Changing the ADHD Game: How understanding neurotransmission can transform your life by Dr. Mayer Hoffer

Author:Dr. Mayer Hoffer [Hoffer, Dr. Mayer]
Language: eng
Format: azw3
Publisher: UNKNOWN
Published: 2017-04-07T16:00:00+00:00

CHAPTER 13

What is The Stage II Treatment all about?

In the preceding chapter, the Stage I treatment for Attention Deficit Disorder was profiled. For many physicians, the use of a psychostimulant for the patient diagnosed with ADD is both the beginning and the end of the treatment effort. If the patient responds to the medication and the inadequate capacity to pay attention is enhanced then isn’t that the goal of treatment? After all, the “attention” of the “Attention” Deficit Disorder has been improved on. Case closed, right?

Not at all. However, if the doctor’s belief system dictates that the problem has been treated and whatever else is left is a separate issue, then no further treatment effort will be considered. In particular, if the patient returns and says something like “I’m still not getting my act together” or “I’m still having a hell of a time getting started on important projects,” they are likely to be told something wise and useless like “You’ll just have to try harder,” or “You have to learn to establish your priorities,” or even “You have to stop being so lazy.”

In my office, I am very specific with patients. They are instructed to look out for not just for the improvement in their focus/concentration/attention but also for their

procrastination/motivation/time management/prioritization. I consider it “half a loaf” (at best) if someone returns to my office in the subsequent few weeks with better capacity to pay attention and no improvement in their overall “executive functionality”.

What do other doctors do at this juncture? Often, the stimulant dose will be increased in an effort to achieve a “fuller” result. As mentioned earlier, once a stimulant dose has been properly tailored and adjusted, giving more is of little value and runs the risk of creating noxious side effects for the patient (nausea, agitation, and irritability). Increasing the dopamine won’t generally increase the norepinephrine side of the coin because the fact is, you can’t get to here (norepinephrine) from there (dopamine).

Sometimes the doctor may suggest talk therapy. This route is generally doomed to failure. It fails not because psychotherapy is useless; psychotherapy is an enormously effective treatment for many psychiatric difficulties. It fails because psychotherapy can’t address the self-regulatory challenges of the ADD person any more than squinting and eating more carrots can address the optometric challenges of the person who needs glasses.

Sometimes the more enlightened physician will refer the patient to a life coach or ADD coach but doing so at this stage may be premature. An experienced ADD coach can be very instrumental in helping a person define the challenges they face and establish parameters on how to address them. But they still can’t address the infuriating and frustrating tendency for ADD people to react impulsively due to their lack of access to their own personal “pause button”. ADD coaches can be enormously helpful, though, once Stage II issues are actually treated properly.

After the first few weeks of the Stage I treatment effort, my patients return for a review session. The distinct minority of my patients are “all better” at that point.

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