Brain Disorder of the Stars

The internet has created a celebrity-filled, instant-news, image-driven world, one that has spilled over into medicine. For every ailment there appears to be a prominent figure willing to say he or she has it, or dealt with it. Attention deficit hyperactivity disorder (ADHD) is no exception. Is that helpful?

At Johns Hopkins School of Medicine in Baltimore, assistant professor David W. Goodman, MD, (photo) teaches in the Department of Psychiatry and Behavioral Sciences. He also has a private practice focused on adult ADHD and a board member and national spokesman for Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), a non-profit advocacy and educational organization.

He spoke with MDMagazine about the celebrity factor in spreading awareness of this condition.

Your practice website has scores of photos and quotes from celebrities, business leaders, politicians, and athletes who say they have ADHD. What’s the benefit?

When celebrities come out as having ADHD, it is helpful, it cultivates public awareness and helps people feel favorably about having it. They can admit they have it or think they have it—sometimes it will be something like “my family thinks I have it.” Hopefully that generates both awareness and treatment.

Celebrities have had a similar positive effect for a lot of disorders.

Who are some of these ADHD celebrities?

At CHADD I’ve worked with [home improvement star] Ty Pennington—he’s a very nice guy and we’ve worked together for three years-- and [comedian] Howie Mandel; there are so many. [The site lists political operative James Carville, entrepreneur Richard Branson, Olympian Michael Phelps, actor Will Smith, Justin Timberlake, Solange Knowles and others who’ve said they have ADHD.]

What’s the process, how does CHADD get these prominent people on board?

Celebrities often will make a statement in public, usually an off-the-cuff remark, but because what you say on the internet is irrevocable, the organization will see it and reach out and see if the celebrity wants to do more. That can start a series of conversations and usually involve the celebrity’s agent and PR firm.

But how specifically does this help the cause?

When a celebrity says it, that generates media attention and public awareness. ADHD diagnosis has been problematic. An estimated 75% of adults who have it haven’t been diagnosed.

What’s the estimated prevalence of ADHD in adults?

About 4.5% of US adults, or 11 million people; for those over age 50 it’s about 3%.

One of my interests is ADHD later in life. It starts in childhood but 60% of the time they continue to have symptoms as adults.

Does it run in families?

ADHD is highly heritable, 75% of the time the cause is genetic.

IS ADHD a behavioral disorder or a structural brain condition?

It’s a neuropsychiatric disorder. Brains are clearly different in people with ADHD.

Have you seen the studies that show that MRI brain images turn up structural differences in the brains of people with ADHD?

I’m very familiar with studies like that, a lot has been done in ADHD with neuroimaging over the last 20 years.

The brains of people with ADHD are physically different?

Yes, at the molecular level regarding dopamine and at the morphological level, with different size of [brain structures] in different areas. There are also brain maturational differences.

There can be a developmental delay of two to three years in the brain centers for emotional control and social maturity. The neural networks are different in adults from people with normal brains.

The recent Netherlands imaging study showing people with ADHD have slightly smaller brains really isn’t news to you then?

No. What is new news is the technologies now being used, such as diffuse tensor imaging, looking at water molecules so you can see neural networks working in vivo. You can see the networks spread out and see which ones are disrupted, that’s the next frontier.There’s also a fifth difference in ADHD. The [normal] brain’s default network has an active area and one in a resting stage and these areas are in synch. In ADHD there’ asynchronicity.

Is there a way to measure the severity of ADHD?

Right now there is no way to measure the clinical severity of symptoms. The measures are still too gross, as exciting as some of the advances are we’re really not at the technical level to do that. Still, ADHD comes in a variety of flavors; inattention is not the same as hyperactivity and impulsivity.

It’s still a relatively new condition, as far as being recognized by medicine, isn’t it?

The history is that ritalin was approved in 1955, but then ADHD took a backseat in the 1960s and 1970s and came more to light in the 1980s. There was an important study in Canada that showed ADHD didn’t just go away when a pediatrician discharged you. I also say it doesn’t go away when you join AARP or start getting Medicare, people just don’t realize they have it.

You’re seeing that in your practice?

I’ve seen it happen when children or grandchildren get diagnosed, they tell their parents or grandparents “Go see this guy—you know, you never picked me up at school on time, you never put my lunch together” and when they do get diagnosed they see a remarkable improvement.

It’s never too late to treat ADHD?

Some people think that, they say “Why bother treating it?” but when the brain fog goes away and you resurrect your self image and erase the negative—that you’re not lazy or incapable-- people find it a remarkable change. They’ve told me “I know I only have so many years, and this is so much better.” I remember one patient who got her ADHD diagnosis she said, “I’m happy I thought you’d say I’m blonde and stupid.”

There’s another belief about ADHD that having it goes along with being creative. Any truth to that?

A lot of creative people have it. It certainly helps think outside the box, but a lot more creative people don’t have it. People usually get ahead in creative fields because of attributes and intelligence. ADHD has negative consequences, it’s not a gift. One of the celebrities I’ve worked with at CHADD, Howie Mandel once said to me, “If ADHD is a gift, please let me know where I can return it.”

Looking ahead, where do you see treatment going?

What will be exciting is that there will be two new drugs, at least, approved for each of the next three years. Treating ADHD is still a huge market. Childhood ADHD growth has plateaued but the adult market is growing. We’ll see drugs that are longer acting and more novel drugs.

What are the challenges in getting people to treatment?

There are still people who question whether it is real or not; there is doubt in the minds of several people. I don’t understand it, to me the evidence is right there.