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Focussed on cure for distracted, forgetful, impulsive

by David Scott

It affects one in every 25 adults – more than one million Canadians – yet only one-tenth of those will ever get a medical evaluation of their condition. The World Health Organization (WHO) looked at people with this untreated illness in Europe and found 22 days of lost job performance per person per year.

Adult Attention Deficit Hyperactivity Disorder (ADHD) is not a new condition but it is finally getting attention, research, medication, acceptance and treatment devoted to it.

“It’s a massively common condition. For something like this to be pretty much unrecognized is a real challenge,” says Dr. Tim Bilkey, BSc’74, MD’78, of Barrie, a leading Canadian expert on the illness.

“I don’t think the condition itself is new but I think our recognition and understanding of it is new. We’re now doing MRI studies, fMRI studies, brain studies, genetic studies, which are better documenting what this really is.”

Since 2009, FAST MINDS, created by Bilkey, has been a nationally accredited educational program for doctors through the Canadian College of Family Physicians. “What I did was I came up with an acronym, FAST MINDS, for adult ADHD, and profiles to help family doctors better recognize the condition.”

FAST MINDS stands for: Forgetful; Achieving below potential; Stuck in a rut; Time challenged; Motivationally Challenged; Impulsive; Novelty seeking; Distractible; and Scattered. For family physicians in Canada, it means the next time they have a patient come in with anxiety and depression, they will be aware that he or she may also have ADHD.

There are other common traits that go along with the condition that doctors who have taken the accredited program can recognize, like addiction and underachieving.

“If patients had an addiction, if they were a struggling student, if they were an adult with a couple of kids with it (ADHD), doctors would be looking for it,” says Bilkey.

In early 2010, he signed a book contract with Harvard University to co-author a book on Adult ADHD with Dr. Craig Surman (Massachusetts General Hospital & Harvard affiliated physician/researcher).

Bilkey has seen 3,400 patients from around the world and continues to see patients from Africa, West Indies, Japan and the U.K., who have sought out his services. The stories from these adult ADHD sufferers are the strength of his new book, says the psychiatrist.

“In a way, we are a voice for all of the people that we’ve seen. We took all those stories, tied the stories to the science and then came up with evidence-based treatments.”

According to Bilkey, in the U.K. and Europe, adult ADHD is still developing as a diagnosis. The U.S. and Canada appear to be leading the way in research, with Germany, the Netherlands and Norway not far behind.

FAST MINDS is as much a workbook as a textbook with checklists, exercises, questions, charts, goals, etc., for patients or caregivers to document progress.

“I think it’s extremely unique. In this book you can tick off things that apply and at the end you’ve got your own synopsis of the challenges and now you can keep them on the radar. Patients can go back to the book and say ‘oh yeah, I’ve got to work on that.’ Or ‘that’s not working for me.’ ” Bilkey admits the label “attention deficit hyperactivity disorder” is not a good descriptor of what this condition really looks like in adults.

“The label itself doesn’t even speak to the issue of impulsivity. Some adults with ADHD are extremely impulsive: financial impulsivity, verbal impulsivity, cutting people off in conversations, sexual impulsivity. An untreated male with ADHD is five times more likely to get somebody accidentally pregnant. An untreated female with ADHD is seven times more likely to get pregnant. That’s impulsivity. Driving your car impulsively leads to increased rates in car crashes.”

The acronym FAST MINDS makes it easy for someone walking through a bookstore to know quickly the symptoms when they see the book. Bilkey said it was originally conceived as a self-help book when he pitched the idea to Harvard. Often it is a spouse, in particular women, who will purchase selfhelp books.

Another reason the author developed an acronym that included symptoms was to hopefully have it included in the unofficial “bible of psychiatry” – the Diagnostic Statistical Manual (DSM), published by the American Psychiatric Association.

“It’s this codebook you have to apply in diagnosing all kinds of conditions: Anxiety, Post-Traumatic Stress Disorder, Depression. The current version – DSM4 – doesn’t even really validate Adult ADHD. It has fleeting references. It’ll say ‘kids may do this, adults will do that.’ The newest DSM is coming out in May 2013. It totally validates the diagnosis of Adult ADHD. It’s the real deal. It’s kind of exciting.”

This article appeared in the Spring 2013 edition of Alumni Gazette
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