Living with ADHD - Online Conference Transcript

Dr. Richard N. Rubinstein, M.D., is a medical doctor with 35 years experience treating patients with Attention Deficit Hyperactivity Disorder (ADHD). He is author of the book, Living with ADHD and is our featured speaker.

Natalie is the RealMentalHealth.com moderator

The people in blue are audience members

Natalie: Good evening, everyone. I want to welcome everyone to the RealMentalHealth.com website.

Tonight's conference topic is "Living with ADHD" which is also the name of the book written by our guest, Richard Rubinstein, M.D. He is a psychiatrist based in Indiana. Dr. Rubinstein has 35 years experience treating patients with Attention Deficit Hyperactivity Disorder. Dr. Rubinstein maintains that people with ADHD do not have to suffer and that there’s plenty of help available if you just know where to look.

Good evening, Dr. Rubinstein and welcome to RealMentalHealth.com

Dr. Rubinstein, because people here have different levels of understanding, could you please briefly explain what ADHD is?

Dr. Richard N. Rubinstein: Yes, Natalie. ADHD is Attention Deficit Hyperactivity Disorder and is abbreviated to either ADHD or ADD, both of which refer to the same condition. ADD is an older term, but ADHD refers to the condition whether or not hyperactivity is present.

There are 3 types of ADHD:

1. Inattentive type: This means that people have trouble concentrating or focusing and are easily distracted. They usually start many tasks without finishing them.

2. Impulsive/Hyperactive type: People with this type are able to focus but have problems sitting still.

3. Combined type: These people display both the inattentive and impulsive/hyperactive traits.

Natalie: How do you know if you or a loved one has ADHD?

Dr. Richard N. Rubinstein: One way is to take a computerized diagnostic test. However, this is seldom necessary. An evaluation by an experienced psychiatrist or other physician can determine this, but in my experience, it's very common that a person or family member can recognize the primary or secondary symptoms. Inattentiveness is shown in some of the following traits:

Not being able to concentrate or focus. Hyper-focusing. This is almost the opposite. People often mistakenly believe that people with ADHD can't focus at all, but they often focus on one thing to the exclusion of everything else.

These people are usually easily distracted, except when they are hyper-focusing. They tend to be forgetful and often "space out." They tend to be late or unreliable and they tend to procrastinate.

As I mentioned, a very characteristic trait is that they typically start things but don't finish them. When people answer yes to a question about that, they almost always turn out to have ADHD.

Natalie: By the way, we have a lot of ADHD information on our site right here. We focus on mental health treatment information and we're home to the first and only social network for people with mental health conditions as well as their family members and friends.

For everyone joining us tonight, you can find more information, and buy Dr. Rubinstein's book "Living with ADHD" when you click on this link.

Dr. Richard N. Rubinstein: I might add, Natalie, that the book is available as an ebook or a 2-CD audio set because many people with ADHD can't concentrate on a book. They are both available on the website. If someone orders the CDs, they can also download the MP3 files.

Natalie: Dr. Rubinstein, many parents with children who have ADHD and even ADHD adults feel that it means there's a lifetime of problems ahead. Is that true?

Dr. Richard N. Rubinstein: Without treatment, that tends to be only too true. But the good news is that with the proper treatment, people with ADHD can have normal, productive lives. It's especially important to diagnose and treat ADHD early in children because their development is severely hindered if their symptoms go untreated. Their academic performance suffers. Their self-esteem doesn't develop properly. Their interaction with their peers is impaired.

Natalie: We have several audience questions which fit in here. I'll post one at a time and then Dr. Rubinstein will answer them. Then I'll continue with the interview.

CMarsh: Dr. Rubinstein - what is the process when someone is diagnosed.

Dr. Richard N. Rubinstein: The diagnosis is generally made in a clinical interview. It's best to include a family member who can give a more objective point of view. Of course, in the case of a child, the presence of a parent or other person is mandatory. The diagnosis is usually not difficult once a complete history is obtained. In the case of children, a report from teachers is quite helpful.

Once the diagnosis is made, a treatment plan is formulated. Normally, this includes medication such as various forms of methyl phenidate (Ritalin), amphetamines, such as Adderall or Adderall XR, or non-stimulants, such as Strattera and Wellbutrin.

Soon Provigil is likely to be approved for ADHD too.

Natalie: You mention that a diagnosis is not too difficult -- yet I read articles that say many times, especially with children, a person can be misdiagnosed as bipolar or with some other condition. Is that because the symptoms are similar or because the person performing the evaluation is making mistakes or is unqualified to do so?

Dr. Richard N. Rubinstein: It's more the latter. It's essential that the evaluation be done by a trained, experienced person. It's not uncommon for the "diagnosis" to be made by teachers who consider any disruptive child to have ADHD. Several teachers have told me that they've seen their colleagues label boys with normal aggressive traits as ADHD. It's not uncommon for a teacher or principal to tell parents that their disruptive child cannot return to school until he or she is on medication.

Natalie: And so, who is the proper person to perform this evaluation?

Dr. Richard N. Rubinstein: The initial evaluation should be done by either a pediatrician with training in ADHD diagnosis or a psychiatrist. In the case of a child under about 12 years old, the psychiatrist should be specifically trained in child psychiatry.

Natalie: By the way, for everyone here tonight, I encourage you to sign up here for our newsletter. It's free and we'll notify you when the transcript is up and of other events happening on the RealMentalHealth.com website:

Here's the next audience question, Dr Rubinstein:

stacyloaks: How young is too young to be diagnosed with ADHD?

Dr. Richard N. Rubinstein: There's no hard and fast rule -- and I don't treat very young children -- but I don't think it would be a good idea to diagnosis a child younger than five or six.

Natalie: I want to get to treatment for a moment...and then we'll also be talking about ADULT ADHD.

First, and I know you are a psychiatrist, but is medication the best treatment for children and adults with ADHD or are there other methods of treatment that work as well?

Dr. Richard N. Rubinstein: There are other treatments, such as behavioral therapy, life coaching, and psychotherapy, but generally medication should be included as part of the treatment. Keep in mind that ADHD is essentially a brain disorder with an organic basis. Talking alone has its limits in terms of how much it can modify/improve brain function.

Natalie: And is medication a life-long treatment or does that change?

Dr. Richard N. Rubinstein: For adult ADHD, medication is a life-long treatment, but a good percentage of children with ADHD are largely symptom-free by the age of 20.

Natalie: We have a lot of audience questions, so I'm going to get to a few right now:

ktsul: Our son had an evaluation that took over a year: major/minor motor skills & psych testing. Now that more is known- are there newer methods of testing?

Dr. Richard N. Rubinstein: For a young child, formal testing may sometimes be needed, though in most cases a thorough clinical interview by a skilled practitioner is enough. I can't see any reason that it should take a year

Natalie: Here are more questions from our audience.

Andy: What about Adult ADD? I was recently diagnosed by a specialist, and I am now on medication (Straterra), but have yet to see any real improvement (it's been 4 weeks). Will that change?

Dr. Richard N. Rubinstein: Andy, you may or may not improve on Strattera. It depends on several factors. First of all, Strattera usually takes more than 4 weeks to work. Secondly, usually the success of Strattera very much depends on getting the right dose. 1-2 milligrams per kilogram (2.2 pounds). And Strattera doesn't work for everyone. I find that Strattera is less likely to work than the Ritalin or amphetamine products, but its main advantage is that it's not a controlled substance and when it works.. it really works well.

With controlled substances, you can't get refills or phone prescriptions and they are prone to being stolen for their street value.

prov1717: I find that losing things, disorganization, etc. increases my tendency to become depressed. Is it common for depression to accompany ADHD?

Dr. Richard N. Rubinstein: Yes. I think that living with problems like that would tend to depress anyone

lesia: Dr Rubinstein My son is 9 and taking Concerta 54mg. He has so many up's and downs. He has a hard time in school. We just changed his meds to the 54, would it be to soon to change them again? It's been 3 months.

Dr. Richard N. Rubinstein: It depends on what you mean by "ups and downs." If you mean that he gets depressed, then that needs to be treated separately. However, if you mean that the medicine wears off during the course of the day, he may need to take additional immediate release methylphenidate in the afternoon.

Natalie: On the subject of medications, is ADHD similar to Depression in that you have to find the right medication that works for you/your child? In other words, is it trial and error?

Dr. Richard N. Rubinstein: Yes, there is no way to know in advance which of the medications will produce the best results in one particular person

ktsul: Any new info on the stats for ADHD running in families? A majority seem to be boys?

Dr. Richard N. Rubinstein: ADHD is common in girls but is less often diagnosed because teachers are more concerned about a child's disruptive behavior in class than his or her difficulty concentrating. Girls tend to be less disruptive than boys most often, probably because of socialization.

wilens43: Our son takes Focalin XR in addition to Tenex. But we are still struggling with our son becoming very argumentative and angry at the extremes of the day. Any suggestions?

Dr. Richard N. Rubinstein: First of all, it's essential for your child to be properly evaluated. It's possible that the child has other problems, such as depression or bipolar disorder, either instead of, or in addition to ADHD.

ktsul: Does your book address the hurtles a parent has to overcome within the school system? ESE classes? IEP meetings? etc. My son is 17 now - the only reason he got an education is because I am proactive AND I badgered the school system.

Dr. Richard N. Rubinstein: The book does address steps that a parent can take, including support groups, but it doesn't specifically address struggling with an uncooperative teacher or principal

Natalie: Dr. Rubinstein's e-book can be purchased when you click here:

ClaimingMyPower: What do you think of the research of Dr. Daniel Amen?

Natalie: And could you please elaborate on who Dr. Amen is and a bit about his research?

Dr. Richard N. Rubinstein: I'm not familiar with Dr. Amen's work. I know that he's done work with imaging such as SPECT, but that's not been correlated clinically at this time.

prov1717: I live in an area of the country where I have not been able to find many ADHD coaches. Is this a new type of help for those of us with ADHD. Is the number of practitioners increasing and would you recommend this service?

Dr. Richard N. Rubinstein: ADHD coaching can be found online, so it is accessible to anyone with Internet access. This is for areas that don't have ADHD coaches. I would not, however, recommend using coaching INSTEAD of proper medical diagnosis or treatment.

Natalie: I want to thank everyone for coming tonight. And thank you, Dr. Rubinstein, for being our guest.

Dr. Richard N. Rubinstein: Thank you for inviting me.

Natalie: Good night everyone.

Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

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Reviewed: 09/2006