Expert: Dr Billy Levin - 8/13/2007

Question
QUESTION: My 43 y.o. husband has been struggling with memory and focus/attention issues for the last 2 years, negatively impacting our relationship (2 years ago I became very weary of being the walking calendar/memory for my 3 kids and husband, as well as tired of doing everything, so I implemented some minor changes, and my husband's difficulties became apparent). The neuropsychologist confirmed the memory concerns but emphatically reported that there was no ADD concern (he had no suggestions and wanted us to return in a year to see if the condition had worsened).  The family practice doc put him on Strattera with limited results. Auditory processing, hearing, vision are all within normal limits (tested by audiologist and SLP at U of MN).  The neurologist (Mayo Clinic) found no neurological concerns and reported attention issues. The ADHD specialist (psychologist)found, via testing and surveys, that my husband definitely has significant inattention issues without hyperactivity(i.e., looks just like ADD on paper); however, as he has no childhood history (e.g., graduated in top 3% of a large high school class, most responsible and organized of the 4 kids in his family, no car incidents, no behavior issues) he does NOT have ADD. Anxiety and depression have been ruled out (counselor, neuropsychologist (MMPI), ADHD psychologist).  The ADD specialist surveyed his sleepiness level via questionnaire (scored just at the bottom of the clinical range (10)) and suggested a sleep study.  Have you seen this scenario before?  Any thoughts or guidance for direction?

ANSWER: "Have you seen this scenario before?" Yes of course, many times in over 22,000 assessments over a 30 year period.  Your description is one of possible high IQ masking the ADD but your description is very suggestive of ADD. If there is a memory problem the most obvious cause is not paying sufficient attention in the first place. As you have not given me what dose of Strattera he took, for how long he took it and if rating scales were usaed to determine the optimal dose, it is impossible to comment on it's effect. My most important comment must be that you have seen so many different people  with so many different opinions and are still floundering in the dark! Surely that must mean, with no disrespect , you have not yet seen a real expert to once and for always finalise if there is a problem, what is the problem and treat effectively if medical treatment is required. I assume they have all examined your husband. Yet I am asked to advise without even having the chance to examine the patient. My advice is seek out a medical doctor who specialises in adult ADD. A therapeutic trial on stimulant medication monitored with conner's rating scales will give you answers within 10 to 20 days.

---------- FOLLOW-UP ----------

QUESTION: Thank you for your response.  I am so frustrated with the whole thing that I could scream!!!!

Additional info:  IQ of 136
         on Strattera since May, 2007, increased
         to 3 capsules/day (40 mg each)as of
         mid-July, 2007 with no appreciable
         changes
2 additional questions:
        1) Can there be a dx of ADD if there is no child-
         hood hx, as determined in this case?
        2) You mention use of a stimulant med; it is my
         understanding that Strattera is a non-
         stimulant med???? Were you implying that it
         might be beneficial to try a different med?

Last comment:  the health care services we have received have been horrible; the neuropsychologist came highly recommended, but he treated us like it was all a big joke, the neurologist at Mayo was the same, the family practice doc is dabbling with the meds.   The ADHD psychologist clearly identified the issues we were having, and seemed to understand; however, he ruled it out solely based on the lack of history.

I sincerely appreciate your input.  

Answer
Your description is very typical of ADHD. If the situation warrents it, it is possible to go onto a trial of medication with a stimulant as there has only a slight response with Strattrea. A diagnosis is`made on the curreent situation and not what happened many yours ago. A high IQ learning problem is often overlooked as a child. due to ignorance.That does not mean it did not exist. theast.p