Dear Alice,

I know you're busy, but I really don't know who to talk to. Everyone is telling me that I'm stupid. I can hardly spell, don't know nouns, verbs. My teachers call me stupid! I get embarrassed, then cheat to get a good grade. I've done this all my life. My teachers & mum had a meeting & they think I have ADHD. I know it has something to do with not concentrating. It's like ADD, except I'm not always hyper. I will not take Ritalin! I don't want to take drugs. Can you explain what are the symptoms of ADHD? And what Ritalin does?

Dear Reader,

It can be difficult to believe in yourself when others don’t, especially when they’re calling you stupid. In actuality, it’s both savvy and strategic that you and your mum are trying to get to the bottom of what you’re experiencing. And if it’s in fact attention-deficit/hyperactivity disorder (ADHD), you’re among a group of many smart — even gifted — individuals, many whose talents go beyond their skills in school. ADHD, similar to other mental health concerns and learning disabilities, can affect people's ability to do as well as they'd like to — or are expected to do — in school and in other areas of their lives. ADHD affects people of all ages. However, young folks in particular may also struggle with self-esteem and confidence, which have the potential to influence academic performance and relationships with peers and teachers. Fortunately, ADHD is treatable, and such treatment is customizable person-to-person. As for Ritalin (generic name: methylphenidate), it’s a stimulant used to treat ADHD. Read on for more about ADHD symptoms, the process of diagnosis, treatment options, and how you can help guide the treatment process.

Attention-deficit/hyperactivity disorder (ADHD) is a chronic condition involving a combination of consistent problems such as difficulty maintaining focus, excess activity levels, and impulsive behavior. While much is still unknown, ADHD is largely believed to be caused by a combination of genetics and the environment. Identified risk factors include environmental toxins (such as lead) and maternal drug and alcohol use during pregnancy, among others. So what exactly does ADHD look like? Many with ADHD experience fidgeting and squirming in situations that involve staying still for an extended period of time, being easily distracted, having a hard time paying attention, and feeling as if always “on the go.” There are three subtypes of ADHD:

  • Predominantly inattentive: For those with this subtype specification, the majority of their symptoms involve inattention. This may consist of failure to pay attention to details, lack of listening skills, inability to follow through on directions, and avoiding or forgetting to do schoolwork or chores.
  • Predominantly hyperactive-impulsive: For those with a hyperactive-impulsive subtype specification, the majority of symptoms are just that. This may consist of excessive physical symptoms that involve constant movement. These symptoms are often complemented by excessive speech mechanisms that include interruption and difficulty waiting their turn to speak.
  • Combined: This subtype is the most common type of ADHD and involves a mix of inattentiveness, hyperactivity, and impulsiveness.

While ADHD rates are higher among males, people of all sexes may experience ADHD. Only a mental health professional can determine whether what you’re experiencing is in fact ADHD. And because there’s no one test that can definitively pinpoint ADHD, receiving a diagnosis depends on how you do on various tests that evaluate symptoms and rule out other possible concerns, such as learning disorders, hearing loss, or depression. It may be worth investigating whether your school has resources in-house that you could access, as evaluations may not to be covered by health insurance and may be pricey.

People who receive an ADHD diagnosis and engage in treatment often report feeling better able to move beyond daily distractions and perform better in a variety of areas, including academics. Two types of therapy are most often used to treat ADHD:

  • Behavior therapy: This involves identifying behavior-changing strategies (such as positive feedback reward systems) to encourage desired behavior.
  • Psychotherapy: This provides those with ADHD a space to openly discuss and learn ways to improve their symptoms.

While therapy can be effective in treating ADHD, the most common forms of treatment typically consist of stimulant medications, or some combination of therapy and stimulants. Stimulants increase activity in the brain and tend to make children and adults more alert, active, and focused for longer periods of time. There are two varieties of stimulants used to treat ADHD, amphetamines and methylphenidates. Additionally, non-stimulant medications may be used if the stimulants weren’t found to be helpful or if someone can’t take stimulants, although these drugs aren’t usually the first line of treatment.

The drug you asked about, methylphenidate, is believed to work by increasing neurotransmitter activity in the brain. These neurotransmitters, such as dopamine and norepinephrine, affect the brain’s ability to think and pay attention. While stimulant use is generally considered low risk when used as prescribed, there are some people for whom it may not be appropriate. If diagnosed with ADHD, before taking any stimulants, it’s best to share with your health care provider if you have any other health conditions, as it can increase blood pressure, heart rate, and anxiety. Some other side effects to be aware of include a decrease in appetite, trouble with sleep, changes in personality, stomachaches, and headaches. There is plenty of evidence to indicate that it’s an effective treatment option for many people, but it’s not the only treatment option. If you aren’t interested in taking medication, you may find that you can receive the support you need through various types of therapy. For more information about ADHD treatment options, check out the National Institute of Mental Health.

Ultimately, seeking to learn more about what’s causing your troubles in school may make it easier for you to do the things that you want — such as studying effectively, understanding more at school, and feeling better about yourself. Exploring what you’re worried about may be a worthwhile next step in making a decision about treatment. Once you know what you’re concerned about, you may be better able to answer questions such as: How would your life be different if you sought out further information and a potential diagnosis? If you do receive a diagnosis, you may want to think about how you would feel about treating it with therapy, different medication options, or the two together. Having an idea of what you do and don’t want out of treatment may help guide the conversation you may have with your health care provider if you do indeed receive an ADHD diagnosis. You can expect this conversation to involve developing a treatment plan tailored to your wants and needs, as well as an explanation from your provider about what the various treatment strategies can do for you.

Amidst the embarrassment you're experiencing in the face of hurtful name-calling, you've managed to take the wise and difficult step of gathering information and considering treatment options. And even if these treatment options still seem unappealing, knowing what they are and how they can have an impact on your life is invaluable knowledge that you now have.

Sincerely,

Alice!

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