Normalizing Attention Deficit Hyperactivity Disorder

ADHD; July 2021

Episode Description

ADHD is diagnosed and treated at a much higher rate than in the past, especially in the United States. Why? In this episode of Mind Your Mind, Dr. Wayne Martinsen, Psychiatrist/Medical Director at Dakota Family Services, explains how the changing world has made it harder for people with shorter attention spans to be successful. In the past, if school was hard for you, you could get a job, work your way up, and live a middle-class lifestyle. Not so in today’s world. Learn more about this fascinating take on ADHD.

What to Expect

  • Learn why low attention span was not a problem 60 years ago.
  • Understand how our culture rewards people with a long attention span.
  • Learn how lifestyle choices impact attention span.


Things to Think About

  • How might ADHD be affecting your, or a loved one’s, success?
  • Do you think selection bias in immigration resulted in a higher population of people with low attention spans?
  • If ADHD is impacting you, have you thought about seeing a professional who can help treat it?

About the Guest

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Dr. Wayne Martinsen, Medical Director and Psychiatrist at Dakota Family Services diagnoses psychiatric and behavioral health conditions, makes treatment recommendations, and provides medication management for clients of all ages. He is also the Clinical Clerkship Director for the University of North Dakota Department of Psychiatry and Behavioral Science. Dr. Martinsen received his doctorate degree from the University of North Dakota.

Dr. Martinsen provides telehealth and in-person services in our Minot and Fargo locations. 

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Transcript
Normalizing Attention Deficit Hyperactivity Disorder

Normalizing Attention Deficit Hyperactivity Disorder
Featuring Dr. Wayne Martinsen, Medical Director/Psychiatrist, Dakota Family Services

Tim Unsinn:

Welcome to Mind Your Mind, a podcast presented by Dakota Family Services, an outpatient behavioral health clinic located in Minot, Bismarck, and Fargo, North Dakota. In this podcast, I will talk with our experts about understanding and nurturing our mental health and wellness. I'm your host, Tim Unsinn. Join me each episode as we explore the intricacies of our minds, decrease the stigma of mental illness, learn practical tips for managing our mental health and well-being, and recognize when it's time to ask for help. Join me now to Mind Your Mind

Tim Unsinn:

On this episode of Mind Your Mind, I'll be talking with Dr. Wayne Martinsen. Dr. Martinsen is the medical director and psychiatrist in Fargo and Minot. Dr. Martinsen diagnoses psychiatric and behavioral health conditions, makes treatment recommendations, and provides medication management for clients of all ages. Our topic is ADHD. And before we get into today's topic, I would love for you, Dr. Martinsen, to tell us why you do what you do.

Dr. Wayne Martinsen:

Well, we've talked about this before a little bit, Tim, but I am absolutely fascinated by mankind, by the human brain, by interacting with people. While I have some difficulty getting out of bed in the morning, sometimes like the rest of humanity, I don't have a problem going to work, and I do engage with people to try to figure out the puzzle of solving problems and then having an impact on people and helping them live the life that they want is just incredibly rewarding.

Tim Unsinn:

Great answer. Thanks again, for being with us on Mind Your Mind. Our topic is ADHD. So why does the U.S. Have such a high rate of ADHD?

Dr. Wayne Martinsen:

Well, if I can back up for a moment here and, and just define ADHD. Attention Deficit Hyperactivity Disorder is defined as problems in one, two or three areas of brain functioning. So it can be problems with attention and concentration. It can be problems with hyperactivity or being hyper verbal, or it can be problems with impulsivity. And you can have problems in one, two, or all three areas of brain functioning. It's a problem that is brain-based and it takes a little thoughtfulness, frankly, to diagnose it because if we're stressed because there's bad things happening in our life, we're not going to be real focused and real attentive. If we are anxious or worried about something happening in our life, we're also not going to be able to focus. If you think about a time when you're worried about a family member's health or, or something that's happening, it's not the time that you could even read your favorite magazine, right?

Dr. Wayne Martinsen:

So, and if you think about depression, one of the, one of the symptoms of depression is difficulty concentrating. So when you diagnose ADHD, you have to make sure that you've eliminated the other things that could be causing. The other thing that happens is that ADHD is a mismatch between our cognitive ability and our ability to focus. So let's say somebody has an average IQ, 100, they should be able to do okay academically, but they can't focus. It's like having a car with a good engine, but a bad transmission. You can't use that intelligence to be successful in school because the brain isn't staying focused well enough. Right? The other thing that we get caught up in, I think in psychiatry and as a society is looking at ADHD as a quote disorder unquote. And I think that's really the wrong way to look at it for the most part.

Dr. Wayne Martinsen:

I think it is on a bell-shaped curve. So things that are on a bell-shaped curve are human height, human weight, right? Hair, color, eye color. There's a lot of variation that's normal. What's happened in advanced countries is that we've created a culture that rewards people with a long attention span. So when I think about my own father who was born in 1922, he drops out of school in the eighth grade? He hasn't finished the eighth grade now in the thirties, that was not such a problem for him. He got jobs, he ran a farm, he ran a successful business. He took care of us and kept us in a middle class lifestyle. We've created a world since then. However, where if you dropped out of school in the eighth grade, it doesn't matter how hard you work. You're not going to get a job other than fast food or manual labor, right?

Dr. Wayne Martinsen:

So you're going to be locked out of a successful life because the world has become so much more complex that we have to at least finish high school, if not college or an advanced degree. And what happens is that that favors people, not only with at least an average cognitive ability, but with a longer attention span. So the people with an average IQ and a long attention span are going to be a lot more successful in the world that we've created. Then people with an average IQ and a short attention span. And so what we find is that if we can improve the attention span chemically, with medications to average, then we improve academic functioning. And if we think about that, Tim, we know that intuitively because most teenagers don't drink coffee, right? They may have a soda or something, but when they get into college and they have to cram for serious exams, we all start drinking coffee because we can mainline caffeine, which is a stimulant. And the biggest problem with caffeine, it's not a bad stimulant for ADHD. The problem is that it's not a really clean drug so that when you get the dose high enough to really focus, if you have a short attention span, you're getting jittery, you're peeing a lot. You're feeling headachy, your gut hurts, right? So, so we've come up with cleaner medications that have less side effects that really do the same thing. And so I think one of the things that happens culturally is we've just created a more and more complex culture where we reward with better jobs, better incomes the people with a long attention span. And so we have to find some way to bring the rest of, of people who are on this natural curve. This is not abnormal. It's not an illness in my mind, but they need to be successful. In the same way that if you have if you're really near-sighted, you probably can't safely drive a car, but I wear my glasses. I've worn them for now 55 years, I've worn glasses. And I never wake up in the morning, Tim, thinking that "Well, I've worn my glasses for more than five decades. Now, my eyes are going to be good." And attention is the same thing. It's a shortness, it's a problem focusing. And if medication or if coffee, or if meditation helps with that, then a that's what I, that's what I work with people to do.

Dr. Wayne Martinsen:

There are some other cultural factors that are unique to America. So when you look at ADHD, attention span is largely heritable. Okay. So if your mom had a short attention span, your dad had a short attention span. There's a really good chance that you're going to have a short attention span. And who is it that leaves their home country? Who is it that will, you know, especially in centuries past, who would cross an ocean where they might die? It was the people who were more impulsive. It was the people who would jump to an idea without thinking of all the risks. And again, you're looking at people who are more willing to take risks, who are likely to have ADHD. It's a more common genetic variant in immigrants. And so we selected out for people, the immigrants coming in were selected out for shorter attention, span, more impulsivity.

Tim Unsinn:

So we're a nation of ADHD.

Dr. Wayne Martinsen:

Yeah. And so, you know, it's like, I think there is some beyond just the bell-shaped curve thing. That's in every society. I think there's some selection bias for people who came to America.

Tim Unsinn:

With all those that came our parents, grandparents, why weren't they treated or get treated for ADHD?

Dr. Wayne Martinsen:

You know, I think it wasn't identified because it didn't matter that much. If school wasn't a fit for you, then you could just work. You could work on the farm, you could work in the blacksmith shop, you could get a job hauling something, or on a ship. You didn't need the years of education in order to be successful and support a family. And so it really wasn't conceived as a problem in a big way, psychiatrically until probably the forties or the fifties, we started to look at this as something that is an issue. And by the way, here are medications that seem to correct this. I think we became more aware of it as a society, as we created a world in which these people were less successful.

Tim Unsinn:

You're listening to Mind Your Mind. Our guest is Dr. Wayne Martinsen, and we are talking about ADHD. And I think you've kind of answered this next question. And that is why is there more ADHD diagnosed in the U.S. than other countries?

Dr. Wayne Martinsen:

And again, I think it goes back to that focus on academic success. There's also some uniqueness to American education. So, a lot of countries that we compare ourselves to, cause you see these surveys and they look at Americans they're way behind in math. They're way behind in science, they're way behind in history. But one of the differences between our education system and theirs is that in the mid teenage years, so about 14, 15 people who are not gifted or are not facile with learning history, math, science, art sort of directed into a more technical-based career. And so they don't, they don't pursue the same track through their senior year of high school like we do in America, in America, we say everybody has to graduate from the 12th grade and then you get to be a mechanic or you get to be a rocket scientist. But some of those brains that we're pushing to, to finish high school, these are not brains, they'd be much better suited for doing something with our hands, but, but that's not the way we've set up our world. So we've created academically kind of this different experience than than many countries.

Tim Unsinn:

Great answer. I just appreciate that perspective. Now we've talked about medications. You've talked about medications as a treatment for ADHD. Are there any other treatments for ADHD other than medications?

Dr. Wayne Martinsen:

Yes. So making sure that people get adequate sleep. That's huge in America because in the last 10 years, Americans sleep one hour less than they did 10 years ago. And we have not evolved as a species in 10 years, that would take hundreds of thousands of years. And so we are shortchanging our brains in terms of getting adequate sleep, which is going to affect attention. The other thing is that we give short shrift to movement, and as the demands of society become more complex intellectually, we have kids sitting longer and longer in the class period. We give them less movement breaks. Now I was lucky Tim, I was, I was one of those kids who was sort of a wallflower. I could sit there all day long. I found school fascinating, right? But there was a lot of kids that I was in school with, and you see it today, it's even more pronounced. We've cut back on movement time on what we used to call recess, right? Or noon hour. Nobody has an hour at noon anymore to play, to goof off, to, to run. And so, and when we do have an exercise period, it tends to be scripted, not necessarily with kind of the idea of life long movement and physical engagement. What, what is engaging? It's a script and this is what we're going to do. We're going to do some calisthenics. We're going to do these things. And frankly, a lot of kids don't like that. The other thing is that meditation. If people can do it meditation, which we talked about a bit earlier, it improves the functioning of the frontal lobe, which is where attention and impulse control live in the brain.

Tim Unsinn:

Very good information. Wow. ADHD. A lot to take in, which is great news because this is a podcast where you can fast forward, rewind, pause, and do it all over again. Dr. Martinsen, thank you so much for your time on Mind Your Mind. As we wrap up, I have one last question for you. And that is what do you do personally, to mind your mind?

Dr. Wayne Martinsen:

So I am in the process of getting board certified by the American College of Lifestyle Medicine. And, and I'm doing that, that not just because it is good medicine, you know, it looks at how do you take normal health and improve it? So allopathic medicine, the way we typically think of it, Tim is, and I'm an, allopath your family physician is an allopath your internal medicine doctors and allopath, right. So we look at what's normal functioning and then what's the disease state and and how do we return to normal function. In lifestyle medicine, you take a look at what's normal functioning, and then how do you improve beyond that? How do you take the human experience and make it better improve health? And so you do that by a whole food plant-based diet, which I believe in and practice. You do that with meditation, which I believe in and practice, you do that by protecting your sleep, which again, I practice. You do that by healthy relationships. You do that with at least 150 minutes of movement for adults, exercise each week, which I practice. So those are all a part of the lifestyle that I think adds to my ability to, as you put it, mind my mind.

Tim Unsinn:

Thank you so much again for your time. We appreciate you, your talents, your time and just your opportunity to make those around you better. Thank you.

Tim Unsinn:

Thank you for joining us for mind, your mind on podcast presented by Dakota Family Services. You can't have health without behavioral health. Remember to Mind Your Mind. For more information, links to additional resources, contact information, and much more go to Dakotafamilyservices.org.

 

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