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Cogmed Working Memory Training Outline: Everything You Want To Know About ADHD
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Return to ADDvisor Volume 2 2000 Index Number 18 September 15, 2000 In this issue: 1. Clinical Subtypes of ADHD and Medication 2. Resources - The Anxiety and Phobia Workbook
CLINICAL SUBTYPES OF ADHD AND MEDICATION
Wednesday night I attended a lecture by Robert D. Hunt, MD, a psychiatrist from Nashville, TN. The lecture was sponsored by Shire, the company that makes Adderall. As part of his talk, Dr. Hunt described the clinical subtypes of ADHD. He called them:
Cognitive Dysfunction: Inattention Subtype Symptoms: Distractibility, Disorganization Co-existing: Depression, Anxiety, LD Course: Later Onset; Persistent Course Gender: Equal male and female Medication: Stimulants This appears to be ADD without hyperactivity. Because these individuals are not troublemakers, they are identified later but their problems persist. Dr. Hunt reported that these individuals respond to stimulants (Adderall, Ritalin, Dexedrine). Overaroused: Hyperactivity Subtype Symptoms: High Activity; Aggression Co-existing: Acting out, Aggression, ADHD Course: Early Onset; Diminishing Course Gender: More males than females Medications: Clonidine; Tenex The hyperactive kids are picked up fairly quickly because they are such a handful. Their course is "diminishing" because as they grow into adolescence and adulthood, their hyperactivity often transforms into a subjective restlessness. Clonidine or Tenex are used to help "slow them down." Dr. Hunt calls this type, the "Tornado." Behavioral Inhibition: Impulsive Subtype Symptoms: Excessive talking, Touching, Reacting Co-existing: Oppositionality, Aggression Course: Later Onset; Decreasing Course Gender: Equal males and females Medications: SSRIs (Prozac, Paxil, Zoloft, Luvox, Effexor, Serzone, Celexa) and Stimulants (Adderall, Ritalin, Dexedrine) Individuals of this subtype are described as immature, emotive, talkative, touching, moody. They often behave inappropriately. Social skills are often a problem. Medication combinations are often used with this subtype. Dr. Hunt also talked about "sculpting" the medication dose for the individual. Medication choice and dosages are determined by factors of age, mood and aggressivity. Factor of Age When using stimulants, Preschool and primary age children may be given Ritalin or a combination of Tenex and Adderall (as young ADHD patients are more likely the hyperactive type). Adolescents are given Adderall, Ritalin or Cylert. Adults are given Adderall or Dexedrine Spansules. Factor of Mood If the ADD individual is depressed, the irritable patient will be given Paxil or Effexor. The anergic (reduced sensitivity) patient is given Wellbutrin or Celexa. The bipolar patient is prescribed Carbatrol, Depakote or Lithium. Factor of Aggression If the aggressive patient is hyperactive, Ritalin or Tenex plus Adderall is prescribed. The very emotional aggressive individual is either treated with Carbatrol or Depakote for their mood instability or Effexor or Paxil for depressive symptoms. The impulsive-aggressive patient is treated with Inderal or Tenormin; or with Adderall. Dr. Hunt stated that these choices are not necessarily the only ways that these conditions should be treated. Many other factors may play into the medication decision. If you or someone in your family is taking medication, you should always be following up with the prescribing physician. As always, the only way medication can be effective is if it is taken in accordance with the physician’s directions. Dr. Robert Hunt is the Medical Director and CEO of Centers for Attention. His web site is www.centerforattention.com. He also is at Vanderbilt University.
RESOURCES
Anxiety is often a co-existing problem that accompanies ADHD, especially in older adolescents and adults. To help manage anxiety, I recommend The Anxiety and Phobia Workbook by Edmund Bourne.
CONTACT INFORMATION _______________________ Alan R. Graham, Ph.D. Bill Benninger, Ph.D. ADDvisor.com Voice: 1-866-ADDvisor Fax: 847-824-2386 Email: Alan@ADDvisor.com Bill@ADDvisor.com Web: www.ADDvisor.com
c) Copyright 2000 Alan R. Graham and Bill Benninger. All rights reserved The above material may be retransmitted or distributed to whomever you wish as long as not a single word is changed, added or deleted, including the contact information. However, you may not copy it to a web site. Republication of "The ADDvisor" in paper media is encouraged and permitted by organizations and associations which serve parents of ADHD children at the national, state and/or local level as long as the issue is reprinted in its entirety without charge and includes the contact information. With advance permission, we are happy to edit an issue to fit your space requirements. Republication is also encouraged under other circumstances, however, the advance permission of Alan R. Graham and/or Bill Benninger must be obtained in the event that changes in the text are desired or republication is to be made by individuals or by organizations other than those mentioned above.
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