William Shryer is the Clinical Director of Diablo Behavioral Health Care in Danville, CA. Mr. Shryer earned his BA degree in Sociology at California State University in Hayward. He received his MSW from the University of California at Berkeley specializing in Children and Families. Mr. Shryer has been in private practice since 1981 specializing in Autistic Spectrum Disorders, Mood Disorders, and the Anxiety Spectrum in children, adults and their families. Mr. Shryer has lectured frequently to college classes and professionals in the areas of ADD and Autistic Spectrum disorders and their implications in the educational setting. He has been active in a number of CHADD chapters. Mr. Shryer manages three behavioral clinics with a staff of MD’s, Counselors, Clinical Psychologists, and Special Education teachers. He has been the moderator on CCTV, (Contra Costa Television) for both “Mental Health Perspectives”, and “With the Family in Mind” which discussed topics such as Asperger’s Disorder, Autism, Bipolar disorder and Attention Deficit Disorder in children and adults.
Q. Mr. Shryer, you have many years of experience working with children who have been diagnosed with Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD). Would you please define and describe the difference between the two?
The difference between the two has to do with the behaviors a child may exhibit. For example, boys are more likely to show signs of being hyperactive (ADHD) while girls are more like to have trouble paying attention and staying focused (ADD). And because a girl’s ADD symptoms may be less noticeable and less disruptive in the classroom, they are more likely to get missed because in the schools it’s the squeaky wheel that gets the grease. While both boys and girls can exhibit the same behaviors it is just more common that hyperactivity is seen in boys. Now for the why, this may be a genetic neurotransmitter phenomenon that is still poorly understood.
The main factor that gets missed when children are diagnosed is that we are dealing with a disorder that is primarily one of inattention and short term memory. This seems to get lost and many seem to think that hyperactivity and attention deficit are the same thing and they are not. The medications used to treat inattention work very well. Stimulants are still the gold standard, while other medications such as atomoxitine are second tier approaches. Food, diet, therapy, supplements seem to do very little other than having some placebo effects. A highly structured learning environment can assist the student, but not directly impact the ADHD. Knowing what is ADHD and what is not is the exception and not the norm and this feeds right into the next question.
Q. In your practice have you had clients referred to you who have been mis-diagnosed? Why is there confusion even among well-trained clinicians?
I would have to say that the majority of patients referred to us have been mis-diagnosed. This can be summed up very easily as the main reason for all of this is a poor or inadequate history. So many therapists don’t spend the time delving into the family history. ADHD is highly genetic and it tends to be sex linked meaning it is more likely to go from mother to daughter and father to son than mother to son, etc. I always say that it is important to know the difference between deficits of attention and attention deficit disorder.
Children and teens with deficits of attention can exhibit the same behaviors as a person with ADD or ADHD when they actually have a type of Obsessive Compulsive Disorder. These children are too busy in their heads thinking or obsessing about irrelevant things that take the priority rather than school work, for example. Also, a depressed child will not be able to pay attention due to sadness and a child or teen with Asperger’s Disorder cannot pay attention due to having too much fun thinking about dinosaurs, vacuum cleaners or quantum physics.
Children with mood disorders such as bipolar disorder often have co-occurring attentional issues, often due to the speed at which thoughts are flying through their brain. The confusion that exists even between well trained clinicians is perhaps due to the fact that they have forgotten the importance of treating more than just the tip of the iceberg.
Q. How are the two conditions different in adults? What behaviors are typical for each?
In adults the difference between ADHD and ADD is often hard to spot due to the fact that the hyperactivity of childhood gives way to more of a sense in internal restlessness. For many women in the US with poorly treated or un treated ADHD there is a sense of depression. Often they may seem to be depressed and we have found that when properly treated for their ADHD their depression is resolved. Untreated or poorly treated ADHD in adults is a huge problem and there are still many clinicians that believe that this disorder goes away at puberty. Some of the symptoms of adult ADHD are memory problems, poor follow through, going off topic during a conversation, interrupting, social skills difficulties, etc.
Q. How is each treated?
Both conditions are treated the same with attention being paid to any co-occurring conditions. The gold standard is still psychostimulants such as mixed amphetamine salts also known as Adderall, methylphenidate preparations also known as Ritalin. There are many variations of these and the old fashioned and generic such as dexadrine tablets and longer acting dexadrine spansuls work just as well as the far more expensive preparations.
Q. Mr. Shryer, would you please recommend some resources for those interested in learning more about ADD and ADHD?
A excellent article by Gayle Zieman, PhD givez a good overview of ADHD from a variety of perspectives. It can be found at http://www.ziemang.com/pnm_articles/9903adhd.htm The website for Children and Adults with Attention Deficit Disorder at www.CHADD.org and the website of Diablo Behavioral at www.behaviorquest.com and click on “Concerns and Symptoms and then onto Attention Deficit Disorder. Also on the website by clicking on “Resources” then clicking on Attention Deficit Disorders will put you into many resources for ADHD.
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