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Tuesday, May 25, 2010

To Focus or Not to Focus Part 2

I had the opportunity to interview board certified psychiatrist, Dr. Arthur Smukler.  He has had a private psychiatric practice for over 30 years and is on the faculty at UCLA.  Working with older adolescents and adults, he has a strong interest in helping people understand themselves and uses medication only when necessary.

Can you give the readers a brief overview of AD/HD?

1.  An inability to attend without hyperactivity.
Katie fits this category.  She was an excellent athlete who worked very hard in school and was getting all A’s and B’s.  The problem was that is took her 5-6 hours to get all of her work done.  She hated school and hated her life, was extremely unhappy because she never got to be with her friends and enjoy being a child. 
2.  An inability to attend with hyperactivity. 
Billy fits this category.  He can’t sit still in school.  His teachers have always sent notes home about his inability to control himself and his body.  He constantly interrupts the teacher and other students at inappropriate times.  He starts to do his homework and then forgets it.  He is bright enough to do the work but can’t finish it without someone standing over him.

3. A combination of both, hyperactive and inattentive varying at times.
 Hugo fits this category of a combined inattentive and hyperactive child.  At times he stares off into space like a dreamer when people are trying to talk to him.  Other times he is moving his legs in rhythmic annoying motions, tapping his fingers, interrupting conversations, and making jokes when other people are trying to talk.  At times he can’t do his homework.  He has to be told numerous times to do his chores because he keeps getting distracted.  Like in most disorders, nothing is exact; it is a mixture.  

Please refer to the The DSM IV Criteria.

In addition, AD/HD can be associated with other psychological problems, which is understandable because if someone can’t concentrate and do a good job at school they are going to feel badly about themselves.  This can lead to depression or anxiety or behavioral problems, etc..

Can you explain the brain of an AD/HD person?

What happens in the brain of someone with attention deficit disorder is that thoughts can’t be productively harnessed and they wind up going all over the place because the brain physiology is flawed.  It is flawed because the brain has flawed wiring.  It is unable to get from point A to point B without going all over the alphabet first.

One big question I always get from parents is, “How come my child can focus on his video games for hours, but can’t get his homework done?”


Great question.  When a child is interested in what he is doing, he is excited and stimulated.  This then excites a part of the brain that helps the child focus.  Therefore, his focus is more productive and goal oriented.  When a child is called upon to do something that is not interesting, his focus lags and his mind goes all over the place.  That speaks to the actual treatment of attention deficit disorder.  

What is the treatment?

The treatment is counterintuitive.  We prescribe stimulants, which one would initially feel would make it all worse because if someone can’t focus and you give him a stimulant you’d think that he’d be even less focused and more scattered.  That is not the case.  When stimulants like Ritalin or amphetamines such as Adderall  are prescribed, it helps the brain work in a more efficient manner so that the child and or adult can concentrate effectively.  It evens out the playing field so that the child who can’t concentrate effectively, can now in a healthy manner, start a problem and efficiently complete it without wasting hours and hours.

What if a family doesn’t want to use medication?

The family needs to be questioned as to why they have this narrow outlook on helping their child.  Would they not prescribe insulin if their child had diabetes or antibiotics if their child had an infection or calcium for a bone deficiency? Parents need to be educated because their fear is that if children are placed on these medications they may become addicted and the medications may hurt them.  These are loving parents who may not understand how stimulants don’t create problems for the child with AD/HD, but rather, resolve the problem.

Any last words of advice for parents?

Yes, keep an open mind.  If you don’t understand what the professional is recommending, ask.  Professionals aren’t always right, and you know your child.  If you see a doctor who won’t collaborate and learn from you about your child and you learn from the doctor, then find someone you can comfortably relate to.  Attention deficit is a long-term problem and often children with AD/HD go on to be adults with AD/HD, so dealing with this problem early can be a major benefit to your child both as a child and as an adult.  

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