The Root Causes of ADHD: A Comprehensive Approach Beyond Stimulants

Dear Reader,

In recent years, we've seen a notable rise in the diagnosis of Adult Attention Deficit Hyperactivity Disorder (ADHD) and, correspondingly, an increase in the prescription of stimulants like Adderall and Vyvanse. This surge brings to light a critical issue in modern psychiatry: are we adequately addressing the root causes of ADHD, particularly in adults? At Potomac Psychiatry, our approach goes beyond surface symptoms, exploring the underlying root cause factors that contribute to attentional problems.

Understanding Adult ADHD: ADHD is often perceived as a disorder of childhood, but its impact can extend into adulthood. Adults with ADHD may struggle with sustaining attention, being easily distracted, difficulties in task completion, and issues with organization. While these are classic hallmarks of ADHD, it's crucial to recognize that similar symptoms can arise from a variety of other causes.

Root Cause Psychiatry™- A Comprehensive Diagnostic Approach: To accurately diagnose and treat attentional issues, we advocate for a Root Cause Analysis Approach. This holistic approach considers the full spectrum of genetic, biological, psychological, and social/environmental factors that could contribute to attentional difficulties, identifies them, and systematically treats them:

1. Genetic Factors:

• BDNF Val/Met: The BDNF gene manufactures a protein called BDNF which “fertilizes the brain” creating new brain cells and synaptic connections. The “Met” allele causes lower production of BDNF due to numerous environmental factors, hormone imbalances and dietary factors.

• COMT Val/Val: The COMT gene manufactures an enzyme that breaks down dopamine and norepinephrine neurotransmitters that are necessary for good executive functioning. The “COMT Val/Val” genetic variant causes excessive production of this enzyme and accelerated breakdown of the neurotransmitters.

• MTHFR - Multiple Variants: The MTHFR genes are responsible for proper methylation of genes, which regulates DNA expression, repairs damaged DNA, reduces the risks of mutated genes, slows cellular aging, and produces serotonin, dopamine, norepinephrine and glutathione neurotransmitters. These methylation mechanisms are all important for proper brain executive functioning. Variants of these genes lead to low manufacturing rates of these vital neurotransmitters.

1. Biological Factors:
   • Thyroid Disorders and Hormonal Imbalances: Conditions like hypothyroidism can mimic ADHD symptoms.
   • Nutritional Deficiencies: Deficiencies in vitamins, such as Vitamin B12, can impact cognitive functions and attention.
   • Sleep Disorders: Issues like sleep apnea significantly affect concentration and focus through reduced brain oxygen levels that impair executive functioning, memory and mood.
   • Substance Use: Alcohol, marijuana, and other drugs can lead to attentional problems.
   • Concussions and Head Injuries: Past head trauma, even a mild concussion, can have long-lasting effects on attention and executive functioning.
   • Seizure Disorders: Conditions like petit mal or partial complex seizures can present with attentional disruptions.
2. Psychological Factors:
   • Anxiety Disorders: From OCD to panic attacks, anxiety can severely disrupt focus and attention.
   • Mood Disorders: Depression and bipolar disorder often have overlapping symptoms with ADHD.
3. Social/Environmental Factors:
   • Stress and Lifestyle: High-pressure work environments and the stress of modern living can lead to ADHD-like symptoms.
   • Technology Overuse: Excessive screen time can contribute to decreased attention spans and difficulties in focus.

The Risks of Overdiagnosis and Overmedication: While stimulants are effective for many with ADHD, there's a growing concern about their over-prescription. This is leading to global shortages of these medications. Misdiagnosing and medicating conditions that mimic ADHD can lead to ineffective treatment and unnecessary side effects. It's imperative to delve deeper, ensuring that the diagnosis of ADHD is accurate and comprehensive.

Collaborative Diagnostic Process: Involving spouses or significant others in the diagnostic process can provide valuable insights and aid in identifying subtle symptoms that might otherwise be overlooked, such as those associated with seizure disorders.

In Conclusion: A Path to Fulfillment: Accurately diagnosing and addressing the root causes of ADHD can transform lives. It's about moving beyond frustration and despair to a place of greater self-understanding, fulfillment, and wellbeing. At Potomac Psychiatry, we're committed to this journey with our patients, helping them uncover and address the underlying factors of their attentional challenges and opening a new chapter of enriched personal awareness and life satisfaction..