By James Wiley, MD, FAAP
It surprises people when I tell them that ADHD is a lot like Type 1 Diabetes, but it is. Both have a genetic component and factors other than genetics. In ADHD, we know that low birth weight or early exposure to visual media may increase the risk of diagnosis. Whereas with diabetes, experts think a viral type infection may unlock the genetic tendency to the disorder. Both diabetes and ADHD result from chemistry problems. In diabetes the pancreas slowly quits making insulin, the hormone that controls blood sugar. While in ADHD, the brain’s neurotransmitters (chemical messengers) like dopamine and norepinephrine, are under activated.
If both disorders are genetic chemistry problems, doesn’t it make sense that we would treat them both with chemistry? No one argues that a body lacking insulin would be treated by doctors with more insulin, as in diabetes. However, questions continue to arise. In the 1980s, doctors questioned whether precise doses of insulin given to completely normalize blood glucose was a good idea because too much insulin can be a bad thing. In contrast, the 1990’s research demonstrated that patients responded better with a more careful and precise control of glucose. Patients went from a dosage of two shots a day to as many as four or five and began using insulin pumps to control glucose. This research changed the management of diabetes.
What about ADHD? Research in 1999 found the same thing to be true. Precise medication management and finding the just right dose of the just right medication produced significantly better outcomes than intensive behavior modification strategies or loose medication management. So what did doctors do? Sadly we didn’t pay attention! We continued a haphazard medication management approach that in many cases amounted to throwing medication at the patient and following up ‘when needed’, instead we needed to carefully follow a medication plan that frequently reassessed medication and dose until the patient was optimized.
No doctor would hand a diabetic a vial of insulin and a handful of syringes and tell them to call if they had problems. At focus we believe that the key to treating ADHD is careful, precise use of medication that lets the patient be him/herself but just focused enough. We also provide families and patients resources so that our care provides more than medicine. Nutrition, exercise and educational accommodations are all mainstays of taking care of both disorders.
Both conditions often share a common quality. They both produce frustrated patients and families. Diabetic families benefit when they find a diabetes team that carefully manages insulin doses and educates the family on the care of the disease. At focus, we are committed to providing families the tools to go from frustration to focus.
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