A Resource Guide
Four questions that I am frequently asked are: When is it time to see a professional about ADD? What to do when a loved one with ADD is in denial about needing help? How do I go about finding a competent professional? When do you order a SPECT study? This chapter will attempt to answer these questions.
This question is relatively easy to answer. I recommend people seek professional help for ADD for themselves or their child when their behaviors, feelings, or thoughts interfere with their ability to reach their potential in the world, whether in their relationships, in their work, or within themselves. If you see persistent relationship struggles (parent-child, sibling, friends, romantic), it’s time to get help. If you see persistent school or work problems, it is time to get professional help. If you see continued monetary problems, it’s time to get help. Many people have told me they cannot afford to get professional help. I respond that it is much more costly to live with untreated ADD than it is to get appropriate help. If you see persistent self-esteem problems, or mood or anxiety problems it’s time to seek help. In my experience, if ADD remains untreated past the age of nine-years-old there is a very high chance of self-esteem and mood problems.
The internal problems associated with ADD can ruin lives, relationships, and careers. It is essential to seek help when necessary. It is also critical for people not to be too proud to get help. Pride often devastates relationships, careers, and even life itself. Too many people feel they are somehow “less than others” if they seek help. I often tell my patients that, in my experience, it is the successful people who seek help when they need it. Successful businesspeople hire the best possible outside consultants when they are faced with a problem that they cannot solve or when they need extra help. Unsuccessful people tend to deny they have problems, bury their heads in the sand, and blame others for their problems. If the ADD symptoms are sabotaging your chances for success in relationships, work, or within yourself, get help. Don’t feel ashamed: feel as though you’re being good to yourself.
In thinking about getting help, it is important to put ADD in perspective. First, I have patients get rid of the concept of “normal versus not normal.” “What is normal anyway?” I ask. I tell my patients who worry that they are not normal, that “normal” is the setting on a dryer. Or that Normal is a city in Illinois. Actually, I spoke in Normal, Illinois, at a major university several years ago. I got to meet Normal people, shop at the Normal grocery store, see the Normal police department and fire department, and even be interviewed on the Normal radio station. I met Normal women. They were a very nice group, but really not much different from those folks in California. The Normal people seemed to have their share of ADD—which is why I was asked to speak.
I tell my patients about a study sponsored by the National Institutes of Health, where researchers reported that 51 percent of the U.S. population suffers from a psychiatric illness at some point in their lives. Anxiety, substance abuse, and depression were the three most common illnesses. At first, I thought this statistic was too high. Then I made a list of twenty people I knew (not from my practice). Eleven were taking medication or in therapy. Half of us at some point in our lives will have problems. It’s just as normal to have problems as to not have problems. Again, it is the more successful people that will get help first. The same study reported that 29 percent of the population will have two separate, distinct psychiatric diagnoses and 17 percent of us will have three different psychiatric diagnoses. In my experience, very few people are completely without these problems. In fact, in doing research, one of the most difficult challenges is finding a “normal” control group.
One of the most persuasive statements I give patients about seeking help is that I am often able to help them have more access to their own good brains. When their brains do not work efficiently, they are not efficient. When their brains work right, they can work right. I often will show them a number of brain SPECT studies to show them the difference on and off medication or targeted psychotherapy, as a way to help them understand the concept. As you can imagine, after looking at the images in this book, when you see an underactive brain versus one that is healthy, you want the one that is healthy.
J.C. was the nineteen-year-old son of a Bay Area physician. His mother brought him to see us because he had problems in school and problems with his behavior. He was angry, resentful, oppositional, and moody. He had been in psychotherapy with three different therapists over the past twelve years. His mother thought that medication might be helpful. J.C. was opposed. “I don’t want medication,” he said, “I want to be myself. It’s not my problem.” His SPECT study revealed marked decreased temporal lobe activity, increased anterior cingulate activity, and decreased prefrontal cortex activity. I showed him his brain on the computer monitor. After he understood the scan, his first comment to me was, “Can you give me something to help my brain?” I gave him medication to stabilize his temporal lobe, and supplements to calm his anterior cingulate gyrus and stimulate his prefrontal cortex. He felt better within several weeks. He was compliant with treatment because he wanted to have optimal access to his own brain.
Unfortunately, the stigma associated with ADD or “psychiatric illness” prevents many people from getting help. People do not want to be seen as crazy, stupid, or defective. They often do not seek help until they (or their loved one) can no longer tolerate the pain (at work, in their relationships, or within themselves). Men are especially affected by denial.
Many men, when faced with obvious problems in their marriages, their children, or even themselves, refuse to see problems. Their lack of awareness and strong tendency toward denial prevent them from seeking help until more damage has been done than necessary. Many men are threatened with divorce before they seek help. Often, with ADD, many men had been diagnosed as children with hyperactivity and had been on medication. They hated feeling different than the other kids and resented taking medication, even if it was helpful for them.
Some people may say it is unfair for me to pick on men. And indeed, some men see problems long before some women. Overall, however, mothers see problems in children before fathers and are more willing to seek help, and many more wives call for marital counseling than husbands. What is it in our society that causes men to overlook obvious problems, to deny problems until it is too late to deal with them effectively or until significant damage occurs? Some of the answers may be found in how boys are raised in our society, the societal expectations we place on men, and the overwhelming pace of many men’s daily lives.
Boys most often engage in active play (sports, war games, video games, etc.) that involves little dialogue or communication. The games often involve dominance and submissiveness, winning and losing, and little interpersonal communication. Force, strength, or skill handles problems. Girls, on the other hand, often engage in more interpersonal or communicative types of play, such as dolls and storytelling. When my wife was little, she used to line up her dolls to teach them. Fathers often take their sons out to throw the ball around or shoot hoops, rather than to go for a walk and talk.
Many men retain the childhood notions of competition and that one must be better than others to be any good at all. To admit to a problem is to be less than other men. As a result, many men wait to seek help until their problem is obvious to the whole world. Other men feel totally responsible for all that happens in their families and admitting to problems is to admit that they have in some way failed.
Clearly, the pace of life prevents some men from being able to take the time to look clearly at the important people in their lives and their relationships with them. When I spend time with fathers and husbands and help them slow down enough to see what is really important to them, more often than not they begin to see the problems and work toward more helpful solutions. The issue is not one of being uncaring or uninterested: It is not seeing what is there.
Many teenagers also resist getting help, even when faced with obvious problems. They worry about labels and do not want yet another adult judging their behavior.
Here are several suggestions to help people who are unaware or unwilling to get the help they need:
At this point, we get many calls and e-mails a week from people all over the world looking for competent professionals in their area who think in ways similar to myself and the principles outlined in this book. Because the principles in this book are still on the edge of what is new in brain science, these professionals may be hard to find. Still, finding the right professional for evaluation and treatment is critical to the healing process. The right professional can have a very positive impact on your life. The wrong professional can make things worse. There are a number of steps to take in finding the best person to assist you.
We maintain a list of people who have taken our affiliate training on our website at amenclinics.com/aaec/about-referrals/referral-network.
I know it is hard to find a professional who meets all of these criteria who also has the right training in brain physiology, but these people can be found. Be persistent. The caregiver is essential to healing.
Here are several common questions and answers about SPECT.
Will the SPECT study give me an accurate diagnosis? No. A SPECT study by itself will not give a diagnosis. SPECT studies help the clinician understand more about the specific function of your brain. Each person’s brain is unique, which may lead to unique responses to medicine or therapy. Diagnoses about specific conditions are made through a combination of clinical history, personal interview, information from families, diagnostic checklists, SPECT studies, and other neuropsychological tests. No study is “a doctor in a box” that can give accurate diagnoses on individual patients.
Why are SPECT studies ordered? Some of the common reasons include:
Do I need to be off medication before the study? This question must be answered individually between you and your doctor. In general, it is better to be off medications until they are out of your system, but this is not always practical or advisable. If the study is done while on medication, let the technician know so that when the physician reads the study, he or she will include that information in the interpretation of the scan. In general, we recommend patients try to be off stimulants at least four days before the first scan and remain off of them until after the second scan, if one is ordered. Medications such as Prozac (which stays in the body four to six weeks) are generally not stopped because of practicality. Check with your specific doctor for recommendations.
What should I do the day of the scan? On the day of the scan, decrease or eliminate your caffeine intake and try to not take cold medication or aspirin. (If you do, please write it down on the intake form.) Eat as you normally would.
Are there any side effects or risks to the study? The study does not involve a dye and people do not have allergic reactions to the study. The possibility exists, although in a very small percentage of patients, of a mild rash, facial redness and edema, fever, and/or a transient increase in blood pressure. The amount of radiation exposure from one brain SPECT study is approximately the same as one abdominal X-ray.
How is the SPECT procedure done? The patient is placed in a quiet room and a small intravenous (IV) line is started. The patient remains quiet for approximately ten minutes with his or her eyes open to allow their mental state to equilibrate to the environment. The imaging agent is then injected through the IV. After another short period of time, the patient lies on a table and the SPECT camera rotates around his or her head. (The patient does not go into a tube.) The time on the table is approximately fifteen minutes. A concentration study is done the same way except that the patient does a concentration task while the medicine is being injected into their arm. If a concentration study is ordered, the patient returns on another day.
Are there alternatives to having a SPECT study? In my opinion, SPECT is the most clinically useful study of brain function. There are other studies, such as quantitative electroencephalograms (QEEGs), Positron Emission Tomography (PET) studies, and functional MRIs (fMRI). PET studies and fMRI are considerably more costly and they are performed mostly in research settings. QEEGs are very useful and provide a different type of look at brain function. Sometimes we do both.
Does insurance cover the cost of SPECT studies? Reimbursement by insurance companies varies according to your plan. It is often a good idea to check with the insurance company ahead of time to see if it is a covered benefit in your case.
Is the use of brain SPECT imaging accepted in the medical community? Brain SPECT studies are widely recognized as an effective tool for evaluating brain function in seizures, strokes, dementia, and head trauma. There are more than a thousand research articles on these topics. In our clinic, based on our experience over twenty-two years, we have developed this technology further to evaluate aggression and non-responsive psychiatric conditions. Unfortunately, many physicians do not fully understand the application of SPECT imaging and may tell you that the technology is experimental, but over five thousand medical and mental health professionals have referred patients to us for scans.