Author Archives: joanjager@live.com

Tools for Discovering your Strengths

Tools for discovering your strengths. Live well with ADHD. Self-advocacy can give you the opportunity to speak for yourself regarding your needs and help to secure the necessary support at work or school and for your personal life. We don’t have to struggle so hard. Developing self-knowledge is the first stepADD Coach Dana Rayburn reminds us, that, “When properly treated, ADHD loses much of its power over our lives. As adults, we can paint a new picture of who we are and what we contribute to the world…” (1)

The goal is to develop your strengths and delegate your weaknesses.

Don’t go it alone, feeling you have to prove yourself over and over again that you CAN persevere! The truth is, delegating the things you aren’t good at, or just plain don’t like, is a good idea for anyone. If you have ADHD, however, it can make the difference between constant struggle and an enjoyable, successful life.

You are uniquely made and have a lot to share with the world. Don’t let self-judgement stop you from becoming all that you can be. For more about learning your strengths, building self-awareness, and developing powerful self-advocacy skills, continue reading here.

Thanks for signing up for the latest news. Hope you find a new appreciation for your talents and can use that awareness to make your life more rewarding.

I know this can be a difficult concept to get your head around. Let’s talk about it.

Joan Jager
ADD freeSources.net

Follow ADD freeSources on Pinterest or Facebook.

Tools for Discovering your Strengths – Introduction to Self-advocacy for ADHD: Know yourself

20 Momentum Strategies to Combat Procrastination

Lack motivation? Okay. What you need is movement.By ADHD Coach and Organizer, Sue West

Procrastinating or just have no motivation today? Here’s a quick list of 20 strategies to get yourself moving, so you can catch a bit of momentum. As you gain momentum, often you’ll just keep going. You may or may not “find” motivation, but momentum is what’s needed. Not every task you work on “needs” motivation. That’s a feeling, right? What you need is movement.

The Practical Momentum Strategies

1. What’s the most interesting part of the project? Start there.

2. What part of the project will you be best at? Start there.

3. Play first. Get it out of your system. (Set a timer to stop the play though.)

4. Do the difficult first, with “play” as the reward.

5. Set a timer and stop at the end of 5-15 minutes, just enough to get you started.

6. Write or draw out your list of steps and take just the first small step. Just one.

7. Change your environment. Go to someone else’s office, a coffee shop, a library and use the change in environment to wake up your mind.

8. Listen to music (instrumental), TED talks, a book, or a class while you work. Yes, the choice is important, of what you listen to and what you choose to work on. It takes some thought.

9. Work on the tedious tasks while someone else comes to your office or home (e.g., bookkeeper, cleaning service, assistant). Use their presence to focus you on your own task. Or while your children do their homework.

10. Talk through your project with someone else first.

11. Read about how others have handled this project – the experts.

12. Hire it out.

13. Can you work in a team for support on at least one piece? Connections can give you momentum to keep going.

Lack motivation? That’s Okay. What you need is movement.The Psychological, Emotional, and Self-Talk Strategies

1. Ask yourself: Why am I not starting? What am I afraid of?

2. Say something like: I know how to do this. I know I can start it, just dip my toe into the water and see what’s there.

3. Ask yourself: Have I already made some decision? Do I need to let this go?

4. Ask yourself: What is the best and worst that could happen? What are the benefits of starting now versus waiting?

5. Break up the work so you can set small, interim deadlines before the big, looming one.

6. Self-care: Sometimes it’s the rest of your life which is draining your mental energy. Focus on self-care first.

7. Have you ever had this happen before on a similar task? Think about what you did to get started.

A psychologist once told me that you can either start with the practical to get traction, or you can start with the psychological. Either way, both are key elements. So start at one end and work towards the middle and you’ll get what you need.

 

 Guest post by Sue West – Certified ADHD coach, Certified Coach Organizer, Master Trainer in chronic disorganization.  President of the Institute for Challenging  Disorganization – 2015 to present.   For more about Sue and contact information, see: CoachSueWest.com 

Original source

 

Photos created on Canva 

ADHD Coaching Options

Can’t afford a personal ADHD coach? You have other options!

ADHD Coaching groups and other coaching options, including self-coaching. 

Most ADD Coaching Groups are offered periodically by a just a few different coaches. To find them, your best bet may be Google or another search engine.  I do know of a few regular groups. Some are rather expensive, but are still less than individual coaching and a few are quite reasonably priced.

Reach Further – Finally, a truly affordable ADHD coaching group offered by Jennie Friedman. Facebook community for accountability, online meetings and shadow coaching available a few times a week. Try the first month for FREE. Just $29 a month thereafter!

ADHD Coaching Corner – An informal women’s support group led by Elizabeth Lewis with coach Jennie Freidman checking in on Wednesdays.  Meet Monday, Tuesday, and Thursday. Shadow coaching Saturday mornings. Currently just $15 a month, but that’s bound to go up.

Coach Marla Cummin’s ADDed Perceptions Mentor Group 3 months for $150.00

ADHD Success Club with Dana Rayburn – Try for $67 the first month. $177 a month ongoing.  Morning or afternoon sessions on Tuesday and Thursdays. Live and recorded.

ADHD Time Management Intensive from ADD Classes- 4-week virtual classes with Laura Rolands – program $197

 

Group coaching Waiting lists

Small group Coaching with Nikki Kinser – Get on the waiting list ( I believe this is $200 a month)

ADHD reWired Coaching and Accountability group with EricTivers – Limited to 12 persons – Meet three times a week for ten weeks on Zoom – August 23 – October 27, 2017 – Price unknown – Requires an interview to get in and registration is confusing. Some discounts may apply

Virtual Online Group with Coach Rudy Rodriguez, LCSW –  Meet on Zoom Mondays from Noon to 1:30 Eastern – Facebook for accountability. Includes two 15-minute private sessions a month. Folder and handouts – Starts in the Fall of 2017 – Limited to 10 members – Cost unknown

 

Self-coaching

Self-coaching Questions – FREE PDF

Your Path Forward: Conquer your Adult ADHD one Step at a time – FREE self-coaching video program that provides self-paced small habits to help you build routines that can help you accomplish both daily tasks and larger projects. ADHD coach Linda Walker offered this last year and is renewing it in July 0f 2017.  – Available in French at Petits Pas, Grande’s Resultats  http://adultadhdsolutions.com/

CreativeGeniusCoaching YouTube channel – FREE – Coach Linda Walker

You are Not your Adult ADHD Workbook – Coach and organizer Sue West – Your roadmap to managing your days. It’s possible. In small steps. Workbook $27. For personal coaching, as well, price increases accordingly. $100 an hour

Maximum Productivity Makeover – Six full video modules with training manuals and workbooks. Accountability group page, Weekly emails to keep you on track – Coach Linda Walker – Self Study is $385

Two other self-coaching programs Walker include video, audio, and workbooks.  Thrive! The Natural Approach to Optimal Focus and Effectiveness for Creative Geniuses and Achieve! The Natural System to Take Control of Your Life and Unlock Your Full Potential for Creative Geniuses  $155 each. 

ADD Crusher – A virtual coaching program from Alan Brown. 10 sessions in two Videos with Audio Companion. Four hours of ADD-beating instruction. Plus, PDF Toolkits for each of the strategies (or, Ways), provide “crib notes” to help you put the learning into action. – $96

The Disorganized Mind: Coaching Your ADHD Brain to Take Control of Your Time, Tasks, and Talents – Paperback book by Nancy Ratey – $12.33

ADHD Self-coaching: Progress Report (Link works) by Zoe Kessler – 3 months after starting Nancy Ratey’s program outlined in the above book, The Disorganized Mind.

Thrive with ADD Self-Coaching Workshop (Workbook & CD’s) $97 – Bonnie Mincu

Untapped Brilliance: How to Reach your full Potential with Adult ADHD by coach Jacqueline Sinfield – Self-coaching primer written In straightforward language provides practical advice and simple, easy to follow techniques. See Amazon for Kindle version for $10, but order the paperback version from Jacqueline – $15 + $7 shipping from Canada

Oline classes ADHD Classes

3 Core Series ADHD classes with therapist Don B Baker – Change the way you think about and manage your ADHD wiring. Start with Opening the Suitcase for $45. Discount for all three.  Package.

 

***Support groups may also provide information, empathy, and help you with strategies that can lead to self-improvement. Find online and in-person ADHD support.

I want to change my ADHD life. What can I do?

ADHD is a way of life, a difference in the way you see and move in the world. You can learn to manage the world and use your brain.A series of short guest posts by Sarah Jane Keyser.

ADHD has strengths as well as weaknesses; like heads and tails, you can’t have one without the other.

Attention Deficit Hyperactivity Disorder is not an illness (in spite of the name) and there is no “cure”. ADD is a way of life, a difference in the way you see and move in the world.

You can learn to manage the world and use your brain.

There are many ways to train your brain. Usually, a combination of medication, ADHD coaching strategies, and exercise is most effective. Each individual needs to discover what combination works best for him or her.

Here are some ways that you can change your life:

Life Styles for ADHD – You can do many things for yourself. A good program includes exercise, what to eat, how to breathe, how to get to sleep and how to enjoy.

Maintaining the ADHD Brain – If your car runs on two cylinders you take it to the garage. If your brain sputters take it to a doctor for a checkup.

ADHD Coaching Strategies – A coach is a partner who guides you to new ways of seeing yourself and the world. An ADD coach who knows how ADD feels and understands the ADHD brain can help you value your strengths and structure your life.

Celebrating ADHD – Learn to appreciate the passion and sparkle which are the gift of ADHD.

 

 

Published by Sarah Jane Keyser, Copyright 2006, all rights reserved. Learn more about ADHD at Coaching Key to ADHD

 

*** About Sarah Jane *** Sarah Jane Keyser worked for many years with computers as a programmer, analyst, and user trainer, but her struggle with inattentive ADD kept getting in the way of her plans and dreams. Her credentials include ADD Coach training at the ADD Coach Academy, the Newfield Network’s graduate coaching program “Mastery in Coaching” and “Coaching Kids and Teens” by Jodi Sleeper-Triplett MCC. Sarah Jane is an American living in Switzerland who coaches in French and English by telephone.

“Image courtesy of mrpuen–FreeDigitalPhoto.net”   Modified on Canva

If you’re not on Pinterest, you can access 50 of ADD freeSources’ Boards on Facebook. Look for the Pinterest tab on the left.

Follow ADHD / ADD freeSources’ board Basic Self-Care – Building Routines and Habits on Pinterest.Follow ADHD / ADD freeSources’ board Diagnosis and Treatment of ADHD on Pinterest.

Follow ADHD / ADD freeSources’ board ADHD Coaching Strategies on Pinterest.Follow ADHD / ADD freeSources’s board What’s getting in your way? Psychological help. on Pinterest.

Neuropathology and Genetics of ADHD – 6 Part Video Series

Neuropathology and Genetics of ADHD – DNA Learning Center videos with Professor Phillip Shaw (1 to 2-minutes each)

Neuropathology of ADHD  – Three brain areas in relation to the neuropathology of ADHD: the frontal cortex, amygdala, and hippocampus.

Neuropathology of Attention  – Research indicates a pattern of right-hemisphere dominance for attention in the mature brain.

Adult ADHD – Persistence and Remission  – “Research suggests 20-25% of children with ADHD have a severe adult form, while approximately 33% show complete remission.” –  “In youth with attention deficit hyperactivity disorder (ADHD), the brain matures in a normal pattern but is delayed three years in some regions, on average, compared to youth without the disorder, an imaging study reveals. The delay in ADHD was most prominent in regions at the front of the brain’s outer mantle (cortex), important for the ability to control thinking, attention and planning. (Executive Functions) (1)

ADHD Comorbidity  – “Similarities between ADHD, oppositional defiant disorder, and conduct disorder. The boundary between these disorders is somewhat unclear.”

ADHD, DRD4, and Brain Development  – “Research links ADHD with a variant of the Dopamine RD4 gene, which is also associated with brain development.

Biochemistry of ADHD – Dopamine  – “An association between ADHD and dopamine receptors may relate to brain development.”

(1) Brain Matures a Few Years Late in ADHD, but Follows a Normal Pattern

NIH News Release- Monday, November 12, 2007

ttps://www.nih.gov/news-events/news-releases/brain-matures-few-years-late-adhd-follows-normal-pattern

6 Questions for Recognizing ADHD in Adults

This proposed version of the World Health Organization ADHD Self-Report Screening Scale is a short questionnaire designed to help people easily assess the possibility that they might have ADHD. (Researchers have revised the scale to fit the new criteria for evaluating ADHD introduced by the DSM-5 and to reflect how ADHD  presents differently in adults than in children.) FREE Printable

It’s important to keep in mind that this new questionnaire isn’t an absolute measure of whether someone has ADHD. But it can be a useful tool for assessing whether a further look is in order.

The official screener hasn’t been published yet. At this time,  “scores” would be best guesses based on the following information.

The choice of answers range from never, to rarely, sometimes, often and very often. Never is always zero, but the higher frequency answers are assigned varying points.

  1. How often do you have difficulty concentrating on what people are saying to you, even when they are speaking to you directly?
  2. How often do you leave your seat in meetings or other situations in which you are expected to remain seated?
  3. How often do you have difficulty unwinding or relaxing when you have time to yourself?
  4. When you’re in a conversation, how often do you find yourself finishing the sentences of the people you are talking to before they can finish them themselves?
  5. How often do you put things off until the last minute?
  6. How often do you depend on others to keep your life in order and attend to details?

Points are given to each question according to the relative importance of the question is to diagnostic criteria. The highest score if Questions 1,2, and 3 are answered very often is 5 points. The 4th question’s top score is 2. The 5th’s highest is 4, while the final question is 3. That makes 24 points in total, with 14 points being the point at which additional evaluation is recommended.

We’ve created a FREE Printable of what we think the scale will look like based on the previous information.

 

The development of the new ADHD Screener from a 2017 APSARD conference promotional video – 13-minutes

Sources:

6 Questions for Recognizing ADHD by Neil Patterson – https://blogs.psychcentral.com/adhd-millennial/2017/04/6-questions-for-recognizing-adhd/ (Link works)

The World Health Organization Adult Attention-Deficit/Hyperactivity Disorder Self-Report Screening Scale for DSM-5 

Authors: Berk Ustun, MS1; Lenard A. Adler, MD2,3; Cynthia Rudin, PhD4,5; et al

http://jamanetwork.com/journals/jamapsychiatry/fullarticle/2616166

Brief Screening Tool for Adult ADHD Released

Copy and Paste: http://www.medscape.com/viewarticle/878810?src=wnl_edit_tpal&uac=150032AY#vp_2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WHO ADHD Adult Self-Report Scale

Proposed World Health organization (WHO)

ADHD Adult Self-Report Scale

     6 Questions for Recognizing ADHD in Adults    Never    Rarely     Seldom         Often     Very

   Often

   1. How often do you have difficulty concentrating on what people are saying to you, even when they are speaking to you directly?        0         1           2         4        5
    2. How often do you leave your seat in meetings or other situations in which you are expected to remain seated?        0          1            2          4        5
    3. How often do you have difficulty unwinding or relaxing when you have time to yourself?        0           1            2          4        5
   4. When you’re in a conversation, how often do you find yourself finishing the sentences of the people you are talking to before they can finish them themselves?        0           1            1           2       2
    5. How often do you put things off until the last minute?        0           1            2           3        4
    6. How often do you depend on others to keep your life in order and attend to details?        0           1            1            2         3

 The total number of available points is 24.

Recommend further testing with screening scores of 14 and above.   

For further information see:

6 Questions for Recognizing ADHD in Adults

Source:  

The World Health Organization Adult Attention-Deficit/Hyperactivity Disorder Self-Report Screening Scale for DSM-5 

Authors: Berk Ustun, MS1; Lenard A. Adler, MD2,3; Cynthia Rudin, PhD4,5; et al

http://jamanetwork.com/journals/jamapsychiatry/fullarticle/2616166

Brief Screening Tool for Adult ADHD Released

Copy and Paste: http://www.medscape.com/viewarticle/878810?src=wnl_edit_tpal&uac=150032AY#vp_2

 

ADHD Medications: Part Two – Overview of Medications

A PHYSICIAN’S PERSPECTIVE on ADHD Medications by Theodore Mandelkorn, MD – 2011

Overview of specific ADHD Medications – Get the factsPART ONE: Therapeutic Treatment of ADHD 

PART TWO: OVERVIEW OF MEDICATIONS

It is important to note that medical treatment should always be given for the entire waking day, seven days a week.  There are few medical conditions that we do not elect to treat in the evenings, on weekends or holidays.  No one chooses to turn down their brain chemistry during his or her wakeful hours.  Therefore, all medical treatment for ADHD should last for at least 12-16 hours daily.  With this in mind, I have highlighted (***) the medications that should be preferred treatments for ADHD.

 

NON-STIMULANT MEDICATIONS

  • ATOMOXETINE, 24 HOURS (Strattera)
  • CLONIDINE, TABLETS: 4-5HOURS, PATCH: 5-6 DAYS  (Catapres)
  • GUANFACINE LONG ACTING (Intuniv)

STIMULANT MEDICATIONS:  OVERVIEW,  SAFETY PROFILE,  SIDE EFFECTS

  • METHYLPHENIDATE TABLETS, 2-4 HOURS (Ritalin)
  • DEXTRO-METHYLPHENIDATE, 4-6 HOURS (Focalin)
  • METHYLPHENIDATE SUSTAINED RELEASE, 6 HOURS (Ritalin SR20)
  • METHYLPHENIDATE LONG ACTING, 8 HOURS (Ritalin LA)
  • METHYLPHENIDATE CONTROLLED DISPENSE, 8 HOURS (Metadate CD)
  • METHYLPHENIDATE EXTENDED RELEASE, 12 HOURS (Concerta)
  • METHYLPHENIDATE TRANSDERMAL SYSTEM,  12 HOURS (Daytrana)
  • DEXTROAMPHETAMINE TABLETS, 4 HOURS (Dexedrine, Dextrostat)
  • DEXTROAMPHETAMINE SPANSULES 6 HOURS (Dexedrine)
  • AMPHETAMINE SALTS TABLETS, 6 HOURS (Adderall tablets)
  • AMPHETAMINE SALTS EXTENDED RELEASE, 12 HOURS (Adderall Xr and generic)
  • LISDEXAMFETAMINE, 12-14 HOURS (VYVANSE)

Editor’s note:  “You can’t notice small improvements or side effects without a monitoring sheet.”  See ADDitude Magazine’s 10 Medication Fallacies even Doctors Believe  See below for a few Response to Treatment Rating Scales.

 

NON-STIMULANT MEDICATIONS

Guanfacine, Extended Release   (Intuniv)

This new formulation of an existing medication, guanfacine, was released by the FDA to the market in Dec.  It is an alpha 2 agonist, which will have a 24-hour effect on ADHD symptoms and may be beneficial for individuals with ADHD, particularly those with significant mood, anger, oppositional symptoms.  Preliminary results show that it is clearly beneficial for some patients without the adverse side effects often seen with other ADD medications.

 

Form:                 Pills:  1mg, 2mg, 3mg, 4mg.  Pills must be swallowed.  They must not be crushed, chewed or broken or they will loose the 24-hour effect.

Dosage:        It has a very slow rate of onset and will take 3-4 weeks to assess                        effectiveness.  The primary side effect is tiredness, lethargy, and it must be started slowly.  Suggest starting dose of 1 mg for one week, and raise by 1 mg each week to reach good therapeutic effect.  The effects do last 24 hours.

SideEffects : Lethargy, tiredness, dry mouth, constipation, dizziness,             decreased blood pressure.

Pros:                  A non-stimulant medication that appears to have a good, positive effect on ADD and oppositional symptoms that lasts 24hours with reduced side effect profile, compared to the traditional  treatments.

Cons:                A new formulation with minimal time on the market to truly assess effectiveness.

ATOMOXETINE  24 hours   (Strattera)

This is a medication for ADHD, which was released by the FDA in December 2002.  It is a non-stimulant medication, which is not abusable and can be written without Schedule II restrictions.  This is the first medication that lasts 24 hours and therefore gives full therapeutic effect throughout the day and night .Unfortunately, over the past few years, it has not performed as well as expected.  It tends to often have side effect and does not deliver as robust a response as the stimulants.

Form:                 Capsules: 10mg, 18mg, 25mg, 40mg, 60mg.

Dosage:            Weight based dose:  first four days=0.5mg/kg;  target dose (day five and after)=1.2mg/kg.  This medication must be taken with food to prevent nausea.

Action:               Very slow acting and will take 3-4 weeks (or more) to reach a therapeutic effect.  If the patient is already taking stimulant medications, suggest continuing them and adding the Strattera for the first 4-6 weeks, then tapering the stimulant slowly until discontinued.

Possible Side Effects:    No long-term safety information is available for this medication. Primary side effects in children include sleepiness during the day, appetite changes, and mood or personality changes. If these occur, give the dose at night or lower the dose until they improve.  Then raise dose if possible.  Adults can experience more noted effects:  transitory dry mouth and dizziness, insomnia, sleepiness and significant moodiness. Other effects in adults include possible bladder spasm, sexual dysfunction (uncommon but often result in discontinuation of medication).  Occasionally a child or adult will get very agitated.  If this occurs, discontinue the medication.

Pros:                  24-hour coverage.  Less effect on appetite than stimulants.

Cons:                Many complaints about side effects, lack of efficacy compared to stimulants.  Has not been a very satisfactory treatment for many with ADD

CLONIDINE  tablets 4-5 hours, patches 5-6 days   (Catapres)

Form:                 Patches applied to back or shoulder.  Catapres TTS-1, TTS-2, TTS-3.  Tablets .  Clonidine tablets 0.1mg, 0.2mg, and 0.3mg.

Dosage:            Very individual, usually .1-.3mg.

Action:               Works quickly.  Tablets work within 1 hour, patches within 1 day.

Effects:              Often will improve ADHD symptoms, particularly aggressive and hyperactive behaviors.  Not too helpful for focus and attention.  Decreases motor and vocal tics.  Can have a dramatic effect on oppositional defiant behavior and anger management.  Often used as one dose at night about 1½ hours before bedtime to assist with getting to sleep.

Possible Side Effects:    Major side effect is tiredness, particularly if the dose is raised too quickly.  This disappears with time.  Dizziness, dry mouth.  Some will notice increased activity, irritability.

Pros:                  Excellent delivery system if patch is used.  No pills required

Cons:                Does not usually work as well as stimulants.  Patch can cause skin irritation in many individuals and may not be tolerated.  Can affect cardiac conduction (heart rate and rhythm) in high doses and must not be left around for animals or small children to accidentally ingest.

 

STIMULANT MEDICATIONS

Some general comments can be made about stimulant medications as a class of medications.  The longer acting medications have clear advantages over the short acting medications, not only in duration of therapeutic effect throughout the day, but also in smoothness of the therapeutic effect.  It is very difficult for an individual with ADHD to remember to take multiple doses of medication during the day.  Multiple dosing increases the risk of missing doses, which results in the return of symptoms at inopportune times.  The afternoon dosing is frequently missed, causing significant difficulties.  Furthermore, each additional dose serves as an unnecessary reminder that treatment for this condition is needed and “something is wrong.”

The reason for medical treatment is to “normalize” the dayMy general rule is to always use 12-16 hour medications unless they are not effective or have intolerable side effects.  In such a case, the six or eight hour medications should be tried, because some individuals tolerate them better and find them more effective.  However, if the six or eight hour medication is used, a second dose should be given to allow patients to have the therapeutic benefit for the full day.

 

SAFETY PROFILE

The stimulant medications are one of the most studied treatments in the history of medicine.  The medications have been used extensively in children and adults over the past 50 years with no evidence to date of long-term concerning side effects.  At this time there is no conclusive evidence that use of stimulants causes any long term lasting effects on growth, although there may be some delay in height and weight gain in some individuals.

The short acting stimulants are extremely abusable and are valued highly on the street.  It is best to always use the long-acting preparations, which are not abusable to avoid the temptation of misuse and abuse.

There have been recent concerns expressed by the FDA and the press with regard to the use of stimulant medications and the risk of sudden unexpected death.  This concern was a consequence of a study done in 1999-2003 in which they looked at a large number of individuals taking stimulants and felt that there may be a slight risk.  As reported in an excellent article in the New York Times Feb 14, 2006 the apparent calculated risk of sudden unexpected death in those using amphetamines was 0.35/million (1 in 3 million) prescriptions and the risk for those on stimulants was 0.18/million (1 in 5 million) prescriptions.  There is no real evidence that this is any different from that which occurs in the normal population.  These extraordinary events of unexpected death tended to occur in individuals with congenital cardiac defects.  For this reason, the FDA issued a BLACK BOX warning to all physicians that stimulants should be used very cautiously or not at all in individuals with congenital cardiac defects.

 

COMMON SIDE EFFECTS:

The following side effects are often noted with the use of stimulants.  In general, side effects with the short-acting medications are more pronounced and bothersome than with the long-acting medications.  Thus, long acting meds are somewhat more tolerable for long-term treatment and are certainly a marked improvement for long-term therapeutic effect.

Appetite suppression:  Most will note decreased appetite during the effective hours of the medication.  This often means minimal lunch intake.  I suggest a small protein lunch such as milk, peanut butter crackers, beef or turkey jerky to get through the day.  A milkshake after school helps.  Many find their appetite returns late in the evening (around 8-9pm) when their medication wears off, and they need to be allowed to eat at that time.  If weight gain is a continued concern, I often add cyproheptadine (Periactin) 4mg, ½ tablet at breakfast and dinner.  Periactin is an antihistamine similar to Benedryl, which enhances appetite and often results in 1-2lbs-weight gain per month.  Remember that good nutrition is helpful for all, and these individuals should emphasize protein intake in their diet.

Sleep disturbance:  Many ADHD individuals will have sleep difficulties before they begin their medical treatment.  At night, their brain continues its activity and starts thinking of the day.  Using stimulant medications may either improve or worsen this problem.  In those with no prior sleep difficulty, stimulants can create significant sleep issues.  ADHD individuals do not usually have a problem with sleeping through the night (sleep disorder) but often do have problems with starting the sleep.  A clear-cut bedtime routine helps (bath or shower and then read in bed) with the elimination of caffeine, computers, computer games and television at least one hour before bedtime.  Interestingly, adding stimulant medication actually allows a percentage to sleep better at night, and this technique should be tried.  It only takes one night to see if a dose of short acting stimulant will enable sleep initiation.

Some patients, however, require more assistance.  Many patients will use a small dose of Clonidine tablets given one hour before bedtime to help with sleep initiation.  Clonidine is a mild sedative, not a sleeping pill, and it is non-addictive.  Approximately 60-90 minutes after taking the medication, a brief sleepy phase will occur that lasts about 20 minutes.  If the patient is in bed and trying to go to sleep, it is very effective.  It will NOT make someone stop playing computer games and go to bed.

Mood changes:  One of the biggest complaints about stimulants is that they can cause mood changes.  These come in a number of different forms.

Rollercoaster effect:  Short acting medications have a continuous cycling of the blood level, either rising or falling throughout the day.  This can lead to significant mood changes, particularly at the end of the four-hour cycle when the medication is wearing off.  This problem with cycling is greatly diminished with the use of eight-hour and twelve-hour medications.

Rebound effect.  Stimulants can often wear off very rapidly, and in some individuals, this can cause a rebound, a marked change in demeanor often characterized by irritability, loss of patience, and a worsening of the ADHD core symptoms.  Rebound can occur in the evening when the medication wears off and can also be evident in the morning on first arising.  The morning rebound may require an early dose of immediate release methylphenidate (MPH) prior to the administration of the long-acting dose at breakfast.  The Rebound effect is markedly reduced in frequency and severity in the long-acting stimulants.

Irritability and anxiety:  All of the stimulants have the possibility of causing a generalized irritability, and sometimes even anger, which is not tolerable over a long period of time.  They can cause anxiety and panic disorder and may aggravate existing anxiety.  Often, changing from one stimulant to another will reduce this side effect, so it is worth trying different stimulants to identify the best one for each patient.

Overdose effect:  When using the stimulants it is necessary to gradually raise the dose to find the most effective therapeutic level.  Sometimes in doing this, one gets an overdose effect.  The stimulants are incredibly safe. They have been studied for over 50 years, and there is no evidence at this time of any long-term serious complications when used appropriately for ADHD.  However, if ADHD individuals take too high a dose, they will experience an overdose effect which appears as a dulling of the personality:  They complain of being somewhat physically lethargic, subdued, dull, less conversational, less apt to laugh and be social.  By simply lowering the dose for one day, these symptoms will disappear.

Tic FormationAll of the stimulants have the possibility of temporarily causing a tic disorder or aggravating an existing one.  There is no evidence that the use of stimulant medications will cause a permanent formation of tic disorder or Tourette syndrome.  Children who already have tics (10% of children have mild tics at some point in childhood) and individuals with Tourette syndrome will find a number of different scenarios with the use of medication.  Approximately 1/3 will actually notice that the tics improve (lessen) with the use of stimulants, 1/3 will see no change at all, and 1/3 will find the tics worsen with use of stimulants.  If the stimulants are effective and tics are worse, a medication to help control the tics is usually added to the treatment.

 

METHYLPHENIDATE TABLETS  2-4 hours   (Ritalin IR)

Form:                 Short acting tablets.  Methylphenidate (MPH) 5mg, 10mg, 20mg.

Dosage:            Very individual.  Average 5-20mg tablets every 2-4 hours.

Action:               Immediate release (IR) MPH starts to take effect in 15 minutes, which is extremely helpful for some individuals.  Some children need an early morning dose 20 minutes BEFORE arising in the am, followed by a long-acting medication at breakfast.  Often used as a booster for evening coverage.

Possible Side Effects     See above

Pros:                  Very easy to use for short periods of coverage, such as early morning and evening.

Cons:                Must be administered frequently during the day (3-5 times/day).  Inconvenient to use at school and work.  Often causes rebound and rollercoaster effect.  Very abusable.

 

DEXTRO-METHYLPHENIDATE  4-6 hours   (Focalin)

                                                            8-12 hours (Focalin XR)

 

Focalin is an isomer product of methylphenidate.  Methylphenidate is composed of two mirror-image molecules, and it has been determined that the right-hand side of the molecule contains most of the therapeutic activity.  Therefore the left-hand side has been eliminated, giving a cleaner formulation of methylphenidate.

Form:                 Tablets:  2.5mg, 5mg, and 10mg. (Focalin)

Capsules:  5mg, 10mg, 20mg

Dosage:            The same as methylphenidate, but divide the dose by half.

Action:               The same as methylphenidate, but in some individuals up to 6 hours duration.

Possible Side Effects:    Same as MPH but possibly to a slightly less degree.

Pros:                  A cleaned up version of MPH that may last a bit longer with slightly decreased side effects.

Cons:                Same as MPH.  Very abusable.

 

METHYLPHENIDATE SUSTAINED RELEASE  6 hours   (Ritalin SR20)

Replaced by Ritalin LA.

 

METHYLPHENIDATE LONG ACTING  8 hours   (Ritalin LA)

Form:                 Capsules: 20mg, 30mg and 40mg.

Dosage:            Very individual.  Average: 20-40 mg daily or twice a day, every 8 hours.

Action:               Same as methylphenidate, but eliminates the noontime dose.

Possible Side Effects:    See above.

Pros:                  Eliminates midday dosing.  Works more smoothly than IR methylphenidate and is more effective than methylphenidate SR.

Cons:                Only works for eight hours and therefore subjects the patient to loss of focus and control in mid-afternoon.  This requires an afternoon booster to be administered.

 

METHYLPHENIDATE CONTROLLED DISPENSE  8 hours   (Metadate CD)

Form:                 Capsules: 20mg (10mg and 30mg to be available in 2003)

Dosage:            Very individual.  Average: 2-3 capsules in the am.

Action:               Same as methylphenidate.

Possible Side Effects:    See above.

Pros:                  Works more smoothly than IR methylphenidate.  Sometimes is effective when Concerta and Ritalin LA are not effective.  Not abusable.

Cons:                Works for only eight hours.  (See Ritalin LA)

 

***METHYLPHENIDATE EXTENDED RELEASE  12 hours   (Concerta)

No generic available

Form:                 12-hour long-acting tablet uses a unique delivery system that delivers a constant therapeutic level of methylphenidate for twelve full hours.  Cannot be broken or cut or delivery system is destroyed. Concerta 18mg, 27mg, 36mg, 54mg.

Dosage:            Dosage will vary as with all methylphenidate products.

Concerta 18mg = Ritalin  5mg three times a day

Concerta 27mg = Ritalin 7.5mg three times a day

Concerta 36mg = Ritalin 10mg three times a day

Concerta 54mg = Ritalin 15mg three times a day

Action:               12 hours of consistent therapy with no highs or lows throughout the day.  A few individuals will only get 8-9 hours of effective therapy and will need either a higher dose or a second dose.

Possible Side Effects:    See above.

Pros:                  Unique delivery system (an internal osmotic pump) avoids multiple dosing throughout the day.  No dosage at school.  No rebounding with missed doses.  Fewer side effects, less mood swings, and a better therapeutic response for many individuals.  No daytime dosing.  Less anxiety and worry.  Not abusable.

Cons:                Does not work for all individuals who use methylphenidate.  If ineffective, should try Ritalin LA and/or Metadate CD.  May need a short-acting booster to cover the evening hours.

 

METHYLPHENIDATE TRANSDERMAL SYSTEM  12-15 HOUR (Daytrana)

No generic available

 

The trans-dermal patch arrived on the market July of 2006 as a new and novel delivery system for methylphenidate. The patch has the medication within the adhesive layer and is thus very thin.  It works by diffusion, allowing the medication to gradually diffuse through the skin into the blood stream directly, thus avoiding the intestinal tract.  It is designed to be worn for nine hours and then removed, but will last longer if needed for evening activities.  After removal it will gradually lose effect over the next three hours, thus giving extended and controlled hours of therapy as the day dictates. The unique attribute of the patch is that the patient has complete control of when to start the patch and when to discontinue the patch.  For the first time, the patient can regulate the treatment for part or all of the day.  The medication in the patch is methylphenidate, and thus all of the above information regarding this medication applies.

 

DEXTROAMPHETAMINE TABLETS  4 hours   (Dexedrine, Dextrostat)

Form:                 Short acting tablets  5mg, 10mg.

Dosage:            Very individual.  Average 1-3 tablets each dose every 4-5 hours.

Action:               Rapid onset of action, approx. 20 min.  Lasts 4-5 hours.

Possible Side Effects:    See above.

Pros:                  Excellent safety record.  Rapid acting.  Some patients who do well on dextroamphetamine prefer the tablets to the spansules.  The rapid onset in tablet form is apparently more effective for these individuals.

Cons:                Same as MPH.  Very abusable.

 

DEXTROAMPHETAMINE SPANSULES  6 hours   (Dexedrine)

Generic available

Form:                 Long acting.  Dexedrine Spansules 5mg, 10mg, 15mg.

Dosage:            Very individual.  Average is 5-20 mg.

Action:               Very individual.  May take up to one hour to be effective.  Usually lasts 6-8 hours.  In some individuals, it may last all day.  In others, it may only last 4 hours.  Most will take twice a day, six-hour intervals

Possible Side Effects:    See above

Pros:                  Excellent safety record.  May be the best drug for some individuals.  Long-acting, smooth course of action.  May avoid lunchtime dose at school.

Cons:                Slow onset of action.  May require a short acting medication at the start of the day.  Very abusable.

 

AMPHETAMINE SALTS TABLETS  6 hours   (Adderall)

   

 

Form:                 Long acting tablets: 5mg, 7.5mg, 10mg, 12.5mg, 15mg, 20mg, 30mg.

Dosage:            Very individual, usually between 5mg and 20mg, once or twice each day.

Action:               Usually lasts 6 hours.  May be given once or twice a day depending on the length of therapeutic effect.  Duration of effect varies from person to person.

Possible Side Effects     See above.

Pros:                  Only needs to be given once or twice a day.  Often fewer side effects than the short acting medications.

Cons:                Can cause irritability in a small percentage of patients.  Very abusable.

 

***AMPHETAMINE SALTS EXTENDED RELEASE  12 hours   (Adderall XR)

Generic available April 1, 2009

Form:                 Uses a unique delivery system that delivers a constant therapeutic level of amphetamine salts for twelve full hours.  Capsules:  5mg, 10mg, 15mg, 20mg, 25mg, 30mg.

Dosage:            Very individual.  Average 15-30mg daily.

Action:               Long-acting 12-hour control of ADHD symptoms for coverage during most of the day.

Possible Side Effects:    See above.

Pros:                  Very effective.  Same as Adderall with longer duration of action.  Cannot be abused.

Cons:                May need a booster to cover the evening hours.

 

LISDEXAMFETAMINE  12-14 hours (Vyvanse)

No generic available

 

Form:                 A Pro-drug which renders this delivery system minimally abusable.  A new and novel delivery system which will deliver dextro-amphetamine smoothly over a 12-14  hour period.

Dosage:        Capsules:  30mg, 50mg, 70mg

Action:               The same as Dextroamphetamine

Side Effects:    Same as Dextroamphetamine

Pros:                  The only long-acting Dextroamphetamine on the market, and very unlikely to be abused.

Cons:                Same as stimulants

 

For the introduction to this article, please see: PART ONE: Therapeutic Treatment of ADHD 

 

For an excellent reference book regarding all of the medications that might be used for ADHD  individuals, including not only medications for ADHD but also medications for all of the associated co-morbid conditions, please refer to the following book:

 

STRAIGHT TALK ABOUT PSYCHIATRIC MEDICATIONS FOR KIDS , Revised Edition 2004

by Timothy Wilens M.D.

 

 

 

About the author:

0-ted-mandekornReprinted with permission from Theodore Mandelkorn, MD, a physician with Puget Sound Behavioral Medicine, a clinic that treats teens, children and adults with attention deficit disorder and related conditions.  For further information visit the website at http://psbmed.com,  or call 206/275-0702.

 

ADHD Medications: A Physician’s Perspective

 By Theodore Mandelkorn, MD – 2011

ADHD is a medical condition. Medication is a PRIMARY OPTION for therapeutic intervention.ADHD Medications: PART ONE

  • INTRODUCTION
  • WHO SHOULD TAKE MEDICATIONS, AND WHY?
  • WHAT IMPROVEMENT SHOULD BE SEEN?
  • WHO SHOULD PRESCRIBE MEDICATIONS?
  • MEDICAL TRIALS
  • WHAT IS THE CORRECT MEDICATION?
  • WHAT IS THE CORRECT DOSAGE?
  • WHAT ABOUT “NATURAL” THERAPIES?
  • SUMMARY

 

PART TWO: OVERVIEW OF ADHD MEDICATIONS 

 

INTRODUCTION

Human beings are rarely created in perfect form, so we all arrive in this world with unique differences.  Some differences are blessings, others are handicaps.  Poor vision, for example, is a common handicapping condition that affects millions of people throughout the world.  I consider poor vision a condition of “human-ness.”  People can also have other medical conditions such as diabetes, asthma, thyroid conditions, ADHD, etc.—all are well-recognized differences that can impair the pursuit of a normal lifestyle if not dealt with in some manner.

 

ADHD is characterized by a prolonged history of inattention, impulsiveness and sometimes variable amounts of hyperactivity.  It is important to emphasize that all of these symptoms are normal human characteristics.  Most of us are forgetful and inattentive at times.  We all at times become nervous and fidgety, and we certainly are impulsive to some degree.  It is part of our “human-ness.”  ADHD, therefore, is not diagnosed by the mere presence of these normal and characteristic human behaviors, but by the DEGREE to which we manifest these symptoms.  ADHD individuals have an over-abundance of these normal characteristics.  They have less CONTROL of these behaviors and therefore a more variable and frequently poor outcome of their day.

WHO SHOULD TAKE MEDICATIONS, AND WHY?

If a person meets the clinical criteria for a diagnosis of ADHD and is not succeeding academically and/or socially up to age-appropriate expectations, medication should be a PRIMARY OPTION for therapeutic intervention.  ADHD is a medical condition.  Recent research out of Harvard University has documented an abnormality in the dopamine transporter system in the central nervous system of ADHD adults.  (1)  This transporter system is responsible for moving neurotransmitter chemicals from the synaptic space back into the nerve cell.  ADHD adults have approximately 70% more dopamine transporter than non-ADHD individuals and thus appear to have an overactive transport system.

 

Returning to the vision analogy, there are a number of options open to an individual who has compromised eyesight.  One option is to attempt to correct the problem by wearing glasses to improve the visual acuity.  Perhaps glasses will totally correct the problem or perhaps they will help only partially.  After glasses are in place, we are in a position to assess what further problems are interfering with success.  Then we can address these issues as well.

 

The opportunity to eliminate the symptoms of a medical condition partially or completely should be available to all.  Many children and adults with ADHD benefit enormously from the use of medication. The medications that are in use today act as transporter blockers, thus serving to normalize this aspect of the brain chemistry.  Most families who understand ADHD and its clinical manifestations prefer to try medication as a PART of their treatment plan.  Over 90% of individuals with ADHD will have a positive response to one of the medical treatments.

WHAT IMPROVEMENT SHOULD BE SEEN?

In the early 1930’s, Dr. Charles Bradley noted some dramatic effects of stimulant medications on patients with behavior and learning disorders.  He found that the use of stimulants “normalized” many of the systems that we use for successful living.  People on medication IMPROVED their attention span, concentration, memory, motor coordination, mood, and on-task behavior.  At the same time, they DECREASED daydreaming, hyperactivity, immature behavior, defiance, and oppositional behavior.  It was evident that medical treatment allowed intellectual capabilities that were already present to function more successfully. (2, 3)

 

When medication is used appropriately, patients notice a significant improvement in control.  Objective observers should notice better control of focus, concentration, attending skills, and task completion.  Many individuals are able to cope with stress and frustration more appropriately with fewer temper outbursts, less anger and better compliance.  They relate and interact better with family members and friends.  You should see less restlessness as well as decreased motor activity and impulsiveness. ADHD individuals often complain of forgotten appointments, incomplete homework, miscopied assignments, and frequent arguments with siblings, parents, spouses, workmates, along with excessive activity and impulsive behaviors.  With medication, many of these problems dramatically improve.

 

It is very important to remember what medicine does and does not do.  Using medication is like putting on glasses.  It enables the system to function more appropriately.  Glasses do not MAKE you behave, write a term paper or even get up in the morning.  They allow your eyes to function more normally IF YOU CHOOSE to open them.  You, the individual, are still in charge of your vision.  Whether you open your eyes or not, and what you choose to look at, are controlled by you.  Medication allows your nervous system to send its chemical messages more efficiently, and thus allows your skills and knowledge to function more normally.  Medication does not provide skills or motivation to perform.  Patients successfully treated with medications typically can go to bed at night and find that most of the day went the way they had planned.

Editor’s note:  “You can’t notice small improvements or side effects without a monitoring sheet.”  See ADDitude Magazine’s 10 Medication Fallacies even Doctors Believe  See below for a few Response to Treatment Rating Scales.

WHO SHOULD PRESCRIBE MEDICATIONS?

Licensed physicians, physician’s assistants or nurse practitioners can prescribe medications. This person may serve as a coordinator to assist with the multiple therapies often needed, such as educational advocacy, counseling, parent training and social skill assistance.  Parents should look for a physician who has a special interest and knowledge in dealing with ADHD individuals.  This professional should be skilled in working closely with families to try the many and varied medical treatments that are available until the correct therapeutic response is attained.  Members of CH.A.D.D chapters are an excellent resource for referrals to appropriate professionals. (Editors note: See: Find Treatment and Support for this and other referral options.)

MEDICAL TRIALS

It is necessary to establish a team of observers to appropriately evaluate a medication trial.  Gather information from sources that spend time with the patients.  This might include significant others, parents, teachers, grandparents, tutors, piano teachers, coaches, etc.  As gradually increasing dosages are administered, feedback is gathered from these observers.  Various ADHD rating scales are available to assist in gathering factual data.  The most important assessment, however, is dependent on whether the ADHD patient’s quality of success in life has improved.  For this information, I find no scale takes the place of conversations with patient and family members.

 

When evaluating patients during a trial of medication, it is important to maintain treatment throughout the waking day, seven days a week.  Treating them only at school or in the workplace is totally inadequate.  I need all involved observers, especially parents and/or significant others, assisting in the evaluation process.  Furthermore, I want to know if treatment has an effect on non-academic issues.  Recent studies have found that treatment is necessary for most ADHD individuals throughout the full day, thus allowing full development not only of academic or work skills, but also the all-important social skills that are utilized with friends and family.  After the trial of medication, if positive results are evident, then the family and the patient can make informed decisions as to when the medication is helpful.  Most patients need the medication throughout the day and evening.

WHAT IS THE CORRECT MEDICATION?

At the present stage of medical knowledge, there is no method of predicting which medication will be most helpful for any individual.  At best, physicians can make educated decisions based on information about success rates with individual medications.  Over 80% of ADHD individuals will respond favorably to the stimulant medications, methylphenidate and amphetamines.  Both of these categories of medications may need trials to assess which is best.  If one stimulant does not work, the others should be tried, for experience has proven that individuals may respond quite differently to each one.  Other alternative medications are available including the non-stimulant medications for ADHD.  Experience has shown that the non-stimulants are not as effective as the stimulants, but they more be better tolerated by some.  Each family and physician must be willing to try different medications in order to determine the best and most effective therapy.  This is the only way to find the appropriate medical treatment.  In some children who have multiple diagnoses such as ADHD and depression, or ADHD and anxiety, or ADHD and Tourette syndrome, combinations of medications are being successfully utilized for treatment.

WHAT IS THE CORRECT DOSAGE?

If stimulant medications work, there is an optimal dose for each individual.  Unfortunately, medical knowledge is not at a point where it can predict what the correct medication or dose will be.  This is not an unusual circumstance in medicine, however.  For a person with diabetes, for example, we must try different forms and amounts of insulin to achieve the best control of blood sugar levels. For people with high blood pressure, there are many medications that can be effective, and often a trial of multiple medications and dosages is necessary to determine the best treatment.  For stimulant medications, there is no magic formula.  The dose cannot be determined by age, body weight or severity of symptoms.  In fact, it appears that the correct dose is extremely individual and is not at all predictable.  Again, similar to people who need glasses, the kind of prescription and the thickness of the lenses are not dependent on any measurable parameter other than what the individuals say enables them to see well.  The dose of medication is determined solely by what ADHD patients need to most effectively reduce their symptoms.  One must be willing to experiment with carefully observed dosage changes to determine the correct dosage.  The appropriate dosage does not seem to change very much with age or growth.  Medication continues to work effectively through the teenage years and through adulthood.

With the non-stimulants, the dosage at the present time is calculated according to weight.  These are the only medications for ADHD for which this is true.

WHAT ABOUT “NATURAL” THERAPIES?

At this time, there is no evidence that natural therapies are therapeutic.  There are many anecdotes about various “magical” cures for ADHD, but none have been found to be valid.  Remember:  multiple anecdotes do not mean proof.     Natural therapies such as grape seed extract, blue algae, biofeedback, magnets, megavitamins, diet, and other “natural products” have not yet shown any lasting therapeutic benefit.  At this time traditional medical therapy is the most effective treatment for ADHD.  This is quite similar to other medical treatments such as insulin, THE best form of treatment for Type 1 diabetes, or thyroid pills THE best therapy for an inactive thyroid gland.  Furthermore, natural health food treatments are not regulated by the government and are therefore highly suspect for contamination.  Please be cautious when experimenting with alternative therapies on your family members.

SUMMARY

Individuals with ADHD present with a variety of well-defined symptoms and behaviors.  Medication may be extremely helpful in alleviating some of these symptoms and will allow the other therapeutic modalities to be much more successful.  Families must be willing to work closely with their physician to identify the correct medications and establish the best dosage levels.

 

 

References:

  1. Dougherty, D.D. Dopamine transporter density in patients with ADHD. Lancet 1999; 354: 2132.
  2. Bradley, C. The behavior of children receiving Benzedrine. Am J Psychiatry 1939; 99: 577-585.
  3. Bradley, C. Benzedrine and Dexedrine in the treatment of children’s behavior disorders. Pediatrics 1950; 5: 24-37.

 

NEXT POST: PART II, AN OVERVIEW OF THE SPECIFIC MEDICATIONS USED TO TREAT ADHD

 

 

Resources:

For an excellent reference book regarding all of the medications that might be used for ADHD  individuals, including not only medications for ADHD but also medications for all of the associated co-morbid conditions, please refer to the following book:

 

STRAIGHT TALK ABOUT PSYCHIATRIC MEDICATIONS FOR KIDS , Revised Edition 2004

by Timothy Wilens M.D.

 

Suggested Reading:

 

  1. DRIVEN TO DISTRACTION  by Ned Hallowell, MD
  2. DAREDEVILS AND DAYDREAMERS by Barbara Ingersoll
  3. UNDERSTANDING GIRLS WITH ADHD by Kathleen Nadeau and Patricia Quinn
  4. UNDERSTANDING WOMAN WITH ADHD by Kathleen Nadeau and Patricia Quinn
  5. TEENAGERS WITH ADHD by Chris Dendy
  6. IS IT YOU, ME OR ADHD by Gina Pera (For couples where one has ADHD and the other does not)

 

0-ted-mandekornAbout the author:

Reprinted with permission of Theodore Mandelkorn, MD, a physician with Puget Sound Behavioral Medicine, a clinic that treats teens, children, and adults with attention deficit disorder and related conditions.  For further information visit the website at http://psbmed.com,  or call 206/275-0702.

 

 

The ADD Journey

Living successfully with ADHD. Help for the road ahead.by Cynthia Hammer, M.S.W.

Stage I: “The Journey Begins” (Discovery and Diagnosis)

Relief: “Finally, an explanation!

For many adults, discovering they have ADD, usually by reading an article, a book or seeing something on television, is a very emotional moment. People at this point in time are usually very excited. They want to talk. They want to tell their story. They want to be understood now that they are starting to understand themselves. Most want to immediately seek a professional diagnosis so they can move forward with treatment.

Stage II: “Wandering in the Wilderness” (Increasing Awareness)

This stage is marked by a variety of feelings and questions.

  • Denial: “How do I know this is a valid disorder?”
  • Flickering Optimism: “Maybe there is hope.”
  • Fear, anxiety, and more anxiety: “What if I follow through with treatment, but nothing changes? All that effort and for what?” Another failure?” “Is medication safe? If I use it, will I have to take it for the rest of my life?”
  • Grief, Anger, and Resentment: “Why wasn’t this diagnosed and treated sooner?”

Stage III: “Up and Over the Mountain Top” (Restructuring)

At this stage, the ADDult no longer puts his energy into “What might have been ….” She moves forward with her life, focusing on what works and minimizing the impact of what does not. Some ADDults go to bed in Stage II and wake up in Stage III. It is hard to predict when or why the transition occurs, but it does, and it feels good! In Stage III, ADDults feel less shame about their disorder. They feel more empowered and more comfortable with telling others about their condition. Stage III involves:

  • Accepting: “I’m ready to let go of the past. I want to get on with my life.”
  • Delegating; Using Strategies and Accommodations: “Could some else more easily do this task?” “What strategies can I use, what accommodations can I request to accomplish my goals?”

Stage IV: “Enjoying the Peaceful Valley”(Self-Acceptance)

Along your journey you have enjoyed the occasional oasis…the moments when you recognize and praise yourself for new behaviors, small accomplishments, and completed tasks. You note where you started and how far you have come. The journey has been difficult, (and often you wanted to quit or turn back), but you realized you were making progress toward your destination. By noting the oases along the way, you confirm for yourself that you are traveling in the right direction, on the right road and keep you nourished for continued travel.

Eventually, you reach a point in your journey when you are traveling light. You no longer carry baggage from your past. You are a seasoned traveler, good at figuring out how to pass through this rough landscape. You are confident in your abilities and strong in your knowledge of having survived. You know your journey will get easier–that you will even start to enjoy it. You continue to journey, but now you travel without needing guides and fellow travelers. You journey down the open road of life, sometimes skipping, sometimes trudging, sometimes limping, but now there is usually a song in your heart, a twinkle in your eye, and a smile on your face. It is good to notice another oasis just ahead. Your journey of life has become the adventure you have always looked for.

Everyone on an ADD JOURNEY needs guides and fellow travelers to show the way and provide support when we weaken and falter. Our guides and fellow travelers provide the six essentials of multi-modal ADD treatment.

  1. Diagnosis
  2. Education
  3. Support
  4. Medication
  5. Counseling
  6. Coaching

Just as the wise backpacker carries the ten essentials when out trekking, the journeying ADDult needs to have the ADD treatment essentials at hand. Whether or not all treatments get used during the journey depends on the traveler. Some need to employ all treatments; others, only a few. Below is a chart showing which Guide or Fellow Traveler is most suitable for each stage of the journey

TREATMENT GUIDE/FELLOW TRAVELER STAGE
Diagnosis Psychologist, Psychiatrist, Counselor or Primary Care Physician I
Education and Support Education and Support Groups Self-education Self-Help Groups Friends and Family I and II,
I and II,
II and III
Medication (and/or Alternative Treatments) Psychiatrist, Primary Care Physician (and/or Alternative Health Care Providers) II, III, and IV
Counseling (and Therapy Groups) Counselor, Psychologist or
Psychiatrist
II and III
Coaching Professional Coach or Coaching Partner III

WHO ARE YOUR GUIDES FOR STAGES I AND II?

Psychiatrists are medical doctors who specialize in helping people with mental health problems. Their training includes medical school and usually a three-year postgraduate residency. One advantage of their training is that it enables them to understand, use, and prescribe medications. With respect to ADHD, this is a definite advantage, since ADD treatment usually includes medication. In addition to psychiatrists, other medical doctors along with physician assistants and some nurse practitioners have prescriptive authority. However, none of them do psychological testing.

Sometimes psychological testing is recommended–not to make the ADD diagnosis–but to gain other information on the person’s functioning. Only psychologists do this kind of testing. So, at times, an adult seeking an ADD diagnosis may see several different professionals. Some adults see several experts for another reason. They cannot find a knowledgeable helper. Sadly, many mental health professionals are not knowledgeable about adult ADD. They may look at it as either a “made up” or an over-diagnosed problem. Since mental health professionals are not used to working with adult ADD patients, it is likely that they may believe another problem is dominant.

Professionals in any field tend to “see” only what they know. If they don’t know or understand something, they can’t see or treat it. For example, the psychologist may see your problem mainly as depression or anxiety (especially if you are a woman), not recognizing the ADD as the underlying concern. How you feel about your life because of your untreated ADD may cause you to be depressed or anxious. ADD may be your primary problem, but other problems may need treatment as well.

In evaluating a mental health professional’s knowledge about ADD in adults, many of the following questions could be asked. Most of these questions could also be asked of ADD counselors and ADD coaches.

  1. Do you accept my insurance? Do you diagnose ADD/ADHD?
  2. How long have you been diagnosing this disorder in adults?
  3. How many ADD/ADHD adults have you diagnosed in the past five years. What percent of your practice has a primary diagnosis of ADD/ ADHD?
  4. How familiar are you with the day to day tribulations of having ADD? (You’re trying to learn if they or someone they are close to has this condition. How intimate is their understanding of ADD on a daily basis?)
  5. What is your treatment philosophy? (Will the clinician work with you and be open to suggestions or will he/she call all the shots. Is their treatment of ADD the same for everyone or is it individually tailored?)
  6. In a subtle way, learn what they do to keep current in their knowledge about adult ADD and its treatment protocols.
  7. How do you make a diagnosis? How many visits will it take and how much will it cost?
  8. How long will I have to wait for an appointment?
  9. Ask psychologists how they handle the medication part of treatment.
  10. Ask physicians (and other medical personnel with prescriptive authority) what medicines they use to treat ADD/ADHD.

YOUR GUIDES FOR STAGES II AND III – Therapists and Coaches

Counselors/Therapists: Often, after being diagnosed with ADD, it is a good idea to find a therapist with you whom you can work. Many times adults with ADD have become so mired in negative feelings about themselves that the first thing they need to do is to face these feelings directly and learn how to let them go. Besides dealing with the ADD symptoms themselves, there may be depression, anxiety, or other problems that need to be addressed.

A good therapist can help you develop practical ways to deal with your daily life based on your own problems and circumstances. You will develop insights into how your ADD symptoms have interacted throughout your life, which is likely to help you understand why your life has taken a certain direction. It is our belief that a good therapist will educate you thoroughly about ADD.

Individual therapy is the most likely choice because most people prefer the privacy of a one-to-one relationship with a mental health professional. In individual therapy you and your therapist talk about your particular problems and develop ways in which you can deal with them more effectively. You will probably see your therapist once each week, although the schedule may later change. Visits usually last about forty-five to fifty minutes. After the initial screening is completed, you and the therapist will spend your visits talking about specific challenges, developing coping strategies, sharing new insights, and whatever concerns are on your mind.

The therapy will vary according to the therapist’s orientation. For example, one therapist may help you listen to your negative thoughts and get you to actively challenge them. This method is central to cognitive therapy. Another therapist may help you develop strategies for actively confronting and, hopefully, overcoming the ADD symptoms that make your life less than optimal. Often you will gain insight as therapy proceeds. You may have misunderstood your ADD and thought that you were just “lazy, crazy, and stupid.” You may have many misconceptions that you built up over the years that you can now interpret in the light of your new understanding of ADD.

This does not in any way release you from doing the necessary work to get your life in order. Yes, you will develop insights. But you will also need to work at developing skills you have never had before.

A good therapist will teach the ADD adult to acknowledge the importance of small steps in making progress. Often people don’t continue along the road of self-improvement because they don’t acknowledge their small steps of Progress. The person with ADD often expects a difficult problem to be solved rapidly. “I want it yesterday.” If it can’t be solved soon, the person gets frustrated and gives up. The adult with ADD who learns the value of taking small but positive steps toward a goal learns a very valuable lesson. The good therapist keeps the client on track and helps the client maintain a positive perspective.

Coaches can be therapists, although coaching is not therapy. Coaches can also be another ADD adult, a friend or someone in your family. ADD coaching focuses on practical issues confronting the ADD adult, such as organization, managing time and setting and reaching goals. Coaching could help ADD adults to develop routines and daily habits which will simplify and make their lives more manageable. Some coaches are very forceful and offer lots of suggestions while others prefer coaches who mostly listen and then offer ideas.

A coaching relationship could last any length of time, but a typical relationship lasts at least six months. Sometimes coaching is done in person, one hour a week. It can be done over the phone, 10-15 minutes a day, or even done through e-mail. Hiring a trained person to be your coach is called professional coaching while getting someone else to work with you is called peer or partner coaching.

A coach works with you to improve your results and your successes. A coach will:

  1. help you set better goals and then reach those goals
  2. ask you to do more than you would have done on your own
  3. get you to focus your efforts better to produce results more quickly
  4. provide you with the tools, support, and structure to accomplish more

How does coaching differ from consulting? …therapy? ….sports coaching? …Having a best friend?

Coaching is a form of consulting as coaches provide advice and expertise in achieving personal change and excellence. However, unlike the consultant who offers advice and leaves, a coach stays to help implement the recommended changes, making sure they really happen and ensuring that the client reaches his goals in a lasting way.

In most therapies, patients or clients work on “issues,” reflect on their past experiences and try to understand the psychodynamic causes of their behaviors. Coaching focuses only on the here and now, looking at the problems in the present needing solutions. In this way, it is like solution-focuses therapy. Coaches work with their clients to gain something, such as new skills, not to lose something, such as unhealthy thought patterns. The focus is on achieving personal and professional goals that give clients the lives they want.

Professional coaching includes several principles from sports coaching, like teamwork, going for the goal, and being your best. Unlike sports coaching, professional coaching is non-competitive. You develop your own way to achieve your goals. There is not one best way to do it. It is not focused on outdoing someone else. It is focused on strengthening the client’s skills, such as a trainer might do.

Having a best friend is always wonderful, but you might not trust your best friend to advise you on the most important aspects of your life and/or business. A best friend might not be able or willing to provide the consistency in monitoring and feedback that coaching demands. The relationship with your coach has some elements of a good friendship in that a close relationship evolves. The coach knows when to be tender or tough with you, is willing to tell you the truth, and keeps your best interests foremost in the relationship.

“A coach is your partner in achieving professional goals, your champion during a turnaround, your trainer in communication and life skills, your sounding board when making choices, your motivator when strong actions are called for, your unconditional support when you take a hit, your mentor in personal development, your co-designer when developing an extraordinary project, your beacon during stormy times, your wake-up call if you don’t hear your own, and most importantly: Your coach is your partner in living the life you know you’re ready for, personally and professionally.” —Thomas Leonard, President of Coach University

People hire coaches because they want more to their life; they want to grow as individuals, and they want to make achieving their goals easier. When using a coach, people take themselves and their goals more seriously. They immediately start taking more effective and focused actions. They stop focusing on thoughts and behaviors that drag them down. They create a forward momentum to their lives and they set better goals for themselves than they would have without a coach.

COACH SELECTION RECOMMENDATIONS

Rapport is very important. Your relationship with your coach is important to your professional and personal growth. The effective coaching relationship is an effective model for all your other relationships: inspiring, supporting, challenging and productive. Choose someone you will be able to relate to very well.

Experience in your field is less important, although knowledge of A.D.D. is important. Coaching technology works for a wide variety of people, professions, and situations. A coach with experience in your personal or professional situation may understand you more quickly. However, much of your work with a coach will involve encouraging you to use and develop your personal skills and your expanding network. Therefore, the specific business experience of your coach is not as important as you might think. Coaching technology works independently of the business or professional environment.

Location is normally not important. While some coaches do offer on-site coaching, it is normally not necessary nor efficient. You will get the same or better results with telephone coaching at a fraction of your investment with on-site coaching.

Interview more than one coach before you decide. Most coaches are happy to speak with you for several minutes in order to get to know you and your situation. You can use this time as an opportunity to gather information and an impression about the coach’s style. Compare two or three coaches and select the one who seems most helpful to you. Trust yourself to know what you need.

Ask the prospective coach good questions. Great coaches are willing to answer your questions directly and forthrightly. Consider asking questions about their depth of experience, qualifications, skills, and practice. For example:

  1. “How many clients have you coached, and how many are presently active clients?”
  2. “What is your specialty and how long have you been practicing in that specialty?”
  3. “What is your knowledge of Attention Deficit Disorder? (expand this to be lots of questions–modify those suggested earlier for evaluating a mental health professional’s knowledge of ADD)”
  4. “How many clients have you had with A.D.D.?” What percentage of your clientele has this diagnosis?”
  5. “What qualifies you to coach people in my situation and how many people with my concerns have you coached?”
  6. “How do you typically work with a client?”
  7. “What are the names and numbers of some of your clients so that I may ask about your coaching?”
  8. “How long do clients usually work with you?”
  9. “What are your fees?”

RESOURCES

Find Treatment and Support for ADHD

Find an ADHD coach

The inspiration for this article and some of the information on the journey, its stages, (stage IV is my addition), guides and fellow travelers came from a self-published booklet, “Coaching Partners,” by Lisa F. Poast

Material on therapy and therapists was adapted from  Do You Have Attention Deficit Disorder? by Lawrence Thomas, Ph.D. It is published by Dell Books

Information on coaching was obtained from the International Coaching Federation.

*About the author

0 1 CynthiaHammerEarlyCynthia Hammer, MSW, ACSW, an adult with ADHD and the parent of three sons, two with ADHD. At age 49, she learned that she had ADHD and realized she knew very little about the disorder. Cynthia founded ADD Resources in 1994 and went on to become a nationally recognized advocate for the understanding of ADHD among both those who have it and those who treated it.  Cynthia is now retired and lives in Tacoma with her husband.

Original Source https://web.archive.org/web/20040207085617/http://www.addresources.org/newsletter_sample.php#journey

(Image courtesy of Stuart Miles/ FreeDigitalPhoto.net) Modified on Canva