Bruce Alan Kehr, M.D. is the Founder and President of Potomac Psychiatry, ranked “Best Psychiatry Care Provider in Maryland” in 2020 by Global Health & Pharma. He has been named a Washingtonian Magazine “Top Doctor” for each of the past eight years. Dr. Kehr is a best-selling author whose works have been read by over 800,000 people in 206 countries. In 2020, Dr. Bruce Kehr’s blog was ranked #2 in the nation among mental health-related blogs. Dr. Kehr’s book, Becoming Whole: A Healing Companion to Ease Emotional Pain and Find Self-Love, is an Amazon Best Seller in the self-help categories: Happiness, Counseling, Healing, and Self-Esteem.
In the United States, an estimated 4.4 percent of adults ages 18-44, 4 percent of children ages 4-8, and 9.7 percent of children ages 9-17 experience symptoms and some disability from ADHD. As such, ADHD is one of the most common of all psychiatric disorders. It is also among the most treatable.
Research has established that ADHD is a neurobiological condition with a likely genetic component, wherein critical circuits in the frontal cortex of the brain responsible for sustained attention, organization, planning, and various other executive functions are not functioning properly. The speed and efficiency of information processing is inconsistent, and compromised. These circuits mainly rely upon two neurotransmitters to function (dopamine and nor-epinephrine), and most medications used to treat ADHD increase the availability of one or more of these two transmitters. Additional treatments typically include education, cognitive/behavioral techniques, and cardiovascular fitness exercise. Exercise activates the frontal cortex in all age groups, and increases levels of both dopamine and nor-epinephrine.
If you are a patient suffering from ADHD, or a family member living with someone with ADHD , what is the impact on your life?
For the patient with ADHD, living in reality feels like a “discontinuous experience.” Because they are frequently distracted by wandering thoughts, excessive daydreaming, and external motion and sounds in the environment when trying to focus on a task, they miss out on a number of important environmental cues, and struggle harder to learn new information. This has nothing to do with their level of intelligence, as I have treated many outstanding students, executives, and professionals with ADHD. These highly capable individuals have become overwhelmed and emotionally depleted from the challenge of processing increased volumes of information. Certain information from the environment therefore never “gets inside” their brain, and therefore is unavailable to be processed, particularly when their “supply” of information processing is exceeded by the “demand” to process information while at school or in the workplace.
A useful analogy to assist in explaining this experience is to imagine for a moment that your computer suffers from ADHD. As a result, an average of one out of every ten keystrokes that you type on the keyboard never register in the computer – that portion of the data never gets entered. In addition, the keystroke data that is “dropped” on the way in is random and unpredictable. The computer then inconsistently processes the information that has been entered – at times with the latest Intel Core 2 Duo Processor, and at other times with an Intel 386 microprocessor designed 20 years ago. The end result is that this computer could run Windows 95 just fine, but what about Windows Vista? For simpler processing tasks it would function just fine, but as processing complexity increased, it would begin to function poorly, if at all. How well would the computer function with its varying processors that are commanded to process incomplete information? What would the work product (for example the text or financial information you have created), look like when displayed or printed out?
While our brains may function in certain respects like a computer, a machine lacks a heart. Having ADHD is not just cognitively challenging, it is emotionally painful, as learning becomes more of a struggle, social cues are missed, distractibility is interpreted as a “lack of interest” or “rudeness” by others, and self-esteem is diminished over time. Anxiety and depression may set in. Patients with ADHD are twice as likely to develop a major depressive disorder, significant anxiety disorder, or substance abuse problem as the general population. Social development is slower and more challenging due to missed social cues and delayed brain maturation. Symptoms may be masked by high intelligence and a strong work ethic, which provide for a temporary “work around” the ADHD processing deficits. But as the complexity of life increases at certain transition points (for example moving from middle school to high school; taking standardized tests such as the SAT, LSAT, medical boards or bar examination; or receiving a significant promotion at work) the attentional system may become overwhelmed, emotional symptoms become more pronounced, and psychiatric care becomes necessary.
Living with a loved one suffering from ADHD is also emotionally painful. Life with someone who frequently misplaces or loses belongings, forgets to accomplish chores or duties that were seemingly explained and understood, procrastinates, is disorganized leading to messy bedrooms and assignments, acts impulsively due to a lack of planning, and is distractible in a way that seems like “they just don’t listen,” can lead to feelings of anger, frustration and exasperation. There is also the experience of sadness in watching a loved one struggle with some of the routine demands of everyday life.
The good news is that ADHD is highly treatable, and that medication, education, exercise, and cognitive/behavioral therapy can be “game changing.” Not uncommonly a stimulant medication can improve symptoms 80% to 90% by improving the speed, efficiency and consistency of information processing. Typically the most stubborn symptoms to treat are procrastination and disorganization, which often respond to higher doses of the stimulant (which mainly boosts dopamine levels), or require the addition of Strattera (which boosts nor-epinephrine). Simple organizing techniques such as the use of a PDA, a spiral notebook (not Post-its), and habitually returning personal belongings back to the same location, can be helpful. Specialized neuropsychological evaluations, psychotherapy and educational services, providing tangible techniques to improve study skills and workplace performance, can also bring about increased feelings of mastery and success, and result in improved self-esteem. Effective treatment of ADHD not only enriches the life of the person suffering from the condition, it also enhances those important relationships at work and at home.