Inattentive, hyperactive, and impulsive children often suffer from a lack of attention. This is because those with ADHD have an imbalance in certain neurotransmitters within their brains which help control how they behave as well as their focus. In the brain, there are two main neurotransmitters that play a role in ADHD: norepinephrine and dopamine. Norepinephrine helps regulate arousal in the brain, while dopamine is responsible for focus and attention. When a student with ADHD takes drugs that raise levels of these neurotransmitters, they are often able to concentrate better and behave more appropriately.
Ritalin or Adderall
It has long been known that stimulant medications such as Ritalin or Adderall can help to treat symptoms found in ADHD. The problem is that these medications ‘help’ the neurotransmitters get used up faster, meaning they would need to be taken more often or in higher dosages. Stimulant drugs work by binding to dopamine and norepinephrine transporters (DATs) which are proteins on neurons that take neurotransmitters away after they have been released. Blocking the reuptake of these neurotransmitters, therefore, means more dopamine and norepinephrine are available to bind to receptors in the brain, leading to increased focus and concentration.
The most common stimulant drugs used for ADHD treatment work by blocking DATs. Drugs like methylphenidate (Ritalin) and amphetamine (Adderall) are very effective in treating ADHD symptoms, but they also block the reuptake of two other neurotransmitters: serotonin and norepinephrine. These drugs increase the levels of all three neurotransmitters, dopamine, norepinephrine, and serotonin, although to varying degrees.
Medications that increase dopamine levels in the brain are typically effective in reducing symptoms of ADHD. A study at Stanford University found that children with ADHD had fewer symptoms when they took doses of methylphenidate. The findings were based on magnetic resonance imaging (MRI) of the brain, which showed reduced levels of dopamine transporter binding in participants.
The study at Stanford used a technique called functional magnetic resonance imaging (fMRI) to measure the amount of dopamine in specific regions of the brain. In participants diagnosed with ADHD, brain scans showed that drugs like methylphenidate did result in a significant increase in dopamine concentration. This is important because an excess or shortage of dopamine can lead to hyperactivity or inattentiveness. In fact, according to a study done by Harvard Medical School, drugs that increase dopamine concentration have been used for decades to treat schizophrenia and Parkinson’s disease.
Methylphenidate can be an effective drug in treating ADHD symptoms because it blocks the dopamine transporter, making more dopamine available within the brain. However, for this to work, the drug needs to cross the blood-brain barrier. A study at Cardiff University found that administering drugs that are too ‘large’ or have a complicated chemical structure often has problems crossing this protective layer of cells. According to the study, one factor that affects how well drugs can cross into the brain is their size and complexity.
Methylphenidate is a psychostimulant medication that is used for the treatment of attention deficit hyperactivity disorder (ADHD) and narcolepsy. The drug works by increasing levels of dopamine and norepinephrine in the brain, which results in increased focus and concentration. Methylphenidate can be effective in treating ADHD symptoms, especially in children. However, the drug may not be able to cross the blood-brain barrier as easily because it is too large or complex.
I take Contramyl XR 36mg every morning. It has saved my life because it ‘calms’ my brain. This allows me to focus on whatever task I am working on, and since I work from home, this is highly beneficial.
People learn in many different ways. The way humans learn most frequently is called observational learning or social learning. This is when an individual learns through observing and imitating others. Observational learning occurs through watching and mimicking the behaviour of a model: another human, an animal, or even a cartoon character on TV.
There are two types of observational learning. In social learning, an individual can learn from a model’s positive or negative behaviours. This is called vicarious reinforcement and punishment. During observational learning, the observer watches a model receive praise or criticism for their actions. For example, if a professor praises a student for answering a question correctly, the student may mimic that behaviour in future classes. On the other hand, if a professor criticizes a student for saying something incorrectly, the student is less likely to repeat that behaviour.
Observational learning can also be used when an individual mimics the actions of another model. This type of observational learning is called emulation. For example, if you see your friend start their homework before dinner and finish in a timely manner, you might try to emulate their actions by starting your own homework before dinner.
Lastly, there is imitative learning. This occurs when an individual does not watch or imitate another model but instead mimics the actions of a previous experience. For instance, if you already know how to solve for x and y in the equation 5x + 4y = 19, you will be able to solve for x and y in the equation 7x + 3y = 22 without having to watch or imitate another model because you have prior knowledge of how to solve that type of equation.
Cognitive learning is an individual’s ability to identify relationships between two separate events. If Sally puts on her shoes and then gets in her car, she might think to herself, “I should put on my shoes before getting into the car because then they won’t get wet when it starts raining.” This is an example of cognitive learning.
The second type of learning that frequently occurs among humans is associative learning. There are two types of associative learning: classical conditioning and operant conditioning.
With classical conditioning, a neutral stimulus becomes a conditioned stimulus when paired multiple times with an unconditioned stimulus. An unconditioned stimulus is something that naturally and automatically triggers a response from the body. For example, when you hear the alarm go off in the morning, you know it’s time to wake up. This is because the sound of an alarm has been paired with getting out of bed multiple times throughout your life, and now it triggers a conditioned response (waking up). When an unconditioned stimulus and neutral stimulus are paired multiple times, eventually, the neutral stimulus will trigger a response from the body.
An example of this type of learning is Ivan Pavlov and his dogs. Pavlov noticed that when he fed his dogs, they would salivate (unconditioned response). He began to ring a bell each time before feeding them, and eventually, just ringing the bell caused the dogs to salivate. This was because the sound of the bell had been paired with food multiple times, and now it triggered the salivating response (conditioned response).
Another type of associative learning is operant conditioning. With this type of learning, an individual’s behaviour changes based on the consequences they receive. If a student studies for a test and gets an A, he or she will continue studying for tests in the future because it was pleasurable and led to a positive outcome. If a student studies for a test and gets a B, he or she will probably study less for future tests because it did not lead to a positive outcome.
Social learning is when an individual learns by observing the behaviour of another person in their society. This form of learning includes observational learning, imitation, and emulation.
A social learning theorist named Albert Bandura did a famous experiment called the Bobo doll experiment in 1961. In this experiment, he exposed children to an aggressive model who used violent actions toward a bobo doll (soft punching toy). The children were then given the opportunity to be aggressive towards the bobo doll or play with it peacefully. The children who had watched the aggressive model acted more violently than those who did not watch the model or saw a non-aggressive model. This means that observational learning and imitation played a role in how they learned to behave because they either witnessed someone else behaving aggressively towards the bobo doll or wanted to imitate them based on their previous mental schema.
The final form of social learning is emulation. This is when an individual tries to achieve a goal based on the model’s success. Bandura conducted another experiment in 1965 to test this type of learning. In this study, children watched a video of an adult solving different puzzles with either easy or difficult solutions. They then had the opportunity to complete the puzzles themselves. Those who watched an adult model succeed with easy puzzles were more likely to complete the same puzzle successfully than those who saw an adult model struggle with difficult puzzles or see someone else solve easy puzzles. This shows that emulation takes place when an individual sees another person achieve success in something, and they try to achieve this same goal for themselves.
The final form of social learning is observational learning. The term “social modelling” refers to this type of learning when individuals learn by observing the behaviour of others around them. As we grow up and spend time in our society, we learn how to behave based on what we see other people doing. This can include how we should dress, talk, or behave in certain circumstances.
Observational learning is closely related to imitation. Imitation is when an individual copies another’s behaviour after seeing it done by someone else. This can happen for many reasons, including wanting to fit in with a certain group or just being curious about the other person’s actions. Observational learning and imitation are often mistaken for one another because they both involve an individual imitating someone else’s behaviour.
Associative learning is when one stimulus elicits a response to another stimulus. For example, an experimenter may pair the sound of a bell with the delivery of food to a dog several times until, eventually, just hearing the bell causes the dog to salivate (conditioned response). In Pavlov’s experiment, the unconditioned stimulus was the food, and the unconditioned response was salivation. The conditioned stimulus was the sound of a bell, and the conditioned response was salivation in anticipation of receiving food. Associative learning can happen consciously or unconsciously, depending on the situation.
Taking into account all types of learning, the common underlying factor is that an individual will learn by associating information or stimuli with other stimuli. If one stimulus is consistently paired with another stimulus, an association can form between them.
Eventually, just presenting one of the associated stimuli to the individual may elicit a response automatically because it has previously been learned through pairing/experience. One example of this is knowing that after a bad day, one should go to sleep, and the next day will be better (unconsciously learned association).
Another example is a child who automatically cries when their mother leaves the room because they have learned this behaviour through repeated experience.
While there are many types of learning, all individuals learn in some way due to associations. Whether it is conscious or not depends on the person and what type of stimuli they are exposed to. In Pavlov’s experiment, his dog learned to associate the unconditioned stimulus (food) with the conditioned stimulus (the sound of a bell). In Bandura’s study, children associated success in solving puzzles with watching an adult model that behaviour.
Humans learn by associating information or stimuli with other stimuli, and this is how they have developed throughout history.
What if Neurotypicals are Pavlov, and our medication is their bell?
Autism Spectrum Disorder (ASD) is a large and diverse group of neurodevelopmental disorders that can affect a person’s functioning in several different areas. These can include social interaction, communication, and behavior.
According to the Center for Disease Control (CDC), approximately one out of every 68 children in the United States has an autism spectrum disorder diagnosis. This makes it almost five times more common among boys than girls, although recent evidence suggests that this may be changing.
The symptoms of autism spectrum disorder can be classified into two separate categories: core symptoms and associated symptoms.
Core symptoms include social deficits and communication difficulties, such as problems with nonverbal cues and interactions or trouble transitioning from one activity to the next. For example, a child may be able to engage in a conversation but fail to ascertain when someone else is done speaking.
Associated symptoms include repetitive and restrictive patterns of behavior, such as compulsive eye contact or hand flapping; these behaviors are often referred to as “stimming.”
The specific diagnosis of autism spectrum disorder, in accordance with the DSM-5, is defined by two categories: social communication deficits and restricted and repetitive behaviors.
Medication has two main uses: to address associated symptoms of autism such as hyperactivity or self-injurious behavior (SIB) or to address specific symptoms of autism-like social deficits.
Atypical antipsychotics are the most common medications used to treat associated symptoms of autism, such as aggression, agitation; they are also prescribed for behavioral problems like SIB.
Commonly prescribed atypical antipsychotics include risperidone, clozapine, and aripiprazole.
Of these drugs, risperidone (trade name: Risperdal) is the only one approved for the treatment of irritability in autistic children by the Food and Drug Administration (FDA). Children with autism spectrum disorder who take atypical antipsychotics may experience such side effects as weight gain, sleepiness or drowsiness, and increased saliva.
Medications used to target specific symptoms of autism spectrum disorder include selective serotonin reuptake inhibitors (SSRIs), which can be used to address anxiety and depression; they affect serotonin levels in the brain and can reduce repetitive and self-injurious behaviors associated with autism.
Another type of antidepressant, selective serotonin and norepinephrine reuptake inhibitors (SSNRIs), also known as serotonin-norepinephrine reuptake inhibitors (SNRIs), can help children who experience anxiety, depression, and irritability as a result of autism spectrum disorder.
Common types of SSNRIs include duloxetine (Cymbalta), venlafaxine (Effexor), and desvenlafaxine (Pristiq).
The FDA has not approved any medications for the treatment of autism spectrum disorder, although it has approved risperidone for irritability.
Some argue that autism spectrum disorder has become an umbrella term to justify prescribing pharmaceutical drugs, and others argue that there is a growing epidemic of the condition as a result of environmental factors.
This controversy exists because many children who receive an ASD diagnosis do not entirely fit the normal diagnostic criteria; they may only display some of the symptoms of autism, or they may meet most of the DSM-IV criteria but not all.
Groups like Autism Speaks advocate early intervention for children who are diagnosed with ASD, and treatment plans often begin with therapy to help children adapt before prescribing medication.
Some research suggests that behavioral intervention might be just as effective as medication in treating autism spectrum disorder; other studies show that children who receive treatment with medication and therapy use fewer resources (and thus, save money) than those left untreated.
Medication saved my life and thanks to my wonderful Psychiatrist we found that sweet spot where I am on the perfect dosage to function optimally.
Lily is the harried mother of Connor, a 12-year-old with autism. After years of special education services, he’s gotten much better socially, but he still struggles with reading and writing assignments. His teachers say that he tries hard, but he needs support to get his work done. Homework is a nightmare, even with a reward system and a fine-tuned routine. Connor hates it, and can’t focus without his mom sitting next to him. Lily is worried because she knows he can do the work, but he isn’t keeping up with his classmates.
Autism, a developmental disorder primarily defined by delays in social and communication skills, relies on non-medical interventions for children to progress. Behavioral and speech/language therapies are central to autism treatment. Occupational therapy refines fine motor skills and improves self-help abilities, as well as addressing sensory issues (such as being hypersensitive to touch or noise). Many families report benefits from alternative care.
Despite such intensive non-medical approaches, various symptoms sometimes remain in children who have an autism spectrum disorder (a term that has replaced both Asperger’s Syndrome and pervasive developmental disorder (PDD-NOS). When that happens, families face a tough question: Are there any medications worth trying?
In fact, several medications may benefit children with autism when other options are inadequate. These medications do not treat autism itself, but they offer relief from symptoms that commonly occur along with it. The first step for providers and parents is to collaborate in deciding on what most affects a child’s life and to balance the pros and cons in making a choice for or against autism medication.
There are three groups of medications considered appropriate for autism: those used to treat co-occurring ADHD symptoms, antidepressants/anti-anxiety medications, and atypical anti-psychotic medications. While none directly addresses the developmental disorder of autism, they can profoundly benefit children. Here’s what to consider when discussing medications for someone with autism:
At one time an autism diagnosis automatically precluded a diagnosis of ADHD. Not so anymore. We now know the two conditions frequently occur together. In fact, nearly half of all kids with autism demonstrate ADHD symptoms — an added burden that undermines academic, behavioral, and social progress.
With or without autism, ADHD requires comprehensive, multi-disciplinary care that usually includes, at minimum, both behavioral and educational interventions. As part of this broad approach, ADHD medication can be life-changing for some children.
There are two groups of medication currently used to treat ADHD: stimulants (such as Ritalin or Adderall) and non-stimulants (such as Strattera or Intuniv). When prescribing ADHD medications, the goal is to avoid persistent, significant side effects. Yet finding a good fit is harder when autism and ADHD occur together, for reasons not yet known.
Research shows the success rate for stimulant use is near 80 percent. These medications can bring substantial improvement to “core” ADHD symptoms that undermine social, behavioral, or academic progress in a child with autism, such as poor focus, inability to complete a task, and impulsivity. Medications are not as useful for other ADHD-related issues, such as difficulty with time management and planning. For anyone struggling with both autism and ADHD, removing the added burden of ADHD can have direct benefit at home, in the classroom, socially, and even during the therapy sessions meant to address autism itself. Reading, writing, and other academics often improve as well.
Generally, stimulants are not active after the medication wears off on any given day, allowing for fairly rapid adjustments if a medication is not working well. Side effects are easily managed and, after a period of sustained trial and error to find a best fit, often entirely avoidable. Since side effects are reversible when medications are stopped, a trial of use — as long as it is carefully observed and monitored — should not bring long-term problems.
ADHD non-stimulants cause side effects less often than stimulants, but succeed less frequently. They are called “non-stimulants” in contrast to the stimulant group, but have similar effects as the stimulants; they work by increasing activity in underactive parts of the brain responsible for ADHD. Advantages of non-stimulants are that they may provide 24-hour coverage, as well as helping with sleep or being overly reactive (quick to anger, frustrate, or upset). Side effects vary, but include excessive sleepiness (Intuniv and Kapvay), irritability, stomach upset, or headache (Strattera).
Antidepressant and Anxiety Medications
Common challenges for children with autism include persistent anxiety or obsessive behaviors. These behaviors, such as avoiding or running away from new or unknown situations, separation anxiety, or compulsive checking or washing behaviors, cause big problems in day-to-day life. Anxiety is often associated with strict black-and-white thinking, a combination that can be a trigger for explosive behaviors. Children with autism are also at risk for developing depression, another family of symptoms that sometimes become severe enough to require medication.
For these symptoms, the most commonly prescribed medications for children are selective serotonin reuptake inhibitors (SSRIs), such as sertraline (Zoloft) or fluoxetine (Prozac). Some of these medications have been studied and approved for use with children, although not specifically for autism. This group of medications may help with mood, anxiety, or obsessive thoughts and compulsive behaviors. As with most mental health medications, side effects should be closely monitored.
hese medications, such as Risperdal or Abilify, are the only group of medications specifically approved for children with autism. This is because studies show them to benefit autism-related irritability. However, atypical anti-psychotics may also improve anxiety, impulsivity, or mood.
Along with the wide range of potential benefits comes a larger risk of side effects. These include weight gain and a risk of developing diabetes, among others. Weight, blood sugar, and other measures are monitored when children remain on these medications for any length of time.
Non-medical options are the best first choice for behavioral challenges, but they do not always succeed. Sleep problems are common in autism, though first-line treatments, such as behavioral therapy, should provide tools for managing it. However, sleep aids, non-stimulant ADHD medications, and other pharmaceutical interventions can be considered when needed. Anti-seizure and other psychiatric medications may be useful in children with autism and mood disorders, or self-injurious behavior associated with autism.
Most parents and providers agree that avoiding medication is best when it comes to managing autism. And yet, for many individuals, non-medical care falls short in resolving their intense symptoms. These difficulties, such as rampant inattention, may undermine work with teachers and therapists, slowing overall progress.
Medications for autism are no better or worse than those for most other medical disorders. There are potential benefits and side effects. Used judiciously, and integrated with ongoing therapies for autism, medication may allow children to take significant steps forward in their lives.
Three months later, Connor comes in smiling and holding a book. His third ADHD medication seems to be a good fit. He isn’t as hungry at lunchtime, but he’s making up for it at dinner. His teachers and therapists say he is able to get his work done better. And at home, he’s having longer conversations and reading for fun for the first time. It was a tough choice, and there’s a lot more to work on, but Lily says Connor has taken a big step forward.
The first morning I wake up at the hospital when a nurse come to check my blood pressure. I am still a bit drowsy from the sleeping pill and I kind of put together the room, the day, the previous day and why I am here…
We have breakfast, I go to take a shower and get dressed for the day, not knowing what to expect.
They call me to inform me that a Psychologist is waiting for me in the consultation room. I go in and he introduces himself and tell me to sit and get comfortable. I tell him what I told the Psychiatrist the day before and he takes a lot of notes on the file in front of him.
“I am not saying it is, but it sounds like it…’ he continues.
‘Excuse me?” I ask, “my Psychiatrist mentioned Autism and said I should rest as much as I can today while reading up on Autism, what is Borderline Personality Disorder?” I continue, kind of confused but also intrigued at the same time.
He hands me a piece of paper which reads:
Individuals who match this personality disorder type have an extremely fragile self-concept that is easily disrupted and fragmented under stress and results in the experience of a lack of identity or chronic feelings of emptiness. As a result, they have an impoverished and/or unstable self structure and difficulty maintaining enduring intimate relationships.
Self-appraisal is often associated with self-loathing, rage, and despondency.
Individuals with this disorder experience rapidly changing, intense, unpredictable, and reactive emotions and can become extremely anxious or depressed. They may also become angry or hostile, and feel misunderstood, mistreated, or victimized.
They may engage in verbal or physical acts of aggression when angry.
Emotional reactions are typically in response to negative interpersonal events involving loss or disappointment.
Relationships are based on the fantasy of the need for others for survival, excessive dependency, and a fear of rejection and/or abandonment.
Dependency involves both insecure attachment, expressed as difficulty tolerating aloneness; intense fear of loss, abandonment, or rejection by significant others; and urgent need for contact with significant others when stressed or distressed, accompanied sometimes by highly submissive, subservient behavior.
At the same time, intense, intimate involvement with another person often leads to a fear of loss of an identity as an individual. Thus, interpersonal relationships are highly unstable and alternate between excessive dependency and flight from involvement.
Empathy for others is severely impaired.
Core emotional traits and interpersonal behaviors may be associated with cognitive dysregulation, i.e., cognitive functions may become impaired at times of interpersonal stress leading to information processing in a concrete, black-and white, all-or-nothing manner.
Quasi-psychotic reactions, including paranoia and dissociation, may progress to transient psychosis. Individuals with this type are characteristically impulsive, acting on the spur of the moment, and frequently engage in activities with potentially negative consequences.
Deliberate acts of self-harm (e.g., cutting, burning), suicidal ideation, and suicide attempts typically occur in the context of intense distress and dysphoria, particularly in the context of feelings of abandonment when an important relationship is disrupted.
Intense distress may also lead to other risky behaviors, including substance misuse, reckless driving, binge eating, or promiscuous sex. (APA, 2010)
“Well, I will leave you to rest as your Doctor suggested, I will see you again tomorrow” he says, and say goodbye and leave the room.
I go back to my room I share with 3 other men and lie down on my bed. I read what I can find on Autism, but I also read the paper he gave me. I do not recognize myself at all when reading about BPD. Strange…
I guess I have to wait for the Psychiatrist to clarify exactly what this means. He will only be back the next day and he has prescribed pain killers for the suicide attempt wound on my wrist, anti-depressants and more sleeping pills (which I have to take in front of the nurse so they can confirm that I did take the medication).
I eat lunch and read, I eat dinner and read, I take a shower and read, and I take my evening medication and sleep….
Just some feedback after my session with my Psychiatrist today:
The normal experience of grief is a deep sadness, a yearning for the past, often loneliness and a need to reach out for comfort.
There may be initial shock and an inability to comprehend the reality of the loss, raw anguish, and perhaps anger, at being left behind, or an irrational guilt about being alive instead (survivor guilt).
Over time, the pain lessens and the sense of loss fades into a realistic acceptance that life must go on.
I can confirm that my Dr is happy to highlight that I have fast-tracked the grieving process which usually occurs after a traumatic event.
I have the unique advantage that I framed my experience as a ‘new me being born’ instead of my old self remaining intact.
My appreciation for my mental gifts played in my favour and he is convinced that I already let the trauma fade into the background whilst focusing on my new-found appreciation of life.
The scar on my wrist is thus a cesarean scar (c-section) symbolising the birth of the new me!
Self-observation as an agent of behavioral change
Self-observation is an awareness practice where you turn your attention inward, and non-judgmentally watch what you think, feel, and do.
Imagine that as an observer, you have access to your inner landscape. You observe your thoughts, emotions, sensations, etc. as they occur within you.
These patterns of behaviour are both tenacious and automatic. Self-observation creates a space.
In that space lies an opportunity for you to make a conscious choice. Is my automatic response pattern the best option for this circumstance, or would another behaviour be more helpful now?
Self-observation never becomes a habit. Just like following a diet, you must develop the discipline to periodically reflect and notice what pattern is presenting.
The good news is that just noticing them relaxes them and makes them less compulsive. Self-observation creates a “map” of your own specific habits and patterns.
The more you develop your ability to observe your conduct, the more you can bring your unconscious, reactive patterns of thinking, feeling, and behaving into your awareness.
Then you’ll be able to consciously choose and control them to best serve the situation.
I must now enter this stage in my personal and professional growth. It will allow me to identify behaviours that are to my benefit as well as to those around me.
This is the next step in aligning my skillset with being successful at home and at work. Exciting!
No change, happy to report that we’ll keep it as it is since I function very well.
My Dr is very supportive and confident that I have healthy control over my life right now.
My next appointment is only in March, which is great news indeed!
Today, I would just like to give you feedback after my first month back at work.
Firstly, thank you to each of you for the kindness shown and the acceptance of this new reality of mine. I have managed to not merely accept my spectrum profile but also embrace it.
Several personality attributes prevalent among those on the spectrum are valuable assets: capacities for analytical and “outside the box” thinking, creativity, attention to detail, the ability to focus intensely on a task for long periods of time.
I realized that I have ample reason to be proud of who I am, and with help from clinicians, I am busy winning my inner battle. The therapies and interventions they provide are essential, not because they aim to cure autism, as if it is merely a medical condition, but because they help me address challenges that stem from being autistic in a non-autistic world.
I met with my Psychiatrist this week and he was happy with my progress. My medication works very well, and we can keep the dosages as they are until December. I feel relieved, focused and ‘lighter’.
I am grateful for being able to work on the Brand Integration project and I’m really enjoying it. I did however notice in the recordings of the meetings that my speech pattern is now at a normal speed due to the medication haha.
Also, I find I sometimes struggle to recall a specific word, similar to when you push down on the accelerator of a Mercedes, it’s like: “I’ll be with you in a second…aaaaand…there we go…”.
The new me is still new to me in a way, and I am still taking it day by day while getting to know my new superpower.