Expert: Norm Bishop - 8/27/2004

Question
I am recalling a conversation that I had with a woman about 8 months ago. She said something to the effect of how people often confused ADD with Bipolar.  My doctor says that I have rapid cycling bipolar and that has been the thing that he has used to explain why I can't sleep at night. For the insomnia, he has given me an antipsychotic medication (Seroquel) which works like a dream. One thing that we have never gotten around to medicating (and likely won't since I am now in China) is my inability to make my fingers do very delicate motor tasks, such as playing piano.

A typical practice session for me may not be as fruitful as it is for others because while I am pressing the keys other thoughts are running through my head. And sometimes I can accomplish the tasks that I want to, but not reliably. So, for example, if I play through four measures and play it perfectly, I may come back to that same piece an hour later and not be able to play the four measures perfectly. Another issue is typing. Lots of backing up and correcting mistakes, though I've been typing since high school (ten years gone now) and should be able to do this with no mistakes.

Are such motor skill impairments part of ADD (in an adult)?

Moreover, what is your knolwedge about patients motor skill improvement when on amphetamines? This is said knowing that for any psychiatric disorder, there are a finite number of drugs that can be used (Antipsychotics, antiseizures, antidepressants, anxiolytics, and lithium).

Or could it be that I just have poor motor skills and that's the end of that? (If a person is put on amphetamines, he is more likely to be able NOT to sleep. I don't see that being a useful remedy to any problems that I have.)

Answer
ADD individuals have brain waves that spike much larger than "normal" individuals.  When medicated, amphetamines increase the average wave, but keep them on a more even scale...so while your system is still speeding up, it now more even..which allows you to concentrate better.  Fine motor skills may not be helped, but your ability to concentrate on those fine motor skills could be helped.  

One of the side effects (actually a direct effect) of amphetamines is that sleep is more difficult.  Most people take the medicine in the morning, usually a time released version, like Adderal, so that it is out of your system by bedtime.  It also effects your appetite, making you less hungry, causing weight loss, etc.  There is one new medication that has the same effect on leveling of brain waves, but is not an amphetamine, it is called Strattera and would be the place to start.  

When other medications work, it is my belief that the problem is not correctly diagnosed as ADD.  Often other brain based illnesses are misdiagnosed as ADD.  

Most adults with ADD don't medicate, if they can be successful at life functions without, they just learn to cope with it.  Those who have difficulty with life function success benefit from a medication regimin.  

I would think that your fine motor coordination is effected, certainly your ability to recall patterns would be effected if you have ADD.  But, with a possible sleep disorder, I would tend to stay away from amphetamines.  

Remember that I am an educator, not a Physician.  Before you would consider meds, see a qualified professional who has experience with Adult ADD.

Hope this helped.