ADHD and why it should be called AAD (Attention Abundance Disorder)

dr_parker_adhd_and_why_it_should_be_called_aad_Presenter: Neal Howard
Guest: Dr. Charles Parker
Guest Bio: Dr. Charles Parker, neuroscience consultant.  He’s also an expert in adult ADHD, child ADHD, brain SPECT imaging, and an adult and child psychiatrist.  He’s got over 43 years of experience in the field.  He’s also an author, and his book, New ADHD Medication Rules, is doing well and making waves.


Transcription

Health Professional Radio – ADHD

Neal Howard: You’re listening to Health Professional Radio.  I’m your host, Neal Howard.  Our guest is Dr. Charles Parker, neuroscience consultant.  He’s also an expert in adult ADHD, child ADHD, brain SPECT imaging, and an adult and child psychiatrist.  He’s got over 43 years of experience in the field.  He’s also an author, and his book, New ADHD Medication Rules, is doing well and making waves.  Welcome, Dr. Parker.

Dr. Charles Parker: Thanks, Neal.  Thanks for having me.  I appreciate it.

Neal: I saw it mentioned that ADHD should be called AAD, attention abundance disorder.  Could you talk about that a bit?

[laughter]

Dr. Parker: Yeah, I was being facetious about that.  I mean if we’re going to call it by a label … you know, most people don’t suffer from a deficit.  Most people who have this problem suffer from an abundance.  From a cognitive thinking point of view, they suffer from an unmanageable cognitive abundance.  They actually have this cognitive anxiety thing.  It is the most provocative, most frequent thing that we see with individuals who have been treated for years but have never identified that as a treatment target.

Neal: Paying attention to too many things as opposed to not paying attention to enough.

Dr. Parker: Yeah.  Now, the only reason the word “deficit” comes in is because the label-makers who don’t really think about it more deeply recognise, on a very superficial level, that this person seems to have a deficit in getting things done.  But the deficit is not the problem.  The abundance is the problem that causes the deficit [laughs].  So why wouldn’t we look at what the problem is instead of looking at the appearance of the problem?  It’s pretty amazing.

Neal: It is.  Trying to inject some common sense into this is quite an uphill battle.

Dr. Parker: I don’t think so.  I tell you, people even like yourself – you’re hearing it relatively for the first time – you get it.  I think the average person gets it.  Actually, my target audience is the public.  I mean, I’ve been saying this to my medical colleagues since … for a long time.  Since ’96 we’ve been talking about it.  My feeling is the public is going to change medicine in this regard.

Physicians are busy looking over their shoulder trying to decide what Harvard and Stanford think.  Harvard and Stanford are not thinking this way.  So I can tell you the public is going to say, “I really think that we need to look at the way neuroscientists are thinking about it, and not wait for Harvard or Stanford to weigh in on it.”

Neal: Once the proper questions are asked and the medications are prescribed, what are some of the problems with taking the medication, such as taking them with foods, without foods, overdosing, under-dosing?  How much of that is a problem?

Dr. Parker: I hope you have me come back some time because we’d talk for about two hours on that one.  But I’ll tell you real quickly this: one of my favourite acronyms is DOE, Duration of Effectiveness.

Neal: Duration of Effectiveness, okay.

Dr. Parker: So we want to look at what the body is doing with the meds.  We want to look at other variables that will affect the burn rate of the meds, everything from genetics to breakfast.  But the very first thing that we want to do – and if, let’s say you’re a patient, I’m working with you in the office right now.  The first thing we want to do is know in advance what is expected from the specific medication that I am giving you.  So if I’m giving you Vyvanse for example, which is my favourite medication – and hey, it’s the world’s favourite medication, so I’m not all by myself.

It should burn 12 hours, 10 to 12 hours with an adult person.  If it burns eight hours, it’s not adequately adjusted.  Now, it doesn’t matter what the dose is, whether it’s 20 milligrams or 70 milligrams.  If it’s burning eight hours, it needs a dosage adjustment so that it works at the efficient prescribed expected level of efficiency, so that you then have a duration of expected efficacy, efficiency, so you know that you’re meeting the numbers correctly.

Neal: Absolutely.

Dr. Parker: So there are specific ways that you can get the dosage adjusted based on using the target from the medication itself.  To just draw it away from that kind of complicated thing, it’s like shooting a weapon, like a 22 rifle, without having any idea whether you’re using a long or a short.  There’s just the target out there and I got a gun.  I’m taking a shot at it and I hope I hit it.

Neal: Yeah, I see that happening …

Dr. Parker: I don’t have any idea … Yeah, what I’m using for a weapon – it’s just like “Come back and tell me if I hit it or not.”

Neal: SPECT brain imaging.  What exactly is that and how do you implement it in your practise?

Dr. Parker: It’s a long word.  Single Photon Emission Computed Tomography, which means you inject a radioactive substance into the brain.  It measures regional cerebral blood flow using a nuclear medicine technique, so you can actually see, visually how the brain is functioning.  People take pictures of the brain, like CAT scans and MRIs and stuff, but that’s not function.  That’s a static picture.  I’m for a functional diagnosis, and brain function measurements can actually show where the prefrontal cortex is not working as well as it should be.  So that’s what SPECT imaging does.  It measures brain function.

Neal: Your book, New ADHD Medication Rules, obviously you’re passionate about it and very knowledgeable.  Why exactly did you write the book?

Dr. Parker: I am on a mission.  I’ve seen so many people suffer.  I’ve been on to this for a long time.  I got excited about it when I started doing brain imaging.  One of the reasons I did brain imaging with Dr. Amen, who is a world thought leader in brain imaging – I basically took like an advanced residency with him for four years because I knew he was into evidence.  I think that evidence is where the truth really is in all these matters.

Neal: Absolutely.

Dr. Parker: So I was doing these things this way before I met Amen, and then when I met Amen, he solidified my thinking.  I realised when I was working with him how many people were against hearing the truth, how many medical professionals were waiting for somebody else to tell them what the truth was, usually an academic institution, and not paying attention to good neuroscientific facts that were outside of Daniel Amen, just plain old in-the-literature from 20 years ago.

So what happens is then I got on this mission because it’s like, “Hey guys, I need to join anybody that’s chasing the evidence.”  By the way, a lot of my psychiatric and medical colleagues are in fact chasing evidence.  This isn’t me, by myself, alone.  There are groups of people.  There are whole neuroscience groups that are really looking at finding out about brain function, and that’s the crowd I like to hang out with.

I think if we then articulate it to the public, the public will do what they can to ask for changes in medicine, as they should.  Because SPECT imaging costs about 3,500 bucks, and a lot of insurance, they don’t pay for it.  So what I’m saying is SPECT teaches us to ask the questions more precisely.  Then you take that $3,500 investment and skip over it, if you can, some people do need brain imaging, and we do it all the time in our office.

But the issue is: if they don’t need it, why wouldn’t everybody in America just get to ask the basic question?  “Let me ask you ma’am, is that a cognitive anxiety that you have?  Can we break that down?  Or is that an affective emotional anxiety?”  Because they’re treated differently.  One is treated with a stimulant medication more effectively and the other one is treated with a serotonergic agent [sp] more effectively.

Neal: So that’s where SPECT imaging has its most important function, is in identifying these two distinct forms of anxiety?

Dr. Parker: You can see this on SPECT imaging.

Neal: It’s been a pleasure talking with you today.

Dr. Parker: Thank you very much, Neal.  Have a great day.

Neal: Our guest has been Dr. Charles Parker, author of the New ADHD Medication Rules: Brain, Science & Common Sense, speaking about ADHD, some of the problems with diagnostic processes of today, and trying to make things better for all involved; consumers, researchers and practitioners as well.  You can find more information on Dr. Parker at www.drcharlesparker.com.  Also at www.corepsychblog.com.

You’ve been listening to Health Professional Radio.  I’m your host Neal Howard.  Transcripts of this program are available at www.healthprofessionalradio.com.au.  We’ll have much more health information for you.  Thank you.

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