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ADHD in Adults (transcript)
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>> ANNOUNCER: "SECOND OPINION" IS BROUGHT TO YOU BY BLUECROSS BLUESHIELD. ACCEPTED IN ALL 50 STATES. BLUECROSS BLUESHIELD. LIVE FEARLESS.

 

>> ANNOUNCER: "SECOND OPINION" IS PRODUCED IN CONJUNCTION WITH UR MEDICINE, PART OF UNIVERSITY OF ROCHESTER MEDICAL CENTER, ROCHESTER, NEW YORK.

 

>> DR. PETER SALGO: THIS IS "SECOND OPINION," AND I'M YOUR HOST, DR. PETER SALGO. THIS WEEK -- MYTH OR MEDICINE?

 

>> DR. BRETT ROBBINS: THERE ARE AT LEAST 4 MILLION ADULTS AND CHILDREN IN THE UNITED STATES WHO HAVE THE DIAGNOSIS OF ADHD.

 

>> DR. PETER SALGO: AND SPECIAL GUEST FRANK SOUTH. THE SYMPTOMS HE SUFFERED FOR YEARS EVENTUALLY DERAILED HIS HOLLYWOOD CAREER.

 

>> FRANK SOUTH: I WAS GETTING MORE UNHAPPY. AND I DIDN'T KNOW WHAT TO DO ABOUT IT, AND I WAS AROUND 49 WHEN I JUST SORT OF COLLAPSED UNDER THE WEIGHT OF IT.

 

>> DR. PETER SALGO: FRANK IS HERE FOR A SECOND OPINION.

 

>> DR. PETER SALGO: THANKS SO MUCH FOR JOINING US TODAY, FRANK. I'M REALLY GLAD THAT YOU'RE HERE, AND I KNOW THAT YOU'VE GOT A LOT TO TELL US. BUT FIRST, LET ME GET RIGHT TO WORK AND INTRODUCE YOU TO YOUR "SECOND OPINION" DOCTORS. THEY'RE GONNA BE HEARING YOUR STORY FOR THE VERY FIRST TIME. DR. ANTHONY ROSTAIN FROM THE UNIVERSITY OF PENNSYLVANIA.

 

>> DR. ANTHONY ROSTAIN: HELLO.

 

>> DR. PETER SALGO: AND OUR "SECOND OPINION" PRIMARY CARE PHYSICIAN, DR. LISA HARRIS FROM OUR LADY OF LOURDES MEMORIAL HOSPITAL. WELCOME BACK, LISA.

 

>> DR. LISA HARRIS: GOOD TO SEE YOU.

 

>> DR. PETER SALGO: FRANK, LET'S GET RIGHT TO YOUR STORY. TELL ME ABOUT YOUR CAREER. YOU WERE IN HOLLYWOOD, RIGHT? YOU WERE A WRITER, YOU WERE A PRODUCER, YOU WERE A DIRECTOR.

 

>> FRANK SOUTH: YES.

 

>> DR. PETER SALGO: HIGH, HIGH ACHIEVEMENT, HIGH ACCOMPLISHMENT. I'M ASSUMING HIGH STRESS.

 

>> FRANK SOUTH: YEAH, A LOT OF STRESS. BUT, YOU KNOW, YOU COULD LOOK AROUND YOU AND EVERYBODY SEEMED TO BE HANDLING IT. IT WAS ALL SORT OF THE NORM.

 

>> DR. PETER SALGO: JUST FOR OUR VIEWERS, THEY'D RECOGNIZE THE SHOWS YOU WORKED ON, RIGHT?

 

>> FRANK SOUTH: YES, YEAH. I'VE WORKED ON "CAGNEY & LACEY," "MELROSE PLACE," "FAME." YOU'D END UP GOING FROM SHOW TO SHOW, THEN YOU'D HIT SOMETHING BIG, AND TOWARDS THE END OF MY -- OR MIDDLE END -- I STARTED WORKING ON "MELROSE PLACE" FOR AARON SPELLING, AND THAT WAS A SHOW THAT WE DIDN'T KNOW WHAT WAS GOING TO HAPPEN WITH IT, BUT IT TOOK OFF, AND THEN I WAS DOING 32 EPISODES A YEAR.

 

>> DR. PETER SALGO: NOW, THAT'S A LOT OF EPISODES.

 

>> FRANK SOUTH: A LOT OF EPISODES.

 

>> DR. PETER SALGO: AND IT SOUNDS AS IF YOU'VE GOT TO BE INCREDIBLY FOCUSED. HOW DO YOU, WITH ALL THOSE EPISODES, EVERYTHING FLYING AROUND, HOW DO YOU STAY ORGANIZED?

 

>> FRANK SOUTH: I HAD AN AMAZING ASSISTANT, AND SHE WAS --

 

>> DR. PETER SALGO: SO SOMEBODY ELSE STAYED ORGANIZED?

 

>> FRANK SOUTH: YEAH, I MEAN, SHE WOULD -- SHE HAD -- THERE WERE, LIKE, EVERY EPISODE HAD A BINDER, AND THERE WERE, LIKE, ALL THESE BINDERS. AND THEN I HAD CALENDARS UP ON MY WALLS, AND I HAD HER, WHEN I WOULD START AN EPISODE, SHE WOULD PUT THE BINDER IN FRONT OF ME. IF WE WERE IN POST ON AN EPISODE, SHE WOULD PUT THAT BINDER IN FRONT OF ME. SO THERE WAS ALWAYS SOMEONE THERE. SHE JUST KNEW THAT SHE DIDN'T WANT ME TO -- MY BRAIN TO FRY. YOU KNOW, AFTER A NUMBER OF YEARS, I WAS JUST HANGING ON AND NOT DOING ENOUGH MANAGEMENT OF THE PEOPLE, AND I WAS GETTING MORE UNHAPPY. AND I DIDN'T KNOW WHAT TO DO ABOUT IT. AND I WAS AROUND 49 WHEN I JUST SORT OF COLLAPSED UNDER THE WEIGHT OF IT.

 

>> DR. PETER SALGO: YOU DON'T MEAN PHYSICALLY COLLAPSED, THOUGH, DO YOU?

 

>> FRANK SOUTH: NO. I DID LAY IN BED, YOU KNOW, IN A FETAL POSITION FOR A COUPLE OF DAYS, BUT THAT WAS JUST MOSTLY IN MY HEAD.

 

>> DR. PETER SALGO: BUT THERE WERE OTHER THINGS YOU WERE DOING TO TRY AND COPE.

 

>> FRANK SOUTH: MM-HMM.

 

>> DR. PETER SALGO: AND, BY THE WAY, THERE WAS ADDED PRESSURE, AS I UNDERSTAND IT, AT "MELROSE PLACE," TOO. WAS THERE SOME LEGAL --

 

>> FRANK SOUTH: YEAH, THERE WAS A LAWSUIT GOING ON, AND AFTER THAT WAS SETTLED, AND THEN THERE WAS SOME OTHER LEGAL TROUBLE. AND FINALLY, EVEN THOUGH I WASN'T REALLY THAT DIRECTLY INVOLVED WITH THE STUFF, IT WAS MORE THAN I COULD HANDLE. AARON AND I PARTED WAYS, AND THEN AT THE SAME TIME, MY SON WAS HAVING TROUBLE IN SCHOOL.

 

>> DR. PETER SALGO: I WANT TO GET TO THAT, BUT I'M TRYING TO GET A MENTAL PICTURE OF WHAT THOSE LAST DAYS OVER AT "MELROSE PLACE" WERE LIKE. WAS ALCOHOL INVOLVED?

 

>> FRANK SOUTH: YEAH. I DRANK EVERY NIGHT, AND I ALWAYS DRANK, BUT I WAS DRINKING -- WHAT HAPPENS IS, THERE'S SO MUCH GOING ON IN YOUR HEAD THAT YOU HAVEN'T PROCESSED, AND I DIDN'T KNOW WHY THIS WAS, WHY MY BRAIN WAS GOING LIKE THIS ALL THE TIME, AND EVERYBODY ELSE COULD SEEMINGLY KICK BACK AND PUT THINGS ASIDE. I COULD NEVER PUT ANYTHING ASIDE. AND THEN I WOULD TRY TO TALK ABOUT THINGS AT HOME, AND I COULDN'T. AND SO I WOULD COME HOME, AND I WOULD HAVE, YOU KNOW, A GLASS OF GIN AND ICE, ABOUT, YOU KNOW, A TUMBLER, AND JUST -- IT WOULD TONE THINGS DOWN. YOU COULD FEEL IT JUST [ INHALES DEEPLY ] FINALLY BE ABLE TO TAKE A BREATH.

 

>> DR. PETER SALGO: SO YOU WERE TURNING THE VOLUME DOWN?

 

>> FRANK SOUTH: TURNING THE VOLUME DOWN, AND ALSO, THE NEGATIVITY WOULD GO DOWN, TO A CERTAIN EXTENT.

 

>> DR. PETER SALGO: OKAY. I'M SORRY.

 

>> DR. LISA HARRIS: BUT IT WAS STILL RUNNING.

 

>> FRANK SOUTH: YEAH, STILL RUNNING, BUT AT A LOWER VOLUME.

 

>> DR. LISA HARRIS: HOW WERE YOU SLEEPING AT THAT TIME?

 

>> FRANK SOUTH: I'VE NEVER SLEPT WELL, BUT THIS WOULD MAKE ME THINK I COULD SLEEP, AND I'D WAKE UP AT 2:00 A.M.

 

>> DR. PETER SALGO: OKAY.

 

>> FRANK SOUTH: AND BE JUST HUNG OVER AND WITH THE VOICES GOING.

 

>> DR. PETER SALGO: THE VOICES GOING?

 

>> FRANK SOUTH: YEAH, NOT LIKE VOICES VOICES, BUT THEY ARE -- THEY'RE YOUR OWN VOICE.

 

>> DR. PETER SALGO: YOUR INTERNAL VOICE.

 

>> FRANK SOUTH: YEAH.

 

>> DR. PETER SALGO: TELL ME ABOUT YOUR KIDS AT THE TIME.

 

>> FRANK SOUTH: MY DAUGHTER WAS BORN IN THE MIDDLE OF THIS. MY SON WAS GOING TO GRADE SCHOOL, TO WALDORF SCHOOL, AND THEY SAID, YOU KNOW, HE'S CRAWLING UNDER THE DESK, AND HE'S NOT PAYING ATTENTION, HE'S DOING THIS, AND HE'S DISRUPTIVE. WE WENT TO A PEDIATRICIAN, AND THEY HAD HIM TESTED FOR ADHD, AND ALL OF HIS SYMPTOMS SOUNDED VERY FAMILIAR TO ME.

 

>> DR. PETER SALGO: BUT THEY SAID HE HAD ADHD -- IS THAT WHAT YOU'RE TELLING ME?

 

>> FRANK SOUTH: MM-HMM.

 

>> DR. PETER SALGO: WHAT IS ADHD?

 

>> DR. ANTHONY ROSTAIN: WELL, AS BEST WE KNOW NOW, IT'S A DEVELOPMENTAL DISORDER THAT AFFECTS PEOPLE'S ABILITY TO STAY FOCUSED AND TO COMPLETE TASKS, BUT ALSO TO MANAGE THEIR BEHAVIOR AND TO KEEP STILL WHEN THEY HAVE TO.

 

>> DR. PETER SALGO: LISA, YOU SEE THIS IN YOUR PRACTICE?

 

>> DR. LISA HARRIS: ABSOLUTELY.

 

>> DR. PETER SALGO: WHAT IS IT LIKE WHEN THEY COME IN? WHAT'S TYPICAL?

 

>> DR. LISA HARRIS: SO, FOR PATIENTS THAT HAVE CLASSIC ATTENTION DEFICIT HYPERACTIVITY DISORDER, IT'S AS HE WAS DESCRIBING WITH HIS SON. I REMEMBER ONE PATIENT IN PARTICULAR, WITHIN TWO MINUTES, WENT IN THE BATHROOM AND SHREDDED AN ENTIRE ROLL OF TOILET PAPER, CAME BACK OUT, AND STARTED PICKING UP PAPER AND WAS JUST SHREDDING PIECES OF PAPER, WAS RUNNING AROUND IN CIRCLES IN THE EXAM ROOM, JUMPING OFF THE EXAM TABLE, AND JUST NOT ABLE TO SIT STILL.

 

>> DR. PETER SALGO: SO, NOW YOUR SON'S AT THE DOCTOR'S OFFICE. THE DOCTOR SAYS, "YOUR SON HAS A.D.D." AND YOU TOLD ME JUST NOW YOU WERE BEGINNING TO RECOGNIZE SOME OF THIS IN YOURSELF, SO WHAT DID YOU DO?

 

>> FRANK SOUTH: FIRST, I WENT THROUGH SORT OF THE THING THAT ALL PARENTS DO, OR OFTEN DO, WHEN THEY HEAR A DIAGNOSIS ABOUT THEIR KID. THEY GO, "WELL, YOU KNOW, REALLY, MAYBE IT'S NOT," AND YOU START TO EQUIVOCATE, BUT I ALSO -- AND MY WIFE AND I WERE DOING THAT SORT OF TOGETHER IN THE DOCTOR'S OFFICE, AND THEN WE'RE IN THE CAR ON THE WAY HOME, AND I SAID, "I DON'T KNOW. IT COULD BE. IT COULD BE. BECAUSE IT SOUNDS FAMILIAR TO ME." AND SHE SAID, "WELL, YOU DON'T HAVE IT." AND I SAID, "MM...I DON'T KNOW. MAYBE, MAYBE. HMM. I DON'T KNOW."

 

>> DR. PETER SALGO: LISA, HE COMES TO YOUR OFFICE, AND HE SAYS SOMETHING ON THE ORDER OF, "MY KID JUST GOT DIAGNOSED." WHAT ARE YOU GOING TO ASK HIM?

 

>> DR. LISA HARRIS: I'M GOING TO START ASKING HIM THE SAME TYPE OF QUESTIONS -- DO YOU HAVE DIFFICULTY FOCUSING? DO YOU HAVE DIFFICULTY CONCENTRATING? DO YOU SKIP FROM ACTIVITY TO ACTIVITY? WHAT'S YOUR SLEEP PATTERNS LIKE? AND MANY OF THE THINGS THAT HE WAS DESCRIBING. WHAT WE OFTEN SEE IN OUR PRACTICE IS THAT YOU'LL DIAGNOSE A CHILD, AND THE PARENT WILL SAY, "THERE'S NOTHING WRONG WITH MY KID. HE ACTS JUST LIKE ME."

 

>> DR. PETER SALGO: [ LAUGHS ]

 

>> DR. ANTHONY ROSTAIN: THE FAMILY ACCLIMATES TO THAT, YOU KNOW? YOU'RE A HIGH-ENERGY PERSON, YOU SEEK A JOB OR ENVIRONMENT THAT'S VERY STIMULATING.

 

>> DR. LISA HARRIS: "I'M A TYPE-A PERSONALITY."

 

>> DR. ANTHONY ROSTAIN: RIGHT, A TYPE-A, AND THEN YOU'VE GOT SOMEONE ELSE KEEPING YOU ORGANIZED, SO YOU REALLY DIDN'T HAVE TO DEAL WITH THE CONSEQUENCES IMMEDIATELY, ANYWAY.

 

>> DR. PETER SALGO: OKAY, SO, YOU GOT TESTED?

 

>> FRANK SOUTH: YEAH.

 

>> DR. PETER SALGO: HOW WERE YOU TESTED? WHAT DID THEY DO?

 

>> FRANK SOUTH: WELL, AT THAT TIME, IT WAS A T.O.V.A. TEST, AND IT WAS AN AUDITORY TEST, AND THEN THERE WAS A VISUAL TEST, AND THEN THERE WAS AN INTERVIEW SITUATION, AND THAT WENT ON FOR THREE HOURS, AND THE WHOLE THING TOOK A WHOLE DAY. AND YOU WOULD RESPOND TO -- THERE'D BE THIS [ IMITATES BEEPS ] AND THEN [ IMITATES BUZZER ] AND YOU WOULD HIT IT WHEN THE SOUND WAS THE [ IMITATES BEEP ] SOUND. AND I THOUGHT I WAS DOING GREAT.

 

>> DR. PETER SALGO: [ LAUGHS ]

 

>> FRANK SOUTH: YOU KNOW, AND I WAS HITTING THEM, I'M HITTING THEM, I'M HITTING THEM. "I DON'T HAVE ANYTHING WRONG WITH ME." AND SHE SAID, "YOU HAVE AN ENORMOUSLY SEVERE CASE OF ADHD."

 

>> DR. PETER SALGO: HOW OLD WERE YOU AT THE TIME?

 

>> FRANK SOUTH: 49.

 

>> DR. PETER SALGO: 49 YEARS OLD. AND MOST PEOPLE, WHEN THEY HEAR ABOUT A.D.D., THEY HEAR ABOUT IT IN KIDS, ALL THE CONTROVERSY IN THE POPULAR PRESSES. "WE'RE TAKING CARE OF OUR KIDS, AND WE'RE OVERMEDICATING, UNDERMEDICATING, OVER-DIAGNOSING." HE'S 49. HOW COMMON IS THAT?

 

>> DR. ANTHONY ROSTAIN: WELL, I THINK IT'S IMPORTANT TO REALIZE THAT PROBABLY ONLY 1 OUT OF 10 ADULTS WITH ADHD RIGHT NOW ARE GETTING TREATED. PROBABLY ONLY 1 OUT OF 4 OR 5 HAVE EVEN RECOGNIZED IT IN THEMSELVES. SO THE VAST MAJORITY OF ADULTS WITH ADHD RIGHT NOW ARE GOING UNDIAGNOSED. AND THEY OFTEN COME TO SEE THEIR PRIMARY CARE DOCTOR WITH OTHER KINDS OF PROBLEMS -- DRINKING, SMOKING, DRIVING TOO FAST, OVERWEIGHT -- I MEAN, ALL OF YOUR PRIMARY CARE HEALTH PROBLEMS THAT I THINK PRIMARY CARE PRACTITIONERS STRUGGLE TO GET THEIR PATIENTS TO ADDRESS. IF THEY'RE NOT DEALING WITH THE RECOMMENDATIONS, MAYBE THE QUESTION OUGHT TO BE, "HMM. AM I MISSING SOMETHING?" MAYBE YOU'RE HAVING TROUBLE FOLLOWING DIRECTIONS AND KEEPING TO A ROUTINE OR FOLLOWING THROUGH ON A TREATMENT PLAN.

 

>> DR. PETER SALGO: IS HIS STORY COMMON? THEY BRING IN THE KID, AND YOU LOOK UP, AND THERE'S THE PARENT, AND IT'S A MIRROR IMAGE.

 

>> DR. LISA HARRIS: AND A LOT OF TIMES, YOU CAN TELL FROM THE WAITING ROOM. THE KID'S RUNNING AROUND, AND THE PARENT'S SITTING THERE FIDGETING AND FLIPPING AND NOT PAYING ATTENTION, EITHER.

 

>> DR. PETER SALGO: DO YOU NEED TO BE IMPAIRED BY THIS DISEASE TO BE DIAGNOSED WITH THIS DISEASE? IN OTHER WORDS, CAN YOU JUST HAVE IT AND NOT CARE?

 

>> DR. ANTHONY ROSTAIN: THAT'S ACTUALLY A VERY GOOD QUESTION. MANY PEOPLE HAVE THE SYMPTOMS, BUT IT'S ONLY WHEN IT'S INTERFERING WITH YOUR LIFE, WHEN YOU CAN'T MEET THE EXPECTATIONS OF YOUR JOB, OF YOUR FAMILY LIFE, OR OF YOUR SOCIAL NETWORK, AND PEOPLE ARE SAYING TO YOU, "YOU KNOW, YOU'RE KIND OF, LIKE, INTERRUPTING ME ALL THE TIME, AND IT'S STARTING TO ANNOY ME." THAT'S BEGINNINGS OF IMPAIRMENT. AND I THINK BY THE TIME FRANK GOT TO HIS PEDIATRICIAN WHO'S TAKING CARE OF HIS SON, IT WAS ALREADY STARTING TO AFFECT HIS LIFE.

 

>> DR. PETER SALGO: FRANK, WERE THERE TIPS, LOOKING BACK IN YOUR CHILDHOOD, ANYTHING TIPPING YOU OFF THAT MAYBE THIS WAS GOING ON WHEN YOU WERE YOUNGER?

 

>> FRANK SOUTH: YEAH, WHEN YOU LOOK BACK. YOU KNOW, I MEAN, THERE WAS... I WAS KICKED OUT OF BOY SCOUTS FOR BEING A THIEF AND A LIAR, AND I TOLD MY FATHER RIGHT UP TO THE VERY END, "I DIDN'T DO IT!" "NO!" HE WOULD SAY, AND THEN HE'D LOOK OUT THE WINDOW, AND I WAS PLAYING WITH MATCHES ACROSS THE STREET, AND HE'D GO, "AAH!"

 

>> DR. PETER SALGO: YOU KNOW, I'VE GOT SOMETHING IN MY POCKET. I'VE GOT SOMETHING IN MY POCKET. I HAPPEN TO HAVE A LETTER.

 

>> FRANK SOUTH: [ LAUGHING ] OH! YEAH.

 

>> DR. PETER SALGO: I'M NOT SURE YOU KNEW I HAD THIS LETTER.

 

>> FRANK SOUTH: NO.

 

>> DR. PETER SALGO: YOUR MOM WROTE A LETTER TO DR. SPOCK. AND TO THE KIDS IN THE AUDIENCE, NOT MR. SPOCK.  [ LAUGHTER ] DR. SPOCK, THE FAMOUS PEDIATRICIAN. AND SHE SAID, "CAN YOU GIVE ME SOME ADVICE ON MY BOY, WHO'S HAVING ALL THESE ISSUES?" AND I'M NOT GONNA READ IT OUT LOUD, BUT SHE WAS CONCERNED.

 

>> FRANK SOUTH: YEAH.

 

>> DR. PETER SALGO: AND SHE WROTE THIS LETTER.

 

>> FRANK SOUTH: YEAH, I FOUND IT IN A BUNCH OF FAMILY PHOTOS FOLDED UP, RIGHT? AND I OPENED IT UP, AND I SAID, "MOM! YOU --" AND SHE SAID, "OH. YEAH, I NEVER SENT THAT. I JUST -- I DON'T KNOW. I WAS EMBARRASSED." AND SHE SORT OF, YOU KNOW, WAS BLAMING HERSELF FOR MY BEHAVIOR, AND, YOU KNOW, SHE WOULD -- I WOULD JUST ALWAYS BE ACTING OUT IN ODD WAYS, AND SHE REALLY HAD A HARD TIME BELIEVING THAT I WAS IMPAIRED, YOU KNOW? AND I DIDN'T -- I FINALLY JUST SAID, "MOM, IT'S NOT A PROBLEM. YOU DIDN'T DO ANYTHING WRONG. I'M FINE, YOU KNOW? I JUST HAVE TO BE AWARE OF WHAT'S GOING ON."

 

>> DR. PETER SALGO: AND WITH THAT, WE'RE GONNA HOLD ON JUST FOR A SECOND. EVERYBODY, STAY RIGHT WHERE YOU ARE. AND WE'RE GONNA BE RIGHT BACK TO HEAR YOUR SECOND OPINION, BY THE WAY. BUT FIRST, HERE'S THIS WEEK'S "MYTH OR MEDICINE."

 

>> NARRATOR: ATTENTION DEFICIT HYPERACTIVITY DISORDER, OR ADHD, IS ONE OF THE MOST COMMON NEURODEVELOPMENTAL DISORDERS OF CHILDHOOD, AND THE PERCENTAGE OF U.S. CHILDREN AND ADOLESCENTS WITH THE DIAGNOSIS CONTINUES TO INCREASE EACH YEAR. THIS INCREASE HAS CAUSED WIDESPREAD CONCERN AND HAS SPARKED DEBATE -- IS ADHD OVER-DIAGNOSED? IS THIS MYTH OR MEDICINE?

 

>> DR. BRETT ROBBINS: "ADHD IS OVER-DIAGNOSED" -- THAT IS A MYTH, AND I'M GOING TO TELL YOU WHY. I'M DR. BRETT ROBBINS. I'M AN ASSOCIATE PROFESSOR OF BOTH INTERNAL MEDICINE AND PEDIATRICS AT THE UNIVERSITY OF ROCHESTER MEDICAL CENTER. THERE ARE VERY STRUCTURED AND OBJECTIVE CRITERIA FOR THE DIAGNOSIS OF ADHD. THE FIRST IS YOU HAVE TO HAVE A SERIES OF SYMPTOMS PRESENT FOR AT LEAST 3 TO 6 MONTHS. SECOND, THOSE SYMPTOMS HAVE TO BEGIN BEFORE THE AGE OF 12. THIRD, THOSE SYMPTOMS HAVE TO BE PRESENT IN AT LEAST 2 SETTINGS. FOURTH, THESE SYMPTOMS HAVE TO BE GETTING IN THE CHILD'S WAY. IN OTHER WORDS, THEY HAVE TO DISRUPT THEIR ABILITY TO FUNCTION AT SCHOOL OR HOME OR IN SOCIAL RELATIONSHIPS. GATHERING DATA FROM THE TEACHERS AND THE BOSSES AND THE PEERS AND THE PARENTS AND THE SIBLINGS AND TAKING YOUR TIME BEING METHODICAL AND USING THOSE DIAGNOSTIC CRITERIA, YOU CAN BE MORE CERTAIN THAT THE CHILD TRULY HAS ADHD. AND THAT'S MEDICINE.

 

>> NARRATOR: NOT SURE IF IT'S MYTH OF MEDICINE? CONNECT WITH US ONLINE. WE'LL GET TO WORK AND GET YOU A SECOND OPINION.

 

>> DR. PETER SALGO: WE'RE BACK. WE'RE WITH FRANK. WE'RE DISCUSSING HIS DIAGNOSIS OF ADHD, WHICH WAS MADE AT THE AGE OF 49.

 

>> FRANK SOUTH: YEAH.

 

>> DR. PETER SALGO: AN ADULT. SO, THE FIRST THING I WANT TO DO IS DISCUSS THE DIAGNOSIS OF ADHD IN ADULTS VERSUS KIDS. HOW IS IT THE SAME? HOW IS IT DIFFERENT? LISA, YOU WANT TO START US OFF?

 

>> DR. LISA HARRIS: SURE. I THINK IN CHILDREN, SOMETIMES IT'S A LITTLE BIT EASIER TO IDENTIFY BECAUSE YOU'LL HAVE A CHILD THAT MAY BE HYPERACTIVE. THE MORE DIFFICULT ONES ARE THE ONES THAT ARE INATTENTIVE, AND YOU MAY NOT PICK THEM UP UNTIL SCHOOL AGE. AND WE HAVE A VARIETY OF TESTS AND A BARRAGE OF TESTS THAT CAN BE DONE IN THE PRIMARY CARE OFFICE TO GIVE YOU THE INDICATION, BUT IT REALLY SHOULD BE SENT TO A SPECIALIST FOR DIAGNOSIS.

 

>> DR. PETER SALGO: WELL, YOU'RE THE SPECIALIST.

 

>> DR. ANTHONY ROSTAIN: SURE, WELL, WITH ADULTS, WHAT WE TEND TO SEE ARE PROBLEMS WITH EXECUTIVE FUNCTIONING, MANAGING TIME, STAYING ORGANIZED, HANDLING COMPLEX TASKS, FORGETFULNESS IS A BIG ONE, AND THE HYPERACTIVITY IS REALLY MORE RESTLESSNESS AND NEVER BEING ABLE TO SORT OF SETTLE DOWN.

 

>> DR. PETER SALGO: OKAY.

 

>> DR. ANTHONY ROSTAIN: AND IN THE PROCESS, WE WILL ASK ABOUT CHILDHOOD SYMPTOMS. THEY DON'T HAVE TO HAVE THE FULL DIAGNOSIS AS KIDS, BUT THERE HAD TO HAVE BEEN SOMETHING GOING ON. SO WITH YOU, YOU WERE, LIKE, A LITTLE BIT OF A TROUBLEMAKER, MAYBE, AND KIND OF BREAKING RULES. THAT WOULD BE CONSISTENT WITH THE DIAGNOSIS.

 

>> DR. PETER SALGO: YEAH, BUT IF YOU TOOK EVERY TROUBLEMAKER AND SAID, "YOU'VE GOT ADHD," THERE'D BE NO ONE LEFT.

 

>> DR. ANTHONY ROSTAIN: RIGHT, RIGHT. BUT THE FASCINATING PART IS THE OTHER THING WE LOOK FOR ARE WHAT WE CALL CO-OCCURRING OR COMORBID CONDITIONS.

 

>> DR. PETER SALGO: WHAT ARE THE IDENTITIES?

 

>> DR. ANTHONY ROSTAIN: WELL, FOR EXAMPLE, DRINKING OR MARIJUANA USE -- OVERUSE -- OF SUBSTANCES AND ANXIETY DISORDER IS VERY COMMON.

 

>> DR. LISA HARRIS: SLEEP DISRUPTION.

 

>> DR. ANTHONY ROSTAIN: SLEEP PROBLEMS, AS LISA MENTIONED EARLIER, AND THE OTHER IS REALLY A SENSE OF, I THINK, DEPRESSION ITSELF IS VERY COMMON -- IN FACT, THREE OR FOUR TIMES THE RATE OF THE GENERAL POPULATION. SO PEOPLE WITH ADHD MAY OFTEN GO AND COMPLAIN TO THEIR PRIMARY CARE DOCTOR THAT THEY'RE DEPRESSED OR THEIR LIFE ISN'T GOING WELL.

 

>> DR. PETER SALGO: SO, THEY GOT THE DIAGNOSIS RIGHT.

 

>> FRANK SOUTH: YEAH. OH, YEAH.

 

>> DR. PETER SALGO: SO, LET'S MORPH A LITTLE BIT. WE MADE THE DIAGNOSIS. OKAY, WHAT ARE YOU GOING TO DO ABOUT IT? AND THERE'S A LOT OF CONTROVERSY HERE, SO LET'S JUST DRILL RIGHT IN. HOW DO YOU TREAT ADHD? IN BOTH KIDS AND IN ADULTS?

 

>> DR. ANTHONY ROSTAIN: I START WITH EDUCATION. I REALLY DON'T THINK -- WE REALLY CANNOT UNDERESTIMATE HOW IMPORTANT IT IS FOR PEOPLE TO LEARN WHAT'S GOING ON, AND THAT'S WHY I THINK WHAT YOU'RE DOING, FRANK, WITH EDUCATING PEOPLE WITH YOUR OWN EXPERIENCES IS VITAL. I SEND PEOPLE TO WEBSITES. I SAY, "LEARN ABOUT THIS." THE SECOND IS TO RESTRUCTURE YOUR LIFE TO MAKE IT SIMPLER, TO BUILD IN STRUCTURES THAT HELP YOU GET THINGS DONE. AND THEN AFTER THAT, WE BEGIN TO TALK ABOUT MEDICATIONS AND OTHER STRATEGIES.

 

>> DR. LISA HARRIS: AND IT'S ALSO, THEN, THE SEVERITY OF DISRUPTION OF YOUR LIFE. SO IF SOMEONE COMES IN AND THEY'RE REALLY NOT FUNCTIONAL, THEN WE MAY START WITH SOME MEDICATION. BUT YOU'RE ABSOLUTELY RIGHT, AND BIOFEEDBACK AND SOME OF THE OTHER METRICS THAT ARE A LITTLE SOFTER TOUCH ARE REALLY PHENOMENAL IN THE BENEFIT FOR PATIENTS.

 

>> DR. ANTHONY ROSTAIN: WE HAVE TO GO WITH PEOPLE'S PREFERENCES, THOUGH. EXACTLY RIGHT. SOME PEOPLE SAY, "I WON'T TAKE A MEDICATION." OTHERS SAY, "PLEASE START ME." WE TRY TO BE VERY INFORMATIVE ABOUT WHAT THE SIDE EFFECTS AND THE BENEFITS ARE.

 

>> DR. PETER SALGO: THERE ARE TWO CLASSES OF MEDICATION -- THE STIMULANTS AND THE NONSTIMULANTS. HOW DO THEY WORK?

 

>> DR. ANTHONY ROSTAIN: WELL, STIMULANTS SEEM TO HELP THE BRAIN WORK MORE EFFICIENTLY -- BOTTOM LINE.

 

>> DR. PETER SALGO: BUT YOU'LL EXCUSE ME -- LET ME INTERRUPT RIGHT HERE, 'CAUSE I CAN HEAR EVERYBODY AT HOME SAYS, "WAIT -- THESE GUYS ARE JUMPING OUT OF THEIR CHAIRS, TEARING UP TOILET PAPER, AND YOU'RE GIVING THEM A STIMULANT?"

 

>> DR. ANTHONY ROSTAIN: TO ESSENTIALLY GIVE THE INHIBITORY CENTERS OF THE BRAIN AND THE PARTS OF THE BRAIN THAT LET US FOCUS BETTER, THOSE ARE UNDERPOWERED, AND THE STIMULANTS THEN BRING THOSE ONLINE.

 

>> DR. PETER SALGO: SOMEONE ONCE DESCRIBED THAT AS, "YOU'RE STIMULATING THE BREAK."

 

>> DR. ANTHONY ROSTAIN: CORRECT.

 

>> DR. PETER SALGO: OKAY. WHAT IS THE OTHER CLASS OF DRUGS?

 

>> DR. ANTHONY ROSTAIN: THE NONSTIMULANTS. THEY WORK DIFFERENTLY. THEY TEND TO ENHANCE NOREPINEPHRINE TRANSMISSION, WORK AROUND THE CLOCK. AND THEY MAY BE FOR SOME PEOPLE BETTER, BECAUSE IF YOU'RE WAKING UP DISORIENTED AND/OR CAN'T FALL ASLEEP AT NIGHT, THOSE INDIVIDUALS TEND TO NEED ROUND-THE-CLOCK TREATMENT.

 

>> DR. PETER SALGO: NOW, 49 YEARS OLD. MAYBE SOME PEOPLE ARE EVEN OLDER. YOU'RE TEMPTED TO GIVE, PERHAPS, A STIMULANT TO THIS GROUP OF PEOPLE. IS IT MORE DANGEROUS IN OLDER PEOPLE TO GIVE STIMULANTS, WITH THE CONCURRENT RISK OF ISCHEMIC HEART DISEASE, HEART ATTACKS, AND THINGS?

 

>> DR. LISA HARRIS: WELL, YOU HAVE TO RISK-STRATIFY PATIENTS, SO CERTAINLY SOMEONE WHO HAS UNCONTROLLED HYPERTENSION OR CORONARY DISEASE, YOU'D BE VERY CAUTIOUS ABOUT PRESCRIBING A STIMULANT FOR THEM. AND ALSO, IF THEY ALREADY HAVE SUBSTANCE-ABUSE PROBLEMS, LIKE ALCOHOL USAGE OR ARE UNDER ANTIDEPRESSANTS, YOU MAY BE A LITTLE BIT LEERY OF STARTING THEM ON A STIMULANT.

 

>> DR. PETER SALGO: NOW, FRANK, WHAT DRUG ARE YOU ON -- A STIMULANT OR A NONSTIMULANT?

 

>> FRANK SOUTH: A STIMULANT. I'M ON ADDERALL. AND I WAS ON RITALIN TO START WITH, AND I NEVER LIKED IT. I LIKED WHAT IT WAS DOING FOR ME, BUT WHEN I WAS CHANGED TO ADDERALL, IT WAS LIKE A WINDOW OPENING OR SOMETHING. I'D HAD A GLIMPSE WITH THE RITALIN, BUT THEN ALL OF A SUDDEN, I WENT, "OH! THIS IS WHAT IT'S LIKE." IT WAS LIKE A BREATH OF AIR.

 

>> DR. LISA HARRIS: AND THAT'S A REALLY IMPORTANT THING THAT YOU'RE SAYING, FRANK, SO IF WE'RE GOING TO SWITCH CLASSES OF MEDICATIONS TO A NONSTIMULANT FOR PATIENTS FOR A VARIETY OF REASONS, YOU HAVE TO SPEND A LOT OF TIME EDUCATING THEM THAT YOU'RE NOT GOING TO GET THAT SUDDEN FEELING OF THE WINDOW OPENING, AND THAT'S WHAT PATIENTS ARE LOOKING FOR AND NOT REALLY LOOKING FOR SYMPTOM MANAGEMENT.

 

>> DR. PETER SALGO: AND NONSTIMULANTS TAKE A LITTLE LONGER TO COME ON. THE STIMULANTS WORK RIGHT AWAY.

 

>> DR. ANTHONY ROSTAIN: BUT YOUR RESPONSE IS INTERESTING. IT'S VERY COMMON TO SEE THERE'S A PREFERENTIAL RESPONSE TO ONE VERSUS THE OTHER. TOO OFTEN, PEOPLE WILL JUST BE GIVEN, SAY, METHYLPHENIDATE OR RITALIN, BUT THE AMPHETAMINES OR ADDERALL -- ACTUALLY, EVERYBODY SHOULD BE TRIED ON BOTH UNTIL YOU FIND THE OPTIMUM MEDICATION. AND THEN WE MENTIONED JUST WHAT YOU SAID, LISA, THAT SOMETIMES WE MIGHT SAY IF YOU'RE GOING TO ADD A NONSTIMULANT TO GIVE COVERAGE AROUND THE CLOCK, WE WOULD MAKE SURE THAT THAT PERSON ISN'T THINKING THAT THIS IS GOING TO BE EXACTLY THE SAME, BECAUSE IT'S A DIFFERENT MECHANISM.

 

>> DR. PETER SALGO: NOW, FRANK, I PROMISED YOU'D HAVE AN OPPORTUNITY TO GET A SECOND OPINION.

 

>> FRANK SOUTH: YES.

 

>> DR. PETER SALGO: WE'VE GOT SOME GREAT EXPERTS HERE. THE FLOOR IS YOURS. ASK AWAY.

 

>> FRANK SOUTH: YOU ALWAYS FEEL LIKE, I THINK, AS AN ADHD PERSON, ALWAYS STARTS TO FEEL LIKE, "THIS IS IT. ONCE I GET THROUGH THE REAL WEEDS, HOW DO I GO PAST JUST BEING OKAY?"

 

>> DR. ANTHONY ROSTAIN: HOW DO YOU START TO THRIVE INSTEAD OF JUST SURVIVE?

 

>> FRANK SOUTH: YES. YEAH.

 

>> DR. ANTHONY ROSTAIN: WELL, I MEAN, THE FIRST THING I WOULD SAY IS, IF THE PACE OF YOUR LIFE IS STILL A PROBLEM, IF YOU'RE STILL DISORGANIZED, WORKING ON THE PROBLEMS THAT ARE MOST, YOU KNOW, BOTHERING YOU. AND ALSO FOCUSING ON IF THE MEDICATION IS HELPING YOU TO CONCENTRATE, USING CERTAIN TIMES OF DAY TO KIND OF ZERO IN ON THE TASKS THAT ARE THE LEAST FUN OR THE MOST TEDIOUS, TO DO THEM WHILE THE MEDICATION IS WORKING AT ITS PEAK, 'CAUSE TOO OFTEN, WHAT'LL HAPPEN IS PEOPLE WILL TRY TO DO THINGS IN THE EVENING, AFTER THEIR MEDICATION'S WEARING OFF, AND IT'LL BE VERY FRUSTRATING. THEY'LL STAY UP TOO LATE.

 

>> DR. LISA HARRIS: AND THAT'S ABSOLUTELY HUGE. AND ANTHONY HAD ALREADY MENTIONED EARLIER THAT WE REALLY NEED TO TALK ABOUT EDUCATION, SO HELPING YOU UNDERSTAND THAT THIS IS A CHRONIC DISORDER. IT'S NOT LIKE PNEUMONIA -- YOU TAKE AN ANTIBIOTIC AND IT'S BETTER. YOU ARE GOING TO NEED TO BE ON SOMETHING -- PROBABLY FOR THE REST OF YOUR LIFE -- AND THEN SET THE EXPECTATIONS. SO LET'S LOOK AT YOUR LIFE. ARE YOU DOING TOO MUCH ALREADY THAT WE NEED TO CUT BACK ON AND CUT BACK BY 50%, 75% AND SEE WHAT'S TOLERABLE FOR YOU?

 

>> DR. ANTHONY ROSTAIN: FRANK, THE OTHER THING I WANT TO MENTION IS THAT BECAUSE YOU KNOW YOU HAVE ADHD AND YOU'RE THINKING ABOUT HOW TO LIVE WITH IT BETTER, CELEBRATE THE THINGS YOU DO WELL AND REALLY FOCUS YOUR ENERGY ON THOSE. AND THE THINGS YOU DON'T DO SO WELL, AS MUCH AS YOU CAN, EITHER GIVE THEM OFF TO SOMEONE ELSE TO DO OR GIVE YOURSELF A BREAK THAT IT'S GOING TO TAKE YOU A LITTLE BIT MORE TIME TO GET THEM DONE.

 

>> DR. PETER SALGO: AND SPEAKING OF THAT, HOW ARE YOU DOING?

 

>> FRANK SOUTH: I'M DOING WELL. [ LAUGHS ] YEAH, AND I'VE -- IN THE LAST FIVE YEARS, AS A MATTER OF FACT, I'VE REALLY FOCUSED MORE ON WHAT REALLY HAS BECOME MORE IMPORTANT TO ME THAN ANYTHING ELSE, WHICH IS MY FAMILY AND THE KIND OF WRITING I WANT TO DO.

 

>> DR. PETER SALGO: AND YOUR BEHAVIOR, THE DESTRUCTIVE BEHAVIORS?

 

>> FRANK SOUTH: I NO LONGER DRINK. I HAVEN'T HAD A DRINK IN 14 YEARS.

 

>> DR. PETER SALGO: THAT'S GREAT.

 

>> DR. LISA HARRIS: YEAH, THAT'S GREAT.

 

>> FRANK SOUTH: THAT, YOU KNOW, WAS -- I WENT ON THE ADHD MEDICATION AND WAS STILL DRINKING FOR THREE YEARS, UNTIL I GOT SOME HELP WITH IT, AND THAT MADE A HUGE DIFFERENCE, AND ALSO BEING ABLE TO FOCUS ON THOSE OUTSIDE MYSELF, YOU KNOW? WHEN YOU START FOCUSING ON OTHERS AND SAYING, "WELL, YOU KNOW WHAT -- WHAT CAN I DO FOR THEM?" THEN YOU STOP -- I WAS OBSESSING ABOUT MY OWN PROBLEMS. AND THEN WHEN I STARTED FOCUSING ON OTHERS, IT HELPED A LOT.

 

>> DR. PETER SALGO: FRANK, I JUST WANT TO THANK YOU FOR BEING HERE, SHARING YOUR STORY. I'M DELIGHTED YOU'RE DOING REALLY WELL. AND, PANEL, THANK YOU FOR YOUR INSIGHTS ON THIS CASE. NOW, LET US KNOW WHAT YOU THINK ABOUT TODAY'S DISCUSSION AND FRANK'S SECOND OPINION BY TWEETING US OR BY COMMENTING ON OUR FACEBOOK PAGE. AND NOW HERE'S THIS WEEK'S "SECOND OPINION 5."

 

>> DR. ROGER OSKVIG: HELLO. I'M DR. ROGER OSKVIG. AND I'M HERE TO TELL YOU FIVE THINGS TO KNOW ABOUT ADULT ATTENTION DEFICIT HYPERACTIVITY DISORDER, OR ADHD. FIRST, ADHD IS A CHRONIC DISORDER. WE GENERALLY THINK OF IT AS A CONDITION OF SCHOOL-AGE CHILDREN, BUT AT LEAST 60% OF CHILDREN DIAGNOSED WITH ADHD WILL CONTINUE TO HAVE IT INTO ADULTHOOD. SECOND, THERE ARE SPECIFIC CRITERIA THAT DOCTORS, PSYCHOLOGISTS, AND OTHER HEALTH PROFESSIONALS USE TO MAKE THE DIAGNOSIS. THOSE CRITERIA INCLUDE A DISORDER OF ATTENTION, HYPERACTIVITY, AND IMPULSIVENESS. THIRD, ADHD IS TREATABLE. LET ME EMPHASIZE -- IT IS TREATABLE. A MAJORITY OF PATIENTS RESPOND WELL TO MEDICINE, COMPLEMENTED BY COUNSELING. THERE IS NO CLEAR EVIDENCE TO SUPPORT DIETARY EXCLUSIONS OR SUPPLEMENTS. ANOTHER THING TO KNOW IS THAT SYMPTOMS CHANGE WITH TIME. RESEARCH INDICATES THAT YOU DO NOT "GET OVER IT." ADULTS ADAPT. AS THE BODY MATURES, OUR INTERNAL CHEMISTRY CHANGES, OUR BRAIN GROWS, WE EMOTIONALLY MATURE, AND THE SYMPTOMS OF ADHD LIKEWISE CHANGE THROUGHOUT LIFE. AND FINALLY, IT RUNS IN FAMILIES. A NUMBER OF INHERITED GENES HAVE BEEN ASSOCIATED WITH THE DEVELOPMENT OF ADHD, BUT THE ENVIRONMENTAL FACTORS THAT ACTIVATE THOSE GENES ARE STILL THE SUBJECT OF MUCH RESEARCH. AND THAT'S YOUR "SECOND OPINION 5."

 

>> DR. PETER SALGO: THANK YOU SO MUCH FOR WATCHING, AND REMEMBER, YOU CAN GET MORE SECOND OPINIONS AND PATIENT STORIES ON OUR WEBSITE AT SECONDOPINION-TV.ORG. YOU CAN ALSO SEND US YOUR SHOW IDEAS AND SHARE YOUR OWN HEALTH STORY. MAYBE -- MAYBE WE'LL INVITE YOU TO BE ON THE SHOW WITH US. YOU CAN CONTINUE THIS CONVERSATION ON FACEBOOK AND TWITTER, WHERE WE ARE LIVE EVERY DAY WITH BREAKING HEALTH NEWS. I'M DR. PETER SALGO, AND I'LL SEE YOU NEXT TIME FOR ANOTHER "SECOND OPINION."

 

>> ANNOUNCER: "SECOND OPINION" IS BROUGHT TO YOU BY BLUECROSS BLUESHIELD. ACCEPTED IN ALL 50 STATES. BLUECROSS BLUESHIELD. LIVE FEARLESS.

 

>> ANNOUNCER: SECOND OPINION IS PRODUCED IN CONJUNCTION WITH UR MEDICINE, PART OF UNIVERSITY OF ROCHESTER MEDICAL CENTER, ROCHESTER, NEW YORK.