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First I will go through my answer, but then I will review the Mental Health Act and it’s statutes on “Sectioning”, explain “capacity to make decisions”, and give a few resources. BTW if I say “you” I don’t mean it specifically, it means “someone”.Note some sources may say The Mental Health Act 1983, but it was revised in 2007 with some fundamental changes. If you are unsure, the link above is a good one that explains the differences and changes.So, now my answer:No, in general, NHS MH staff are not pretty dangerous.To be sectioned, you need to do a lot more than just look at porn, or be morally liberal. Sectioning is covered under the Mental Health Act and the decision to section is not a simple one that can be made on a whim.I suspect the person who is so unhappy with this has a mental health need, and are showing behaviours they are happy with but that the mental health team or a close family member are not, and a lack of trust and disagreement is becoming an obstacle. This doesn’t mean it’s their fault they feel as they do- it could be a feature of their illness, or the result of a lack of social support, or lack of understanding about the impact of the behaviour.You don’t say what the “morally liberal” attitude is, but bear in mind in literature used by Mental Health professionals (and police, courts, probation officers…) there are clusters of symptoms/ behaviours that tend to occur in certain kinds of mental health problems that raise grave concerns.Using porn, certain kinds of porn, some sexual behaviours, illicit drug use, alcohol use and certain attitudes about relationships/people are included in some of these clusters- they are not in themselves bad, but with certain personality disorders or mental health problems they can be flags that something is going wrong or they can cause certain problems to become worse.Because they are flags, they might be included in a Community Treatment Order (CTO)- (explained in the area on sectioning below). A CTO might say:You must attend Therapy weeklyYou must take medication as prescribed and report any missed dosesYou must not drink alcohol or take medications/ drugs other than those specifically prescribedYou must reside at (address) and notify (who) in advance of any changes to residenceIf a person breaks the conditions of their CTO, they can be sectioned as it shows the care cannot be given safely in the community.Mental Health professionals must sometimes make decisions and offer advice that is unpopular. To be honest, the less reasonable the person is when these difficult times arise, the more it is felt that they lack understanding of the problems which can lead to sectioning.If you are talking about yourself, can I suggest a strategy or two?Try to be as reasonable and cooperative as possible. You don’t have to agree, just be calm, neutral and not reactive.If this is about a breach of a CTO, they are trying to keep you out of hospital by telling you off… do you want to go back to hospital? If not, do what your CTO requires as you are legally bound to that CTO.If you disagree with a NON CTO related request, ask “why do you think this is a problem?” and “what risk does this pose if I do other than you recommend?” This is a reasonable way of learning why the person is telling you what they think you should do.If sectioning is mentioned, ask “If you are threatening to section me, can you please explain how I pose a risk to myself, to others, and what treatment or assessment I need that can only be provided in hospital?”Its always ok to say “I find it hard when you keep talking about sectioning. Can we just discuss is without threats? I will listen, just help me understand”Learn about your mental health condition and what it means. Learn the flags, and learn how to work with people who only care about keeping you and others around you safe. You can look up your disorder in the DSM-V (the book with all the criteria for the diagnosis of mental disorders) but its not meant for “civilians” although it can help you ask the right questions like “what is a paraphilia?” or “what does hypomania mean?” if you are trying to understand your disorder and the reasons certain conditions or expectations are in place.Want to be treated (legally as well as interpersonally) as an adult who can make their own decisions? Act like one, and I mean that in the psychological sense, not as a judgement. When it comes to health, we may feel like a powerless child dominated by powerful parental figures who try to tell us what to do, but we must be adult to be taken seriously: children lack capacity to make decisions until they show the maturity of adults, and acting a a child has the same consequences.According to Berne, an “Adult” considers facts, reasons, thinks about the “big picture” and makes decisions using a rational, reasoned approach informed by experience and incorporating evidence from various sources including the input of others.A “child” reacts based on feelings just as in childhood, with limited awareness of the big picture and with limited accountability for their actions, limited regard for evidence or input from others, and rather than communicating rationally may pout, scream, avoid, stomp their feet and assume an oppositional/obstreperous stance to avoid things they dislike or do no want.I understand its more threatening to be told something you believe or think is wrong rather than to be told your liver for example is acting up. We often feel personally threatened and judged when we are told our minds are damaged, but in reality, the mind is a function of the brain, which is an organ like the liver, the skin and the kidney…. a very special and complex organ, but a physical one nonetheless. We also as adults like to do what we enjoy and having someone act like a parent eg“Stop doing that or I will punish you!” tends to bring out the child response in us eg “Oh Yeah? Well I hate you!”… to be treated like an adult brings out a reasonable adult response, but sometimes and especially under stress or when impaired by a mental disorder, a person can perceive that the carer (informal or professional) is being parental even when that’s not their intention.Mental Health is as much a physical health problem as any other… whereas you fix a sprained knee with physiotherapy because that aligns with how it’s used, you fix mental health needs with talk, because that’s how we access the mind… although in both cases sometimes medication or other treatment is needed to make that care work faster, better, or to support a person to cope with a need that is so great that the body cannot be restored but instead must be managed.Don’t judge because people don’t agree with you…. do I seem pretty dangerous to you? Your question sounded a bit aggressive and biased, but I have still answered you respectfully and fully, reasonably and with empathy. Right?But, if you had a CTO that says no booze and no porn because those are flags or triggers for you to engage in behaviour that puts you or others at risk, and you had them when I saw you, I’d tell you that you were headed for sectioning too not because I am dangerous, but because you are even if you can’t or won’t see it. Sectioning someone is not a power trip, its not simple, its a lot of boring and complicated paperwork, and it makes us feel like failures, but it’s also not being vindictive- its trying to save you (and other people) from yourself.If you want to message me with any specifics I will try to help you understand. Please trust me based not just on my professional but personal experiences: being oppositional, angry and confrontational with your healthcare team never has the result you hope it will. You will be labelled, and your opinion will lose value, you will be seen as being unreasonable and lacking capacity.Further reading if desired((followed by links to more info))SectioningIt is called “sectioning” because it uses a section of the Mental Health Act.Under the Mental Health Act of 1983, there are different “Sections” (eg, t##sections of the act) that speak of involuntary detention.In general, sectioning can be possible if a person has, or is thought to have,A mental illness which needs assessment or treatmentwhich is sufficiently seriousthat it is necessary for the health and safety of the person or for the protection of other people,and hospitalisation is necessary for the assessment or treatmentAND the person is unwilling or unable to agree to admission.Section 2 is for assessment if a person has not yet been assessed as an inpatient in hospital, or it has been a long time since that assessment, AND for any necessary treatment as a result of that assessment but does not exceed a total of 28 days.Section 3 is a bit different.It is for those who are well known to their healthcare professionalsIt can last up to 60 days, but is renewable and can result in a much longer detention than any other sectionTo be sectioned under 2 or 3, the following take placean application must be made by an approved mental health professional, or by a close relativethat person applying must have seen the person they believe needs sectioning within 14 days of the applicationTwo separate doctors, one with specialist training in the Mental Health Act, must see the person within 5 days of each other, and report on their opinion on the person’s needsAdmission must be completed within 14 days of the last of the assessments from those two doctorSection 4 is for emergency assessment and treatment of a person whose needs cannot wait for a section 2 or 3 to be undertaken. It is a “72 hour hold” whose real purpose is not treatment (as the person can refuse) but to remove the person from the possibility of harm (to themselves or others) whilst assessment to consider if a longer detention, further assessment or further treatment is needed (and to meet the criteria for another Section if needed).To be sectioned under 4, the following take placean application must be made by an approved mental health professional, or by a close relativeThe person must be seen by a doctor who knows them or who is qualified to section under the Mental Health Act, and both the person(s) making the application and the Doctor assessing must see the person within the past 24 hoursThe person must be admitted within 24 hoursSection 5 is when an appropriately trained (eg, mental health) nurse or a doctor prevents a person from leaving a facility. If done by a nurse, it lasts 6 hours or less, and stops when a Doctor arrives to assess. The Doctor can prevent the person from leaving the hospital for 72 hours and unlike section 4, treatment might be provided without the person’s consent. This occurs when the doctor thinks the person is either trying to leave without understanding the consequences and/or that they lack the capacity to make the decision to leave and/or that their or others health and safety are at risk if they leave. Further sectioning is required if the detention is extended.Anyone sectioned under any part of the mental health act has rights under the act: the person should be informed of the decision, how and why it was made, given written information about the act and the detention. Rights are greater under sections 2 and 3, including appealing and seeking help from an Independent Mental Health Advocate.Summary: No one professional can cause you to be sectioned unless you are already in hospital being treated, there is a very proscribed process, and you have clear rights under the mental health act.There is another form of section called a Community Treatment Order (CTO)If a person is hospitalised under the Mental Health Act, treatment can be provided in community instead if it is available there, (the act basically says it is inpatient only if its the only safe place to provide it) but the person must adhere to certain conditions or they risk being returned to hospital.—-Capacity (to consent)Sectioning only occurs when people lack capacity to make a decision for themselves or when they refuse to consent to care when it is believed failure to provide that care risks their or another person’s health and safety.Capacity in regards to consent to care and treatment is a legal term meaning you understand and can assess the risks. It means you can weigh the pros and cons, can consider information given you by healthcare professionals and explain why you make your decisions. People with capacity can disagree and should have their disagreement respected by healthcare professionals. If you have capacity, you consider your health and safety as well as that of others. Capacity can be impaired by alcohol, drugs, and both physical and mental illness, by the person’s emotional and mental maturity, or by coercion (eg, a battered person being convinced by their batterer to refuse care so they avoid detection).Capacity also related to the level of risk and complexity of the decision. A person for example is very drunk might not want to wash themselves and that decision needs to be considered differently than if they needed emergency brain surgery. Health care professionals must assess the risk and ask “If this was the average person, a reasonable and ordinary person, what would they do?” (this is/was called “The Man on the Clapham Bus The man on the Clapham omnibus - Wikipedia”This means always considering the impact (and its duration) of any known impairments. If a person is drunk or high, and a decision can wait until they are sober, it should.When a person lacks capacity for small decisions, eg washing or changing clothes, and their needs are clear (eg, a drunk person covered with body fluids who is at risk from their soiled clothing) “acting in best interest” means acting for them without their complete consent (“Come on Joe, Yeah just do this, stop pulling away Joe I need to get you washed up, Joe, I know you don’t want to but you can’t leave this dirty shirt on, come on, let me get you a clean shirt….”), but when those decisions have greater risk and impact, greater intervention is needed and can include sectioning or court ordered care.ALL decisions about capacity, consent, best interest decisions etc must be comprehensively documented.This sources might help further.Rethink Mental Illness - Mental Health Act/ SectioningRethink Mental Illness - Mental Health Act FAQAbout sectioning - http://Mind.orgThe Mental Health Act - NHS EnglandIndependent Mental Health Advocacy (IMHA)About Independent Mental Health Advocacy - .:: SEAP INC ::.Rethink Mental Illness - CTOInformation for people subject to community treatment orders (CTOs) - cqcCommunity Treatment Order - http://mentalhealthlaw.co.ukThe Brain’s of Porn Addicts -[sic]Signs and Symptoms of Sexual Addictionhttp://digitalcommons.liberty.edu/cgi/viewcontent.cgi?article=1393&context=honorsTransactional analysis - WikipediaEgo States and Types of Transactions in Transactional Analysis Theory - Video & Lesson Transcript | Study.comSmall print: this answer is UK based, and I am explaining the law as I believe it is manifest in practice but am not attempting to give legal advice. Any health advice is within my scope of practice, but is intended to generally inform, not to direct individual patient care.

I have explored talent for a while (years) and learned much about it.I've also looked into intelligence a little bit. I'll share what I've learned below.~~~~~~~~~~~~~~~~~~~~~~~~Talent~~~~~~~~~~~~~~~~~~~~~~~~I'll start by sharing some theory and ideas about what talent is, then I'll share some answers to questions about talent.Let's start by defining talent..Defining talent—a definition of talent from the Gallup OrganizationOne of the more helpful definitions of talent that I've found is one coined by Gallup, a research company that is really about how people can experience more wellbeing and thrive in work and life.Gallup's definition of talent is this:your talents are your naturally recurring patterns of thought, feeling, and behaviour.I'm going to be using that definition throughout this answer..How did Gallup come to their definition of talent?I have some more reading to do before I can fully answer that question.My current answer is that they studied many, many successful managers, learned how they defined talent (the primary role of a manger is to help employees engage their talent in ways that benefit the organisation they work for), and then linked that definition to brain science.(Source: the books, First, Break All the Rules: What the World's Greatest Managers Do Differently and Now, Discover Your Strengths)I may update this answer once I have more to add..What does a talent look like?Gallup would say that a talent has to do with how you filter the world, and the type of things you naturally feel drawn to doing, and find yourself doing without really trying to.Talents are things you can't help but do.E.g. When you walk into a room, what do you do?Several things may determine that (i.e. what's in the room; how you're feeling—i.e. what your mood is—when you walk into the room; and so on), but a big influencer is your talents, which has to do with the way your brain is wired.So, an ability to look at a scene or situation and see how all the parts relate to each other: I'd say that's a talent.A natural draw to compete and always end up being slightly ahead of people: I'd say that's a talent.An ability to vividly see the unique traits and qualities of people when they do or say things—qualities that other people may not see as easily, or at all: I'd say that's a talent..The person who is always neat and organisedProbably the best example I know that shows what talent looks like can be found in people who can't help but keep things around them organised and neat.Things on their desk have to be in just the right place, and spelling errors in things they write have to be corrected as they make them, not later on in an editing pass because they simply can't stand to sit and look at words with squiggly red lines under them because they're just not right.What causes someone to do that? Primarily, talent.Your emotional state—whether you fuss and worry about things all the time—can cause you to do that, and habits can play their part, too, but if someone does such things consistently, regardless of their mood, and have done so naturally for most of their life, that's likely talent at work.As for what talents might cause people to be neat and organised, that depends. Maybe they really like things being as optimal they could be, or maybe they delight in seeing things in order. It depends on the specific talents—the personality traits—they have..Some examples of talentsGallup did some research, and they came up with 34 "themes of talent."Below are 7 of the 34 total talent themes they identified, along with descriptions:ConsistencyWooRelatorDeveloperEmpathyCompetitionHarmony(Source: page 12 and 136 of the book, Now, Discover Your Strengths.)Wikipedia has a list of all 34 of the talent themes Gallup discovered.The themes of talents they discovered form the basis of the Clifton StrengthsFinder (talent-assessment) that they developed to help people identify their talents..Is talent innate or inborn? What is the biological basis of talent?"What is the biological basis of X?" is a good question to ask about a lot of things, because it stops people from theorising (as much) and gets them to try to find the source of a phenomena in the human body.From what I've learned, I would say that talent is partly innate, and partly influenced by your early life experiences with people and the world around you.Apparently the biological basis of talent is the synaptic connections in your brain that you develop from the time you are born until around the middle of your teenage years.This leads to the next question....Can talent be learned?If the biological source of talent is your synaptic connections, based on what we currently know about the brain, the answer is no.According to Marcus Buckingham (page 53–59, Go Put Your Strengths to Work):45 to 50 percent of your personality is nature. That is to say 45 to 50 percent of your personality is due to the genes that you inherited from your mother and your father.Buckingham goes on to say that "an overwhelming body of research suggests that" the two things that influence the other 50 to 55 percent of your personality are:pretty much anything, which could range from "repeated ear infections" to "variations in genes as you grow"your peers. Not peer pressure, but your interactions with your peers and what that tells you about how you can be effective as you navigate life.According to Buckingham, once you reach the middle of your teenage years, much of your brain development related to your personality is locked in, so to speak.I don't know how or why said brain development is locked in.Buckingham draws on research to suggest that it happens to give you a unique competitive advantage. I don't feel life is about competition, and I think that theory only holds up if you hold certain beliefs about the nature of reality. There are indeed other beliefs about the nature of reality, and as such, I feel there are other reasons why we develop this way. But I digress.So if your personality is "locked in" at an early age, does that mean you can't grow and improve?Nope, you absolutely can.You will likely know this from your own experience. Another thing that indicates this is a concept known as neuroplasticity..Why can't we learn or develop new talents?Based on current research, the basic answer is that:for biological reasons, your brain likes to "piggyback" on existing synaptic connections rather than form completely new ones.what you can learn depends on your genes.To summarise pages 235 to 243 of the book, The One Thing You Need to Know by Marcus Buckingham, apparently:The process of learning involves forming new synaptic connections between neurons in your brain.What you are able to learn is partly influenced by your genes. E.g. You may "always excel at remembering people's names because you have the genes for it, but you always struggle with analyzing data because you don't [have the genes for it]." (Page 241, The One Thing You Need to Know.)The way your brain is wired is unique, and part of that uniqueness is due to your unique genes. (99.9% of your genes are apparently the same as mine, but that 0.1% difference is enough to result in your unique personality--your unique patterns of thoughts, feelings, and behaviour.)It takes significant biological resources to build new synaptic connections. To quote page 55 of Go Put Your Strengths to Work, "genes have to be switched on, proteins created, blood vessels built."Your brain is designed to protect these connections by insulating them with a substance called myelin. This makes sure you don't need to re-lean things you've already learned (like hand eye coordination), but it also somewhat inhibits synaptic growth.It requires fewer biological resources to "piggyback" on synaptic connections that are already in place, so you will grow the most where you already have the most existing connections. To share a quote from Joseph LeDoux, a professor of neuroscience who is quoted in the book: "Added connections are therefore more like new buds on a branch rather than new branches." Marcus refers to these areas as your "thick synaptic branches."That doesn't mean you can't learn new things... it just means that it's biologically more effective for your brain to "piggyback" on existing "brain infrastructure," rather than building entirely new infrastructure.To quote page 55 of Go Put Your Strengths to Work:"Since [your body] doesn't want to build infrastructure unnecessarily, [it] looks for ways to exploit preexisting infrastructure. In other words, [your brain] finds it easier to to create new synaptic connections in those areas of your brain where you already have abundant synaptic connections. You grow the most where you are already strong."This has many implications for learning, or more specifically, how one should approach learning. Though that's an answer for another question.To get an idea of the branch-like nature of synapses and what a myelin sheath (the thing that protects synaptic connections—sort of like bark on tree branches) looks like, see the below diagram:Image has been released into the public domain. Source: Wikipedia (http://en.wikipedia.org/wiki/File:Complete_neuron_cell_diagram_en.svg)- (http://en.wikipedia.org/wiki/File:Complete_neuron_cell_diagram_en.svg) complete neuron cell diagram (http://en.wikipedia.org/wiki/File:Complete_neuron_cell_diagram_en.svg)Google images also has more images: synaptic connections - Google Search.Can talent be lost?Not that I know of, or at least, not easily.Unless you have some sort of traumatic brain injury or experience something that inhibits your ability to draw on those "branches" of synaptic connections in your brain, your talents—your naturally recurring patterns of thought, feeling, and behaviour; your personality—should remain more or less the same.Various things may impact the expression of your talents, such as:your moodthe health of your physical bodythe knowledge and skills you havelegal and illegal drugsand so on.Things you learn and skills you develop may also be "forgotten." I don't fully understand why this happens, but I believe it has something to do with what your brain does with synaptic connections that aren't used often.I also don't know why some synaptic connections stick around for pretty much your entire life (such as those that relate to your personality), while other unused ones "fall away," but I suspect it has something to do with myelin and the amount said synaptic connections are used..What are the differences between talents, skills, and knowledge?Skills and knowledge can be learned.As described above, talents—the thick synaptic "branches" in your brain—are:partly innate (due to factors such as your genes)partly formed in the early years of your life, then locked into place, so to speak, by myelinTalent—those thick synaptic "branches" in your brain—can be augmented with knowledge and skills, but from what I understand, you won't be able to significantly alter those existing synaptic connections.I'm not sure what the specific biological basis of skills and knowledge are. I'm pretty sure it has something to do with your synaptic connections, but I want to learn more before I start talking about this in detail.That covers talent. Let's switch over to intelligence.~~~~~~~~~~~~~~~~~~~~~~~~Intelligence~~~~~~~~~~~~~~~~~~~~~~~~This is something I haven't really explored much, but I'll share what I have learned and observed..How I define intelligenceGenerally I use the word to refer to cognitive abilities—i.e. stuff you can do because of your brain and the unique way it is wired.And when I say cognitive ability, I don't just mean your ability to do well on IQ tests or to solve math problems.So I guess my definition of intelligence is "ones ability to do something"So if you say someone is intelligent, it's because they have great ability to do something..Howard Gardner's theory of multiple intelligencesRecently I learned of someone else who believes there is more than one type of intelligence—more than one type of "ability to do something."Cognitive development theorist, Howard Gardner, came up with the idea that there are different types of "intelligence," which is known of his Theory of Multiple Intelligences..How Gardner defines intelligenceTo quote Wikipedia, according to Gardner, intelligence is:1) The ability to create an effective product or offer a service that is valued in a culture,2) a set of skills that make it possible for a person to solve problems in life, and3) the potential for finding or creating solutions for problems, which involves gathering new knowledge.(Source: Wikipedia - theory of multiple intelligences, referencing Gardner, Howard 2000, Intelligence Reframed: Multiple Intelligences for the 21st Century. Basic Books Inc.).An overview of his theoryTo summarise what Howard said in a video interview [1], his theory comes out of the field of psychology. [Specifically, I believe it's from the field of developmental psychology.]It was developed to document the fact that human beings have very different kinds of intellectual strengths, and that these strengths are very important in how children learn, how people represent things in their minds, and how people use them in order to show what it is that they've understood.To paraphrase Gardner:If we all had the one kind of mind, the same type of intelligence, then we could teach everyone the same thing, in the same way, and that'd be fair. But once you realise that people have very different kinds of minds, different kinds of strengths--some people are good at thinking spacially; some people are good at thinking in language; some people are very logical; other people need to be hands on, they need to explore actively, they need to try things out. Once we realise that, then an education that treats people the same way is actually an unfair education [system]. Because it picks out one type of mind, which [he] calls the law professor mind--somebody who's very linguistic and logical. And if you think like that, great. But if you don't think like that, there's no room in the train for you.[this is almost a direct quote, but I need to go over it to make sure I got it accurately].The different types of intelligence Gardner identifiedI'm not going to go into too much depth about this, but here are the types of intelligence:Linguistic intelligenceLogical-mathematical intelligenceMusical intelligenceBodily-kinesthetic intelligenceSpatial intelligenceInterpersonal intelligence [relating to other people]Intrapersonal intelligence [self-awareness, and use of it]Source: Howard Gardner, multiple intelligences and educationFor more information, you can Google around, or check out Gardner's book, Intelligence Reframed: Multiple Intelligences for the 21st Century.There's also mention of three other types of intelligence that could be added to that list.To quote an infed.org article:Since Howard Gardner’s original listing of the intelligences in Frames of Mind (1983) there has been a great deal of discussion as to other possible candidates for inclusion (or candidates for exclusion). Subsequent research and reflection by Howard Gardner and his colleagues has looked to three particular possibilities: a naturalist intelligence, a spiritual intelligence and an existential intelligence. He has concluded that the first of these ‘merits addition to the list of the original seven intelligences’ (Gardner 1999: 52).Wikipedia has an overview of each of the types of intelligences, including a description of Naturalistic and Existential intelligence..An important clarificationNote that the idea isn't that you only have one or two of these intelligences. Rather, the idea is that you have varying amounts of each to some degree.To quote Wikipedia:"Although the distinction between intelligences has been set out in great detail, Gardner opposes the idea of labeling learners to a specific intelligence. Each individual possesses a unique blend of all the intelligences. Gardner firmly maintains that his theory of multiple intelligences should "empower learners", not restrict them to one modality of learning."Source: McKenzie, W. (2005). Multiple intelligences and instructional technology. ISTE (International Society for Technology Education)I prefer to call them "intelligence strengths" since that, to me, paints a different picture. In other words, we're all intelligent, but in different ways.E.g. I may have really good interpersonal and intrapersonal strengths, whereas you might have really good musical and logical-mathematical strengths..How this links in with talent and brain scienceTo quote an article that quotes what Gardner wrote in his introduction to the tenth anniversary edition of his book, Frames of Mind: The theory of multiple intelligences (1993):In the heyday of the psychometric and behaviorist eras, it was generally believed that intelligence was a single entity that was inherited; and that human beings – initially a blank slate – could be trained to learn anything, provided that it was presented in an appropriate way. Nowadays an increasing number of researchers believe precisely the opposite; that there exists a multitude of intelligences, quite independent of each other; that each intelligence has its own strengths and constraints; that the mind is far from unencumbered at birth; and that it is unexpectedly difficult to teach things that go against early ‘naive’ theories of that challenge the natural lines of force within an intelligence and its matching domains.[emphasis mine]~~~~~~~~~~~~~~~~~~~~~~~~How does talent and intelligence relate?~~~~~~~~~~~~~~~~~~~~~~~~I haven't explored Gardner's material enough to say.It depends on what the biological basis of his multiple intelligences is.My theory would be that, using Gardner's definition of intelligence and Gallup's definition of talent, both have a lot of overlap (biologically speaking)—Gallup just measured that biological basis in a different way.But for practical purposes, it doesn't really matter.You can still get lots of benefit from what is understood about talent and strengths (the Gallup Organization, Marcus Buckingham (author), and Jenifer Fox are pioneers in that field), and Howard Gardner's theory of multiple intelligences helps give you a good premise to draw on when relating to people and creating things (like school syllabuses, or lesson plans—for students of any age).The basic premise, and take away from this answer, is this:we are all unique, and have different strengths, talents, and ways of thinking and learningwe have great capacity for growth, and that growth will be most sustainable, when we draw on our existing strengths, skills, and knowledge to inform our further learning and exploration~~~~~~~~~~~~~~~~~~~~~~~~Postscript~~~~~~~~~~~~~~~~~~~~~~~~A note about my answerI'm not a brain scientist, or an expert on the subject.Maybe there are some things I'm missing, or don't fully understand. Indeed, there are still things for me to learn, and this will be true for other people who study the brain (there's much to learn about the brain and our physical bodies).I'm just sharing what I've learned, from what I consider to be fairly credible sources.So keep that in mind when reading my answer.As you can probably tell, this is a subject that interests me because it relates to one of my favorite subjects of all time: human potential, and how we can use it.If you see something that could be corrected, please suggest an edit or let me know in the comments below.~~~~~~~~~~~~~~~~~~~~~~~~References~~~~~~~~~~~~~~~~~~~~~~~~Most references are in the body of my answer.The rest are here:[1] Howard Gardner video interview:~~~~~~~~~~~~~~~~~~~~~~~~Further reading~~~~~~~~~~~~~~~~~~~~~~~~For a more in-depth explanation of talent, see this article by Gallup:Exactly What Is Talent, Anyway?Below are links to answers I've written to similar Quora questions:What is the way that you used to find your talents and develop your strength?Can hard work beat a born talent?Is drawing a natural talent?How can you become a talented person?What is the way that you used to find your talents and develop your strength?How am I going to survive and grow with so many intelligent people around me?To better understand talent, and to discover your own talents, see:Now, Discover Your Strengths by Marcus Buckingham and Don CliftonStrengthsFinder 2.0 by Tom RathThe One Thing You Need to Know by Marcus Buckingham (more about understanding talent than discovering your own talents)I also have a Quora blog dedicated to the subject of strengths:Strengths and talents: engaging the best of youI use it to collate the best resources I know of about strengths.

ADDERALL XR® is a stimulant medicine. The following have been reported with use of stimulant medicines.1. Heart-related problems:• sudden death in patients who have heart problems orheart defects• stroke and heart attack in adults• increased blood pressure and heart rateTell your doctor if you or your child have any heart problems, heart defects, high blood pressure, or a family history of these problems.Your doctor should check you or your child carefully for heart problems before starting ADDERALL XR.Kindly email safetrip01 at protonmail dot com to purchase Adderall 30mg and others.Your doctor should check you or your child’s blood pressure and heart rate regularly during treatment with ADDERALL XR.Call your doctor right away if you or your child has any signs of heart problems such as chest pain, shortness of breath, or fainting while taking ADDERALL XR.2. Mental (Psychiatric) problems: All Patients• new or worse behavior and thought problems• new or worse bipolar illness• new or worse aggressive behavior or hostilityChildren and Teenagers• new psychotic symptoms (such as hearing voices,believing things that are not true, are suspicious) or new manic symptomsTell your doctor about any mental problems you or your child have, or about a family history of suicide, bipolar illness, or depression.Call your doctor right away if you or your child have any new or worsening mental symptoms or problems while taking ADDERALL XR®, especially seeing or hearing things that are not real, believing things that are not real, or are suspicious.What Is ADDERALL XR?ADDERALL XR is a once daily central nervous system stimulant prescription medicine. It is used for the treatment of Attention Deficit Hyperactivity Disorder(ADHD). ADDERALL XR® may help increase attention and decrease impulsiveness and hyperactivity in patients with ADHD.ADDERALL XR® should be used as a part of a total treatment program for ADHD that may include counseling or other therapies.ADDERALL XR® is a federally controlled substance (CII) because it can be abused or lead to dependence. Keep ADDERALL XR® in a safe place to prevent misuse and abuse. Selling or giving away ADDERALL XR® may harm others, and is against the law.Tell your doctor if you or your child have (or have a family history of) ever abused or been dependent on alcohol, prescription medicines or street drugs.Who should not take ADDERALL XR®?ADDERALL XR® should not be taken if you or your child:• have heart disease or hardening of the arteries• have moderate to severe high blood pressure• have hyperthyroidism• have an eye problem called glaucoma• are very anxious, tense, or agitated• have a history of drug abuse• are taking or have taken within the past 14 days an anti-depression medicine called a monoamine oxidaseinhibitor or MAOI• is sensitive to, allergic to, or had a reaction to otherstimulant medicinesADDERALL XR® has not been studied in children less than 6 years old.ADDERALL XR® is not recommended for use in children less than 3 years old.ADDERALL XR® may not be right for you or your child. Before starting ADDERALL XR® tell your or your child’s doctor about all health conditions (or a family history of) including:• heart problems, heart defects, high blood pressure• mental problems including psychosis, mania, bipolarillness, or depression• tics or Tourette’s syndrome• liver or kidney problems• thyroid problems• seizures or have had an abnormal brain wave test (EEG)Tell your doctor if you or your child is pregnant, planning to become pregnant, or breastfeeding.Can ADDERALL XR® be taken with other medicines?Tell your doctor about all of the medicines that you or your child takes including prescription and non- prescription medicines, vitamins, and herbal supplements. ADDERALL XR® and some medicines may interact with each other and cause serious side effects. Sometimes the doses of other medicines will need to be adjusted while taking ADDERALL XR®.Your doctor will decide whether ADDERALL XR® can be taken with other medicines.Especially tell your doctor if you or your child takes:• anti-depression medicines including MAOIs• anti-psychotic medicines• lithium• narcotic pain medicines• seizure medicines• blood thinner medicines• blood pressure medicines• stomach acid medicines• cold or allergy medicines that contain decongestantsKnow the medicines that you or your child takes. Keep a list of your medicines with you to show your doctor and pharmacist.Do not start any new medicine while taking ADDERALL XR® without talking to your doctor first.How should ADDERALL XR® be taken?• Take ADDERALL XR® exactly as prescribed. Your doctor may adjust the dose until it is right for you or your child.• Take ADDERALL XR® once a day in the morning when you first wake up. ADDERALL XR® is an extended release capsule. It releases medicine into your body throughout the day.• Swallow ADDERALL XR® capsules whole with water or other liquids. If you or your child cannot swallow the capsule, open it and sprinkle the medicine over a spoonful of applesauce. Swallow all of the applesauce and medicine mixture without chewing immediately. Follow with a drink of water or other liquid. Never chew or crush the capsule or the medicine inside the capsule.• ADDERALL XR® can be taken with or without food.• From time to time, your doctor may stop ADDERALLXR® treatment for a while to check ADHD symptoms.• Your doctor may do regular checks of the blood, heart, and blood pressure while taking ADDERALL XR®. Children should have their height and weight checked often while taking ADDERALL XR®. ADDERALL XR® treatment may be stopped if a problem is found during these check-ups.• If you or your child takes too much ADDERALL XR® or overdoses, call your doctor or poison control center right away, or get emergency treatment.What are possible side effects of ADDERALL XR®?See “What is the most important information I should know about ADDERALL XR®?” for information on reported heart and mental problems.Other serious side effects include:• slowing of growth (height and weight) in children• seizures, mainly in patients with a history of seizures• eyesight changes or blurred visionCommon side effects include:• headache • decreased appetite• stomach ache• trouble sleeping• weight loss• dry mouth• fast heart beat• nervousness • mood swings • dizzinessADDERALL XR® may affect you or your child’s ability to drive or do other dangerous activities.Talk to your doctor if you or your child has side effects that are bothersome or do not go away.This is not a complete list of possible side effects. Ask your doctor or pharmacist for more informationHow should I store ADDERALL XR®?• Store ADDERALL XR® in a safe place at room temperature, 59 to 86° F (15 to 30° C).• Keep ADDERALL XR® and all medicines out of the reach of children.General information about ADDERALL XR®Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not use ADDERALL XR® for a condition for which it was not prescribed. Do not give ADDERALL XR® to other people, even if they have the same condition. It may harm them and it is against the law.This Medication Guide summarizes the most important information about ADDERALL XR®. If you would like more information, talk with your doctor. You can ask your doctor or pharmacist for information about ADDERALL XR® that was written for healthcare professionals. For more information, you may also contact Shire Pharmaceuticals (the maker of ADDERALL XR®) at 1-800-828-2088 or visit the website at http://www.adderallxr.com.What are the ingredients in ADDERALL XR®?Active Ingredients: dextroamphetamine saccharate, amphetamine aspartate monohydrate, dextroamphetamine sulfate, USP, amphetamine sulfate USPInactive Ingredients: gelatin capsules, hydroxypropyl methylcellulose, methacrylic acid copolymer, opadry beige, sugar spheres, talc, and triethyl citrate. Gelatin capsules contain edible inks, kosher gelatin, and titanium dioxide. The 5 mg, 10 mg, and 15 mg capsules also contain FD&C Blue #2. The 20 mg, 25 mg, and 30 mg capsules also contain red iron oxide and yellow iron oxideManufactured for Shire US Inc., Wayne, PA 19087.ADDERALL XR® is registered in the US Patent and Trademark Office©2007 Shire US Inc. Rev. 3/07381 0107 001AXXXXXXThis Medication Guide has been approved by the U.S. Food and Drug Administration.ADDERALL XR® CAPSULES CII Rx OnlyAMPHETAMINES HAVE A HIGH POTENTIAL FOR ABUSE. ADMINISTRATION OF AMPHETAMINES FOR PROLONGED PERIODS OF TIME MAY LEAD TO DRUG DEPENDENCE. PARTICULAR ATTENTION SHOULD BE PAID TO THE POSSIBILITY OF SUBJECTS OBTAINING AMPHETAMINES FOR NON-THERAPEUTIC USE OR DISTRIBUTION TO OTHERS AND THE DRUGS SHOULD BE PRESCRIBED ORDISPENSED SPARINGLY.MISUSE OF AMPHETAMINE MAY CAUSE SUDDEN DEATH AND SERIOUS CARDIOVASCULAR ADVERSE EVENTS.DESCRIPTIONADDERALL XR® is a once daily extended-release, single-entity amphetamine product. ADDERALL XR® combines the neutral sulfate salts of dextroamphetamine and amphetamine, with the dextro isomer of amphetamine saccharate and d,l-amphetamine aspartate monohydrate. The ADDERALL XR® capsule contains two types of drug-containing beads designed to give a double-pulsed delivery of amphetamines, which prolongs the release of amphetamine from ADDERALL XR® compared to the conventional ADDERALL® (immediate- release) tablet formulation.EACH CAPSULE CONTAINS: Dextroamphetamine Saccharate Amphetamine Aspartate Monohydrate Dextroamphetamine Sulfate USP Amphetamine Sulfate USPTotal amphetamine base equivalence5 mg 1.25 mg1.25 mg 1.25 mg 1.25 mg3.1 mg10 mg 2.5 mg2.5 mg 2.5 mg 2.5 mg 6.3 mg15 mg 3.75 mg3.75 mg 3.75 mg 3.75 mg 9.4 mg20 mg 5.0 mg5.0 mg 5.0 mg 5.0 mg 12.5 mg25 mg 6.25 mg6.25 mg 6.25 mg 6.25 mg 15.6 mg30 mg 7.5 mg7.5 mg 7.5 mg 7.5 mg 18.8 mgInactive Ingredients and Colors: The inactive ingredients in ADDERALL XR® capsules include: gelatin capsules, hydroxypropyl methylcellulose, methacrylic acid copolymer, opadry beige, sugar spheres, talc, and triethyl citrate. Gelatin capsules contain edible inks, kosher gelatin, and titanium dioxide. The 5 mg, 10 mg, and 15 mg capsules also contain FD&C Blue #2. The 20 mg, 25 mg, and 30 mg capsules also contain red iron oxide and yellow iron oxide.CLINICAL PHARMACOLOGYPharmacodynamicsAmphetamines are non-catecholamine sympathomimetic amines with CNS stimulant activity. The mode of therapeutic action in Attention Deficit Hyperactivity Disorder (ADHD) is not known. Amphetamines are thought to block the reuptake of norepinephrine and dopamine into the presynaptic neuron and increase the release of these monoamines into the extraneuronal space.PharmacokineticsPharmacokinetic studies of ADDERALL XR® have been conducted in healthy adult and pediatric (6-12 yrs) subjects, and adolescent (13-17 yrs) and pediatric patients with ADHD. Both ADDERALL® (immediate- release) tablets and ADDERALL XR® capsules contain d-amphetamine and l-amphetamine salts in the ratio of 3:1. Following administration of ADDERALL® (immediate-release), the peak plasma concentrations occurred in about 3 hours for both d-amphetamine and l-amphetamine.The time to reach maximum plasma concentration (Tmax) for ADDERALL XR® is about 7 hours, which is about 4 hours longer compared to ADDERALL® (immediate-release). This is consistent with the extended-release nature of the product.130 25 20 15 10500 4 8 12 16 20 24 TIME (HOURS)Figure 1 Mean d-amphetamine and l-amphetamine plasma concentrations following administration of ADDERALL XR® 20 mg (8am) and ADDERALL® (immediate-release) 10 mg bid (8am and 12 noon) in the fed state.A single dose of ADDERALL XR® 20 mg capsules provided comparable plasma concentration profiles of both d-amphetamine and l-amphetamine to ADDERALL® (immediate-release) 10 mg bid administered 4 hours apart.The mean elimination half-life for d-amphetamine is 10 hours in adults; 11 hours in adolescents aged 13-17 years and weighing less than or equal to 75 kg/165 lbs; and 9 hours in children aged 6 to 12 years. For the l- amphetamine, the mean elimination half-life in adults is 13 hours; 13 to 14 hours in adolescents; and 11 hours in children aged 6 to 12 years. On a mg/kg body weight basis children have a higher clearance than adolescents or adults (See Special Populations).ADDERALL XR® demonstrates linear pharmacokinetics over the dose range of 20 to 60 mg in adults and adolescents weighing greater than 75 kg/165lbs, over the dose range of 10 to 40 mg in adolescents weighing less than or equal to 75 kg/165 lbs, and 5 to 30 mg in children aged 6 to 12 years. There is no unexpected accumulation at steady state in children.Food does not affect the extent of absorption of d-amphetamine and l-amphetamine, but prolongs Tmax by 2.5 hours (from 5.2 hrs at fasted state to 7.7 hrs after a high-fat meal) for d-amphetamine and 2.1 hours (from 5.6 hrs at fasted state to 7.7 hrs after a high fat meal) for l-amphetamine after administration of ADDERALL XR® 30 mg. Opening the capsule and sprinkling the contents on applesauce results in comparable absorption to the intact capsule taken in the fasted state. Equal doses of ADDERALL XR® strengths are bioequivalent.Metabolism and ExcretionAmphetamine is reported to be oxidized at the 4 position of the benzene ring to form 4-hydroxyamphetamine, or on the side chain α or β carbons to form alpha-hydroxy-amphetamine or norephedrine, respectively.DEXTROAMPHETAMINEADDERALL XR® 20 mg qdADDERALL® 10 mg bid LEVOAMPHETAMINEADDERALL XR® 20 mg qdADDERALL® 10 mg bid2MEAN PLASMA CONCENTRATIONS OF DEXTRO AND LEVOAMPHETAMINE (ng/mL)Norephedrine and 4-hydroxy-amphetamine are both active and each is subsequently oxidized to form 4-hydroxy- norephedrine. Alpha-hydroxy-amphetamine undergoes deamination to form phenylacetone, which ultimately forms benzoic acid and its glucuronide and the glycine conjugate hippuric acid. Although the enzymes involved in amphetamine metabolism have not been clearly defined, CYP2D6 is known to be involved with formation of 4-hydroxy-amphetamine. Since CYP2D6 is genetically polymorphic, population variations in amphetamine metabolism are a possibility.Amphetamine is known to inhibit monoamine oxidase, whereas the ability of amphetamine and its metabolites to inhibit various P450 isozymes and other enzymes has not been adequately elucidated. In vitro experiments with human microsomes indicate minor inhibition of CYP2D6 by amphetamine and minor inhibition of CYP1A2, 2D6, and 3A4 by one or more metabolites. However, due to the probability of auto-inhibition and the lack of information on the concentration of these metabolites relative to in vivo concentrations, no predications regarding the potential for amphetamine or its metabolites to inhibit the metabolism of other drugs by CYP isozymes in vivo can be made.With normal urine pHs approximately half of an administered dose of amphetamine is recoverable in urine as derivatives of alpha-hydroxy-amphetamine and approximately another 30%-40% of the dose is recoverable in urine as amphetamine itself. Since amphetamine has a pKa of 9.9, urinary recovery of amphetamine is highly dependent on pH and urine flow rates. Alkaline urine pHs result in less ionization and reduced renal elimination, and acidic pHs and high flow rates result in increased renal elimination with clearances greater than glomerular filtration rates, indicating the involvement of active secretion. Urinary recovery of amphetamine has been reported to range from 1% to 75%, depending on urinary pH, with the remaining fraction of the dose hepatically metabolized. Consequently, both hepatic and renal dysfunction have the potential to inhibit the elimination of amphetamine and result in prolonged exposures. In addition, drugs that effect urinary pH are known to alter the elimination of amphetamine, and any decrease in amphetamine’s metabolism that might occur due to drug interactions or genetic polymorphisms is more likely to be clinically significant when renal elimination is decreased, (See PRECAUTIONS).Special PopulationsComparison of the pharmacokinetics of d- and l-amphetamine after oral administration of ADDERALL XR® in pediatric (6-12 years) and adolescent (13-17 years) ADHD patients and healthy adult volunteers indicates that body weight is the primary determinant of apparent differences in the pharmacokinetics of d- and l-amphetamine across the age range. Systemic exposure measured by area under the curve to infinity (AUC∞) and maximum plasma concentration (Cmax) decreased with increases in body weight, while oral volume of distribution (Vz/F), oral clearance (CL/F), and elimination half-life (t 1/2) increased with increases in body weight.Pediatric PatientsOn a mg/kg weight basis, children eliminated amphetamine faster than adults. The elimination half-life (t1/2) is approximately 1 hour shorter for d-amphetamine and 2 hours shorter for l-amphetamine in children than in adults. However, children had higher systemic exposure to amphetamine (Cmax and AUC) than adults for a given dose of ADDERALL XR®, which was attributed to the higher dose administered to children on a mg/kg body weight basis compared to adults. Upon dose normalization on a mg/kg basis, children showed 30% less systemic exposure compared to adults.GenderSystemic exposure to amphetamine was 20-30% higher in women (N=20) than in men (N=20) due to the higher dose administered to women on a mg/kg body weight basis. When the exposure parameters (Cmax and AUC) were normalized by dose (mg/kg), these differences diminished. Age and gender had no direct effect on the pharmacokinetics of d- and l-amphetamine.RaceFormal pharmacokinetic studies for race have not been conducted. However, amphetamine pharmacokinetics appeared to be comparable among Caucasians (N=33), Blacks (N=8) and Hispanics (N=10).3Clinical TrialsChildrenA double-blind, randomized, placebo-controlled, parallel-group study was conducted in children aged 6-12 (N=584) who met DSM-IV® criteria for ADHD (either the combined type or the hyperactive-impulsive type). Patients were randomized to fixed dose treatment groups receiving final doses of 10, 20, or 30 mg of ADDERALL XR® or placebo once daily in the morning for three weeks. Significant improvements in patient behavior, based upon teacher ratings of attention and hyperactivity, were observed for all ADDERALL XR® doses compared to patients who received placebo, for all three weeks, including the first week of treatment, when all ADDERALL XR® subjects were receiving a dose of 10 mg/day. Patients who received ADDERALL XR® showed behavioral improvements in both morning and afternoon assessments compared to patients on placebo.In a classroom analogue study, patients (N=51) receiving fixed doses of 10 mg, 20 mg or 30 mg ADDERALL XR® demonstrated statistically significant improvements in teacher-rated behavior and performance measures, compared to patients treated with placebo.AdolescentsA double-blind, randomized, multi-center, parallel-group, placebo-controlled study was conducted in adolescents aged 13-17 (N=327) who met DSM-IV® criteria for ADHD. The primary cohort of patients (n=287, weighing ≤ 75kg/165lbs) was randomized to fixed dose treatment groups and received four weeks of treatment. Patients were randomized to receive final doses of 10 mg, 20 mg, 30 mg, and 40 mg ADDERALL XR® or placebo once daily in the morning; patients randomized to doses greater than 10 mg were titrated to their final doses by 10 mg each week. The secondary cohort consisted of 40 subjects weighing >75kg/165lbs who were randomized to fixed dose treatment groups receiving final doses of 50 mg and 60 mg ADDERALL XR® or placebo once daily in the morning for 4 weeks. The primary efficacy variable was the ADHD-RS-IV total scores for the primary cohort. Improvements in the primary cohort were statistically significantly greater in all four primary cohort active treatment groups (ADDERALL XR® 10 mg, 20 mg, 30 mg, and 40 mg) compared with the placebo group.There was not adequate evidence that doses greater than 20 mg/day conferred additional benefit.AdultsA double-blind, randomized, placebo-controlled, parallel-group study was conducted in adults (N=255) who met DSM-IV® criteria for ADHD. Patients were randomized to fixed dose treatment groups receiving final doses of 20, 40, or 60 mg of ADDERALL XR® or placebo once daily in the morning for four weeks. Significant improvements, measured with the Attention Deficit Hyperactivity Disorder-Rating Scale (ADHD-RS), an 18- item scale that measures the core symptoms of ADHD, were observed at endpoint for all ADDERALL XR® doses compared to patients who received placebo for all four weeks. There was not adequate evidence that doses greater than 20 mg/day conferred additional benefit.INDICATIONSADDERALL XR® is indicated for the treatment of Attention Deficit Hyperactivity Disorder (ADHD).The efficacy of ADDERALL XR® in the treatment of ADHD was established on the basis of two controlled trials in children aged 6 to 12, one controlled trial in adolescents aged 13 to 17, and one controlled trial in adults who met DSM-IV® criteria for ADHD (see CLINICAL PHARMACOLOGY), along with extrapolation from the known efficacy of ADDERALL®, the immediate-release formulation of this substance.A diagnosis of Attention Deficit Hyperactivity Disorder (ADHD; DSM-IV®) implies the presence of hyperactive- impulsive or inattentive symptoms that caused impairment and were present before age 7 years. The symptoms must cause clinically significant impairment, e.g., in social, academic, or occupational functioning, and be present in two or more settings, e.g., school (or work) and at home. The symptoms must not be better accounted for by another mental disorder. For the Inattentive Type, at least six of the following symptoms must have persisted for at least 6 months: lack of attention to details/careless mistakes; lack of sustained attention; poor listener; failure to follow through on tasks; poor organization; avoids tasks requiring sustained mental effort; loses things; easily distracted; forgetful. For the Hyperactive-Impulsive Type, at least six of the following symptoms must have persisted for at least 6 months: fidgeting/squirming; leaving seat; inappropriate4running/climbing; difficulty with quiet activities; "on the go;" excessive talking; blurting answers; can't wait turn; intrusive. The Combined Type requires both inattentive and hyperactive-impulsive criteria to be met.Special Diagnostic Considerations: Specific etiology of this syndrome is unknown, and there is no single diagnostic test. Adequate diagnosis requires the use not only of medical but of special psychological, educational, and social resources. Learning may or may not be impaired. The diagnosis must be based upon a complete history and evaluation of the child and not solely on the presence of the required number of DSM-IV® characteristics.Need for Comprehensive Treatment Program: ADDERALL XR® is indicated as an integral part of a total treatment program for ADHD that may include other measures (psychological, educational, social) for patients with this syndrome. Drug treatment may not be indicated for all children with this syndrome. Stimulants are not intended for use in the child who exhibits symptoms secondary to environmental factors and/or other primary psychiatric disorders, including psychosis. Appropriate educational placement is essential and psychosocial intervention is often helpful. When remedial measures alone are insufficient, the decision to prescribe stimulant medication will depend upon the physician's assessment of the chronicity and severity of the child's symptoms.Long-Term Use: The effectiveness of ADDERALL XR® for long-term use, i.e., for more than 3 weeks in children and 4 weeks in adolescents and adults, has not been systematically evaluated in controlled trials. Therefore, the physician who elects to use ADDERALL XR® for extended periods should periodically re- evaluate the long-term usefulness of the drug for the individual patient.CONTRAINDICATIONSAdvanced arteriosclerosis, symptomatic cardiovascular disease, moderate to severe hypertension, hyperthyroidism, known hypersensitivity or idiosyncrasy to the sympathomimetic amines, glaucoma.Agitated states.Patients with a history of drug abuse.During or within 14 days following the administration of monoamine oxidase inhibitors (hypertensive crises may result).WARNINGSSerious Cardiovascular EventsSudden Death and Pre-existing Structural Cardiac Abnormalities or Other Serious Heart ProblemsChildren and AdolescentsSudden death has been reported in association with CNS stimulant treatment at usual doses in children and adolescents with structural cardiac abnormalities or other serious heart problems. Although some serious heart problems alone carry an increased risk of sudden death, stimulant products generally should not be used in children or adolescents with known serious structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, or other serious cardiac problems that may place them at increased vulnerability to the sympathomimetic effects of a stimulant drug (see CONTRAINDICATIONS).AdultsSudden deaths, stroke, and myocardial infarction have been reported in adults taking stimulant drugs at usual doses for ADHD. Although the role of stimulants in these adult cases is also unknown, adults have a greater likelihood than children of having serious structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, coronary artery disease, or other serious cardiac problems. Adults with such abnormalities should also generally not be treated with stimulant drugs (see CONTRAINDICATIONS).5Hypertension and other Cardiovascular ConditionsStimulant medications cause a modest increase in average blood pressure (about 2-4 mmHg) and average heart rate (about 3-6 bpm) [see ADVERSE EVENTS], and individuals may have larger increases. While the mean changes alone would not be expected to have short-term consequences, all patients should be monitored for larger changes in heart rate and blood pressure. Caution is indicated in treating patients whose underlying medical conditions might be compromised by increases in blood pressure or heart rate, e.g., those with pre- existing hypertension, heart failure, recent myocardial infarction, or ventricular arrhythmia (see CONTRAINDICATIONS).Assessing Cardiovascular Status in Patients being Treated with Stimulant MedicationsChildren, adolescents, or adults who are being considered for treatment with stimulant medications should have a careful history (including assessment for a family history of sudden death or ventricular arrhythmia) and physical exam to assess for the presence of cardiac disease, and should receive further cardiac evaluation if findings suggest such disease (e.g. electrocardiogram and echocardiogram). Patients who develop symptoms such as exertional chest pain, unexplained syncope, or other symptoms suggestive of cardiac disease during stimulant treatment should undergo a prompt cardiac evaluation.Psychiatric Adverse EventsPre-Existing PsychosisAdministration of stimulants may exacerbate symptoms of behavior disturbance and thought disorder in patients with pre-existing psychotic disorder.Bipolar IllnessParticular care should be taken in using stimulants to treat ADHD patients with comorbid bipolar disorder because of concern for possible induction of mixed/manic episode in such patients. Prior to initiating treatment with a stimulant, patients with comorbid depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder; such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression.Emergence of New Psychotic or Manic SymptomsTreatment emergent psychotic or manic symptoms, e.g., hallucinations, delusional thinking, or mania in children and adolescents without prior history of psychotic illness or mania can be caused by stimulants at usual doses. If such symptoms occur, consideration should be given to a possible causal role of the stimulant, and discontinuation of treatment may be appropriate. In a pooled analysis of multiple short-term, placebo-controlled studies, such symptoms occurred in about 0.1% (4 patients with events out of 3482 exposed to methylphenidate or amphetamine for several weeks at usual doses) of stimulant-treated patients compared to 0 in placebo-treated patients.AggressionAggressive behavior or hostility is often observed in children and adolescents with ADHD, and has been reported in clinical trials and the postmarketing experience of some medications indicated for the treatment of ADHD. Although there is no systematic evidence that stimulants cause aggressive behavior or hostility, patients beginning treatment for ADHD should be monitored for the appearance of or worsening of aggressive behavior or hostility.Long-Term Suppression of GrowthCareful follow-up of weight and height in children ages 7 to 10 years who were randomized to either 6methylphenidate or non-medication treatment groups over 14 months, as well as in naturalistic subgroups of newly methylphenidate-treated and non-medication treated children over 36 months (to the ages of 10 to 13 years), suggests that consistently medicated children (i.e., treatment for 7 days per week throughout the year) have a temporary slowing in growth rate (on average, a total of about 2 cm less growth in height and 2.7 kg less growth in weight over 3 years), without evidence of growth rebound during this period of development. In a controlled trial of ADDERALL XR® in adolescents, mean weight change from baseline within the initial 4 weeks of therapy was –1.1 lbs. and –2.8 lbs., respectively, for patients receiving 10 mg and 20 mg ADDERALL XR®. Higher doses were associated with greater weight loss within the initial 4 weeks of treatment. Published data are inadequate to determine whether chronic use of amphetamines may cause a similar suppression of growth, however, it is anticipated that they will likely have this effect as well. Therefore, growth should be monitored during treatment with stimulants, and patients who are not growing or gaining weight as expected may need to have their treatment interrupted.SeizuresThere is some clinical evidence that stimulants may lower the convulsive threshold in patients with prior history of seizure, in patients with prior EEG abnormalities in absence of seizures, and very rarely, in patients without a history of seizures and no prior EEG evidence of seizures. In the presence of seizures, the drug should be discontinued.Visual DisturbanceDifficulties with accommodation and blurring of vision have been reported with stimulant treatment.PRECAUTIONSGeneral: The least amount of amphetamine feasible should be prescribed or dispensed at one time in order to minimize the possibility of overdosage. ADDERALL XR® should be used with caution in patients who use other sympathomimetic drugs.Tics: Amphetamines have been reported to exacerbate motor and phonic tics and Tourette’s syndrome. Therefore, clinical evaluation for tics and Tourette’s Syndrome in children and their families should precede use of stimulant medications.Information for Patients: Amphetamines may impair the ability of the patient to engage in potentially hazardous activities such as operating machinery or vehicles; the patient should therefore be cautioned accordingly.Prescribers or other health professionals should inform patients, their families, and their caregivers about the benefits and risks associated with treatment with amphetamine and should counsel them in its appropriate use. A patient Medication Guide is available for ADDERALL XR®. The prescriber or health professional should instruct patients, their families, and their caregivers to read the Medication Guide and should assist them in understanding its contents. Patients should be given the opportunity to discuss the contents of the Medication Guide and to obtain answers to any questions they may have. The complete text of the Medication Guide is reprinted at the end of this document.Drug Interactions: Acidifying agents -Gastrointestinal acidifying agents (guanethidine, reserpine, glutamic acid HCl, ascorbic acid, etc.) lower absorption of amphetamines.Urinary acidifying agents -These agents (ammonium chloride, sodium acid phosphate, etc.) increase the concentration of the ionized species of the amphetamine molecule, thereby increasing urinary excretion. Both groups of agents lower blood levels and efficacy of amphetamines.Adrenergic blockers -Adrenergic blockers are inhibited by amphetamines.Alkalinizing agents -Gastrointestinal alkalinizing agents (sodium bicarbonate, etc.) increase absorption of amphetamines. Co-administration of ADDERALL XR® and gastrointestinal alkalinizing agents, such as antacids, should be avoided. Urinary alkalinizing agents (acetazolamide, some thiazides) increase the concentration of the7non-ionized species of the amphetamine molecule, thereby decreasing urinary excretion. Both groups of agents increase blood levels and therefore potentiate the actions of amphetamines.Antidepressants, tricyclic -Amphetamines may enhance the activity of tricyclic antidepressants or sympathomimetic agents; d-amphetamine with desipramine or protriptyline and possibly other tricyclics cause striking and sustained increases in the concentration of d-amphetamine in the brain;cardiovascular effects can be potentiated.MAO inhibitors -MAOI antidepressants, as well as a metabolite of furazolidone, slow amphetamine metabolism. This slowing potentiates amphetamines, increasing their effect on the release of norepinephrine and other monoamines from adrenergic nerve endings; this can cause headaches and other signs of hypertensive crisis. A variety of toxic neurological effects and malignant hyperpyrexia can occur, sometimes with fatal results. Antihistamines -Amphetamines may counteract the sedative effect of antihistamines.Antihypertensives -Amphetamines may antagonize the hypotensive effects of antihypertensives. Chlorpromazine -Chlorpromazine blocks dopamine and norepinephrine receptors, thus inhibiting the central stimulant effects of amphetamines, and can be used to treat amphetamine poisoning.Ethosuximide -Amphetamines may delay intestinal absorption of ethosuximide.Haloperidol -Haloperidol blocks dopamine receptors, thus inhibiting the central stimulant effects of amphetamines.Lithium carbonate -The anorectic and stimulatory effects of amphetamines may be inhibited by lithium carbonate.Meperidine -Amphetamines potentiate the analgesic effect of meperidine.Methenamine therapy -Urinary excretion of amphetamines is increased, and efficacy is reduced, by acidifying agents used in methenamine therapy.Norepinephrine -Amphetamines enhance the adrenergic effect of norepinephrine.Phenobarbital -Amphetamines may delay intestinal absorption of phenobarbital; co-administration of phenobarbital may produce a synergistic anticonvulsant action.Phenytoin -Amphetamines may delay intestinal absorption of phenytoin; co-administration of phenytoin may produce a synergistic anticonvulsant action.Propoxyphene -In cases of propoxyphene overdosage, amphetamine CNS stimulation is potentiated and fatal convulsions can occur.Veratrum alkaloids -Amphetamines inhibit the hypotensive effect of veratrum alkaloids.Drug/Laboratory Test Interactions: Amphetamines can cause a significant elevation in plasma corticosteroid levels. This increase is greatest in the evening. Amphetamines may interfere with urinary steroid determinations.Carcinogenesis/Mutagenesis and Impairment of Fertility: No evidence of carcinogenicity was found in studies in which d,l-amphetamine (enantiomer ratio of 1:1) was administered to mice and rats in the diet for 2 years at doses of up to 30 mg/kg/day in male mice, 19 mg/kg/day in female mice, and 5 mg/kg/day in male and female rats. These doses are approximately 2.4, 1.5, and 0.8 times, respectively, the maximum recommended human dose of 30 mg/day [child] on a mg/m 2 body surface area basis.Amphetamine, in the enantiomer ratio present in ADDERALL® (immediate-release)(d- to l- ratio of 3:1), was not clastogenic in the mouse bone marrow micronucleus test in vivo and was negative when tested in the E. coli component of the Ames test in vitro. d,l-Amphetamine (1:1 enantiomer ratio) has been reported to produce a positive response in the mouse bone marrow micronucleus test, an equivocal response in the Ames test, and negative responses in the in vitro sister chromatid exchange and chromosomal aberration assays.Amphetamine, in the enantiomer ratio present in ADDERALL® (immediate-release)(d- to l- ratio of 3:1), did not adversely affect fertility or early embryonic development in the rat at doses of up to 20 mg/kg/day (approximately 5 times the maximum recommended human dose of 30 mg/day on a mg/m2 body surface area basis).Pregnancy: Pregnancy Category C. Amphetamine, in the enantiomer ratio present in ADDERALL® (d- to l- ratio of 3:1), had no apparent effects on embryofetal morphological development or survival when orally administered to pregnant rats and rabbits throughout the period of organogenesis at doses of up to 6 and 16 mg/kg/day, respectively. These doses are approximately 1.5 and 8 times, respectively, the maximum recommended human8dose of 30 mg/day [child] on a mg/m2 body surface area basis. Fetal malformations and death have been reported in mice following parenteral administration of d-amphetamine doses of 50 mg/kg/day (approximately 6 times that of a human dose of 30 mg/day [child] on a mg/m2 basis) or greater to pregnant animals. Administration of these doses was also associated with severe maternal toxicity.A number of studies in rodents indicate that prenatal or early postnatal exposure to amphetamine (d- or d,l-), at doses similar to those used clinically, can result in long-term neurochemical and behavioral alterations. Reported behavioral effects include learning and memory deficits, altered locomotor activity, and changes in sexual function.There are no adequate and well-controlled studies in pregnant women. There has been one report of severe congenital bony deformity, tracheo-esophageal fistula, and anal atresia (vater association) in a baby born to a woman who took dextroamphetamine sulfate with lovastatin during the first trimester of pregnancy. Amphetamines should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.Nonteratogenic Effects: Infants born to mothers dependent on amphetamines have an increased risk of premature delivery and low birth weight. Also, these infants may experience symptoms of withdrawal as demonstrated by dysphoria, including agitation, and significant lassitude.Usage in Nursing Mothers: Amphetamines are excreted in human milk. Mothers taking amphetamines should be advised to refrain from nursing.Pediatric Use: ADDERALL XR® is indicated for use in children 6 years of age and older.Use in Children Under Six Years of Age: Effects of ADDERALL XR® in 3-5 year olds have not been studied. Long-term effects of amphetamines in children have not been well established. Amphetamines are not recommended for use in children under 3 years of age.Geriatric Use: ADDERALL XR® has not been studied in the geriatric population. ADVERSE EVENTSHypertension: [See WARNINGS section] In a controlled 4-week outpatient clinical study of adolescents with ADHD, isolated systolic blood pressure elevations ≥15 mmHg were observed in 7/64 (11%) placebo-treated patients and 7/100 (7%) patients receiving ADDERALL XR® 10 or 20 mg. Isolated elevations in diastolic blood pressure ≥ 8 mmHg were observed in 16/64 (25%) placebo-treated patients and 22/100 (22%) ADDERALL XR®-treated patients. Similar results were observed at higher doses.In a single-dose pharmacokinetic study in 23 adolescents, isolated increases in systolic blood pressure (above the upper 95% CI for age, gender and stature) were observed in 2/17 (12%) and 8/23 (35%), subjects administered 10 mg and 20 mg ADDERALL XR®, respectively. Higher single doses were associated with a greater increase in systolic blood pressure. All increases were transient, appeared maximal at 2 to 4 hours post dose and not associated with symptoms.The premarketing development program for ADDERALL XR® included exposures in a total of 1315 participants in clinical trials (635 pediatric patients, 350 adolescent patients, 248 adult patients, and 82 healthy adult subjects). Of these, 635 patients (ages 6 to 12) were evaluated in two controlled clinical studies, one open-label clinical study, and two single-dose clinical pharmacology studies (N= 40). Safety data on all patients are included in the discussion that follows. Adverse reactions were assessed by collecting adverse events, results of physical examinations, vital signs, weights, laboratory analyses, and ECGs.Adverse events during exposure were obtained primarily by general inquiry and recorded by clinical 9investigators using terminology of their own choosing. Consequently, it is not possible to provide a meaningful estimate of the proportion of individuals experiencing adverse events without first grouping similar types of events into a smaller number of standardized event categories. In the tables and listings that follow, COSTART terminology has been used to classify reported adverse events.The stated frequencies of adverse events represent the proportion of individuals who experienced, at least once, a treatment-emergent adverse event of the type listed.Adverse events associated with discontinuation of treatment: In two placebo-controlled studies of up to 5 weeks duration among children with ADHD, 2.4% (10/425) of ADDERALL XR® treated patients discontinueddue to adverse events (including 3 patients with loss of appetite, one of whom also reported insomnia) compared to 2.7% (7/259) receiving placebo. The most frequent adverse events associated with discontinuation of ADDERALL XR® in controlled and uncontrolled, multiple-dose clinical trials of pediatric patients (N=595) are presented below. Over half of these patients were exposed to ADDERALL XR® for 12 months or more.Adverse eventAnorexia (loss of appetite) InsomniaWeight lossEmotional lability Depression% of pediatric patients discontinuing (n=595) 2.91.5 1.2 1.0 0.7In a separate placebo-controlled 4-week study in adolescents with ADHD, eight patients (3.4%) discontinued treatment due to adverse events among ADDERALL XR®-treated patients (N=233). Three patients discontinued due to insomnia and one patient each for depression, motor tics, headaches, light-headedness, and anxiety.In one placebo-controlled 4-week study among adults with ADHD, patients who discontinued treatment due to adverse events among ADDERALL XR®-treated patients (N=191) were 3.1% (n=6) for nervousness including anxiety and irritability, 2.6% (n=5) for insomnia, 1% (n=2) each for headache, palpitation, and somnolence; and, 0.5% (n=1) each for ALT increase, agitation, chest pain, cocaine craving, elevated blood pressure, and weight loss.Adverse events occurring in a controlled trial: Adverse events reported in a 3-week clinical trial of pediatric patients and a 4-week clinical trial in adolescents and adults, respectively, treated with ADDERALL XR® or placebo are presented in the tables below.The prescriber should be aware that these figures cannot be used to predict the incidence of adverse events in the course of usual medical practice where patient characteristics and other factors differ from those which prevailed in the clinical trials. Similarly, the cited frequencies cannot be compared with figures obtained from other clinical investigations involving different treatments, uses, and investigators. The cited figures, however, do provide the prescribing physician with some basis for estimating the relative contribution of drug and non-drug factors to the adverse event incidence rate in the population studied.Table 1 Adverse Events Reported by More Than 1% of Pediatric Patients Receiving ADDERALL XR® with Higher Incidence Than on Placebo in a 584