MANAGING STRESS IN OUR LIVES

Friday
Mar012013

BEHAVIORS ASSOCIATED WITH ADHD...SYMPTOMS OR COPING STRATEGIES?

A number of behaviors that are frequently found associated with people who have ADHD, seem to be coping strategies.  Thus these behaviors help to reduce stress associated with ADHD even though they may appear to be symptoms of the disorder and a part of the problem.

One behavior is procrastination.  Deadline pressure seems to help someone with ADHD to complete a task. It appears that the brain of someone with ADHD. has to use energy that is usually reserved for emergencies or novel learning activities to concentrate and focus.  Their brain is reluctant to do this and it seems that deadline pressure convinces their brain to use this energy to focus at least for a limited period of time. That may be why people with ADHD are more successful using procrastination to complete tasks than other people are.

Another behavior is irritability.  Irritability occurs around people and may be held in check and not revealed to others.  The irritability is not part of mood problems and seems to serve to remove someone with ADHD from the presence of others.  This reduces stress as interacting with people requires a lot of concentration and attention.  

An additional behavior is a tendency to interrupt others.  This "impulsive behavior" is necessary to pass on some information that the person with ADHD will very likely not be able to remember if they wait until it is their turn during the conversation.

Additionally, people with ADHD have to use a different part of their brain to concentratea and the energy used to concentrate is depleted rapidly.  Thus later in the  day, when the child with ADHD is with their family or the adult with ADHD is with their significant other or spouse and/or children, the person with ADHD will have very little concentration left and will likely be quite irritable if they have to interact with others or they will isolate themselves from others.

Obviously, the above coping strategies frequently leads to stress in relationships, unhappiness and feelings of being a failure.  

These coping strategies are not necessary [but may persist] after medication treatment has begun along with cognitive and behavioral strategies.  Thus treatment can relieve a lot of stress that the person with ADHD experiences before treatment.

Friday
Mar012013

PROCRASTINATION AND ADHD

There are a number of reasons that any person might have difficulty concentrating or focusing.  I have had young adults in their 20's come to me convinced that they have Alzheimer's [Dementia] because they can't remember to do things even after a short amount of time.  Inevitably, they are experiencing stress and their brains automatically devote brain activity [and energy] to trying to understand and reduce the stress. The things that the person is trying to remember are not a high priority for their brain and so it is not remembered.  Once the stress is reduced or eliminated, the person's concentration [and memory] returns. People who are depressed also will not concentrate well, likely for the same reason as it represents a stress that the brain automatically focuses on.  Also, infectious illnesses, hormone imbalances, sleep disturbances, and other illnesses can reduce focusing and concentration. Once these problems are resolved, the concentration returns to normal.

Differentiating concentration problems that are related to ADHD is helped if there is a childhood onset of distractibility and difficulty sustaining concentration, except for preferred activities.  Also, reading comprehension is often compromised.  In addition, there is a tendency to interrupt others, become irritable during longer conversations and have difficulty making decisions.

I have found that procrastination [waiting until the last minute to complete a task]  is found very frequently in people who have ADHD.  Other people might procrastinate and yet those with ADHD actually use the deadline pressure to complete the task and are not overwelmed by the last minute pressure to finish the task.  Other people without ADHD who procrastinate are often so stressed by the deadline that they cannot finish the task.  

As with some of the other symptoms [behavior patterns] that are associated with ADHD, procrastination serves a purpose and actually helps the person complete the task.

Sunday
Feb242013

MEDICATION FOR PTSD

A number of different medications have been prescribed for PTSD.  These mostly include antidepressants. At times this can be helpful as chronic stress associated with PTSD can lead to depression that can be relieved, at least in part, by medication.  I say in part because if the stress connected to PTSD is ongoing then depressive symptoms can be precipiated again or never resolved with medication and therapy.  

Anxiety triggerd by events that remind the brain of past traumas is the main symptom of PTSD.  This anxiety is related to the almost instantaneous alarm response of the brain as it tries to avoid a catastrophic response.  It seems that frequent alarm reactions is better than being completely overwelmed.  Anything that can reduce the intensity of the anxiety response or reduce the frequency of anxiety responses will be helpful.  Medications targeting this have included propranolol, atypical antipsychotic medications and benzodiazepines.  Propranolol reduces the physical reactions to stress and thus can reduce the intensity and frequency of these reactions.  Atypical antipsychotic medications are also able to significantly reduce anxiety reactions and at lower doses are usually well tolerated without side-effects.  It may be difficult to explain why an antipsychotic medication is helpful and yet the intensity of the anxiety response in PTSD benefit from this type of medication. Benzodiazepines can temporarily reduce anxiety but often have side-effects and will over time be less effective.  There can also be dangerous withdrawal symptoms for the shorter acting benzodiazepines.

Tuesday
Feb192013

ADHD AND IRRITABILITY

Irritability is frequently seen along with problems focusing and concentration in people with ADHD.  The irritability may reflect the stress associated with having to force concentration using energy in parts of the brain that is supposed to be reserved for emergencies or novel learning experiences or the irritability could be a way that the brain copes with the drain on concentration that people represent by keeping people with ADHD away from other people.

Regardless, irritability is important to address as often it is seen as an indication of mood swings and there is a reluctance to prescribe Rx for ADHD.  Daily irritability is related to ADHD and not to mood swings. If ADHD is treated, often the irritability will be reduced significantly.  At times, the irritability will continue after the ADHD symptoms are treated.  I have found that often Lamictal will stop the irritability.  The dose of Lamictal has to be adjusted for each individual person to get optimal results.  After a year of doing well with irritability well controlled, the Lamictal can be stopped with no return of irritability.

Remember, daily irritability is associated with ADHD and not with mood swings.

Wednesday
Feb132013

WATCH OUT FOR ENDOCRINE DISRUPTING CHEMICALS

What now?! I suspect that most of us are tired of hearing about new dangers that we face.  However, now that the Taliban is apparently not as much of a threat, maybe we can learn about something that is actually more of a threat to our health than the Taliban.  What is this?  They are chemicals in our environment [food, couches, machine receipts and shampoos, etc.] that disrupt our endocrine systems and may be a significant factor in the increasing obesity in the industrialized world.  

Research studies [initially from Bruce Blumberg at UC Irvine and now his findings have been replicated a number of times] have identified 20 substances that are called [after Blumberg] obesogens. This problem is now recognized by the Presidential Task Force on Childhood Obesity and the National Institutes of Health.  Chemicals identified include materials in plastics, canned food, agricultural chemicals, foam cushions and jet fuel.  Mice exposed at birth to very small amounts of some of these chemicals became obese and passed on this to future generations.  Another study found that women with pesticide residue in their blood gave birth to babies who were more likely to be overweight by 14 months.  The most vulnerable periods seem to be in utero and in prepubertal children.  

One survey cited by the Scientific American, found that only 19% of physicians cautioned pregnant women about endocrine disrupting chemicals found in pesticides and less than 10% warned about BPA that is found in some plastics and receipts and phthalates that are found in cosmetics and shampoos. 

So why aren't these chemicals being regulated?  Well, apparently similar to the delayed regulation of cigarettes, the chemical industry is resisting it.  Congress has yet to pass the Safe Chemicals Act that would require more stringent testing of potentially toxic chemicals.  We all have to pay for obesity and that does not include all the suffering that occurs related to obesity.  So, pesiticide free food, no plastic containers for food and no cosmetics or shampoos with dangerous chemicals.  

It would seem a good time to let others know about this as well as telling our representatives and senators that we want these endocrine disrupting chemicals gone.