Diagnosing and Treating Adult ADHD

The somewhat counterintuitive use of stimulants to treat hyperactivity disorders was first described in 1937, when a Dr. Bradley from Rhode Island noticed that children with behavior problems seemed to improve when treated with amphetamines. However, it wasn't until 1978 that ADHD was recognized as a disorder that could affect adults as well as children.

Adult ADHD is generally diagnosed using a checklist. Four or more marks in the top portion of the checklist is a strong indicator for Adult ADHD. (For what it's worth, in my case the first six questions read like an autobiography.)

The treatment of Adult ADHD is highly dependent on the level of imparement and the particular health care provider. In my case, my heath care provider offered me a typical self-directed treatment regimen of lifestyle changes (yoga and diet changes, primarily), and medication (non-stimulant or stimulant, at my option).

The drug I ended up being prescribed, Adderall, is a mixture of four amphetamine salts in equal proportion:

• amphetamine aspartate,
• amphetamine sulfate,
• dextroamphetamine saccharate, and
  
• dextroamphetamine sulfate.

It is claimed that this formulation has fast-acting and slow-acting components, reducing the peaks and valleys generally associated with amphetamine use. Though the particulars of this process are still somewhat unknown, Adderall has overtaken Ritalin (active ingredient, methylphenidate) in the marketplace for ADHD treatment because it is more convenient, requiring only one dose per day (as opposed to Ritalin's two) to be effective.

Other medication options include the non-stimulant Strattera (active ingredient, atomoxetine) and the antidepressant Wellbutrin (active ingredient, bupropion).

I chose Adderall over the other options for two reasons:

1. The way that amphetamines such as Adderall affect the body is very well-known, while antidepressants are still somewhat mysterious.
2. I don't want to be constantly medicated. Non-stimulant medications for ADHD must be taken continuously for a week or two before they take full effect. Stimulant medications such as Adderall can be safely taken when necessary and not taken when not necessary.

(My current prescription is for a generic form of Adderall, 20mg, one tablet per day or as needed. Generally, a 90-day supply lasts me for six or seven months.)

Coin Flip

The coin flip came up tails, so my first week's studying and examination will be unmedicated.

A Short History of Stimulants

Because the drug at the center of this experiment, Adderall, is so contentious, and because I am a nerd for obscure bits of history, I'd like to write a little about amphetamines and stimulants and their historic and current use.

Stimulants are as old as history itself. Caffeine, the world's most prominent stimulant, has been used for at least 3000 years. Chinese physicians were using the ephedra plant (active ingredient, ephedrine) over 5000 years ago, and there is evidence that the natives of South America were chewing the leaves of the Coca plant (active ingredient, cocaine) as early as 2000 years ago.

Amphetamines are synthetic derivatives of naturally-occurring ephedrine. Though used informally for millenia, amphetamines were not chemically isolated until 1887 and were not formally characterized until the 1920s. They were widely used both recreationally and medically in the United States until 1957, when the FDA limited them to prescription-only use.

Widely prescribed for conditions such as narcolepsy, depression, and ADHD, our society's appetite for amphetamines is giant and increasing. In 1999, doctors wrote roughly 15 million prescriptions for amphetamines, and in 2000 the United States had roughly 5% of the world's population but produced and consumed 85% of the world's methylphenidate.

(Fun fact: Americans are said to consume 45 million pounds of caffiene a year.)

Goals and Experimentation

Students have long used substances to help them study harder, faster, and stronger. Traditionally, the drug of choice has been caffeine. However, it's now clear that caffeine is a mere protein shake compared to academic steroids like Adderall and Ritalin. How does the ready availability of such drugs on the campus affect the learning process? I will answer this question three different ways:

1. Through analysis of relevant on-campus media coverage. Media written by and for students will be analyzed to determine how these drugs have affected campus culture.
   
2. Through interviews with stakeholders of the educational process. This will include interviews with educators and administrators to explore how these drugs have affected the educational process.
   
3. Through experimentation. My goal is to go to a top-ten law school without putting myself in massive debt. My academic and professional resume are adequate, but I will not succeed without a near-perfect score on my LSAT. I will experiment to see how my score on the LSAT changes over time and in response to Adderall.

The experimental protocol: I will take the official LSAT on Saturday, February 10, 2007. Every week, beginning Saturday, October 21, I will take a practice LSAT exam and report my scores and experiences. I will use Adderall to assist my studying and test-taking on alternating weeks beginning Saturday, October 14. On that day, I will flip a coin -- heads, and the first week is an on-week, tails, and the first week is an off-week.

I am in the process of refining my protocol. If you have any suggestions, please leave them as a comment. I'm specifically looking for recommendations for the following:

1. LSAT study books and/or other study materials. Which books work and which ones don't?
   
2. Specific study methods. How many days per week? How many hours per day? How should I structure my study time?
3. Are LSAT courses really worth it? If so, which ones are recommended.

While you guys help me with that, I'll be writing interview questions and making a list of interesting people to interview. With luck, the first interview will be ready next week.

About Me

I have no reason to be unsatisfied with my life. I have a BS and a MS in Computer Science from a university with a solid reputation, a well-paying job in South Carolina, and I live a relatively drama-free existence. However, my life so far could be characterized by the three great virtues of a programmer -- laziness, impatience, and hubris.

I hate it. Hate hate hate. Hate.

My approach to education was apathetic. I chose Computer Science as my major because it came easily to me, not because I particularly enjoyed it, and my GPA suffered as a result. (If the subject didn't interest me, it was hard to find the motivation to go to class, much less take notes.)

March of my senior year was one giant oh-shit moment. I was sliding toward graduation and had no real post-graduate plans. I had no job lined up and had made no serious plans to go to graduate school. I was saved by my undergraduate advisor, who singlehandedly muscled me into my school's MS program, four months after the application deadline.

I did not learn from the consequences of my procrastination. My performance in my graduate coursework was adequate, but my progress on my thesis work was not, and a year and a half after its original due date, I received an ultimatum from the department -- finish the thesis by the end of the semester, or quit. At that time I had been stalled at 90% complete for six months. While I rearranged deck chairs on the Titanic, my MS was slipping through my fingers. I was so distractable that I couldn't concentrate on my thesis work for any more than five minutes a night, and the constant throb of stress was leaking into my day job and my relationship with my girlfriend. At the urging of said girlfriend, I went to the doctor, where I was promptly diagnosed with Adult ADHD and issued a prescription for Adderall, 10mg.

My thesis was finished that week. In retrospect, I wish I could say the achievement was mine alone. The Adderall opened a well of confidence, motivation, and focus, and to risk melodrama I can say that I drank deeply. The thesis claims to be dedicated to my father, but it should be dedicated to Adderall, my performance enhancing drug.

Selfishly, I am still looking for a greater satisfaction. The drug saved my degree, but it hasn't made it any easier to deal with my drudgerous little job, my intellectually lame co-workers, or my unhealthy tendency towards boredom. If nothing changes, I will never achieve the so-called American dream -- I am too lazy to pull myself up by my bootstraps, too impatient to accept that success can't be immediate, and too prideful to admit to myself that the first two are true. Regardless, the fundamental narcissism of my way of life demands that a change be made.

I will win admission to a top ten law school. And not pay a dime for it. I am too nice to negotiate successfully. I fold under pressure. Yet I deconstruct arguments innocently and gleefully, like a toddler deconstructs your dead grandmother's china. I read Groklaw like a rubbernecker. I would almost certainly make a horrible lawyer, but I will enjoy myself, and in the new calculus of selfishness that alone makes the effort worthwhile. This blog will document my effort.