THE PROBLEM WITH DOUBT

I was reading Arthur The Seeing Stone, by Kevin Crossley-Holland and one of the characters [protrayed as Merlin] mentioned that "Doubt is like rust which corrodes metal. It travels from your brain into your body and eats you away." Then alittle later another quote referring to doubt was "Nothing comes of doubt, except inaction and more doubt." When I thought about these quotes they seemed to be accurate.  Doubt does make it harder to do something and it does seem to erode confidence.  The other problem with doubt could be that when we hesitate and do not act on what we first think or believe is right, we are not trusting ourselves and this can lead to worries, hesitating and other stress type reactions.  Maybe it is these stress reactions that "eats us away."  

So, if we don't want to risk getting rusty on our insides, we might want to avoid doubts and second guessing ourselves and worrying about what has or will happen in our lives and ...you get the picture.

Luckily, there are rust removers available.

SUICIDAL THOUGHTS THAT TURN INTO SUICIDE ATTEMPTS

Suicide is a leading cause of death for adolescents.  A recent article in JAMA Psychiatry by Nock, Ph.D.,et. al. decribes research investigating what factors lead to suicidal behavior in adolescents.  Lifetime rates of: suicidal thoughts = 12%; suicidal plan = 4%; suicidal attempts = 4%.  Importantly, 60% of adolescents who are suicidal with a plan, attempt suicide within one year of the onset of having suicidal thoughts.  For most [55%] of suicidal adolescents they started psychiatric treatment before they became suicidal.  Suicidal behavior rates were  highest in females and lowest in non-Hispanic blacks.   Females attempt more and males complete more as they use more lethal means [guns].  Adolescents are less likely to have suicidal attempts if they live with both their biological parents and have siblings.  Psychiatric diagnoses that predict progression from suicidal thoughts to plan to attempt include: major depression; dysthymia; eating disorders; ADHD; conduct disorders. Symptoms of anxiety, agitation and poor behavioral control, predict suicide attempts.  

This research points out how important it is to take suicidal thoughts seriously and especially suicidal plans. More than half of adolescents who are suicidal with a plan will attempt suicide within a year of the onset of their suicidal thoughts.  If you know an adolescent who is suicidal, talk to them and tell an adult about it.

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.

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.

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.