Speaker 0 00:00:59 And good evening. Thank you for joining disability and progress, where we bring you insights into ideas about and discussions on disability topics, and actually could be any time of the day that you're listening to this. Now, my name is Sam. I'm the host of the show. Charlene dolls. My research woman who's actually live in the studio. Hello, Charlene. Hello, everybody. And happy fall. I wanted just a couple reminders first that we are podcasted. So anything you do say or can say, could be held against you, um, but feel free to listen to the podcast. We've got lots of 'em up there and also if you'd like to be on our email list, you can email me at disability and
[email protected]. And tonight we have an awesome guest in with us and Dr. Walt KKI. Hello, Dr. KKI.
Speaker 2 00:01:50 Hi, how are you doing
Speaker 0 00:01:51 Today? Good. Thank you. Dr. KKI is a, um, is a developmental pediatrician and an author. And we're going to be talking about his new book, ADHD medication. Does it work and is it safe? Did I get all that correct?
Speaker 2 00:02:09 Yeah, absolutely.
Speaker 0 00:02:10 I just wanna thank you for being kind enough to give us your time. Um, thank you very much. That's uh,
Speaker 2 00:02:17 Oh my, my pleasure enjoying being here.
Speaker 0 00:02:20 So can we start out by getting a little bit of history on you and how you got into, um, pediatrician, why you decided that was your route?
Speaker 2 00:02:32 Well, uh, I, I, I initially I looked at the possibility of, uh, going into neurology or psychiatry mm-hmm <affirmative> and then I realized that when we're working with children with disabilities, that you have to be aware of both the neurology and the, um, the psychiatrist psychology of what is going on mm-hmm <affirmative>. So the only way to do that in medicine is to be a developmental pediatrician. Ah, a developmental pediatrician is kind of halfway between neurology and psychiatry, and we pride ourselves on considering both aspects of a child's development.
Speaker 0 00:03:10 Gotcha. Well, your book was a fascinating read to me. Um, and the ADHD medication, is it safe? Does it work? Um, can you give people, I think people have a lot of ideas of what they think ADHD is. Can you please give us a definition?
Speaker 2 00:03:33 ADHD is a neurologic condition, which, uh, interferes with the child's ability to focus and learn in a classroom type setting mm-hmm <affirmative>, uh, ADHD can also affect social development, uh, and other aspects of development as well, but primarily it is a disorder that affects learning and acquisition of knowledge, uh, concentration, uh, and, and ability to plan for the future as well.
Speaker 0 00:04:05 So talk about some of the symptoms that one might see if they are looking at ADHD.
Speaker 2 00:04:12 Well, the symptom that most people think about when they hear about ADHD is hyperactivity mm-hmm <affirmative>. Um, hyperactivity means, uh, a level of activity that is beyond what you would expect for a child. For example, a child who comes home from school and, uh, immediately, uh, runs outside, uh, jumps into the car to pretend like he's driving the car jumps out of the car, uh, knocks over a trash can. That type of impulsivity and hyperactivity, uh, is, is what we generally see in ADHD as well.
Speaker 0 00:04:47 Are there more than one type of ADHD? Is there more,
Speaker 2 00:04:51 Yes, there, there are three types and the primary type is the hyper or are the, the primary type is, uh, a combination of the first two types. The first type is the primarily inattentive type. So ADHD, primarily inattentive type. And that means that that children have the difficulty focusing, concentrating, uh, but they're not hyperactive and not impulsive. So they're usually diagnosed later because they're less obvious. Uh, and they're more often seen in girls than in boys. The boys tend to be more hyperactive, the impulsive, the girls tend to be more inattentive and, and what the teachers would call space.
Speaker 0 00:05:33 And would that be just a D D then?
Speaker 2 00:05:36 Yes. Okay. I'm sorry for, so, so the first, um, uh, form of ADHD is primarily in center type. The second form is primarily hyperactive or impulsive type, and the third type is combined. So, and, and the third type is really the most common. Most children have a combination of hyperactivity impulsivity on one side and the difficulties learning and concentrating and planning for the future on the other side.
Speaker 0 00:06:05 And so just to, um, clear up the acronym, a D H D attention deficit hyperactivity disorder. Yes. Yeah.
Speaker 2 00:06:15 And that doesn't make a whole lot of sense, does it <laugh> for, to call something attention deficit hyperactivity disorder, but then to say primarily inattentive type, meaning that they're not hyperactive or impulsive. Mm. So I suspect that we'll see another name change at some point in the future. Um, but, but leave it to say that the combined type is the most common type, the hyperactive impulsive type without the inattentive tension is the least likely to occur. Um, but for the most part, what we're looking at is impulsivity on one hand and difficulty focusing and concentrating on the other.
Speaker 0 00:06:56 So have,
Speaker 2 00:06:57 And those,
Speaker 0 00:06:58 Go
Speaker 2 00:06:58 Ahead, go ahead.
Speaker 0 00:07:00 Have the numbers changed throughout time or is it just my imagination that I feel like I'm hearing every other time about somebody being diagnosed with it?
Speaker 2 00:07:12 Well, um, ADHD is diagnosed in approximately seven to 8% of the population. And those studies that have looked at that, uh, incidence rate, uh, have found that same rate in many different countries across the world, using different techniques for making the diagnosis. And yet the, the number always seems to be around seven to 8%. Uh, does that seem like a I number to you?
Speaker 0 00:07:40 Well, I just feel like I know a lot of people who say they have ADHD.
Speaker 2 00:07:46 Okay. Well, let me, let me explain, let me tell you a story of what happened to me. Uh, not too long ago, actually, I went in to see my dermatologist mm-hmm <affirmative>, uh, and he was on vacation. So he, they asked me to see his assistant Uhhuh <affirmative> she walks in the room with my chart and she says, oh, you're a doctor. Uh, what kind of medicine do you practice? And I said, well, I'm a developmental pediatrician. I see children with ADHD and learning difficulties and, uh, cerebral palsy and anxiety and so on. And he, and she said, oh, ADHD that's overdiagnosed, isn't it
Speaker 0 00:08:23 <laugh>. And
Speaker 2 00:08:24 I looked at her and said, well, let me answer that question by asking you another question. Um, what is the incidence of skin cancer in? Remember she said a dermatologist have, right. So I said, what is the incidence of skin cancer in people over 60? And she said, oh, it's around 40%. I said, 40%. Wow. That sounds like, um, skin cancer's being overdiagnosed. And she said, no, no, no, no, not at, not at all. People don't take care of their skin. They don't, uh, they go out in the sun without putting sunblock on. They don't wear hats. They don't take her. Oh, wait a minute. I see what you're trying to do here.
Speaker 0 00:09:03 I, yeah, yeah, yeah.
Speaker 2 00:09:05 And basically what I was saying to her was that how often a disorder occurs has nothing to do with its validity as a diagnostic diagnostic entity. Mm-hmm <affirmative> uh, if you went home tonight and your husband said, oh, guess what? Uh, Kathleen across the street was diagnosed with leukemia. And you said, well, that's strange because I know ed next door was also diagnosed with leukemia a couple days ago. And, and then you find out over the next few days that seven people on your block have leukemia, what would you say? Would you say,
Speaker 0 00:09:40 I'd say it's time for me to
Speaker 2 00:09:41 Move
Speaker 0 00:09:43 <laugh> you,
Speaker 2 00:09:44 You would wanna exactly. You'd wanna find out what's in the water. What about those telephone lines that are running behind your house, right? Uh, you wouldn't say leukemia's being overdiagnosed. So how often a disorder occurs has nothing to do with, with its validity. When I see a child and I'm evaluating that child for ADHD, I, I, I, I've only got two options either. The, the, the prevalence of ADHD in my office is 0%, or it's a hundred percent because I've only got one kid in there mm-hmm <affirmative> and that's all that matters to me is working with that one child at that one time and knowing how often it occurs in other children is irrelevant to how often it occurs in that child.
Speaker 0 00:10:28 So it sounds to me like what you were telling me earlier is that ADHD with the hyperactivity is more common in boys and that without the hyperactivity is more common in girls, is this correct?
Speaker 2 00:10:43 That's correct. Yes.
Speaker 0 00:10:45 And so, but the, the, but ADHD or D D is it, should I just call the whole thing, ADHD to make it simple? Or do you want me to separate? I'm just curious. Is
Speaker 2 00:10:58 There, well, the current terminology is
Speaker 0 00:11:00 ADHD. Okay.
Speaker 2 00:11:01 And that's the same, um, designation I use in the book. So we might as well stick with
Speaker 0 00:11:05 That. Okay. Is there, is there a more com like, is it in general more common in boys than girls or is it equal opportunities? Well,
Speaker 2 00:11:14 That's an interesting question because when I first started doing this 40 years ago, mm-hmm, <affirmative> the, the research showed that the ratio of boys to girls was 10 to one that occurred much more frequently in boys than in girls. Mm. Um, about 20 years ago, I checked the research again and found that the incidents rate had dropped to 5, 5, 5 to one. So it occurred in five boys for every one girl that it occurred in more recently, it it's currently, the ratio is considered to be about three to one. And you can see that the ratio is coming down as time goes on. And I suspect in the future, as we discover more and more girls with the inattentive form, we will find that the ratio was actually one to one.
Speaker 0 00:12:01 Ah, just that girls tend to be diagnosed either later or maybe even not at all, because they have a different form
Speaker 2 00:12:12 A at you. Exactly. Yes. Um, either later or not at all. So I've, I've seen some girls that, that were not diagnosed until they were 18 or 19. I, one time I had a 72 year old, old woman come into my office and say she wanted an valuation for ADHD. And I said, well, uh, you're 72 years older. If we found find it, are we gonna start medication? She said, no, I just wanna know why I've been having so much difficulty my whole life. Oh,
Speaker 0 00:12:42 <laugh>.
Speaker 2 00:12:43 And indeed she did have ADHD. We did the testing. Mm-hmm <affirmative> she had a flagrant case of ADHD and she didn't start on medication because she simply said, I don't really need it right now. I don't run a position where I have to pay attention. I just wanted to know why I was having so much difficulty my
Speaker 0 00:13:01 Whole life. And I'm sure she was thinking, boy, it sure would've been nice if it was done like 50 years ago <laugh> or 60 years
Speaker 2 00:13:07 Ago. Exactly. Well, but 50 years ago, if they, if she had gone to her doctor, they probably, would've not, not diagnosed ADHD and her.
Speaker 0 00:13:16 So can you talk a little bit about the history of how it, it became a diagnosis?
Speaker 2 00:13:22 Sure. Um, let's let me, um, tell you another story. Sure. Um, let's imagine that we've been we're we're going back in time now a hundred thousand years, and you are a cave woman in living in a tribe of 30 other cave people a hundred thousand years ago. Mm-hmm <affirmative> your job every morning is to go out and pick berries for the, for the tribe's breakfast. Okay. And so one morning you're bent over a Bush, picking berries, putting them in your leather sat. And all of a sudden you hear a wrestling and the bushes behind you. What should you do?
Speaker 0 00:14:00 Look
Speaker 2 00:14:02 You what,
Speaker 0 00:14:03 Look to see what it is
Speaker 2 00:14:05 Exactly. If you and you turn around. And if you look and see that it's the wind, you can go back to picking your berries. You'll get back to the cave. The, the, the tribe will be happy that they had breakfast. You're more likely to, to have a spouse or a mate, more likely to have children. And you're more likely to carry that distractability gene to the next generation. Mm. Now what is what happens instead though, if you turn, you hear it, the sound rustling in the bushes behind you, and you turn to look and you find that it's a savor tooth tiger <laugh> then you run or you pull your knife and fight. But in either case your distraction from the picking the berries and, and paying attention now to the saber tooth, tiger saves your life. You get back to the cave, you're a hero.
Speaker 2 00:14:52 Um, and you end up mating with lots of different people in the tribe, and you have lots of children and you carry the distractability gene to the next generation. Ah, so distractability actually kept us alive for a hundred thousand years, right? And then suddenly about 150 years ago, we tell children that they have to start going to school. You can't just learn in your father's blacksmith shop anymore, or on the farm, you have to go to school, learn to read. And some of those kids who are highly distractable and impulsive, um, and who would've been leaders of their tribe are now gonna have difficulty in the classroom. Hmm. So what I'm trying to say here is that ADHD is not a disease like pneumonia is right. When you get pneumonia, a bacteria invade your lungs, grows in your lungs, prevents oxygen from getting to the rest of your body.
Speaker 2 00:15:49 And it, and in, in conscious some great difficulty, but in ADHD, there is no offending, um, insult like that. Instead, we, we know that in 80% of cases of ADHD, children inherited from the parents and maybe they didn't even know they had it because they were able to get along without that at for various reasons, or maybe it wasn't as severe in them that it is in their, in their child. Right. But in either case, uh, it is a real diagnosis and it deserves real attention and treatment, even though going back to that situation, you know, the first thing I could do as a physician is I could invent a time machine, send my kids back in time and let them be cavemen again. <laugh> but of course I haven't been very successful in, in developing time travel. So the second option is I could change the way children are educated in the United States.
Speaker 2 00:16:49 And, and I actually did attempt to do that. We started three or four different schools, four children with ADHD and learning difficulties. Those schools are still on ongoing Tampa day school in Tampa has about 155 students, uh, in, in, in the program. And the difference in that program is that we teach the way children learn instead of asking them to learn the way we teach. So if a child is not succeeding in school, it's not his fault. It's our fault because we haven't learned how to teach him. Now, that's the other way I could approach this. But then of course, that doesn't deal with college college experience. And when kids get off to college, they're not gonna have those kinds of, of educational programs for them. So they're gonna start having difficulty in college. So the next option is to try medication. Now, you might say that doesn't seem fair to start a child on medication who doesn't have a disease. And yet it is the only thing that we know that works now. And it distinguishes the difference between a happy child as an adult, as he grows up to be an adult versus a miserable child,
Speaker 2 00:18:04 We need. So the, the medication, uh, has dramatic effects on reducing hyperactivity, impulsivity, attention problems. It helps us focus and concentrate, um, and, and, and allows kids to do all the things that they want to do in a school setting or socially.
Speaker 0 00:18:22 Right. I wanna talk a little bit about, you know, we were talking about, um, you were talking about schools and things like that. I think that, sorry. Um, we talk about mostly, we think about kids having ADHD. I, I wonder how often does a kid grow out of having ADHD? Does it happen? And if so, how often does it happen?
Speaker 2 00:18:58 Well, the short answer, your to, to your question is, no, it doesn't happen. People don't outgrow ADHD. Um, they will still have the difficulty focusing and concentrating if they're not using medication, even as adults, as, as was the case in that 72 year old woman. Um, so
Speaker 0 00:19:18 Will they learn to manage it
Speaker 2 00:19:19 Better? You don't outgrow ADHD, but you do sometimes outgrow the need for medication. So for instance, if you have ADHD, but you marry somebody who is very detail oriented, who remembers to pay the bills on time, <laugh>, you'll do fine. And if you have an executive secretary, it reminds you where to be at certain times, then you'll do fine without medication. But, uh, if without those, without those comp compensatory strategies, um, every, every person with ADHD is gonna continue to have difficulty focusing and concentrating. Actually, there was one study that was done and they brought back children who had been diagnosed with ADHD. They brought 'em back at 24 years of age and asked them if they had the symptoms of ADHD. So they went through the whole list and only about 50% of the, the people that had been diagnosed with ADHD, uh, said they had the symptoms currently.
Speaker 2 00:20:17 However, the interesting part of that study is they, they then went to the parents of those 24, 25 year olds, and they said, does your son or daughter have these behaviors of these symptoms? And they found in almost 90% of the cases that the parents still saw, those problems occurring in their child, even though the child didn't see them himself or herself. So the, the, the symptoms do persist, but, but oftentimes adolescents and young adults feel that they can do it without medication and without the intervention, uh, or without any help. And some of them do fairly well. Some of them feel misery.
Speaker 0 00:21:01 I wonder if there's enough technology now that, that it can assist one and kind of make up for the shortcomings of, you know, what one may have had trouble with in some ways
Speaker 2 00:21:15 In, in what way would technology?
Speaker 0 00:21:17 Well, for, for
Speaker 2 00:21:18 Instance, I can think of a number of different ways, but what are you
Speaker 0 00:21:20 Referring to? Well, I, I don't know all the things that you might, but I was just thinking about, you know, reminders, right? Of, uh, there's so many reminders now on our phones that we can set alarms for them.
Speaker 2 00:21:31 Exactly. Well, there's actually, uh, programs in many of the large cities in the United States and even some of the smaller, uh, towns as well for ADHD coaching mm-hmm <affirmative>, uh, a coach, an ADHD coach is not the same thing. As a therapist, an ADHD coach works with a child to help them develop what are called executive function skills. Ah, the executive function is that little man that sits inside of your head. <laugh> that kind of dictates what you're gonna remember, what you're gonna forget. Right. Uh, what you're gonna say next, uh, it's, it's, it's kind of that little person sitting at the control panel, uh, running your brain and, and, and, and ADHD is almost like that person taking a break, uh, going off and, and, and running to the refrigerator and getting something else to eat, but not helping that person attend or concentrate or focus. Mm.
Speaker 0 00:22:27 I, I think if I remember correctly in your book, you said, um, there are like nine symptoms and six, when, when you're, when you're diagnosing children, they need to have six of the nine. Is this, did, am I remembering this correctly? Right?
Speaker 2 00:22:44 The, the, the current methodology from making the diagnosis is to find a predo first there's three steps that you have to do. Actually first, you have to find that the, the symptoms are present and not only present, but that they are causing difficulty. And that they're predominant, which means that they're there most of the time. So for instance, everybody forgets things once in a while, everybody gets distracted. Once in a while, everybody, uh, gets disorganized once in a while. Mm-hmm <affirmative> everybody, uh, is impulsive once in a while. But most of the time we get over that and we, uh, refresh our memory and we, and straighten up. But for some people, when that, those difficulties, the difficulty focusing distracting and impulsive and so on that they get to the point that they're occurring all the time. They're interfering with the child's learning. They interfere with the child's development.
Speaker 2 00:23:49 They interfere with the child's social development and developing friends and, and keeping friends. Um, so at that point, those behaviors, even though they occur every, and everybody normally once in a while, they're occurring too frequent in this child. And, and, uh, it's interfering with his ability to learn you also, in order to make the diagnosis, have to show that there is no other medical condition that is inter that is causing this problem. So you have to make sure that it's, that the child doesn't have, uh, a learning disability or anxiety, or maybe even a thyroid problem that could cause hyperactivity or, um, a, a hearing problem or a vision problem, that those things could be interfering with a child's ability to focus and attend as well, and not the ADHD, but once you've ruled out all the other causes, and once you have determined that a child meets the criteria, and once you have determined that, that those behaviors are occurring so frequently that they are interfering with that child's ability to learn, then you have the diagnosis of ADHD.
Speaker 0 00:24:58 So two things, then it sounds like if you have ADHD, you have had it. When, since you were young, you don't acquire it as an 18 year old or a 24 year old, is this correct?
Speaker 2 00:25:12 Well, it's partially correct. Uh, yes. In most cases, ADHD is transmitted from parent to child. So in most cases, a child's born with, with those behaviors. But the problem is if you see a two year old child, who's running around the room and jumping up and down and laughing and giggling, when you're trying to teach him something, you don't necessarily think that there's a problem
Speaker 0 00:25:34 There. No, that'd be most two
Speaker 2 00:25:35 Because that's pretty normal behavior for a two year old. Yes. But if he's he's four or five and in kindergarten now, and doing the same things, that's not appropriate, and it's gonna interfere with his development and interfere with his learning. And we then see that as a problem.
Speaker 0 00:25:51 So you say six out of the nine things for diagnosing a child, but only five for adults. Why the difference?
Speaker 2 00:26:00 Well, in adults, adults are able to compensate for their ADHD better than children are. Ah, but what I mean by that is exactly what I said earlier. That if, if a person knows that he has difficulty, um, being on time for appointments, then he makes sure that his, um, his secretary has set up his appointments and reminds him an hour before the appointment. And, and, and, and does all the things that are necessary to help him function. Uh, without that, um, he's going to need to rely on other avenues to fix the problem
Speaker 0 00:26:43 Is ADHD. I guess it sounds like you would not consider ADHD a learning disability, but is it often accompanied by learning disabilities or with learning disabilities?
Speaker 2 00:26:56 Y yes. About 40% of children with ADHD also have a learning disability. What the distinction, uh, is here's the, the, the distinction and ADHD affects learning. If you can't focus and can't concentrate, then you're not gonna be able to learn very well. Mm. And even if you do learn ADHD inhibits your ability to store what you learned as memories. So you may have learned it well on Monday, but when you come back to school on Tuesday, you've forgotten what you learned because of your ADHD. So as a result, um, yes, there are nine symptoms listed. And to make the diagnosis in a, in a child, you must have six of those, but why six and not seven or five. And the, the, the distinction is there have been hundreds of research studies looking at those symptoms and trying to make a prediction of how many are necessary.
Speaker 2 00:27:53 And the research has basically shown us that when we get to six of those symptoms, um, the child almost definitely has ADHD. Um, unfortunately we don't have any blood tests x-rays to, to make the diagnosis of ADHD. And so we must rely on the presence of those behavioral difficulties. And that's why a lot of people doubt the diagnosis of ADHD, because they feel that we're, um, that it all, it's so subjective, that it depends on how you view things more than it does the actual behaviors of the child. And indeed, we did see this at times, sometimes I would have a parent fell out a questionnaire, listing those nine behaviors. And then I would ask her to give that questionnaire to his, to the child's teachers, his math teacher might come back and say, he concentrate on focuses really well, but the reading teacher says he can't focus or concentrate more than 10 seconds. Mm what's the difference? Well, in that case, that child may have a learning disability in reading and not in math, and it's not ADHD at all. So it behooves us to do a full psychological evaluation to determine if a child has other things that could be interfering with the child's ability to focus such as distract, such as, uh, a learning disability, anxiety, um, obsessive compulsive disorder, and many other conditions they could interfere with the child's ability to learn.
Speaker 0 00:29:18 And have you, somebody told me once that, um, she had found in her line of work that every premi she had ever seen had ADHD, is there anything attached to that or is it just her experience?
Speaker 2 00:29:36 Did you say every premi,
Speaker 0 00:29:38 Every premi that she had had in her class had ADHD, is there anything to that
Speaker 2 00:29:48 By Preme? You mean a premature infant that was born early,
Speaker 0 00:29:51 Right? Correct.
Speaker 2 00:29:52 Okay. Well, yes, there is a higher incidence of ADHD. It, like I said earlier, 80% of the cases seem to be genetically related, but in 20% of the cases, there's no evidence of any genetic, uh, predisposition in the family. And, and, and so certain in mild injuries to the brain can cause ADHD as well. Uh, not getting enough oxygen because of the, a Preme that can't, um, uh, use his lungs to breathe very well. Uh, maybe more prone to get ADHD. Uh, in addition, children who have had head injuries or been in a car accident, or, uh, many other things that could affect the head can actually cause some of the symptoms of ADHD, but in 80% of cases, it is genetically related. But your, your friend is, is correct. Uh, premature infants do appear to have much more ADHD when they grow up than children who are born, born full term.
Speaker 0 00:30:54 So the next question I'm gonna ask you, it probably is a loaded question, but do you ever feel like it does sometimes get overdiagnosed or that it's misdiagnosed?
Speaker 2 00:31:11 Um, I, I believe ADHD is both overdiagnosed and underdiagnosed. And what I mean by that is that in the 7% of children that get diagnosed with ADHD, there are some mistakes, right, without having a blood test or an x-ray test to make the diagnosis, that's going to be, uh, that's going to happen at time. But one of the things I will tell you is that the medication treatment is so quick and so dramatic that it, it almost tells us whether we are correct in the diagnosis or not. Uh, 80 to 90% of children will respond dramatically to the medication I'm talking usually within two to three hours after the first dose. Um, if I can, I, I would like to take a few minutes and discuss what happens. Uh, you know, the, the book that I wrote was not necessarily about ADHD itself. It was really more about the medication mm-hmm <affirmative> and, and how to use the medication intelligently.
Speaker 2 00:32:16 And let me point out what happens if you don't use medication. All right. So I'm gonna, um, tell you what research studies have shown. What happens to children who have ADHD as a child and grow up to be an adult. What happens to them? The adults have, are diagnosed, who are diagnosed with ADHD. As children are three times more likely to have been unemployed compared to non ADHD adults. They change jobs more frequently. They're more likely to have poor job performance, quit a job impulsively, or have been fired. They often earn a lower salary. They have fewer friends, they move more frequently. They're more likely to parent a child at a younger age. And they're more they're twice as likely to be separated or divorced. They're four times more likely to have a contracted, a sexually transmitted disease. They're more likely to have a child born outside of marriage.
Speaker 2 00:33:12 ADHD. Adults are twice as likely to have been arrested and 15 times more likely to have been incarcerated for longer periods of time. They are three to five times more likely to have been convicted of a crime. They're two to six times more likely to have been in a car accident. And that's only about half the findings I could go on and on and on. That's a pretty depressing list. Mm-hmm <affirmative> if you have a child with ADHD and you hear me recite that list, you may say, oh my God, all you've done is predict a lot of pain and misery for me for the next 15 or 20 years. But here's the astounding thing. What, what the same research studies have found is that if you look at the adults and, and break them up into two groups, those adults that were treated with medication and diagnosed with ADHD, and those adults who were diagnosed with ADHD, but not treated with medication, the adults who, with, who were treated with medication did not have the risk factors that I just listed. They did not have the poor job performance, or if they did, they had it only to the same degree that it occurs in people without ADHD. So basically what that's telling us is that medication and childhood prevented these poor outcomes in adulthood. What could be a stronger case for the effectiveness of medication than that?
Speaker 0 00:34:37 So I have two comments on that. Um, uh, but I would like to step back, um, a minute, because your first part of your book, very early in the book, it, you, there's a diary that you do, um, yes. Between a child and his parents and a teacher. And it's very striking, not, I mean, children are resilient and children do pop back. We've seen this over and over again, even if they don't have H ADHD, if they have disabilities, if they have many things, they, they are pretty resilient. But I find that parents often hold the keys. Like they're often, it's like, if there's a stigma, they don't wanna deal with it. If there's, and, and it feels like ADHD is something like that. It, it falls into it with me as, um, as a person with a disability. It almost falls into that, that track that you hear.
Speaker 0 00:35:38 So, and so has a disability and, and people form their opinions right away. <laugh> and I feel like ADHD falls along that where if first of all, if a kid has it, the parent doesn't necessarily want to admit that. And it's hard to admit that. And secondly, that they certainly don't want to medic necessarily medicate their child. So when you're going through this and it, and the D is a very interesting thing that, uh, just talks about the night and day difference. How do you treat the parents so that they're, it's not such a stigma to them?
Speaker 2 00:36:17 Well, I think the best way to treat the parents is to treat them as, as intelligent people who are concerned about the development of their child. And, um, a good physician will spend just as much time listening to the concerns of the parents as they do, trying to tell the parents what to do. But at some point, uh, the physician has to sit down with the parents and talk and listen. Um, I know that most doctors, when they make a diagnosis, they may spend five or 10, maybe 15 minutes talking to the parents about the diagnosis and what to do. But with ADHD, I spend an hour talking to the parents about what the diagnosis is, what it means, uh, uh, what, the way methods of treatment are, how do we determine if the treatment is effective or not? And how do we determine whether the benefits outweigh the side effects of the treatment? So I think it's the answer to your question is the best way to spend, to, to respect a parent's concerns, worries, wishes, and desires is to listen closely to what they say, and to attend to that.
Speaker 0 00:37:36 It seems like there's a lot of medications that could work for this. How in the world do you go about finding the right one? Feels like there's a lot of trial and error can be,
Speaker 2 00:37:49 You mean in, in terms of finding the physician
Speaker 0 00:37:52 For medications, for ADHD.
Speaker 2 00:37:55 Oh, how to find the right medication, right. Well, yeah. Yes. That, that is a problem. It's one of the reasons why I wrote the book. Um, how many medications do, are you aware of that are used to treat ADHD?
Speaker 0 00:38:09 I'm sure there's a lot more, but I think I'm aware of five or six of them.
Speaker 2 00:38:12 Okay. There are 46 medications <laugh> approved by the FDA for the treatment of attention to deficit disorder. The incredible thing about that, let let's let's that you divide those medications up into, into stimulant medications and non stimulant medications. There are 36, uh, stimulant medications and of those 36 medications. There's really only two generic substances in those medications, methylphenidate and amphetamine. And those two medications are, are what populates every, uh, medication or pill that is prescribed for ADHD. The difference is that the drug companies have learned that if you change a medication just enough, the FDA will approve it as a new medication. Oh, geez. Therefore they can charge more for a brand name medication than a generic medication. And then they have that ability to charge more for usually about eight to 10 years.
Speaker 2 00:39:14 So, uh, but, but in the process of changing the medications to make more, more medications and therefore to increase the profits, the, the pharmaceutical companies have done us a real favor. And that is they've come up with many different forms of these medications, even though they're the same medication let's take Ritalin. For example, Ritalin is probably the best known Ritalin and Adderall. Okay. They're both stimulant medications. They both work in the same way. They both last about three to four hours. Now three to four hours is a problem because if you take it at home, by the time you get to school, it's starting to wear often by 11 o'clock is worn off completely. So the child has to go to the nurse's office, get another dose. And he usually forgets to do that. But if he does get the dose, then it wears off, around, um, three o'clock in the afternoon, and he needs a third dose to help with homework.
Speaker 2 00:40:08 So some of the, the pharmaceutical companies have developed a longer acting medication that last eight hours, another medication may last 10 hours, uh, daytrona is the skin patch that can last up to 18 or 20 hours. If you leave the patch on that long, or if you are done with, if you're a college student and you're done by the end of the day at 12 o'clock, you can pull your patch off and you don't have to take the medication anymore. So, so the, the pharmaceutical companies have developed many different forms of these medication that help us as physicians tailor a treatment plan for each child individually. So if we're dealing with a young child who might not be able to swallow a capsule, most of the capsules that are longing, uh, are come as capsules in a fly five or six year old won't swallow a capsule often.
Speaker 2 00:40:59 So there are orally dissolving pills. There are chewable tablets, there's liquid preparations. And, and again, some of those liquid preparations or short-acting, some of them are long-acting. So there's a whole host of medications. Actually, if you go to my website, um, ADHD medication, book.com, there is a database in, on the website where you can search, and you can say, I wanna see all the long acting medications, and it will print out a list for you. You, you can then change that and say, I wanna see all the long acting liquid preparations. And then it'll, it'll show you what medications meet those criteria. Um, so there is a way to address that problem, but basically it's to physician's job to determine the right medication for you. The reason I have written this book is so that you, as a parent can ask the right questions of your physician. Uh, you can point out, oh, he's having more trouble eating dinner. That's one of the side effects of medication. Yeah. Can we do something about that?
Speaker 0 00:42:04 It, it does seem like there are indeed side effects to different medications as with everything. And I have heard and seen people who have trouble getting some medications sometimes. So example, I knew somebody who was on the patch, it worked beautifully for them, but they had trouble getting it. Like it wasn't consistent. So then
Speaker 2 00:42:25 They, they were, they were on what,
Speaker 0 00:42:27 Uh, uh, one of your, one of the medications that was a patch.
Speaker 2 00:42:31 Oh, a skin patch. That's probably daytrona.
Speaker 0 00:42:33 Yes. And so that in itself then, uh, brought more problems because they would just get stabilized and then, then there would be trouble getting
Speaker 2 00:42:45 It. You're you're you're exactly right. And actually in the book, there's a three or four page story about, uh, the mother trying to get the right medication for her child. And she keeps going back to the pharmacy and being told one thing, for instance, she's told, well, we don't stock that medication. So she goes back, the doctor gets, it, gives her another medication. She goes back to the pharmacy and the pharmacy says, well, we do have that medication in stock, but your insurance company doesn't cover it. Right. And it'll cost $500 a month. Right. So yes, there's problems, uh, that occur with that. And luckily we have many options to deal with that. Um, unfortunately with other disorders, we may only have three or four medications to use and don't really have the options to tailor the dose like we do with ADHD. The other thing I wanna mention is you mentioned side effects, and I wanna point out that there are side effects to these medications.
Speaker 2 00:43:38 Mm-hmm <affirmative>, but none of the side effects are serious. None of the side effects are life threatening. None of the side effects last longer than the medication. And what I mean by that is once you stop taking the medication, the side effects go away within 24 hours. So yes, these medications have side effects, but they are treatable and manageable and they're not serious and they're not long term. Um, and they can be dealt with the most common side effect that, that, uh, that parents worry about. Not that not the most common, the most, two most common side effects are appetite reduction and difficulty falling asleep. But the one the parents worry most about is what's called the zombie effect, right? Parents worry that the, that the medication's gonna turn their child into a zombie. And I have to tell you two stories, bear with me on this because these two stories, uh, are true stories enlighten me every day.
Speaker 2 00:44:39 When I think about them, about how we work with children with ADHD, um, the first is a child named Michael Michael was nine years old. He came to me, uh, hyperactive, impulsive, having difficulty in school. We did all the tests. He came back with obvious ADHD, very clear ADHD. I started him on medication and asked them to come back in three weeks. So they did come back in three weeks and I said, well, how are things going? And the mother looked at me and said, um, well at school, he's doing great. He's focusing, he's learning. The teacher says, he's a model student now it's really amazing. And I, and I said, well, that's great to hear. And she said, but at home, he's depressed. And I said, well, well depressed. What do you mean? Why, why do you think he's depressed? She says, well, he comes home. He drops his book bag on the floor. He runs, he goes to his room and he reads for two hours
Speaker 3 00:45:36 <laugh>
Speaker 2 00:45:37 And I said, well, why do you think he's depressed? And she looked at me like I was mad. She said, well, doctor, he's never done that before in his life. When he comes home from school, he drops his book bag on the floor and he runs to the living room. He knocks over the lamp. He pulls the cat's tail. The cat starts screaming and he runs after the cat and trips over the cat and falls down and, and, and knocks over the flowers that we had in the pot. And, and I, and I, and I, so I turned to the child and I said, what books have you read recently? And he said, oh, I just finished a book called Harry Potter. <laugh> it's about this, um, this kid that goes to, to school to become a wizard. And he fights all the bad guys. And, and, and I said, you know, I read Harry Potter too.
Speaker 2 00:46:24 And I think I loved it just as much as you did. And so then I let him go back to playing the video game that he was playing. And I looked at the mother and I said, um, Michael's not depressed. He's the child now on medication that he would've been, if he didn't have ADHD. And if, if you had seen him, if, if he was eight or nine years old and had always been quiet and serious and studious, and gone back to his room for two hours, mm-hmm <affirmative>, would you have been concerned? She said, well, no, of course not. And I said, then this is your child without ADHD.
Speaker 2 00:47:05 So that's, that's one story. And I hope that that clarifies things because, because the interpretation of the side effects is sometimes more important than just knowing that a side effect occurs. The second story involves a, a young girl that I saw when she was 12 years old. Um, and, and one time I was, uh, sitting, eating my lunch and looking at the list of patients that were coming in to see me in the afternoon. And I saw her name on the list, and I hadn't seen her for seven years. And so she comes into the office she's by herself, her parents didn't come with her. She's 19 years old now instead of 12 and sh and I said, well, welcome. And what what's been going on? She said, well, Dr. KSKY I wanted, um, to let you know that I'm ha I, I think I need to go back on that medication.
Speaker 2 00:47:59 I'm having trouble. I'm a freshman at the university of Florida, and I know I'm smart, but I'm getting lousy grades, uh, and just having a lot of trouble getting my work done. So I think I might need to go back on that medication. And I said to her, well, what happened 12 years? I mean, seven years ago, when you were 12 years old, we started you on medication. Then I didn't see you again for seven years. What happened? She said, well, Dr. KKI when you started me on that medication, I hated you. I hated the way it made me feel. And I said, well, how did it make you feel? And she said, um, well, I got very serious. Um, my friends told me I wasn't as much fun to be around now. I used to be the one that was always cracking the joke.
Speaker 2 00:48:44 Uh, I was the life of the party. Everybody was always laughing with me and at me, and suddenly when I took my medication, they said, I wasn't as much fun to be around. And I said, oh, okay, well, that's a concern. But so at any rate, I started her back on medication, asked her to come back in a couple weeks and she did. And I said, how are things going? And she said, well, in school, they're going great. I've got all my grades have gone from all Fs to all A's. I get my homework done in two hours instead of five hours. Uh, and things are going really well in school. And I said, well, how about your friends? She said, well, that's the weird thing, Dr. Eski my friends tell me I'm actually a better friend when I take my medication. Ah, I said, how's that?
Speaker 2 00:49:32 She said, well, because when I'm on my medication, I listen to them more. I pay attention to what they're saying to me. I comment on what they say instead of what I want to talk about. And they say, I'm just a much better friend when I'm on the medication than when I'm off the medication. When I'm off medication, I'm distracted, I'm silly. I'm playing around. And so what happened here? What happened between the 12 year old girl and the 19 year old college student? How did she change? Well, so she didn't change at all. Right. What changed was the expectations of her friends and the medication did the same thing at 12 as it did at 19. But when she was 12, the parents interpreted that as a side effect. And when she's 19, they interpret that as a treatment for the problem she's having in college.
Speaker 0 00:50:30 How long
Speaker 2 00:50:30 Did it, I hope those two stories help clarify the, the kind of constant drama we have between side effects and effectiveness of medication. Hmm.
Speaker 0 00:50:43 How long did it take you to write this book?
Speaker 2 00:50:47 <laugh> well, there's two answers to that question. It took me two years to actually get the words down on paper, but it took me 40 years, ah, to learn what I learned, to be able to write those things down on paper and the, the greatest teachers that I've had have been my, the students that I've seen and the kids that I've seen. So in reality, I think I say this in the book. I, uh, the, the, I should really have 500 or 5,000, um, second authors on this book. Mm-hmm <affirmative> because those 5,000 kids that I saw with ADHD over my 40 years in my practice taught me about ADHD.
Speaker 0 00:51:30 If you could have the parents take away one thing from your book, what would you want it to be?
Speaker 2 00:51:40 Whoa. Um, I guess the, the, the most important thing I would want them to take away is that ADHD, even though it is a somewhat mysterious disorder, there is unlike many other medical conditions. There is a highly effective treatment with very few side effects and no serious side effects. And that really is the essence of the entire book. Mm. Now, uh, I don't think people are gonna believe me if I just say medications work. So I I've added a lot of documentation about how they work and why they work and what they do in the brain. Um, and, and what the side effects are. So I, I, I, I recently went on amazon.com and, and looked at the books that have been written on ADHD. They actually have about 500 books in Amazon published on ADHD, but some of those books are for adults. Some of those books are how to manage children's behavior with ADHD.
Speaker 2 00:52:55 Some of those books are how to work with the school and how to teach your child. But very few, if none of the books were about medication specifically. Mm yeah. And so I felt that this book filled the void, that, that, uh, parents are BELE with advertising and friends who say, oh, we tried this medication. It worked really well. And, and some of the times the physicians don't even know what medications there. They are. Not all, every physician cannot possibly know all 46 medications. I can't tell you the details of every one of those medications. I can get pretty close, but it is the physician's job to do that for the parents. But this book provides the questions that you can ask your physician in ways of presenting information to your physician. So you get the best possible response to the medication and the best treatment for the ADHD.
Speaker 0 00:53:52 Thank you so much for presenting all this. The book is ADHD medications. Does it work and is it safe and where can people all get your book?
Speaker 2 00:54:04 Mm-hmm <affirmative> well, thank you for having me. This has been a pleasure. Oh, where can we get the book? Yes. The book is
[email protected]. It's also available online through, uh, Barnes and noble. It's not yet available in the stores. Uh, so it's, it has to be purchased online. Uh, but it's very easy to get at Amazon. Uh, I, a friend of mine ordered one recently and said it arrived in two days.
Speaker 0 00:54:28 So really quick, did this, did writing this book, teach you anything?
Speaker 2 00:54:35 I think, um, writing the book taught me to listen. Uh, and even though I, I knew that before I wrote the book, it became so obvious when I was going through that journal that you mentioned mm-hmm <affirmative> um, about how physicians need to listen to their parents. Right. And, and what they say. So that is probably the best lesson that I learned in, in the process of writing a book.
Speaker 0 00:55:05 My research person is also with us in the studio. Charlene, did you wanna ask anything?
Speaker 4 00:55:10 No, I, no, but it, it was a great book and I, uh, appreciated the opportunity to read it.
Speaker 2 00:55:21 Well. Well, thank you. I'm glad to hear that.
Speaker 0 00:55:24 Well, thank you very much. We appreciate you coming on and spending your time with us and good luck with the book. And I hope this helps many people, parents, teachers, as well as kids. I think that become, you know, not always wanting to be medicated. So thank you very much.
Speaker 2 00:55:42 Well, it's been a pleasure being here today, and I think the work that you're doing with this, this program on a regular basis is amazing. Keep up the good work.
Speaker 0 00:55:52 Thank you. This has been disability and progress. If he's expressed on the show or not necessarily those of K F a I or it's board of directors. My name is Sam. I'm the host of the show. If you have a comment or want to be on our email list, you may email me at disability and progress at Sam. jasmine.com. Charlene do is my research assistant and she was here too. Thank you very much tonight. We were speaking with Walter, Dr. Walter Carisi. He who was a, who is a developmental pediatrician and an author of his book called ADHD medication. Does it work? And is it safe? This is K 90.3, FM, Minneapolis and K org. Thanks for listening later.
