Speaker 1 0:04

Welcome to the Healthy Matters podcast with Dr. David Hilden , primary care physician and acute care hospitalist at Hennepin Healthcare in downtown Minneapolis, where we cover the latest in health healthcare and what matters to you. And now here's our host, Dr. David Hilden .

Speaker 2 0:21

Hey everybody, it's Dr. David Hilden , and this is episode nine. Today we are gonna talk about attention deficit hyperactivity disorder, A D H D with psychiatrist Dr. John Weger . He is a colleague of mine here at Hennepin Healthcare in downtown Minneapolis. Dr. Wohrer , thanks for being on the show.

Speaker 3 0:38

Hey, thank you for having me.

Speaker 2 0:40

It's great to have you here today. And let's just start us out right away. What is a d d? What is a D H D and is, is there a difference?

Speaker 3 0:48

Well, that's a really good question. In the old days, we used to kind of specify between a d D and a d h , adhd . Now, because people like me are a psychiatrist and we try to keep it simple. Everything is a D H D , but we discuss it a little bit like inattentive type combined subtype or hyperactive subtype.

Speaker 2 1:05

So there's subtypes of a D h adhd . Correct . So what does it stand for? Attention deficit Hyperactivity disorder. Correct. What are the symptoms of that

Speaker 3 1:14

A ADHD has? You know , they're kind of two main families of symptoms. The first subgroup, so to speak, are the ones you usually think about the inattentive symptoms. These are the ones that , uh, get people in trouble, not immediately at school, but a little bit later down the road. For example, not paying attention when someone is given a , uh, request by a parent or a teacher, it takes 'em while they don't process it immediately very quickly. They don't follow through on what they say they will do, not because it's an onerous job, just because they get to a point and they forget about doing what they were doing. Multi-step tasks also are very, very difficult.

Speaker 2 1:47

Is it always in children?

Speaker 3 1:48

No, no. It's , uh, this is often where we see it in children, because each time as academic or intellectual rigor goes up a little bit like kindergarten to first grade , uh, upper elementary, middle school, high school, and so on, or from high school to college, high school to job, job. Every time that goes up, that's when we notice that people seem to just have this difficulty with staying on task.

Speaker 2 2:10

Are kids, do they know they're doing it or , or are they just, are they what we always call spacey kids? They're just not paying attention.

Speaker 3 2:16

So for the most part , uh, it's, it's not a willful thing. It's not like a malevolent thing. It's just they get distracted. You know, the stereotypical, you know, you're talking to someone and you look out the window and go, oh, squirrel. And that's what happens is just people with adhd , they won't return back to the topic they, that they were previously on. Not because they don't want to, it's just because they've moved on, they've got something else they wanna do or they're thinking about or something else they need to do. That's

Speaker 2 2:41

The inattentive part. You said there's another presentation, another type of symptom.

Speaker 3 2:45

Yeah, there is the , um, hyperactive, impulsive part. And this is kind of what is more, you know, whereas the inattentive stuff, it is what gets people in trouble at work or at school later on down the road when there's an evaluation. The hyperactive, impulsive part that is what gets you in trouble immediately and the inability to stay still, where they just keep moving. It's almost like sometimes it's not even, they're talking so much, it's as if a wall of sound follows behind them. They, they just, you know, they sit down noisily, they're tapping their feet, they're tapping their hands , uh, they can't wait their turn, they're interrupting, budding in line. It's just, it , it's, it's very difficult for them to keep their body quietly, just keep moving.

Speaker 2 3:20

I bet most of us can think of a kid like that either with both of those things, the inattentive part or the hyperactivity part. Do we know what is actually going on in the brain?

Speaker 3 3:31

Not specifically, but we have some ideas. Kids with a d h , adhd and , and I'm focusing mostly on kids, but this can extend to adults most development, you know, it's sort of, as you develop, your brain develops often will go from the back part like cerebellum, you know, visual centers and go forward to the frontal cortex. Frontal cortex is what we call the association cortex. It's where you add different pieces of information together to come up with some kind of planning,

Speaker 2 3:56

Kind of that higher level function. Yeah , that planning function.

Speaker 3 3:59

So with kids with adhd , the frontal part develops somewhat more slowly. And this is just, you know, we all develop and we all mature very differently, but the frontal cortex in people with ADHD develops later. Also, there are some, we think there are some difficulties with the , a particular transmitter, the dopamine neurotransmitter that is, and either the , um, signal doesn't get through. It is not transmitted as efficiently in the brain. It's not loud enough. You could say it . So you've kind of got these structural issues, you've got these chemical issues, and you've also got some genetic issues. You know, if the , it's, I was reading something like heritability, if both parents have ADHD or a monozygotic twin as a adhd , the, there's a very high heritability, like 75% in the min monos. I got twins, you know, identical twins.

Speaker 2 4:46

Identical twins, yeah.

Speaker 3 4:47

And with parents. Yeah. I , I , I don't think the heritability is quite that high, but it is one of those things.

Speaker 2 4:52

I bet there's a whole bunch of people listening right now that are nodding their heads, oh yeah, that sounds like my kid <laugh> and , or that sounds like , um, my kid's friend at school. But how do we know when it's a pathologic process or something that needs attention versus my kid's just easily distracted? I mean, when does it become something that someone like you, a psychiatrist, gets involved? Yeah,

Speaker 3 5:13

That's, that's a good point. And kind of the , the very short answer is when it causes trouble, and sometimes it may not be recognized immediately because some of these kids, they do school well, they do their job well, and they kind of coast through and then all of a sudden they hit this higher level of intellectual rigor or procedural rigor, and all of a sudden they just hit a wall and they can't do it anymore. The engine's overheated and the wheels come off. It's , uh, generally one of those things where we all have some of it. I mean, I always joke, you know, I made the mention about, you know, people will say, oh, I saw squirrel and that's why it got me distracted. You know, one time I was sitting in my office asking a kid these questions that we will ask <laugh> , and they were making our , uh, they were rather rebuilding our picu and all of a sudden , uh, uh, porta-potty just goes lifting up in the air, and of course you're gonna look at a porta-potty floating out your window. It's just not something , oh,

Speaker 2 6:02

It was like in the window cuz it was a Republican on ated construction site . Okay . Yeah ,

Speaker 3 6:05

It was like seven floors up. And so yeah, that's not pathologic. That's just,

Speaker 2 6:09

Yeah, I might have looked at that too.

Speaker 3 6:10

It was, it was something. But , uh, when it starts causing problems, often we'll see the parents say, oh, this kid just doesn't listen. Or the teacher will say something like, you know, this person is very bright, but I just don't get it. Their, their work is terrible. Their handwriting is awful because there are some other, you know, sort of neuropsychological neuropsychiatric and so-called neurological soft signs that accompany adhd . So these things in concert will often bring it to, usually first a teacher's attention or the parents

Speaker 2 6:39

A little bit later in the show, I'm gonna ask you quite a bit more about how is it diagnosed and how is it treated, because so many people are interested in, you know , is it medications and , and how do you even know? But before we get to that, I want to ask you just a little bit more about the, the illness in general. I'm gonna start out with this. How common is

Speaker 3 6:56

It? It's predominantly considered what's , uh, what's termed a neurodevelopmental illness? You know, it's something that we see earlier in age. So we see up to about seven to 8% in the US for those, you know, school-aged 18 and under. It depends on the area of the country you're from and whether this is diagnosis, whether this is genes, I'm not sure. But for example, in the southern southeastern parts like Louisiana or Kentucky, often school-aged kids will be somewhere around 10 to 12% of kids are diagnosed with D adhd . Whereas in the West Nevada and California, sometimes it's more like 5%, but kind of the average that's agreed on in the US is seven to 8%.

Speaker 2 7:35

Is that going up? Because I have the sense that it's going up, but is that true?

Speaker 3 7:39

It is going up? I think some of it is because the population is going up. Some of it is because we have more knowledge, we see more things about, you know, this could be adhd. And people are realizing that this isn't just a , a naughty kid. This isn't just someone who isn't trying, often they're trying really hard and they're getting frustrated because they just can't pay attention. You

Speaker 2 7:58

Brought up the term, this isn't just a naughty kid. I bet you have heard, and as I have, many people have said something like, okay, I know what these kids are like, they're just naughty kids, and now you're putting this medical label on it and you're putting drugs in them and you're treating kids and adults forevermore. They're just misbehaving. What do you say to that? Uh ,

Speaker 3 8:17

A diagnosis does not give you the, you know , for example, if you have ADHD that doesn't give you the right to steal a car or do something like that, that doesn't give you the right to be sarcastic to someone. But it does make it much harder to kind of reign in those responses. So this is often a kid that is trying very hard to do well in class in all aspects social as well. So maybe they blurt something out because they think it's gonna be funny and that's gonna earn 'em kind of some, you know, class clown points or they blurt out an answer first because they're trying to impress the teacher. Kind of the corollary to that is , well, how come my kid can play video games? So well, it's because ADHD is like the perfect video game magnet. Kids with ADHD do lots of things, not at a super deep level, but on a superficial level very well. And video games are perfect for that. You've got a million things going on at the same time, and they can handle that. But if you sat them down and said , okay, I want you to solve this calculus problem, that can feel like torture because it's, you're doing the same thing, very rigorous, very precision oriented. This just isn't how these kids are set up. And, and it's often misinterpreted as naughty.

Speaker 2 9:20

I wanna delve into that more, John , the video game and screen connection. Is it more the case that kids with adhd , whether diagnosed or not, are just simply better at screens? Kind of like what you have talked about? Or is it that the screens itself promote the condition which came first?

Speaker 3 9:39

Good question. Again, kids with ADHD are better at screens and because this is something they're good at in a world of many other things that they're told that they're not good at, they stick with it. They run with it. So it's like, yes, I can do, I can play Call of Duty all night because here I'm a superstar, but at at high school, i , I , I look like someone who's just having a lot of difficulty . Someone who's not paying attention to someone who's not good enough. So there is sort of that egosyntonic aspect of it, because it is, it's very, it , there are issues with addiction, which is an entirely different thing. Some people, they, they drift into this electronic world, but also the world is changing. I mean, kids communication now is so much more digital. There's so much more going on. Like with social media, we're in the age of, you know, I was listening to cnn , we're in the age of the 24 hour news cycle. Anything you want to find out, you'll find out now. And in many ways this is great for an ADHD brain, but it also reinforces that instant gratification and that lack of frustration tolerance. If I can't figure this out now, I'm gonna move on to the next thing that I can figure out. Social media also has its pitfalls because there's still this issue with responding before thinking adequately through a response. So as we've seen, there's, you know, there's all sorts of things in the, in the news today about social media and its impact on, on the mental health of people, especially adolescent and younger women,

Speaker 2 10:57

And many of us, you know, who use social media. I , I think it it , we seem to have the attention span of a nat <laugh>, you know , it's true. You know, everything is is in short little bursts. I wonder what is the effect on a developing kid's brain or a young adult's brain who might have adhd when you're never required to do anything that takes longer than 10 seconds with your two thumbs on your phone. Is there an effect? I wonder?

Speaker 3 11:21

Yes, I do think there is an effect. Yeah . And it , it's interesting you're bringing this up and I hope I'm not going off topic, but a lot, there's a lot of these brain training things that you can buy online now, and I, I really wish that these would end up to be fruitful because this feeds right, it goes right to what kids with ADHD feel reinforced with. The problem is if you're constantly reinforcing that instant gratification, you're not reinforcing the deferred gratification. And that can be really problematic.

Speaker 2 11:47

We're talking with Dr. John Weger . He is a psychiatrist seeing adults and children here at Hennepin Healthcare in downtown Minneapolis. And we're talking about attention deficit hyperactivity disorder. We're gonna take a short break, but when we come back, I'm gonna ask Dr. Romar about and how do you diagnose this thing and how is it treated? Stay with us. We'll be right back.

Speaker 1 12:09

You are listening to the Healthy Matters podcast with Dr. David Tilden . Got a question or comment for the doc, email us at Healthy matters hc m e d.org or give us a call at six one two eight seven three talk. That's 6 1 2 8 7 3 8 2 5 5. And now let's get back to more healthy conversation.

Speaker 2 12:32

And we're back with Dr. John Weger , a psychiatrist and colleague you of mine here at Hennepin Healthcare in downtown Minneapolis. Before I get into a diagnosis of a D H D John , I wanna ask you about the prevalence , uh, in men versus women. Is there a difference

Speaker 3 12:47

There? Most definitely is, and that's a , that's a great point. And it's very interesting because up until about the age of seven, it's pretty, even boys and girls. But then once you get past the age of seven, the prevalence of those who were born , um, biologically male is much higher than those who were born biologically female. It's anywhere from, you know, for every one biological female to 1.6. Some people even say one to three. So there is another , it's two

Speaker 2 13:13

Or three

Speaker 3 13:13

To one. Yeah, it's really something.

Speaker 2 13:15

Do we know why that

Speaker 3 13:16

Is? That I don't know. I mean, that would be a great thing because a lot of these kind of what are called externalizing illnesses are more, you know, there are some illnesses that are for some reason manifest more in men. And these are usually what we used to call externalizing, you know, conduct issues, oppositional defiant issues. Whereas there are some mo other issues that are considered more prevalent in women such as anxiety and depression. We don't exactly know why it would be a great, oh my goodness, it would be a great story, the rule of cortisol and estrogen and testosterone and development. But that is , um, that is something that I will leave to my friends at the University of Minnesota. Yeah . Hopefully smarter than me. Hopefully

Speaker 2 13:51

Somebody's researching that . That's a great, great , uh, it's a bit of an unknown it sounds like. Yeah . How about one more, one more thing that's been on my mind. What about diet? Does what kids eat matter?

Speaker 3 14:01

You know, this is funny because the data used to really not say too much of it, but a again, if you're filling your tank with junk, it's not gonna last long. You're going to burn off that energy. And my wife swears that when we give our kids nothing but sugar rather, when I give our kids nothing much , it's

Speaker 2 14:17

Only you. I'm sure your wife only gives them kale and tofu,

Speaker 3 14:20

<laugh>. No, it's , uh, you , yeah , there is something to be said there. So, and it brings up a good point. I mean, some kids, these may be triggers some kids, if it's , there's a ton of caffeine in it, you bet they're gonna be bouncing off the walls. Same

Speaker 2 14:31

With the sugar. Is that , that causes a little bit of a sugar high , doesn't

Speaker 3 14:35

It? Absolutely. And a and a sugar crash that can look like, you know, can look like irritability, can look like and , and like we're gonna talk about in a little bit, I guess , uh, it , it can look like the medicine wearing off too.

Speaker 2 14:45

Yeah, yeah. And so, but there's not a known direct causality between what you

Speaker 3 14:50

Eat, not anything strong, it's more kind of the general,

Speaker 2 14:53

Okay. Let's shift gears. Let's talk about how it is diagnosed. So first of all, who should be tested or screened?

Speaker 3 15:01

Well, anybody that's having a lot of trouble in school, in their workplace, they should think about getting this screened. Especially if there's a strong, you know, if mom and dad both have adhd , if brother sister have adhd , some sibling, and they're starting to see the same problems, not listening in class, despite the fact that they can recite to you cer they still can't write their ABCs. You know, the kind of these discrepancies that you notice between sort of their intellectual capacity and their school performance or their job performance. And sometimes it's listening to the teachers. Sometimes it's a job or a supervisor that brings us up later on in

Speaker 2 15:36

Life. So could it be at any age that you should be initially looked at? I I I heard somewhere that if you're a 35 year old person, you've never been diagnosed with this in the past, it might not be this, is that a myth? You

Speaker 3 15:47

Know, that that used to be kind of considered, you know, people consider considered adhd like asthma just sort of burns out as you get older, right ? Well, the fact of the matter is it doesn't, and a lot of people, especially if you grew up in a very structured sort of environment, you did not have that, that flexibility. People just said, no, you just need to work harder. Those people figured out a way. I mean, and you will figure out a way to get this stuff done, but then you finally hit a brick wall. So yeah, we're fine . It's interesting because if you look around the world, adult ADHD is diagnosed way more than it is here in the us but the , uh, the converse is true for kiddos. We, our , our rates are much higher than even kind of what you would consider Canada or comparable contrary .

Speaker 2 16:25

Let's talk about how it is diagnosed. So somebody comes in to see you, what do you do?

Speaker 3 16:29

Well, there's several things that you can do. They all sort of work and feed together. The first is just a good clinical interview. You go down what are called the DSM five criteria for the inattention, for the hyperactive impulsive, and if they meet so many of these criteria by the age of 12. Okay, that's a very, very strong indicator that we have adhd . There are also tests that you can do. For example, in school there are tests called the Vanderbilt or the Connors are similar, that often there's a teacher report you send to the teacher, they send it back, a parent report and a child self report . And then these data are compiled together. If those are both kind of suggesting. There are also more detailed neuropsychological tests, and these are focused on , um, continuous performance and the most, most common ones, one is called the tova or the test of variable attention or the Connor's C P T Continued performance test in which basically you're in front of a computer and you have to trigger the computer when you notice some kind of a difference. Does

Speaker 2 17:25

A D H D go along with other mental health diagnoses or is it often diagnosed just in isolation?

Speaker 3 17:32

No, it is highly, highly comorbid as we like to say . Mm-hmm . It's high , you know , there are so many things associated with it and it, the , in many ways, this will guide your treatment. I mentioned something, you know, you've got predominantly male profile, so you also have predominantly male things like what we call oppositional defiant disorder, conduct disorder. Substance use issues are highly comorbid. Now this isn't like, oh my gosh, this isn't like a death sentence that you're headed towards these things. It just means, you know, if you're having trouble staying focused and you're more likely to seek out the thrilling thing, you do have to be , uh, careful about it. Um, other things that we notice, and when you think about it, it makes sense. Like 30 to 40% of kiddos with ADHD also have anxiety. 10 or so percent of them 10 to 20, depending on the studies, have depression. A lot of kiddos also have autism. A lot of people have comorbid ticks. And then when you look at a certain subset of ticks , you know, Tourettes combine motor, physical ticks , the , the rate is even higher. So yeah, it's highly comorbid.

Speaker 2 18:31

Before I ask you to talk to us about treatment specifically, I want to ask you about what happens if it's not treated. What is the consequence of undiagnosed and untreated adhd ?

Speaker 3 18:42

Well, first it makes the kiddo's life much harder. Kids with undiagnosed or untreated ADHD are much more likely to like, get in traffic accidents to not perform to their potential. Or even if you're not looking at potential on all these other highfalutin things, if you're looking at something more like just enjoyment, you know, finding a job that they like to do, maybe they want to be a computer programmer, but they just can't keep it together for periods of time. So their , their overall satisfaction with life is generally not as good. That being said, the brain will find a way, the brain will find ways of coping and if it's something that you really like doing, people can, but it will be much harder. It will take much more time and many people will become discouraged or it's just less enjoyable for

Speaker 2 19:23

Them. I think that's an important point. I'm really glad you mentioned that. So John , most of us have heard of drugs like Ritalin and Adderall, and so let's talk about treatment.

Speaker 3 19:32

So there was a study, I believe it was 2003, 2004, called the mta, which was a multi-site study that shows, hey, what treatment works best community treatment therapy or medication, if you have just what I call just straight ahead rock and adhd , you know, no comorbidities, no nothing. Medicine was considered the treatment of choice. The first medication that people use is about 75% effective. It may not bring you all the way to where you wanna be, but it helps if you have to go to a second medication, then it's like 90% effective. So the meds are very, very effective. There's also just some degree of the behavioral therapies are very helpful for kids behavioral therapies focusing on how does a parent respond to a kid. Like going back to what you had said earlier, this isn't necessarily a naughty kid, but this is a kid that needs to make some better choices. So it's not, you know, if they got halfway done with a particular project at home, the parent redirects 'em to that. And part and parcel with that is reward. I mean, it can't just be all negative stuff. You know, like, hey, if you get this stuff done, like a star chart for example, you get a star, you get so many stars, you get a small reward, you get so many small rewards, you get a big one. These are great things that people can do.

Speaker 2 20:42

So is that what you mean by therapy? Uh , like just what parents can do in the home or are you talking about a psychologist or a psychiatrist such as

Speaker 3 20:49

Yourself? Both. I mean, it , it , it focuses on the whole family system. But yeah, there are some things, there are some behavioral type treatments where the um, kiddo will, you know , will go in to see the therapist. The therapist will work with them on behavioral plans. Like okay, you know that immediately after school you're too wiped out, but by six o'clock you've got hockey, what can you do between 4:00 PM and 6:00 PM to get your work done? Or what can you, what do you need to do to prepare for that? Other therapies are also very helpful, especially if there are comorbid things like anxiety. Esp now with anxiety and adhd , treating that other comorbid illness, whether it's anxiety, depression, what have you, it is so much more helpful. And that group in that MTA study actually did better than just medicine.

Speaker 2 21:33

Is that what cognitive behavioral therapy is C B T or is that a specific type of therapy?

Speaker 3 21:38

There is something called, there's a parental therapy, P C I T that talks about the interaction between parents and children. But that's, you know, when you're talking specifically about kids, there are some cognitive therapies. Cognitive therapies are great for a wide variety of things. You know, it kind of teaches you to take this out and think of it very factually, okay, you didn't take care of the dog, the dog created a mess, you clean up the mess, no harm, no foul , you're not a bad person . But that's what happens. So yeah, the behavioral therapies can be very helpful. And you know , behavioral therapies are often they have the reinforcers, like the so-called star chart or, or or rewards.

Speaker 2 22:14

Let's go back to medications because that's on a lot of people's minds and people are a little freaked out about 'em because these are the first line treatments, or at least the ones that people have heard of that go under the brand names. I do have to say these are brand names. Yeah . I always like to say that Ritalin and Adderall are brand names for stimulants. I mean basically they're forms of amphetamines. Those two words alone make people nervous. How do they work? Why do they even work and are they, what are the downsides?

Speaker 3 22:40

Way back in 1937, I think it was, they were doing a study on, I think it was Pneumoencephalogram or something of barbaric and terrible where they were taking these kids because it was America in the 1930s and they didn't care as much about about

Speaker 2 22:52

Rice. We did stuff to people.

Speaker 3 22:54

We did stuff to people and they would use a version of these medicines called Benza, but they didn't use it for focus. They used it to help calm the kids down. After the study was all said and done, you know, the kids wanted to stay on the medicine cuz they could focus. And that kinda led to the , these studies. What they do is they work on the dopamine receptor. So there are two main receptors associated, not to get all science nerdy, but there are two main receptors. We think about, oh

Speaker 2 23:16

I'm a nerd, John

Speaker 3 23:17

<laugh>, atta boy . Um, there are two main receptors, the norepinephrine and the dopamine. So think about uh , an informational signal going through kind of an oversimplification, but a way that I like to think norepinephrine. If you crank that up, that cranks up the signal strength. If you use dopamine that's like Dolby, that reduces the noise. These medicines help to do these things. You start out at a very low dose. The problem is anytime you work with dopamine, there are also things that are involved. Dopamine helps with attention . Dopamine helps with mood. Dopamine also helps with movements. In fact, many of the basal ganglia, they used to think that hey, these are only involved in movements. And they'd be , oh wait, no, this is information processing too. And it all goes together. So you've got the frontal lobe, the connection to the kind of deeper basal ganglia and the cerebellum. I mean there are all these connections and what this does is it potentiates those connections between those areas such that the kids can function better. Some of it has to do with planning. Some of it is even like when you talk about frontal lobe to cerebellum, you're talking about motor planning. And that goes back to the earlier thing. Why are kids with ADHD so noisy <laugh>? Yeah, so,

Speaker 2 24:22

But the wall of sound but, but isn't a stimulant. Wouldn't that be, I mean at the face of it, that sounds like it would make your hyperactivity worse. Your fidgety kids gonna get worse. But that doesn't happen. Why?

Speaker 3 24:34

This is again maybe oversimplification, but this is what helped me through that school is it stimulates the part of the brain that puts the brakes on. It stimulates the, of the good brain that helps you stay focused on what's important at that

Speaker 2 24:45

Time. This is an oversimplification, but is caffeine a mild version of the same thing? Cuz it's well known that college kids do better on their tests if they had a pot of coffee.

Speaker 3 24:53

It is, it's uh , there's not as much dopamine, so it's a little different. Nicotine certainly does . And we know there are nicotine receptors all over the brain. Now I don't advocate smoking because the , the risk is so much . Oh my gosh, it's not even but

Speaker 2 25:06

It's that same stuff about stimulation. Exactly . Be helpful for these kinds of things. What's the downside? Are these addictive medications? They are , for

Speaker 3 25:15

Instance. They are, but it's, I , I'd like to use this with my, my patients. If you came in, if I was, if I was you, Dr . Hilton and someone came in with a broken arm, I wouldn't say, oh no opiates for you because they potentially are addictive. No, they have to be watched and there's certain things that you have to watch for. So there it is addiction. But that is actually, I'll be honest, the least of my worries. Not because I'm cavalier, it's just because I watch these and there are lots of other things like the the pap program, which we monitor all of the prescriptions that go out. If someone is using too many, we find out about it.

Speaker 2 25:45

So addiction isn't your biggest concern about these. Is there a concern with these stimulant medications?

Speaker 3 25:50

Yeah, weight loss is a big, big one. And I, well I correction, I don't mean to be cavalier about addiction. It is, you know, in certain aspects but that's where you screen out and you really look for adhd . But what we also find is some people with adhd , if they especially are kind of a thrill seeker, you treat that early, there's less risk of addiction too. You know, and it depends on the person. Some people say if you treat kids earlier, there's less risk of addiction. Some say if you treat later, I think it's just person by person. But the other things that I worry about much more in my office are, as I mentioned earlier, there's, you know, dopamine works on movement and it can cause ticks. These are just these very quick motor movements like coughing, clearing your throat, blinking your eyes. They can be permanent. They're usually not, usually you stop the medicine, the ticks go away and ticks are, you know, you see them in the environment as well. You even without stimulant. So that's one thing it can, because it is a stimulant, it can drive your heart really hard. So if you have a kiddo that has a history of some cardiac issues, yeah you probably wanna get an EKG or talk to their primary or a cardiologist before starting a stimulant or monitoring those things. It does cause weight loss several times. It will cause weight loss and that can be an issue in and of itself. These kiddos, you know, you don't wanna have like a human skeleton kid walking around. Mm-hmm <affirmative> because that can lead to its own sort of social ostracization.

Speaker 2 27:07

Do you find any stigma for kids who are either with the diagnosis or when other kids find out they're on one of these medications?

Speaker 3 27:14

In the old days, yes. Now not so much is good . You know, the nice thing is many of these medicines, both Adderall and um, Ritalin coming longer acting forms and with the longer acting forms, you don't have to go to the nurses station in the middle of the day. You take one in the morning and it's good for most of the day. So that has been, that's been helpful. But I think there's just so many things now that people are kind of awakening to saying, Hey, you know what? You know , I'm not gonna make fun of this kid cuz they have asthma. Same thing, no

Speaker 2 27:41

Big deal. Yeah. Before I let you go, could you answer this? Does it get better over time?

Speaker 3 27:47

I think people get better at dealing with it. A lot of it is people learn ways of coping with it. I think what we do notice is that the hyperactivity and the impulsivity goes way, way down and that causes less social stigma. So yeah, that does get better. But I think, you know, a lot of people, they just kind of, you know, they've got this, they learn how to work it much the same as somebody with asthma would, would not go to a very polluted town or stay, stay inside during a , you know, weather warning type of day. It's the same kind of a thing.

Speaker 2 28:14

That's actually reassuring to me that there there is good news. People do live happy, productive lives , um, with their adhd .

Speaker 3 28:22

Oh, it, yeah, it doesn't define who you are . It doesn't even say how smart you are. I tell kids , this is just attention. We can work on

Speaker 2 28:28

This. John , thank you for being

Speaker 3 28:30

Here. Thank you for having me.

Speaker 2 28:31

We've been talking with Dr. John Weger , a psychiatrist and colleague, you of mine here at Hennepin Healthcare in downtown Minneapolis. It's been a pleasure having you on the show, John . And thanks for shedding some light on this important topic. Listeners, I hope you've enjoyed this episode and if so, I hope you'll leave us a review, download and subscribe to the podcast and I hope you'll join us for our next episode. In the meantime, be healthy and be well.

Speaker 1 28:55

Thanks for listening to the Healthy Matters podcast with Dr. David Hilden . To find out more about the Healthy Matters podcast or browse the archive, visit healthy matters.org. Got a question or a comment for the show, email us at Healthy Matters hc m e d.org or call 6 1 2 8 7 3 talk. There's also a link in the show notes. And finally, if you enjoy the show, please leave us a review and share the show with others. The Healthy Matters Podcast is made possible by Hennepin Healthcare in Minneapolis, Minnesota, and engineered and produced by John Lucas At Highball Executive producers are Jonathan Camino and Christine Hill. Please remember, we can only give general medical advice during this program, and every case is unique. We urge you to consult with your physician if you have a more serious or pressing health concern. Until next time, be healthy and be well.