DR. PAULO MATTOS M.D.
ADHD Head in the clouds
OM
MENDED BY
THE
ABOUT ATTENTION DEFICIT HYPERACTIVITY DISORDER
REC
100 QUESTIONS AND ANSWERS
O
BR
ASI
DE
ÇÃ
ATEN ÇÃO
ASSOCIA
17 TH EDITION | REVISED AND EXPANDED
LE IRA DO DÉFI
CI
T
ADHD Head in the clouds 100 QUESTIONS AND ANSWERS ABOUT ATTENTION DEFICIT HYPERACTIVITY DISORDER
Copyright © 2020 Associação Brasileira do Déficit de Atenção (ABDA)
All rights reserved by Autêntica Editora Ltda. No part of this publication may be reproduced, either by mechanical or electronic means or via xerographic copy, without prior authorization from the publisher. The publisher is not responsible for the content, operation, maintenance or updating of links or other resources presented by the author in this book.
editor
layout
Marcelo Amaral de Moraes
Christiane Morais de Oliveira
assistant editor
Luanna Luchesi revision
Conor Hennessy graphic project
Diogo Droschi
International Cataloging Data in Publication (CIP) (Brazilian Book Chamber, SP, Brazil) Mattos, Paulo ADHD - Head in the clouds : 100 questions and answers about attention deficit hyperactivity disorder / Paulo Mattos ; tradução Rafael Bozzola. -- Belo Horizonte : Autêntica, 2021. Título original: No mundo da lua : 100 perguntas e respostas sobre o Transtorno do Déficit de Atenção com Hiperatividade (TDAH) ISBN 978-65-5928-043-8 1. Deficiência de aprendizagem 2. Distúrbio do déficit de atenção com hiperatividade - Miscelânea 3. Perguntas e respostas 4. Transtorno de déficit deatenção com hiperatividade (TDAH) I. Título. 21-63701 CDD-616.8589 Índices para catálogo sistemático: 1. Distúrbio de déficit de atenção com hiperatividade : Neurologia : Medicina 616.8589 Maria Alice Ferreira - Bibliotecária - CRB-8/7964
Belo Horizonte Rua Carlos Turner, 420 Silveira . 31140-520 Belo Horizonte . MG Tel.: (55 31) 3465 4500
São Paulo Av. Paulista, 2.073, Conjunto Nacional Horsa I, 3º andar . Sala 309 Cerqueira César . 01311-940 São Paulo . SP Tel.: (55 11) 3034 4468
www.grupoautentica.com.br SAC: atendimentoleitor@grupoautentica.com.br
To my parents, thanks for everything.
Summary
PA G E
About the author 15 Preface to this edition 17
CHAPTER 1 – INTRODUCTION
PA G E
1
What is ADHD, Attention Deficit Hyperactivity Disorder?
23
2
But is this enough to reach a diagnosis of ADHD?
25
3
Is ADHD a made-up disease?
26
4
And why is there so much fuss around an ADHD diagnosis?
27
5
Wouldn't this be an attempt to control children's behavior?
29
6
Why isn't ADHD just a more flamboyant behavior?
31
7
But the media often disagrees regarding ADHD!
33
8
What are the problems associated with ADHD?
36
9
Can ADHD bring about benefits for the patient?
38
10
Is it possible to have ADHD without it causing troubles?
40
11
Why a Q&A book?
43
CHAPTER 2 – THE SYMPTOMS
PA G E
12 13
Are all patients similar to each other?
47
Is it difficult to reach an ADHD diagnosis?
58
14
So, the criticism that an ADHD diagnosis isn't rock solid, is correct?
60
15 16 17
Are there different types of ADHD?
62
Does ADHD exist only with inattention?
65
Can ADHD persist into adult life?
66
18
But why did doctors use to think that ADHD didn't affect adults?
67
19
How is an ADHD diagnosis reached in adults?
69
20
Can other disorders have similar symptoms to ADHD?
71
21
How can ADHD symptoms affect the life of an adult?
73
22
Why are relationship problems associated with ADHD?
83
23
Why is it that adults with ADHD keep changing what they are doing?
86
24
Is drug abuse more common in people affected by ADHD.
88
25 26 27
I have ADHD!
89
But everybody thinks I am inattentive!
91
Are there lab tests to diagnose ADHD?
92
28
Isn't it strange that there are no lab tests to diagnose it?
93
29
How are parents able to notice if their daughter or son has ADHD.
94
30
From what age are parents able to detect ADHD symptoms?
96
31
Is there a difference in ADHD in boys and girls?
100
32
In what time in child's life is an ADHD diagnosis made?
101
33
Are there other ADHD symptoms that are not listed in the DSM system?
103
CHAPTER 3 – THE CAUSES
PA G E
34
Is ADHD a secondary effect of the use of digital media?
111
35 36 37 38 39
Is ADHD a genetic condition?
113
Is there an ADHD gene?
115
What role does the environment play in all of it?
118
Can family problems cause ADHD?
119
Can emotional conflicts cause ADHD?
120
40
Can ADHD be a consequence of how children are raised?
122
41
Can I have a genetic test made to confirm an ADHD diagnosis?
124
42
What is the main conclusion of the genetic studies of ADHD?
125
43
Are there biological risk-factors that are not genetic?
126
44 45 46
What is altered in the brain of ADHD patients?
127
Can I have a CT scan to diagnose ADHD?
131
What about other kinds of tests?
132
47
Are there other tests employed in ADHD cases?
134
CHAPTER 4 – COMORBIDITIES
PA G E
48
What other disorders can appear together with ADHD?
139
49
But doesn't ADHD by itself cause emotional problems?
142
50
What learning problems are associated with ADHD?
144
51
Are there clinical problems connected to ADHD?
146
52
How can the consequences of ADHD be mitigated?
147
CHAPTER 5 – TREATMENT OVERVIEW
PA G E
53
Will my son have to be medicated?
153
54
Can the attitude of parents towards their children “aggravate” their ADHD?
157
55
Is it normal for the parent to feel tired and hopeless?
160
56 57
What can parents do to help with treatment?
162
Shall we start right now?
165
58
But isn't it difficult to the advantages of changing the behavior?
167
59
And what about those days when I am boiling with anger?
168
60
Why don't they ever learn, even when I punish them?
169
61
What other social and family problems may occur?
172
62
Is it possible to “manage” impulsivity?
174
63
How is it possible to help with relationship problems?
177
64
Is there a solution for poor memory?
180
65
What is the most effective way to communicate with people with ADHD?
182
66
How to deal with the constant fight that is studying when they are home?
183
67
Where to start when it comes to school?
185
68
How should the study environment at home be?
186
69
How to reward positive behavior?
192
70
Is it possible to stimulate someone who doesn’t want to study?
194
71
Are there special tips regarding the time to do the homework?
198
72
What other items are important to motivate studying?
200
73
Are there ways to improve memorization?
202
74
Are there ways to improve memorization?
204
75
Is there any general advice?
205
76
And what about tips for adults?
207
CHAPTER 6 – THE SCHOOL
PA G E
77
What are the ideal characteristics of a teacher of children and teenagers with ADHD?
221
78
What should teachers expect in terms of academic performance?
223
79
How may teachers suspect of a coexisting problem?
226
80
And the behavioral problems that may be connected to ADHD
231
81
What are the main tips for teachers?
234
82
Is there a type of school that is a better fit for the student with ADHD?
238
83
Should the student with ADHD receive special treatment?
239
84
Won't special treatment embarrass the student?
240
CHAPTER 7 – MEDICATION
PA G E
85 86 87 88 89
Is it mandatory to treat ADHD with drugs?
247
How do ADHD drugs work?
248
Which drugs are used to treat ADHD?
250
Is it possible to use more than one medication?
253
Do stimulants cause dependence?
254
90
Are there serious side effects to the use of stimulants?
256
91
Well, I am still unsure whether I should take the drugs or not.
257
92 93 94 95
Does medication cure ADHD?
258
How long should drug treatment last?
260
Am I going to be a “prisoner” of the medication?
262
Does medication build up in the body?
263
96
Are there instances in which the medication does not work?
264
97 98
When is it time to start psychotherapy?
266
What is neurofeedback?
268
99
Is treatment with a speech therapist mandatory?
269
100
Are there other important measures to be taken?
270
ABOUT THE AUTHOR
DR. PAULO MATTOS is a psychiatric doctor at the Federal University of Rio de Janeiro (Universidade Federal do Rio de Janeiro – UFRJ), he holds Master’s and PhD titles in psychiatry and Postdoc in biochemistry. He is also a founding member of the Brazilian Association of Attention Deficit (Associação Brasileira do Déficit de Atenção – ABDA) scientific committee. Member of the Brazilian Association of Psychiatry (Associação Brasileira de Psiquiatria), Brazilian Academy of Neurology (Academia Brasileira de Neurologia) and of the American Psychiatric Association. He is also neurosciences coordinator of the D’Or Institute of Research and Education (Instituto D’Or de Pesquisa e Ensino – IDOR). All copyrights were donated by the author to the Brazilian Association of Attention Deficit, a non-profit organization. Get to know ABDA's website at www.tdah.org.br
PREFACE
Life imposes multiple challenges. Many of them transform our lives and, as a result, also the fate of millions of people. First our family, then our neighborhood, our city, our country and, in the end, we realize that we have touched the whole world. Head in the Clouds has definitely changed the reality of people with ADHD (Attention Deficit Hyperactivity Disorder). In the mid-2000s, ADHD was still an unknown topic in Brazil. And I was just a mother of two children with undiagnosed ADHD, in a desperate search for answers to the difficulties that plagued their lives. In anguish of finding a solution, I tried countless treatment options and I visited different professionals: psychologists, psychoanalysts, physicians ... The conclusion was always the same: “it’s the parents’ fault” and, more precisely, the mother’s. This statement proved the absurdity of the ignorance that, even today, is repeated by many professionals. Amid so many types of treatment and so many unprepared professionals, experiences like mine fail and generate countless losses: emotional, financial and health ones, as well as losses to family stability. Despite my best efforts, I could not see a light at the end of the tunnel. As unusual as this may seem, the answers that would clarify the reason for my anguish would reach me through my office door. I am a psychologist, neuropsychologist and psychotherapist, specialized in psychoanalysis. My professional role and my life 17
purpose have always been to bring light and understanding to those in need. At that time, however, it was I who needed a light, some help for my two children. And that light came to me through the hands of a patient, who was carrying a book in her bag. I found the title Head in the Clouds funny. But the subject seemed interesting. Although the book’s title suggested a trip to the skies, in reality, what it proposed was a way back to earth. A definite encounter of a person, who did not know what ADHD was, with themself. Little did I know of the power contained in those pages. They were just words printed on paper, but they brought the most precious and necessary contents for that moment in my life: psychoeducation and knowledge. This allowed me to let go of that feeling of “I don’t know anything about this” and to change to the belief that “now, I understand and know what to do with all of this”. After reading Head in the Clouds, Dr. Paulo Mattos stopped being just the author of the book, and to me he became the voice of hope. And how I heard that voice! This voice not only changed my children’s lives, but redirected mine, teaching me everything I know today about ADHD and what I keep on learning. From the meeting with the author of Head in the Clouds, who became my children’s doctor and my professional guru, the need arose to create an institution that fought for the awareness, diagnosis and treatment of ADHD. It was then that the Brazilian Association for Attention Deficit (ABDA) was born, with the aim of disseminating scientific information about this disorder in Brazil. Today, almost 20 years after its foundation, ABDA is the only non-profit association that fights for people with ADHD in Brazil. It is the largest patient association in Latin America
18
and is recognized by professionals and other patient associations around the world. Head in the Clouds was the passport that allowed me to start a new journey with my children and my patients. Undoubtedly, like me, health and education professionals, people and families who still struggle against ignorance about ADHD, have in this book a real manual, with scientific questions and answers about the disorder. A kind of exit screenplay against stigma and disinformation. I dedicate my eternal gratitude to the master, partner and friend, Professor Dr. Paulo Mattos, for having generously ceded the copyright, as well as all the proceeds from the book to ABDA projects, since its first edition. To Autêntica Editora (our publisher in Brazil), which honors us greatly by taking over the rights to publish and disseminate this work, I also extend my sincere thanks for betting, supporting and believing in our cause. Iane Kestelman Psychologist, Psychoanalyst, neuropsychologist and Voluntary Head of the Brazilian Association of Attention Deficit (ABDA)
19
www.grupoautentica.com.br/autentica-business Twitter: Autêntica Business Facebook: Autêntica Business