Understanding ADHD with Dr. Shirin Alonzo | San Diego Health


– Hi, I’m Susan Taylor with Scripps Health in San Diego, California. Please subscribe to our
Scripps Health YouTube channel. We’ve got great videos
featuring the latest technology, our stellar doctors, and
inspiring patient stories. You have a child and they
have a hard time focusing, paying attention, controlling
impulsive behavior. They grab things from
people, interrupt others, speak at inappropriate times. They squirm or fidget. They take unnecessary risks. Or you’re an adult and you
just can’t focus on your job. You forget important
details and deadlines. Your paperwork and
recordkeeping are disorganized. Could you have, could your child have ADD, attention deficit disorder, or ADHD, attention deficit
hyperactivity disorder? According to the Centers for
Disease Control and Prevention, there are some 10 million
adults who have ADHD. Here to talk about the signs,
symptoms, and treatment is Dr. Shirin Alonzo from
Scripps Coastal Medical Center in Escondido, California. She’s an internist and pediatrician with a specialty in
neurodevelopmental disorders. Thanks so much for being with us. – Thanks for having me. – Let’s start off with the basics. What is ADD? What are the signs, the
symptoms, when does it start? – Great question. This has changed over time. So before, we used to classify problems with concentration and attention through two different types of words. One was ADD and the other was ADHD. So ADD is attention deficit disorder, and ADHD is attention deficit
hyperactivity disorder. What we did to simplify this, we actually consolidated. And now there’s one
diagnosis, and it’s just ADHD. We don’t use ADD anymore. And we say a person has ADHD, either the inattentive
type, the hyperactive type, or the combined type, which is both inattention
and hyperactivity. – But aren’t kids fidgety by nature? I mean, they can’t sit still. They’re constantly running and jumping. Their attention is scattered. How do you know when these behaviors are something more than just being a kid? – That’s a great question. You really can tell when these behaviors are more than just being
a kid based on the age and what we expect from that person. So when a person is in
kindergarten, for example, we expect them to be
able to learn their ABCs, expect them to be able to sit down for a certain amount of time. If they’re not able to do that, we now know that that inattention or that hyperactivity is
affecting their learning. That’s when we really need to dive in to see what’s really going on. – Can these symptoms change over time? – Yes, the symptoms can
absolutely change over time. They can be modified over time, meaning less symptoms. They can get worse over time, meaning that there’s more symptoms. – And what are the causes of ADHD? – There are no specific causes of ADHD, but ADHD is a learning disability and a neurodevelopmental disorder that we know is due to genetic
and environmental factors. These can be due to
in-utero drug exposure, meaning drug exposures in the womb. Anything that affects
the brain development when the brain is developing in the womb can contribute to learning
disabilities and ADHD. – What kind of drug exposure to the womb? – Any types of hard drugs
or alcohol can contribute, so cocaine, heroine, et cetera. There are different studies
for different drug types, but any time there are drug exposures, there can be a higher risk
for learning disabilities and neurodevelopmental
disorders like ADHD. – And what other causes
are there, risk factors? – There are several risk factors, the most being when that
child is in the womb and how they’re developing. I wanna mention that there’s some misnomers or misunderstandings. So family stress, different lifestyles does not cause ADHD. It may cause depression or anxiety that may show up as ADHD symptoms, meaning that they may
not be paying attention, having a difficult time concentrating. And that’s why when a
child is having difficulty concentrating or paying
attention in class, it’s important to really figure out everything that’s going on. What is the home situation like? Is there a history of
depression or anxiety? Are there mental disorders? Does the patient have
early bipolar disorder, you know, childhood bipolar disorder? So it’s really a full complex evaluation. Are there other potential genetic causes? Are there associations with neurodevelopmental genetic disorders? So we cannot just say
we’re gonna blame ADHD or we’re gonna say oh, this is normal. We’re gonna do a full evaluation and really see what are
the potential causes that are contributing to
the symptoms that are ADHD. – Risk factors, what
about a low birth weight or premature delivery? – Yes, absolutely. Anything that’s gonna develop
the growth of the fetus. So if a patient is born
with a low birth weight or prematurely can contribute to any types of neurodevelopmental disabilities. – What about if the mother smokes cigarettes during pregnancy? – So there are no confirmed studies that that is going to contribute to ADHD that are well-studied. So it’s really still a vast area because there is no one test that says this is the cause of why
you can’t concentrate or have attention problems, et cetera. The really important
thing to know about ADHD, it’s also a variety of symptoms. And we do screening tools to see do you have enough
symptoms of inattention, of concentration, of both
that affect your daily life and your learning? If yes, yes, yes, yes, then we say, okay, you
have this diagnosis. Now, if there’s nothing else associated, no mental illness, increased stress, behavior disorders,
neurodevelopmental disorders, genetic disorders, then we say, okay, this is purely an ADHD
diagnosis and we focus on that. – So what are the
treatment options for ADHD? – So ADHD is a learning disability and affects people’s abilities to learn and to process information
in a timely manner. So the treatment options
are really gonna be on the severity of the symptoms. So if a patient has milder symptoms that are only affecting their daily life or learning minimally, we may wanna modify the classroom settings when they’re in the classroom, making sure that they’re
closer to the teacher, making sure they have enough time to do their test taking, et cetera. If they’re more severe
symptoms or moderate symptoms, they may need medication
to help them focus, to help their hyperactivity. A lot of people are afraid of medications. But let me tell you, these medications are very important, especially if it’s affecting learning. Because what happens to a
child when they fall behind, they notice that they’re behind. They notice that their
peers are learning quicker. They start feeling that
their peers are smarter, that their friends are smarter. They start wondering
what’s wrong with them. They’re struggling every day to complete a task, their homework. They’re getting bad grades. Then they feel like
something is wrong with them. – What kind of medication
are you talking about? – So if a person truly has ADHD, the medications are variable. And there’s different types
of stimulant medications and non-stimulant medications
to help with focus. Of course, we always want to also look for underlying contributions
to ADHD like poor sleep that can exacerbate symptoms and making sure that
they’re sleeping well, well-balanced diet, et cetera, to make sure that they’re
in a healthy state to be able to manage the tasks that need to be accomplished for that day. – If ADHD is left untreated, what happens? – This is a great question, and this goes back to what I was saying about medication and why
it can be very important, especially if it’s
affecting your daily life and your ability to
complete tasks and learn. If a child has untreated ADHD, they know that they are
learning at a slower pace. It affects their self-esteem. They have higher rates
of depression, anxiety, suicide, divorce when they’re older. It affects you for the rest of your life if this goes untreated. So I truly, truly encourage anyone that has any family members
that may be suffering with ADHD or or learning disabilities to get the appropriate help and treatment. – Can you outgrow ADHD? – ADHD can change over time. A lot of times outgrowing basically means the symptoms are there but they don’t affect you the same way. So as demands change, so for example, someone may
go through their entire life having ADHD and they were never diagnosed, they never knew. But you look back and
you ask them questions about their childhood. “Oh, I never liked school. “It wasn’t for me. “It was boring. “I couldn’t sit still. “I didn’t do my homework. “I just didn’t like it.” Then you get to adulthood. They choose fields where they don’t have to sit in a office. It’s more fields that might be outdoors or doing other activities. So then the ADHD or the
symptoms that they may have had when you had to sit still
and get jobs accomplished very quickly may not pertain. So the symptoms may still be there but may not be affecting their life the way it did when they were a child. – In a couple of minutes,
we’re gonna talk about this. So we want you to hold this thought. Can a change in diet actually
help the symptoms of ADHD? We will come back and talk about that in a couple of minutes. What are the common
misconceptions about ADHD? I know that some people say, “Oh well, you know, if you
punish your kids enough, “they wouldn’t be so lazy, right, “they would pay better attention.” Is that one of ’em and
what are some other ones? – Yeah, that’s great. You know, a lot of times I’ll hear, “Oh, well, he’s just being a boy. “That’s just how boys are. “His dad was the same way.” Or they might say, “Oh,
well, she’s just shy. “She doesn’t like to speak up. “She just doesn’t like the material. “That’s why she doesn’t get good grades.” It’s really a lot of excuses, okay? Anytime a person is
having trouble learning, we really have to evaluate it and see if this is normal or abnormal. That would be my take-home message today. Please allow a clinician, someone that is able to see
if this is normal or abnormal. Another misconception is
if someone is growing up in an environment with multiple languages, that oh, because they’re in an environment with multiple languages, you know, they might have a harder
time pay attention. They’re not up to par with the other kids because they’re in a multicultural family with multiple languages. That’s not true either. The developmental milestones
and the expectations remain the same. – And what about the emotional
stigma of having ADHD? – So any type of diagnosis that pertains to learning disabilities
or any type of disability does have a stigma associated because it makes you feel not normal. Well, the way we break
stigmas is by normalizing it, because every person is unique and special and learns in a very different way. And just because you might
need a little bit more support or a little bit more test taking, or you might need a
medicine to help you focus, that’s okay because many people suffer with ADHD on a daily
basis in an untreated way, and it affects their
mood, their behaviors, their relationships with other people. And we live in a age where
there’s really no need to suffer. There’s a lot of different
treatment options, and we can individualize
a therapy plan together so that you can feel
better about your life and you can reach the optimal
success that you’re meant for. – You referenced it a
couple of minutes ago, if you suspect that your child has ADHD, what’s the process for diagnosing it? Who should you take your child to see? – Absolutely, there are
different avenues for doing this because ADHD really affects learning and abilities to get things done. You can always let your
school teacher know, counselor, principal, you can
go through the school system. It’s always a good idea to
let your pediatrician know, because we really have to
evaluate for other causes that could be contributing
to these symptoms. Sometimes we need to do lab work to make sure there’s
not a hormonal imbalance causing some of these symptoms. So talking to a medical
professional, a physician, to be able to evaluate, talking to your school district. Getting a psychologist on board sometimes requires a diagnosis. It really depends. So it can be very confusing. But if I had to simplify this, I would say let your doctor know and talk to the teacher at school. – So when you say let your doctor know, you’re saying if you’re a child, talk to the pediatrician. – Yes. – If you’re an adult, go to
your primary care doctor– – Yes. – Or do you go to a neurologist? – So first you will go to
your primary care doctor. Always first go to your
primary care doctor and they can help you
route through the system. – Do kids who have been
diagnosed with ADHD, do they need special education? – So children with ADHD
will have a special plan, not necessarily called special education, but it will be an individual plan. And they will be able to
have more time for tests. They’ll be able to have different teachers that may be able to help them focus by accommodating them in classrooms. But people with ADHD or children with ADHD that affect their learning
do have the ability to have a classroom setting
that is gonna make them succeed. But the only way they can do that is if the school knows about it and creates the plan for them. – And then what happens if
you’re an adult with ADHD? How do you present yourself to an employer to talk about whatever special
conditions you might need? – It really depends on the type
of employment that you have and what the expectations of that role is. Per the American Disabilities Act, you do not need to disclose if there is a learning disability or any type of disability when
you are being interviewed. Afterwards, if you feel
that there may be something you might need that’s
gonna help you succeed, more time accomplishing tasks, et cetera, then you may disclose to your employer. But usually if a person
who’s an adult has ADHD and they’ve known and
it’s been controlled, they actually usually do not
disclose to their employer because they don’t need accommodations. It really depends on the severity, what their job is, and how it affects their day-to-day occupation. – All right, so let’s come
back and talk about this. Can a change in diet actually help the symptoms of ADHD? – There are no studies that show a specific type of diet is gonna help a specific type of symptom. However, we know in general that if kids have
processed foods or sugars, even without ADHD they’re
gonna be more hyper, okay? So we might wanna pay attention
to those kinds of foods that we’re giving our kids. But there’s no studies to say if you’re on this diet, this
symptom is gonna be eliminated. All we can really recommend
is having well-balanced meals, staying well hydrated,
getting enough sleep, and having your body in optimal level so that you can learn. If your brain is tired and not having nutritious ingredients, you’re not gonna learn
the way you really can. That goes for anybody
whether or not you have ADHD. – And how vocal and up front should you be about this condition with your family, with your friends, with your coworkers? ‘Cause I know that some kids
might be getting bullied or teased because they have ADHD. And when you’re in the workforce, maybe you are isolated by your coworkers because of this condition. So how up front should you be about this? – That’s a personal choice, especially when you’re an adult. When you’re a child it’s
also a personal choice, and when you’re a child you
may not quite understand what that means. But a parent should
always be 100% transparent with the school district and the teachers regarding what the child has or what symptoms they may have or what diagnoses they may have because it’s working together
with the school district for that child. As an adult, really breaking that stigma is the most important thing. But it’s really up to you to decide how much you wanna share and with who. Finding people that you trust that will value your time, that will value your expertise. So if you feel comfortable sharing that you have a certain
diagnosis, that’s okay. You don’t have to tell
everybody your diagnoses. You don’t have to tell
everybody, you know, that you’re going through a divorce. You don’t have to tell everybody that you have diabetes or cancer. You can choose who you
share information with. However, if you notice it’s affecting your abilities to do
things, talk to your doctor. You may have to talk to your employer to get an accommodation plan. But just know that
there’s a lot of avenues for you to succeed. – Any final thoughts, Doctor? – I would really just say to be open about the symptoms that you’re having. If you’re a child and
you’re a parent of a child that might have these symptoms, to let your provider know, not to be afraid of the
different treatment options, to really work together with
your primary care doctor, the school district, or employer, to figure out a plan
that’s gonna work for you so that you don’t have
to suffer in silence with these symptoms. – Dr. Alonzo, thanks so
much for being with us. – Oh, thank you so much for having me. – If you want more
information on ADD and ADHD, please click on the link or go to scripps.org/videos. Want more critical
information about your health? We take care of you from head to toe. Please subscribe to our
Scripps Health YouTube channel and follow us on social
media @scrippshealth. I’m Susan Taylor. Thanks so much for joining us. It’s our mission at
Scripps to help you heal, enhance, even save your life.

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