27 Jun DEAR POSSIBILITIES
Your questions about ADHD and Learning Disabilities answered by
Brenda S Miles, PhD C Psych, Clinical Paediatric Neuropsychologist and Dr. Doron Almagor, MD MRCPC, Child, Adolescent and Adult Psychiatrist
I’m a 34 year-old father and lawyer living in Los Angeles. Recently I was diagnosed with ADHD. I’ve been working with a coach and making progress. I’m really happy to know that it was ADHD (and not me) that has given me trouble all these years! I’m still working through lots of shame and guilt about some major mistakes in my life, but I think it’s time to finally try medications and maximize what I can get from coaching. But I want only the best medication and I don’t want to take any chances. What’s the best medication available right now in 2020?
Wanting the Best in LA
Dear La La Lawyer,
Ah, Los Angeles—sun, surf, celebrities and, of course, the biggest botch-up in Oscar history! We remember it well. It’s 2017 and Warren Beatty and Faye Dunaway are announcing Best Picture of the year. Beatty examines the card, hesitates, and then says, “La La Land!” The cast and crew run to the stage, hug, cry, and celebrate. Warm feelings all around, right? And then the glorious Hollywood bubble bursts for the La La crowd. “Oops, actually the real winner is…Moonlight!” Um, well that was awkward—and a really big mistake as far as live TV goes.
So, La La Lawyer, this is your life. We get it. You’ve made progress and you want what’s best. And the last thing you want is some botch-up that downgrades your life from Blockbuster potential to bottom of the B-list. But here’s the deal…
[Insert dramatic movie music here]
The very best medication for a hotshot Hollywood lawyer is…Envelope, please.
THE MEDICATION THAT WORKS FOR YOU!
We’re not kidding, and there’s no mistake. That really is the best answer we can give you. Case closed.
All right, all right. If you’re the guy who sits through every credit at the end of every movie because you live for the fine-print, here are some deets. There are many medications for ADHD and they fall into two broad categories: stimulants and non-stimulants. In Canada there are lots of choices, and in the United States there are even more! Some medications last for 3 hours, others last for 16. Some medications will agree with you. Others may not. Whatever medication you cast ultimately into the story of your life, know this. You can’t make this decision all by yourself. You need a director for this process—or a medical doctor to be more exact—who will work with you to find the medication that works best.
Finding the best fit, even with an expert, is going to take some time. And that’s okay. You said you wanted the best, right? And maybe for some directors, finding the right actor for the right role in the right movie at the right time happens right away. But lining up all those rights in a row is kind of a rare thing when it comes to treating ADHD. In fact, when it comes right down to it, finding the right fit for you will probably take some trial and error. And that’s all right. When have you settled for an off-the rack suit to close a multi-million dollar deal with Universal Pictures? Um, never? You deserve tailor-made, just for you. The same can be said for medication.
Now this treatment tailoring might seem a little Rocky (Best Picture, 1977) at first, especially if you’re anxious to find the right fit right away. But be patient. Work with a specialist and stick with the process. In the end, it’s not about finding the Best ADHD Medication in 2020. It’s about crafting your Best Life with expert advice, and supporting what’s great about you From Here to Eternity (Best Picture, 1954).
We are a happy family of four in Ottawa. I think we probably all have ADHD, but it’s our youngest daughter who has been diagnosed. She’s a fun-loving, bright and caring child in Grade 7. She’s doing pretty well at school. The teacher has noticed that sometimes she’s daydreamy and misses things, but she seems smart enough to figure things out without hearing everything! And she works really hard so her grades are always good. The doctor says our daughter’s ADHD is “mild”. Does mild ADHD even need to be treated if she is doing so well?
Mildly Concerned in Canada’s Capital
Dear Concerned with a Capital C,
Great question! And we are more than mildly intrigued. But what of this word, mild? Mild definitely has its place. Mild Chili. Mild jalapeños. Mild cheese. But mild doesn’t really work when it comes to describing ADHD—at least not the way we think about it. Okay, for the record, the DSM-5 (which is a really big book for clinicians that describes symptoms of different diagnoses) does say you can classify conditions into mild, moderate or severe. So you might see “mild” ADHD on your daughter’s assessment report. But ADHD makes life challenging—and even mild challenges are, well, challenging. Ever stood at the water cooler with a “mildly challenging” colleague who doesn’t quite share your political views? Ever endured two months of “mild” insomnia? Okay, you get the idea. Mild challenges can add up!
Your daughter sounds really bright. And you need to be pretty brainy to miss___________________and still know what’s going on. See what we did there? We took something out and you still got the drift, right? But as your daughter keeps moving through school and her teachers talk about ____________________, and ___________________, and the Roman Empire ________________________, and then ____________________, it might be tougher for her to keep up. Right now she’s working hard, but she may need to work even harder because ADHD makes focus difficult, and organization difficult, and finishing assignments difficult, and remembering you have that exam tomorrow difficult! Mild ADHD is that pebble in your shoe, always reminding you that walking would be a whole lot easier without it. Sure, it’s not a rock in your Crocs or a boulder in your Manolo Blahniks, but a small pebble can stop you in your tracks—and so can “mild” ADHD.
So, should “mild” ADHD be treated? Yes…because it’s ADHD.
Science says that children, teens and adults who have ADHD enjoy the best outcomes in life overall when a combination of treatments is used. Here’s our advice. Take some time and think objectively about what is tough for your daughter, even if you’ve been told her ADHD is mild. Talk with your daughter for her own perspective, too. How much time does she spend trying to keep up with homework and assignments? Does her mind wander, even when she tries to focus? Does she feel tired or anxious or angry or frustrated? Talk to the teacher, too. Does the teacher notice gaps in your daughter’s understanding? Is your daughter easily distracted when the classroom gets noisy? Once you think systematically about what’s challenging, and how hard your daughter is working to overcome difficulties, you can begin to determine how much she is affected by ADHD. Then speak with your child’s doctor or paediatrician about treatment options and move forward with a plan. Act now, rather than waiting to see what happens, so mild concerns don’t turn into much bigger ones.
ASK US A QUESTION!
Dear Possibilities is an advice column offered through the Possibilities Clinic headquartered in Toronto, Canada. Ask anything about attention, behaviour, learning, ADD, ADHD or Learning Disabilities in children, adolescents and adults and Dr. Doron Almagor, MD, a neuropsychiatrist, and Dr. Brenda Miles, CPsych, a neuropsychologist, will answer. We can’t offer specific diagnostic or treatment advice for you or your child—that would require a personalized appointment—but we’ll do our best to answer general questions. When you share what’s on your mind, we’ll know more about the kind of information you’re looking for. So, please, ask us a question. No matter where you are in the world, we’re here and eager to help! Submissions may be edited for clarity and to protect confidentiality.
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