ADHD and Giftedness

The topic of "Gifted and ADHD" is extremely complex and sometimes controversial. On the one hand, many "gifted" students are misdiagnosed as having ADHD because they become fidgety, restless, or disruptive when they are bored. They often already know the material the teacher is covering that day, or have to sit and wait for other students to complete the work that they completed in half the time. On the other hand, gifted students with ADHD are often under diagnosed because they are bright and "they could do the work if they wanted to."

Gifted students with ADHD might do well academically until they have to work on long-term projects that require sustained effort on subjects they might not be that interested in. They might have an ability to compensate and "cover up" their difficulties with inattention, distractibility, disorganization, planning, time management and follow through. One good source of information is the ERIC Clearinghouse, do a search for "Gifted ADHD" and you'll find many scholarly articles on the subject.

I see many extremely bright adults with ADHD, including doctors, lawyers, professors, scientists, teachers, and others. Often they do well academically because academics are often something that they are interested in. A calculus problem might be just as stimulating for some people as a computer game is for others. Where they struggle is with the mundane tasks of daily life, such as completing needed paperwork at the office, keeping up on the checkbook, bills, and doing the taxes, remembering to send a card to a friend who is ill or when it's their birthday.

Doctors get into trouble with hospitals because they don't dictate discharge summaries in a timely manner, and lawyers get into trouble with their firm because they don't always remember to accurately record their billable hours, and both might have difficulty in relationships because they don't pay attention to what is important. What I'm trying to say is that I am not necessarily as concerned with academic success as I am about the other areas of life that might be affected by ADHD. ADHD tends to be a "life disorder," not just an "academic disorder."


Related Topics: ADHD: Back to School, Help Your Child With ADHD

Diagnosing ADHD

A common side effect of stimulants, including caffeine and medications used to treat ADHD, is irritability. Often people respond better to and better tolerate one stimulant over another or become irritable on any stimulant tried. In that case, they can also try Strattera.

Only about 70 - 80% of people with ADHD respond to medications. Whether or not someone responds well or whether or not someone experiences side effects does not mean that someone does or does not have ADHD. The same is true of other medical conditions. If you didn't respond to a high blood pressure medication, you wouldn't say that you didn't have high blood pressure.

It is also possible that the ADHD diagnosis is incorrect. In general, it's possible to see ADHD symptoms at school and not at home, but only rarely the other way around. If no ADHD symptoms occur at school, you have to question the diagnosis and wonder whether or not something is going on at home, whether the child is depressed or anxious, or whether there are other things that could be causing symptoms similar to ADHD at home.

Related Topics: ADHD: Is it Real?, ADHD Overlooked in Girls

ADHD Medications in Development

I receive many questions about alternatives to existing medications on the market for ADHD, and what is being developed for the future. Although I can't tell you when new drugs will be available, I can tell you what is in the pipeline:

1. Methylphenidate Transdermal System (MTS): A methylphenidate (brand name Ritalin by a different company) patch. Studies so far have yielded positive results and FDA approval is pending. MTS is a product of Shire Pharmaceuticals, who also produce Adderall and Adderall XR.


2. Attenace (modofinil) once-daily tablets. Currently modofinil has a brand name of Provigil and is marketed for daytime sedation related to narcolepsy, and excessive sleepiness associated with shift work or obstructive sleep apnea. FDA approval might occur before the end of the year.


3. Extended-release guanfacine (brand name Tenex by a different company) tablets (SPD503). Guanfacine is a high blood pressure medication that has been used in the treatment of AD/HD for severe hyperactivity, severe impulsivity, emotional outbursts, and oppositional behavior, often in combination with a stimulant. Tenex and Strattera might be somewhat similar. It will also be marketed by Shire Pharmaceuticals who hope to submit a New Drug Application by the end of this year.


4. An abuse-resistant amphetamine prodrug (NRP104) is also in development by Shire and River Pharmaceuticals, and a New Drug Application submission to the FDA is anticipated.


5. An extended-duration formulation of Adderall, which will extend the duration of action of Adderall XR several more hours, is in the final phase of research and development.


6. Many other medications with unique mechanisms of action are in much earlier stages of research, including drugs that are also being studied for Alzheimer's disease, for anxiety disorders, and for depression. St. John's Wort (Hypericum perforatum), an herbal product, is in early clinical trials at the National Center for Complementary and Alternative Medicine. Bupropion SR (Wellbutrin SR) is being studied for ADHD and alcohol problems in adolescents.

Related Topics: ADHD: Alternative Treatments, Choosing the Right ADHD Medication