still, frequent fidgeting and squirming uncontrollably
• the inability to stay seated, even when they’re instructed to stay still
• inappropriate behavior like climbing or playing at inappropriate times, or on inappropriate objects like chairs or desks
• problems playing quietly when requested
• incessant talking even when instructed to be quiet

Inattention
Signs of inattention include:
• trouble staying on task for even short periods of time
• lack of attention when you are speaking to them
• issues with staying organized at school, work and home
• forgetfulness regarding assignments, requests, chores, homework, etc.
• easy distractability when performing a task

Impulsivity
Signs of impulsivity include:
• difficulty waiting in line
• blurting out of answers in class or in meetings even when not called on
• constant interruption of conversations

If you or your child has exhibited any of these signs, the next step is testing. A professional assessment can give you more insight into the condition, with regards to possible treatment and management.

I was surprised at the level of error and inaccuracy in your recent editorial, “Equal Pay Bill Should Be Dead” related to HB 4101, the payment parity for Nurse Practitioners in Oregon.

First and foremost, I take exception to your claim that services provided by NPs are different from those provided by physicians. Ask the patients of nurse practitioners their opinion. You may be surprised to hear the nearly universal positive regard patients have for their NPs. Some may even say they value their NP more than their MD. This view is supported, in many cases, by decades of research which as revealed that NPs provide care that is equal to or better than physicians on the same service, meaning that not only are the services delivered the same, but the services provided by NPs are often higher in quality. Of course, some services are different based on the different providers’ scope of practice and years of experience and HB 4010 would have no impact on the reimbursement rates for physicians when they provide more complex or intensive care based on their education and experience. Rather, HB 4010 says that when a physician OR an NP provides the identical service, those services should be reimbursed the same way. It is difficult to understand how anyone can argue against equal pay for equivalent services. Even the health insurance providers who oppose HB 4010 understand that there are hundreds of examples of services provided by NPs that are exactly the same as those provided by a physician; this is why these services are given the same insurance codes by those insurance companies.

Additionally, your editorial calls into question the chaos that would ensue if NPs were to suddenly be reimbursed at the same rate as physicians. In fact, most NPs are already paid the same as physicians by private insurance plans. HB 4010 would simply require that this common practice be made the standard. Also, where NPs do not have payment parity, the actual and potential impact on patients is serious. For example, in many rural areas (where NPs provide crucial access for patients), some NPs have restricted their hours, are forced to decline patients covered by some carriers, or are considering leaving the area due to financial pressures on their practices due to decreased reimbursement rates.

Finally, you question the challenges raised by “contracts becoming invalid.” It is absolutely crucial to note that contracts between providers and carriers are not as sacred as asserted by the Bulletin or by Representative Conger. In fact, in most many cases, when an insurance provider decides to reduce rates for NPs, those insurance companies simply mail a notification that payment rates are being reduced. No rationale given, no explanation needed, and no negotiation available.
HB 4010 was designed to be a fix for the current system and there are few professionals more supportive of health care transformation than Oregon’s Nurse Practitioners. In fact, NPs have been actively participating in developing Governor Kitzhaber’s approach. The simple fact is this: Oregon can’t afford to lose the services of NPs any more than it can of physicians and Oregon’s NPs can’t afford to be paid less than physicians for exactly the same services.

Considering the complexity of issues related to Depression, in my practice I have a multidimensional holistic approach to target Depression.  In my practice, I use a combination of therapy, lifestyle counseling, nutritional counseling, spirituality, and medication prescribing if appropriate and the patient is interested. I have helped many many people overcome the terrible delibitating disease of Depression.

While I don’t advocate the use of medication for everyone,  for some people with diagnosable mental health conditions medication may be quite helpful in losing or preventing weight gain through the mechnism of decreasing apathy.  Psychotherapy, particularly CBT, is also very useful in helping with weight issues. Anything that will help a person be more mentally healthy I believe will contribute to healthy weight.

Now, I know it is the holiday season, but please do not pass the eggnog!

There is another study that I found that I find very interesting. It is found in the Journal of Affective Disorders in January of this year. “Personality and the perception of health and happiness” Cloninger CR, Zohar AH.  In this study they found that the traits of Self-directedness was strongly associated with all aspects of well-being. Additionally, Cooperativeness was strongly associated with perceived social support which we know is strongly associated with well-being. Another personality trait of Self-transcendence was associated with positive emotions.
Can these personallity traits be developed? The research is not clear but I believe it can. Cognitive behavioral therapy is one way. Another way I forsee in developing these qualities would be through the development of spirituality. I regularly see patients in my practice who have been able to develop these qualities to help them be more happy people. That is why I regularly engage my patients in CBT and also have discussions of spirituality to those patients who are open to it. Many have been able develop these personality traits and others that have helped them improve their perceptions of happiness.

There has been insufficient studies showing any benefit of caffeine on mental health. A few studies have suggested caffeine has a positive effective on depression and ADHD. This may due to caffeine increasing alertness, attention and cognitive functioning and by possibly elevating mood. There is also preliminary evidence of caffeine benefiting some people struggling with Obsessive Compulsive Disorder which I thought was interesting because OCD is a subset of an anxiety disorder and my experience has seen caffeine making anxiety worse. Neveretheless, the research is compelling.

But do the benefits outweigh the negative side effects? We know that caffeine can increase heart palpitations and contribute to stomach problems such as Gerd. These are annoying troublesome physical side effects. What do we know about its mental health downside? We do know that caffeine is addicting and may encourage other types of addictions like cigarette smoking. We also know that caffeine in large amounts can bring out psychosis and manic behavior as well as exascerbate general anxious states, panic disorder or social anxiety disorder.

My advice is to keep caffeine to a minimum. If you struggle with Depression, OCD or ADHD, see your primary care mental health provider to investigate safer, healthier treatment for your mental health conditions. There are other things less harmful and that can do the job more effectively than caffeine.

This is yet another example of how the body and brain effect each other. When one improves the condition and health of the body, the brain also is effected for the positive! It also works the other way around. If one improves brain health, the health of the body will improve also! If you have had a heart attack or are at high risk, you might want to discuss with your nurse practitioner or doctor the possible treatment of a SSRI.  Your heart and brain will thank you!

Yesterday, there was an article in my local Bend, Oregon newspaper about gender neutral parenting being on the rise. This is really concerning to me with my personal and professional experience and what I know about brain science. I believe while it sounds like a good idea in reality is harmful to our kids. The article quoted a person in a Social Work program who stated that sex was determined at birth and that gender is socially learned. This is a politically correct philosophy but it doesn’t match up with current brain science. Boys and girls brains are different and are used differently by each sex. There is a learning difference that  isn’t recognized in a majority of education curriculum. This is why I believe that we have many more diagnosed ADHD boys out there. Teachers aren’t engaging them in the way they need to be engaged and the boys are bored, restless, distracted, even physically aggressive. I am a professional that works regularly with ADHD kids and their families. I prescribe medication often per parent request which is sometimes unfortunate as we really don’t know the long term effects of stimulant medication. I feel the problem needs to be partly remedied in teaching methods that recognize sex differences and not one size fits all. Boys learn by games, challenge even competition. That has been largely removed from school with a preference of touchy feely types of teaching which works great with girls but not boys. Until our school’s teaching methods match up to current brain science, I am afraid our children will not learn up to their full potential.

Many experts now believe that plastics are hurting our brains. Teenage boys today have lower testosterone levels than their grandfather’s did 30 years ago. Teenage boys are also suffering more ADHD symptoms: lack of motivation, drive, ambition, ability to plan and follow-through as well as increased rates of depression. Gender confusion has escalated in recent years. Girls are developing way earlier than they did even 15 years ago. Many researchers now believe that this may all be due to the increased use of plastics (or bisphenol A) in our society. Another cause may be herbicides and pesticides which I will not address in this article and will save for another time.

Recently, the FDA has come out with a statement that basically reverses a previous statement they made claiming that low levels of bisphenol A (BPA-the chemical in polycarbonates) does not have long term health consequences in humans. Please note: they now believe that it is harmful to humans! There have been a plethora of research supporting this view in recent months. Frankly, I am surprised it isn’t more prominent in the news given the enormity of research and the severity of BPA effects. Please note that BPA release estrogenic chemicals that are endocrine disrupters.

In the January 27, 2011 edition of the Brain Development journal it claimed that prenatal and lactational exposure to low-doses of BPA alters adult behavior.

In the April 23, 2011 journal of Current Opinion Pediatrics it found that there was a relationship between prenatal BPA exposure and increased hyperactivity and aggression in 2 year old female children.

The Mar 22, 2011 edition of Reproductive Biomed Online found that BPA effects reproductive health by interfering with the process of implantation of endometrial stromal fibroblasts.

There are many more human and animal studies that cannot be ignored that I don’t have room or time to address. One such animal study from China reports that rats exposed to BPA take longer than control rats in figuring out how to get through a maze. The FDA also recognizes that these animal studies cannot be ignored and they are calling out for more research and more comments by the public. In the meantime, they have preliminarily warned the public about BPA in baby products such as baby formula, which cans are often lined with BPA and baby bottles and pacifiers. It is believed that babies are particularly vulnerable to the effects of BPA. They advise to use BPA free types of plastic.

The problem is, there have been other research showing that virtually all plastics have BPA in them, even those claiming to be BPA free. What is one to do?

My advice? Get rid of as much plastics in your house as possible. I threw out all my plastic tupperware and now use glass containers. I use wax paper instead of plastic. I try and use food products that have not been packaged in plastic or tin cans. (Tin cans are often lined with BPA.) Also, do not drink out of water bottles or juice bottles! We have no idea how long these bottles have sat in a warm truck somewhere leaching its BPA into the product. Studies show that by eating more fresh, unpackaged, unprocessed foods, BPA levels can be lowered.

I am concerned about the children…I hope you are too.