Here are some interesting facts about the two stimulant families, methylphenidate (Ritalin, Concerta, Metadate…) & Amphetamine (Adderall, etc.)

• Stimulants appear to be less effective on ADHD in children who are also on the Autism Spectrum  and those who’s ADHD is brain injury related.
• Stimulants don’t directly effect executive function.  (However, it is my non-scientifically validated opinion that being able to concentrate helps ADHD’ers work on their executive function issues.)
• Metadate CD capsules can be opened and sprinkled on food for kids who have trouble with the pills.
• New research indicates that there is no statistically relevant difference in hight with medicated kids.  There is a lag in growth, but it appears that we catch up. There is a slight difference in weight.
• Generic drugs only have to be within 20 – 30% of the original’s effectiveness.  Most of them are made by the same drug makers that produce the name brand though.  However, my personal experience is that I respond differently to generic Ritalin, though my insurance won’t let me get the name brand any more.  (The same goes for Catapres/Clonadine.)  But, I’ve actually found that I respond better to specific generic producers.  When possible, I order these meds by producer.

Here are some interesting contrasts between the two families:

• Dosing can be a little harder with the methylphenidate family.  (I’m going to call it the Ritalin family from now on to save on my typing.)  It is only 10 – 30% bioavailable.  That means that a relatively little amount of the drug the you take actually gets in to the blood stream.  It can be more effected by metabolism etc.  The Amphetamine family, (Adderall from not on,) is about 80% bioavailable.
• Ritalin is not effected by being taken with food.  Adderall can be.  Some research indicates that Adderall is less effective in an acidic medium.  (So don’t take it with a huge glass of grapefruit juice.)
• Our body adjusts to the Ritalin some time within the first 6-12 months.  Therefore, it is likely that the dosage will need to be adjusted upwards once in that period.  This is a one time body adjustment and will not need to be repeated   (There are other reasons why dosage might need to be raised at a later date though.)
• The mechanism of action is different.  (It is my understanding that,) Adderall actually aids in dopamine production, while the Ritalin blocks dopamine’s re-uptake.

One last interesting note on extended release forms of Ritalin.  (I hope I get the actual numbers right.  I have to go on my ADHD affected memory because I can’t find my notes on this one…)

• Ritalin LA is an 8 hr dose that give 50% of the drug at the beginning and 50% on the back end.
• Concerta is a 10 – 12 hr dose and  Metadate is a 6 – 8 hr dose.  They give about 30% up front and 70% through the rest of the dose.

Hope this helps those who wanted to know more about ADHD meds.  I think the next post will be on ADHD and substance abuse…  but we’ll see what strikes my fancy!

This hit me pretty close to “where I live.”  My father was finishing lunch with a friend less than a block away… and was getting ready to head over to the race.  We couldn’t get in touch with either of them until they arrived back home more than an hour later.  My wife works downtown at a space that hosts marathon-related events.  I am beyond thankful that I don’t have more of a story to tell than that.  But this post isn’t about me.

This about US.  Whenever a tragedy like this happens, I am struck by the stark contrast of this horrible day, from every other day, (since September 11th.)  I always hope that tragedy can bring us perspective.  All to often I think we as Americans take for granted the “blanket of freedom” and safety that is provided us every day.  As a parent, this sort of thing is even more terrifying than I ever thought anything could be.  I know what kind of person I am.  If I had been there, I like to think that the “5 years ago me,” would likely have run toward the disaster to help total strangers.  I also know that if I had been there yesterday, my first and only thought would have been for my 4 year old son.  The first thing that I’m grateful for is that I wasn’t there, and that I didn’t have to make that decision.  I was safely at home with my son a town away in Milton.  Still, I would not leave the house with my son, until hours later when it was safe for us to drive downtown to pick Mommy up.

Our planned trip to Chuck E. Cheese seemed somehow risky to me.  Letting my wife take the train home was out of the question.  I think it is appropriate for us to be tremendously grateful for what we have in this country on every other day.  Terrorism’s goal is to make us question how safe we are at the very times and places where we should be safe.  Acts of terror perpetrated on our soil like Oklahoma City, the Olympic bomber, 9/11, the Unabomber, etc are horrific.  But, their iconic milestone stature in our society speaks to their infrequency.

Beyond the immediate safety of my family, I am grateful for much else today.   I am grateful for the safety and security we have every day.  It is a far thiner line than we think that separates us from lawlessness, fear, and anarchy.  I find myself imagining what it must be like to be a parent in other places in the world.  And, not just third world countries.  When we hear about genocide in places in Rwanda it is far to easy to dismiss it as something that happens to “other people, somewhere else.”   Maybe because it it Africa.  Maybe because it is just to hard for us to imagine evil on such a large scale.

But, I wonder what it would be like to get on a city bus with my son in Tel Aviv?  How quickly did Yugoslavia descend in to neighbor killing and raping neighbor?  Can you truly protect your family from the cartels in certain parts of Mexico?  Is any successful businessman safe from being kidnapped in Venezuela or Columbia?  Imagine what daily life is like in Syria right now?  How about Iraq.  10 years after Saddam, you still might not know if you’re going to die in a bomb blast when you go to the market.  Imagine living like that?   I’m grateful that we don’t have to.

I’m also grateful for all of our men and women in uniform around the world.  We talk about how traumatic the sights and sounds of yesterday are, and rightly so.  We talk about it being impossible to forget.  Well, let’s consider what our returning service men and women have seen and done.  Even the most hardened soldier is still a human being.  My heart goes out to all human being who have had to witness things like this.

I am grateful to our law enforcement community and our nation’s commitment to keeping us safe.  Think about today, the next time you want to complain about airport security.  Know that a starting State Police Officer in MA makes 43.5K to risk his life everyday.  Kids or not, that Statie doesn’t have a choice.  His/her job is to go toward the blast.  As a society, we should respect that commitment on any Tuesday afternoon, not just today.

This might be rambling and not particularly well written.  I’m okay with that.  I just needed to get this out.  It is part of my healing process.  I guess what I’m trying to say is that I’m scared.  I’m scared for my family and myself.  I’m angry at what has been taken away.  But, I’m tremendously grateful for what we still have. I hope we all are.

The following is a redacted copy of a letter I wrote for a client recently to help her get the accommodations her daughter needs.  I honestly don’t know if it will be helpful or not.  I don’t know if they even consider the professional opinion of a coach.  I thought it would be interesting to share, both as a practical document and in terms of addressing the larger philosophical issue of what to do with our ADHD children, especially the bright ones.  (FYI: I haven’t met the dumb ones yet.  Misunderstood and struggling: yes!  Dumb: no way!  Perhaps my next post will be on our need to redefine “smart” in our school system and in our society.)

April 2013

To Whom It May Concern:

Hello.  My name is Matt Reid, ACC, AACC.  I am a certified ADHD coach.  I am located in Milton, but have clients with ADHD between the ages of 13 and 60 across The United States.  I also teach and speak to parents groups, support groups, and groups of teachers on ADHD related topics across New England.  I also have ADHD myself.  I primarily work with my clients one-on-one, but occasionally am asked by parents to get involved in their interactions with their respective school systems.

This letter is to support [Removed] need for accommodations at [Removed] High School.  It is my intention to add depth to the rather brief letter provided by her doctor.  [Removed] came to me this winter with a legitimate medical diagnosis of ADHD, (combined type.)  During the course of several sessions I had with [Removed], I saw no reason to doubt the ADHD diagnosis.  She is classically ADHD, having trouble maintaining focus and sitting still.  These issues are greatly improved through the use of medication, but are not by any means eliminated.

[Removed] is typical of many of the ADHD teens with whom I work. She is very bright, but her functioning is considerably affected by their ADHD. This type of kid represents a large subgroup of the ADHD population.  Unfortunately, it has been my personal experience for more the 25 years and my professional experience for as long as I have been an ADHD professional that school systems often do not know what to do with very smart kids with ADHD.

First off, I want to say that it is not my intention to come across as argumentative, or aggressive. I certainly don’t want to make any accusations about the [Removed] Schools, [Removed]   Unfortunately, my experience, more often than not, has been that this sort of issue can up being rather contentious.  Here’s to hoping that [Removed] is the exception, but I can tell you what I see across the state on an almost daily basis: Often the school sees a kid who isn’t quite failing, doesn’t seem to need any subject-specific help, is wildly inconsistent, and may appear unmotivated or lazy.  As a result, the system doesn’t make much of an effort to be supportive of or flexible for that student.

I worry that this is exactly the situation [Removed] could find herself in. With [Removed] and students like her, it is supremely important to peel back the layers and see what is going on underneath.  Any good ADHD clinician knows that there are two equally important questions to ask when assessing the effects of the disorder.  First, what is the person not able to do because of the diagnosis?  Second, what is the person able to do, but at a tremendous and unreasonable cost?  It is apparent that [Removed] falls definitively in the latter category.  She is clearly intellectually capable of succeeding in her current course of study. However, without substantial changes in the structure of her learning environment, her ADHD will not let her succeed due to the volume of output required. (It is tragic that kids who are smarter, hard working, and with better compensation mechanisms often have a harder time qualifying for the help that they need.)

The bottom line is that her current situation is untenable.  I cannot speak directly to what went on in junior high, as I was not working with [Removed] at that time, but I’m told she was happy and successful.  She liked school, was on the above level track, and was on the honor roll.  By the time she found her way to my office only half way through her first year at [Removed] High, she was angry, anxious, stressed, sleep deprived, and literally hated school.  She was doing six to seven hours of homework a night to barely get by, not sleeping, and under a constant level of stress that I would not wish on any adult, let alone a high school freshman.  (Incidentally, there is actually a growing body of research suggesting that serious long term psychological and neurological damage may be done to teens when subjected to this level of stress over an extended period of time.)

In the case of ADHD students like [Removed], the worst possible solution is to just drop them down to less demanding classes.  For one, it doesn’t work.  If we dumb it down for them, the resulting boredom exacerbates the ADHD symptoms.  Often in this situation the kids don’t actually do any better.  Sometimes they even do worse.  It is a travesty when smart kids are told at a young age that they are somehow not as smart as they really are, simply because they process and produce more slowly than the neurotypical kid next door.

The philosophical question for kids like [Removed] is how to intellectually challenge them without killing them?   This is where “reasonable accommodations” come in.  I understand the perspective of the school.  My father was a teacher and administrator for 35 years.  I understand the instinct to be wary of kids trying to “get away with something.”  I can assure you that this is not that case of a kid/family trying to game the system.

The best thing from the school’s perspective, about kids like [Removed] is that the accommodations that benefit them the most often don’t require a substantial allocation of resources by the school.  Some of the accommodation I would recommend for [Removed] are as follows:

• Untimed tests.
• Extended time on written assignments.
• Competency based grading.  (The idea that if she learns the material, she won’t be graded down because she didn’t complete all 30 math problems.)
• Reduced course load, including the option to take summer courses to make up requirements.
• Inclusions of free periods in a lighter schedule so that she can choose a quiet environment like the library to get work done during the day, or to decompress from the stress of school.
• Relaxation of school requirements of how many years of a given subject she has to take to graduate.
• The option to include an academic support class in her schedule with the goal of helping her strengthen her executive functioning.

I realize this has become a rather lengthy letter.  Perhaps you can tell that I’m passionate about this subject and about helping ADHD kids, [Removed] specifically.  I went through exactly what she is going through 20 years ago at Newton North.  With most of these accommodations in place, I learned, excelled, and have become a successful, happy, productive adult.  I know that that is what we all want for [Removed] too.  With some institutional flexibility, creative outside the box thinking, and the right accommodations, I’m am confident that [Removed] will be able to succeed.

I am happy to make myself available for any questions or additional follow up.  Feel free to contact me at any time.

Sincerely,

Matt Reid, ACC, AACC

But, here’s the thing:  I was a chef for 13 years.  If it don’t taste good, I don’t want no part of it!  I’m a lot like your kids that way.  Which is why this is a great option for kids who struggle with eating in the stimulants.  Believe me, I’ve been there.  My parents forced me to drink those Ensure brand shakes out of a can.  Their awfulness still turns my stomach 25 years later.  Bottom line, it didn’t take a lot of supplementing as long as we worked my eating schedule around the meds.  But, if I had had access to this tasty treat, I would have enjoyed a daily smoothie without complaint…  maybe.

Matt’s World’s Yummiest Protein Shake

Ingredients:

1. 8 oz skim milk
2. 1 sm squeeze real chocolate syrup*
3. 1 heaping scoop Vanilla flavored Whey Protein powder**
4. 1/2 a banana, fresh or frozen***
5. 10-15 Blueberries, depending on size, fresh or frozen***
6. 2-3 Strawberries, quartered, fresh or frozen***

Method:

1. Start by measuring the milk in the caraffe of the blender.
2. Add everything else and blend**** until smooth.
3. It should fit in a Pt. glass with 1/2 a banana… though I like a whole one…

*I like Alaskah organic that I get at Whole Foods.  Good flavor, consistency, ingredients.

**I like the Whole Foods 365 brand.  Dissolves well, subtle vanilla flavor, and you can’t beat the price.

***I buy fresh berries when they are on sale, freeze then on a flat tray, then pack them in ziplocks. They last forever that way.  You can buy them frozen too.  As for bananas, I just peel and freeze those that are about to go bad… but not quite and use them for shakes or banana bread.  I do use them fresh, but actually prefer the consistency of the shake when the banana is frozen.  Use whatever in season fruit you like.  I did lots of peaches this summer.

****Don’t think you need a $500 Vita Prep to make a shake.  That’s one of the biggest scams going.  I have a retro model Waring 2 speed with a class caraffe that will always do my bidding and is silly easy to clean.  (They run about $100)  I’m sure you could do even better if making a shake is your only criterion.

HAPPY SHAKING!

WOULDA-COULDA-SHOULDA

All the Woulda-Coulda-Shouldas/  Layin’ in the sun./  Talkin’ ’bout the things/  They woulda-coulda-shoulda done…/  But those Woulda-Coulda-Shouldas/  All ran away and hid/  From one little did.

Shel Siverstein’s Falling Up

In an effort to avoid my own ADHD perfectionist tendencies, I choose not to edit, proofread, reread, obsess, ruminate,  hyperfocus, and generally get all mental about these posts.  I generally ask for forgiveness for typos, misspellings that spell check misses and the occasional gramatical mistake.

My incredibly helpful father (a former high school English teacher) and my helpful and very “detail oriented” mother (who used to be in publishing) have encouraged me to have someone edit my postings.  I think they are worried that these posts will “be out there forever” and that it will reflect poorly on me to allow such small mistakes to exist.  (By the way, they will both be reading this… how else would I have six whole people reading my blog?)

If and how I edit my blog is a really fundamental question.  Perfectionism is a serious issue that most of us ADHD’ers deal with on a daily basis.  We often drive ourselves and those around us crazy by obsessing over at best semi-important details in an unrealistic and unproductive pursuit of some kind of perfection.  (Perhaps I’ll do a whole entry on that soon.)

My fear when I started this blog was that I wouldn’t have the follow through to post regularly.  I didn’t want to post unimportant things just to be blogging.  I truly want this to be a forum for what I have learned and what I continue to learn on a daily basis about how to manage life with ADHD.  I made a conscious decision to post my disclaimer and just hammer out my thoughts, because I knew the biggest enemy of my follow through was perfectionism.

The whole idea of this blog is to help others with ADHD in two ways.  First, I try to offer real suggestions on how to manage your ADHD.  But, I also try to draw from my own life and experience, to be somewhat of a mentor and role model.  If I can show other ADHD’ers that I can get out of my own head and actually write new posts semi-regularly, I think that is much more powerful than proving to them that I can occasionally post a flawless essay on something or other.

Honestly, this has been in my blog’s draft folder for about a month.  I’ve been giving it some serious thought.  I’ve decided that I’m going to give my dad admin privileges so he can edit any active post, if he wants to.  But otherwise, I’m not going to worry about it.  If something doesn’t get edited, I’m going to continue to be okay with that.  And if someone reads something before it gets edited, so be it.

I feel that my ideas and my content are strong enough that they can sustain a few typos.  If anyone thinks otherwise, it is their loss.  And, again, believe it or not the typos go a lot further towards my feeling like a good ADHD role model than any content could. Remember, DONE well is always better than NOT DONE perfectly.