When we don’t understand certain things about ADHD, we really don’t understand ADHD.
Or at least we have a cursory understanding, a textbook understanding. We’ve left out the best parts!
I’ve been working with ADHD kids and their parents since 1984, as a teacher, a school counselor, and an ADHD coach. I am also a step-parent with an ADHD adult step-son, and I have many family members with ADHD, including my father and one of my exes.
I’ve watched the misunderstanding of ADHD take its toll on kids, on parents, on adults with ADHD, and even on professionals who don’t really understand ADHD and are made miserable by trying to make this misinformation work.
You’ve seen it too: the teachers that are quite confident that they understand ADHD when you can see that they don’t. Or the doctors that miss co-occurring diagnoses because they aren’t as well versed in mental health issues
Don’t you think it’s time to set the record straight once and for all?
Here are 10 premises that, minimally, people MUST understand about ADHD:
*1. Talking about ADHD as a deficit is not the only, nor the most helpful, way to think about ADHD. The best understanding is comprehensive – it is a biological, mental, and emotional difference. All that being said, I’m grateful for the legal rights that the word “Deficit” provide.
*2. Every time we reach for a “cure” or a way to controlor stop someone’s ADHD, we make the choice to see ADHD as a problem. We don’t need a “cure” for ADHD – ADHD is our genius. Do we need support? Absolutely. But every human, including the coolest, most successful people in the world, needs support.
*3. When we focus on what your child can’t do, your child has to fit our mold to be “good.” When we focus on what your child can do, he/she is “good” most of the time!
Think about it…
*4. The ADHD brain doesn’t work the way a neurotypical brain works. Trying to find conventional solutions for an unconventional mind is pointless. This is often apparent when people confuse executive function challenges with ADHD. Most people with ADHD have executive function challenges. Many people with executive function challenges do not have ADHD. (Whether they’ve been diagnosed or not!)
*5. If on our own, we can’t think of any other solutions to support an ADHD child, we need to get help for ourselves and for the child. This goes for parents, teachers, coaches, doctors, therapists, and anyone else. We can’t settle for “I don’t know what else to do.”
*6. ADHD kids are not trying to make your life miserable. They’re trying to figure out who they are and where they belong, beyond being a member of your family. Until they know that, they’re a bit miserable themselves.
ADHD kids need adults to model adult behavior and to get help when we need help.
*7. Thinking you’re in a power struggle with your ADHD child or teen is completely unhelpful and misguided, no matter what it looks like. Kids don’t know how to effectively access their power. They’re fumbling around not competing with you. You can both have power when you understand that power does not have to be overpowering. The right use of power empowers everyone.
*8. The worst way to reach us is to yell, nag, and lecture. It’s important that, as adults, we communicate more concisely with our ADHD children/clients/students/patients.
*9. People with ADHD are motivated by freedom, fun, interesting ideas, acceptance, and appreciation. Yes, you can get a child to complete a task by threatening or intimidating him or her, but you do a good deal of damage to that child at the same time.
*10. People with ADHD need more than medication. We need a safety net, of which medication may be one of the ropes. (That’s a family decision and every family is different). Other ropes might be: an accountability partner, coaching, exercise, Omega-3s, eliminating certain foods, massage, essential oils, or other alternative modalities. The more ropes, the safer I am.
What are some misunderstandings about ADHD that you think are crucial to making sure your child gets the help he or she needs?
Just scroll down to the comments section and share your experience with us.
Copyright 2017. Yafa Crane Luria. All Rights Reserved. Originally published as “If We Don’t Understand This, We Don’t Understand ADHD” on Blocked to Brilliant.
She was diagnosed with ADHD (then called “Minimal Brain Dysfunction”) in 1980, one of the ﬁrst to be diagnosed as an adult. Yafa specializes in helping ADHD families who have tried everything and are still frustrated by their child’s or teen’s Blocked but Brilliant brain. She can be reached at her website: BlockedtoBrilliant.com Fun fact: Yafa’s nickname as a child was “Mountain Goat” because she climbed on EVERYTHING!
Title photo – (Photo courtesy of satva/FreeDigitalPhoto.net) Modified on Canva.com
Brains with a question (Photo courtesy of Graphics Mouse/FreeDigitalPhoto.net)
Helping hands (Photo courtesy of Graphics Mouse/FreeDigitalPhoto.net)
Welcome. Thanks for inviting me into your inbox. I’m new to having more than a few subscribers, so please bear with me as I try to figure out what you might be most interested in.
If you’re the parent of a child with ADHD, I have a collection of online articles, websites, activities, and videos that your kids might like. It’s been popular in Parent groups on Facebook this week. See my Kids ADHD Page – Things to read, do and watch.
I like Why I Chose to Medicate my Child by Dianne Dempster about how a family that eats organic and prefers holistic treatments for illness came to the decision to try ADHD medication for their son. “I knew that I could always have my son stop taking the medication; but, if he never tried it, I wouldn’t really know if it would help him or not…Ultimately everything comes back to my son.” If you’re considering a stopping medication over the summer break, ADDitude magazine has an article weighing the pros and cons of medication holidays.
For myself, as an adult with bipolar disorder and ADHD, one of my biggest challenges with the greatest reward has been coming to believe and trust in myself. “For many of us, with ADHD or not, there’s an underlying feeling of not being good enough, wanting to be better, wanting to be in better shape or better at things.” Unconditional Acceptance of Yourself by Leo Babauta of Zen Habits addresses that pain, helping to repair that feeling of being unworthy.
Getting the word out on feeling better about having ADHD, Kari Hogan of ADDing to the Mayhem shared 16 Steps to Better Self-Esteem with ADHD that details many non-medical treatments that will improve your daily functioning and make you feel more confident in yourself and more in control of your life.. (These ideas work for kids and teens as well.)
“Your first step is STRUCTURE.
By creating structure, each day, you’re giving yourself a reason to wake up and get out of bed!
The second step echoes the first step. Set up a daily to-do list. This will give you a sense of accomplishment (it gives you a reason to be proud of yourself).
Step 3. FOCUS on your good qualities…”
I have the feeling that this is just TOO much information but hope you will find something that meets your needs.
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.
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.)
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.
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.
Dougherty, D.D. Dopamine transporter density in patients with ADHD. Lancet 1999; 354: 2132.
Bradley, C. The behavior of children receiving Benzedrine. Am J Psychiatry 1939; 99: 577-585.
Bradley, C. Benzedrine and Dexedrine in the treatment of children’s behavior disorders. Pediatrics 1950; 5: 24-37.
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.
DRIVEN TO DISTRACTION by Ned Hallowell, MD
DAREDEVILS AND DAYDREAMERS by Barbara Ingersoll
UNDERSTANDING GIRLS WITH ADHD by Kathleen Nadeau and Patricia Quinn
UNDERSTANDING WOMAN WITH ADHD by Kathleen Nadeau and Patricia Quinn
TEENAGERS WITH ADHD by Chris Dendy
IS IT YOU, ME OR ADHD by Gina Pera (For couples where one has ADHD and the other does not)
About 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.
About 4.4 percent of American adults — 10 million people — have ADHD. And roughly 8 million children have been diagnosed with the disease, making it one the most commonly occurring mental health disorders in the United States.
The rate of co-occurring substance use disorders is high among those with ADHD. Individuals with this diagnosis are 2.5 times more likely to develop a substance use disorder. A study by researchers at Massachusetts General Hospital found that 15 to 25 percent of adults who have a substance use disorder also have ADHD.
For co-occurring ADHD and substance abuse disorders, the best treatment programs combine medical treatment for ADHD, drug detox and therapy that address both disorders. Additionally, proper ADHD treatment during childhood can prevent further development of the disorder that may lead to a substance use disorder during adulthood.
The risk for substance abuse is often higher for people with ADHD. Compared to the general population, people with ADHD are:
Three times more likely to develop a nicotine use disorder
Two times more likely to develop an alcohol use disorder
Two times more likely to develop a cocaine use disorder
5 times more likely to develop a marijuana use disorder
Research shows that those with ADHD may have lower levels of dopamine — the brain chemical responsible for reward-seeking behavior — and turn to substance abuse or other dopamine-releasing behaviors as a result.
Despite the increased risks, those with co-occurring ADHD and substance use disorders are not doomed to struggle with addiction their entire lives. Many rehab centers offer specialized programs for co-occurring disorders that focus on treating the separate disorders concurrently, giving patients a realistic chance of reaching recovery and living a healthy life.
Treatment for Co-Occurring ADHD and Substance Use Disorder
Treatment for co-occurring mental health and substance use disorders is most effective when the disorders are treated simultaneously. Addressing them at the same time is preferred to treating them one at a time, which was the generally held practice in the past.
Medication is the most common form of treatment for ADHD, and with proper use, it can greatly benefit those with co-occurring ADHD and substance use disorders. Stimulant and nonstimulant medications can be effective in treating individuals with ADHD with or without a co-occurring substance use disorder. The most common types of medications used to treat ADHD are stimulants.
A study by researchers at Massachusetts General Hospital examining the results of six long-term studies found that stimulant treatment for ADHD during youth leads to reduced risk of developing a substance use disorder during adolescence and adulthood.
The two most common stimulants used to treat ADHD are methylphenidate and analogs of amphetamine.
Amphetamine medications activate the reward pathway and trigger the release of dopamine in the brain, bringing balance to dopamine levels among those with ADHD. This can help alleviate drug cravings.
According to researchers at Columbia University, clinical trials of Ritalin (methylphenidate) have also been effective in reducing symptoms of ADHD and substance use disorder when combined with relapse prevention therapy. The drug has a relatively low risk of abuse under proper medical supervision.
Methylphenidate has been used for decades to treat ADHD and has shown to be effective for children and adults. Uncontrolled trials of methylphenidate have shown to have a positive impact in reducing symptoms of ADHD and cocaine use disorders, according to researchers at Columbia University.
Some nonstimulant medications can be used to treat ADHD and may present an alternative to stimulants. While stimulants have a higher abuse potential, nonstimulants are often seen as a less effective treatment option.
Atomoxetine is a selective norepinephrine reuptake inhibitor that can be used to treat ADHD. It affects those with ADHD similarly to stimulants, but in a more gradual manner. With no known abuse potential, atomoxetine is an attractive alternative to stimulant medications.
Tricyclic antidepressants have also been used to treat ADHD. However, they are generally less effective than stimulants in treating ADHD.
Problems with Medication Treatment
Research from Massachusetts General Hospital shows medications that are effective in treating adult ADHD may be effective for adults with ADHD and co-occurring substance use disorders, but the medical benefits of the medications are hindered if an individual is actively abusing substances.
Patients may require higher doses in order for a medication to be effective.
The presence of other substances in a patient’s system may make the therapeutic effects of a medication less effective.
Individuals actively engaging in substance abuse are more difficult to treat with medication, with or without a co-occurring disorder.
Alcohol and ADHD Medications
ADHD medications are associated with high risks when used concurrently with alcohol. Adderall is a medication of particular concern because it is commonly abused by college students who participate in binge drinking culture at parties, bars and nightclubs.
Individuals who abuse Adderall and alcohol together find that the depressant alcohol effects are lessened by the stimulant properties of Adderall, allowing them to drink more for longer periods of time.
Abuse of Adderall or other ADHD medications while drinking may cause people to consume hazardous amounts of alcohol. ADHD medications that block the depressant effects of alcohol may cause individuals to ignore signals from their bodies that they have had enough to drink, which can lead to dangerous health concerns such as alcohol poisoning.
It is crucial for people to consult their doctor about alcohol use while taking any type of ADHD medication.
About the Author: Trey Dyer is a writer for DrugRehab.com. Trey is passionate about breaking the stigma associated with drug addiction in the United States. When Trey is not writing, he can be found fly fishing, playing soccer or cooking BBQ.
Adler, L. et al. (2005, March). Long-term, open-label study of the safety and efficacy of atomoxetine in adults with attention-deficit/hyperactivity disorder: an interim analysis. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15766294
Somoza, E. (2004). An open-label pilot study of methylphenidate in the treatment of cocaine dependent patients with adult attention deficit/hyperactivity disorder. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15077842
Wilens, T. et al. (2003, January). Does stimulant therapy of attention-deficit/hyperactivity disorder beget later substance abuse? A meta-analytic review of the literature. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12509574
“Image courtesy of stock photos/FreeDigtalPhoto.net” Modified on Canva
Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood brain disorders and can continue through adolescence and adulthood. Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity (over-activity). These symptoms can make it difficult for a child with ADHD to succeed in school, get along with other children or adults, or finish tasks at home.
Brain imaging studies have revealed that, in youth with ADHD, the brain matures in a normal pattern but is delayed, on average, by about 3 years.1 The delay is most pronounced in brain regions involved in thinking, paying attention, and planning. More recent studies have found that the outermost layer of the brain, the cortex, shows delayed maturation overall,2 and a brain structure important for proper communications between the two halves of the brain shows an abnormal growth pattern.3 These delays and abnormalities may underlie the hallmark symptoms of ADHD and help to explain how the disorder may develop.
Treatments can relieve many symptoms of ADHD, but there is currently no cure for the disorder. With treatment, most people with ADHD can be successful in school and lead productive lives. Researchers are developing more effective treatments and interventions, and using new tools such as brain imaging, to better understand ADHD and to find more effective ways to treat and prevent it.
(Note: I’ve also posted this article as a series of shorter posts. See those here.
Symptoms of ADHD
Inattention, hyperactivity, and impulsivity are the key behaviors of ADHD. It is normal for all children to be inattentive, hyperactive, or impulsive sometimes, but for children with ADHD, these behaviors are more severe and occur more often. To be diagnosed with the disorder, a child must have symptoms for 6 or more months and to a degree that is greater than other children of the same age.
Children who have symptoms of inattention may:
Be easily distracted, miss details, forget things, and frequently switch from one activity to another
Have difficulty focusing on one thing
Become bored with a task after only a few minutes, unless they are doing something enjoyable
Have difficulty focusing attention on organizing and completing a task or learning something new
Have trouble completing or turning in homework assignments, often losing things (e.g., pencils, toys, assignments) needed to complete tasks or activities
Not seem to listen when spoken to
Daydream, become easily confused, and move slowly
Have difficulty processing information as quickly and accurately as others
Struggle to follow instructions.
Children who have symptoms of hyperactivity may:
Fidget and squirm in their seats
Dash around, touching or playing with anything and everything in sight
Have trouble sitting still during dinner, school, and story time
Be constantly in motion
Have difficulty doing quiet tasks or activities.
Children who have symptoms of impulsivity may:
Be very impatient
Blurt out inappropriate comments, show their emotions without restraint, and act without regard for consequences
Have difficulty waiting for things they want or waiting their turns in games
Often interrupt conversations or others’ activities.
ADHD Can Be Mistaken for Other Problems
Parents and teachers can miss the fact that children with symptoms of inattention have ADHD because they are often quiet and less likely to act out. They may sit quietly, seeming to work, but they are often not paying attention to what they are doing. They may get along well with other children, whereas children who have more symptoms of hyperactivity or impulsivity tend to have social problems. But children with the inattentive kind of ADHD are not the only ones whose disorders can be missed. For example, adults may think that children with the hyperactive and impulsive symptoms just have disciplinary problems.
Based on the types of symptoms, three kinds (presentations) of ADHD can occur:
Combined Presentation: if enough symptoms of both criteria inattention and hyperactivity-impulsivity were present for the past 6 months
Predominantly Inattentive Presentation: if enough symptoms of inattention, but not hyperactivity-impulsivity, were present for the past six months
Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of hyperactivity-impulsivity but not inattention were present for the past six months.
Because symptoms can change over time, the presentation may change over time as well.
What causes ADHD?
Scientists are not sure what causes ADHD, although many studies suggest that genes play a large role. Like many other illnesses, ADHD probably results from a combination of factors. In addition to genetics, researchers are looking at possible environmental factors, and are studying how brain injuries, nutrition, and the social environment might contribute to ADHD.
Genes. Inherited from our parents, genes are the “blueprints” for who we are. Results from several international studies of twins show that ADHD often runs in families. Researchers are looking at several genes that may make people more likely to develop the disorder.4,5 Knowing the genes involved may one day help researchers prevent the disorder before symptoms develop. Learning about specific genes could also lead to better treatments.
A study of children with ADHD found that those who carry a particular version of a certain gene have thinner brain tissue in the areas of the brain associated with attention. This research showed that the difference was not permanent, however, and as children with this gene grew up, the brain developed to a normal level of thickness. Their ADHD symptoms also improved.6
Researchers are also studying genetic variations that may or may not be inherited, such as duplications or deletions of a segment of DNA. These “copy number variations” (CNVs) can include many genes. Some CNVs occur more frequently among people with ADHD than in unaffected people, suggesting a possible role in the development of the disorder.7,8
Environmental factors. Studies suggest a potential link between cigarette smoking and alcohol use during pregnancy and ADHD in children.9,10 In addition, preschoolers who are exposed to high levels of lead, which can sometimes be found in plumbing fixtures or paint in old buildings, have a higher risk of developing ADHD.11
Brain injuries. Children who have suffered a brain injury may show some behaviors similar to those of ADHD. However, only a small percentage of children with ADHD have suffered a traumatic brain injury.
Sugar. The idea that refined sugar causes ADHD or makes symptoms worse is popular, but more research discounts this theory than supports it.12 In one study, researchers gave children foods containing either sugar or a sugar substitute every other day. The children who received sugar showed no different behavior or learning capabilities than those who received the sugar substitute.13 Another study in which children were given higher than average amounts of sugar or sugar substitutes showed similar results.14
In another study, children who were considered sugar-sensitive by their mothers were given the sugar substitute aspartame, also known as Nutrasweet. Although all the children got aspartame, half their mothers were told their children were given sugar, and the other half were told their children were given aspartame. The mothers who thought their children had gotten sugar rated them as more hyperactive than the other children and were more critical of their behavior, compared to mothers whothought their children received aspartame.15
Food additives. There is currently no research showing that artificial food coloring causes ADHD. However, a small number of children with ADHD may be sensitive to food dyes, artificial flavors, preservatives, or other food additives. They may experience fewer ADHD symptoms on a diet without additives, but such diets are often difficult to maintain.12,16
How is ADHD diagnosed?
Children mature at different rates and have different personalities, temperaments, and energy levels. Most children get distracted, act impulsively, and struggle to concentrate at one time or another. Sometimes, these normal factors may be mistaken for ADHD. ADHD symptoms usually appear early in life, often between the ages of 3 and 6, and because symptoms vary from person to person, the disorder can be hard to diagnose. Parents may first notice that their child loses interest in things sooner than other children or seems constantly “unfocused” or “out of control.” Often, teachers notice the symptoms first, when a child has trouble following rules, or frequently “spaces out” in the classroom or on the playground.
No single test can diagnose a child as having ADHD. Instead, a licensed health professional needs to gather information about the child, and his or her behavior and environment. A family may want to first talk with the child’s pediatrician. Some pediatricians can assess the child themselves, but many will refer the family to a mental health specialist with experience in childhood brain disorders such as ADHD. The pediatrician or mental health specialist will first try to rule out other possibilities for the symptoms. For example, certain situations, events, or health conditions may cause temporary behaviors in a child that seem like ADHD.
Between them, the referring pediatrician and specialist will determine if a child:
Is experiencing undetected seizures that could be associated with other medical conditions
Has a middle ear infection that is causing hearing problems
Has any undetected hearing or vision problems
Has any medical problems that affect thinking and behavior
Has any learning disabilities
Has anxiety or depression, or other psychiatric problems that might cause ADHD-like symptoms
Has been affected by a significant and sudden change, such as the death of a family member, a divorce, or parent’s job loss.
A specialist will also check school and medical records for clues, to see if the child’s home or school settings appear unusually stressful or disrupted, and gather information from the child’s parents and teachers. Coaches, babysitters, and other adults who know the child well also may be consulted.
The specialist also will ask:
Are the behaviors excessive, and do they affect all aspects of the child’s life?
Do they happen more often in this child compared with the child’s peers?
Are the behaviors a continuous problem or a response to a temporary situation?
Do the behaviors occur in several settings or only in one place, such as the playground, classroom, or home?
The specialist pays close attention to the child’s behavior during different situations. Some situations are highly structured, some have less structure. Others would require the child to keep paying attention. Most children with ADHD are better able to control their behaviors in situations where they are getting individual attention and when they are free to focus on enjoyable activities. These types of situations are less important in the assessment. A child also may be evaluated to see how he or she acts in social situations and may be given tests of intellectual ability and academic achievement to see if he or she has a learning disability.
Finally, after gathering all this information, if the child meets the criteria for ADHD, he or she will be diagnosed with the disorder.
How is ADHD treated?
Currently available treatments aim at reducing the symptoms of ADHD and improving functioning. Treatments include medication, various types of psychotherapy, education and training, or a combination of treatments.
Stimulants such as methylphenidate and amphetamines are the most common type of medication used for treating ADHD. Although it may seem counterintuitive to treat hyperactivity with a stimulant, these medications actually activate brain circuits that support attention and focused behavior, thus reducing hyperactivity. In addition, a few non-stimulant medications, such as atomoxetine, guanfacine, and clonidine, are also available. For many children, ADHD medications reduce hyperactivity and impulsivity and improve their ability to focus, work, and learn. Medications also may improve physical coordination.
However, a one-size-fits-all approach does not apply for all children with ADHD. What works for one child might not work for another. One child might have side effects with a certain medication, while another child may not. Sometimes several different medications or dosages must be tried before finding one that works for a particular child. Any child taking medications must be monitored closely and carefully by caregivers and doctors.
Stimulant medications come in different forms, such as a pill, capsule, liquid, or skin patch. Some medications also come in short-acting, long-acting, or extended release varieties. In each of these varieties, the active ingredient is the same, but it is released differently in the body. Long-acting or extended release forms often allow a child to take the medication just once a day before school, so he or she doesn’t have to make a daily trip to the school nurse for another dose. Parents and doctors should decide together which medication is best for the child and whether the child needs medication only for school hours or for evenings and weekends, too.
For more information about stimulants and other medications used for treating mental disorders, see the booklet, Mental Health Medications, on the National Institute of Mental Health (NIMH) website. The Food and Drug Administration (FDA) website has the latest information on medication approvals, warnings, and patient information guides.
What are the side effects of stimulant medications?
The most commonly reported side effects are decreased appetite, sleep problems, anxiety, and irritability. Some children also report mild stomachaches or headaches. Most side effects are minor and disappear over time or if the dosage level is lowered.
Decreased appetite. Be sure your child eats healthy meals. If this side effect does not go away, talk to your child’s doctor. Also talk to the doctor if you have concerns about your child’s growth or weight gain while he or she is taking this medication.
Sleep problems. If a child cannot fall asleep, the doctor may prescribe a lower dose of the medication or a shorter-acting form. The doctor might also suggest giving the medication earlier in the day, or stopping the afternoon or evening dose. Adding a prescription for a low dose of a blood pressure medication called clonidine sometimes helps with sleep problems. A consistent sleep routine that includes relaxing elements like warm milk, soft music, or quiet activities in dim light, may also help.
Less common side effects. A few children develop sudden, repetitive movements or sounds called tics. Changing the medication dosage may make tics go away. Some children also may have a personality change, such as appearing “flat” or without emotion. Talk with your child’s doctor if you see any of these side effects.
Are stimulant medications safe?
Under medical supervision, stimulant medications are considered safe. Stimulants do not make children with ADHD feel high, although some kids report feeling slightly different or “funny.”
Preschoolers are more sensitive to the side effects of methylphenidate, and some may experience slower than average growth rates. Very young children should be closely monitored while taking ADHD medications.17,18,19
FDA warning on possible rare side effects
In 2007, the FDA required that all makers of ADHD medications develop Patient Medication Guides that contain information about the risks associated with the medications. The guides must alert patients that the medications may lead to possible cardiovascular (heart and blood) or psychiatric problems. The agency undertook this precaution when a review of data suggested that ADHD patients with existing heart conditions had a slightly higher risk of strokes, heart attacks, and/or sudden death when taking the medications. Recently published studies, however, have not found evidence that using stimulants to treat ADHD increases the risk for cardiovascular problems.20,21
The FDA review also found a slight increased risk, about 1 in 1,000, for medication- related psychiatric problems, such as hearing voices, having hallucinations, becoming suspicious for no reason, or becoming manic (an overly high mood), even in patients without a history of psychiatric problems. The FDA recommends that any treatment plan for ADHD include an initial health history, including family history, and examination for existing cardiovascular and psychiatric problems.
One ADHD medication, the non-stimulant atomoxetine (Strattera), carries another warning. Studies show that children and teenagers who take atomoxetine are more likely to have suicidal thoughts than children and teenagers with ADHD who do not take it.22If your child is taking atomoxetine, watch his or her behavior carefully. A child may develop serious symptoms suddenly, so it is important to pay attention to your child’s behavior every day. Ask other people who spend a lot of time with your child to tell you if they notice changes in your child’s behavior. Call a doctor right away if your child shows any unusual behavior. While taking atomoxetine, your child should see a doctor often, especially at the beginning of treatment, and be sure that your child keeps all appointments with his or her doctor.
Do medications cure ADHD?
Current medications do not cure ADHD. Rather, they control the symptoms for as long as they are taken. Medications can help a child pay attention and complete schoolwork. It is not clear, however, whether medications can help children learn better. Adding behavioral therapy, counseling, and practical support can help children with ADHD and their families to better cope with everyday problems. NIMH-funded research has shown that medication works best when treatment is regularly monitored by the prescribing doctor and the dose is adjusted based on the child’s needs.23
Psychotherapy and Parent strategies
Different types of psychotherapy are used for ADHD. Behavioral therapy aims to help a child change his or her behavior. It might involve practical assistance, such as help organizing tasks or completing schoolwork, or working through emotionally difficult events. Behavioral therapy also teaches a child how to monitor his or her own behavior. Learning to give oneself praise or rewards for acting in a desired way, such as controlling anger or thinking before acting, is another goal of behavioral therapy. Parents and teachers also can give positive or negative feedback for certain behaviors. In addition, clear rules, chore lists, and other structured routines can help a child control his or her behavior.
Therapists may teach children social skills, such as how to wait their turn, share toys, ask for help, or respond to teasing. Learning to read facial expressions and the tone of voice in others, and how to respond appropriately can also be part of social skills training.
How can parents help?
Children with ADHD need guidance and understanding from their parents and teachers to reach their full potential and to succeed in school. Before a child is diagnosed, frustration, blame, and anger may have built up within a family. Parents and children may need special help to overcome bad feelings. Mental health professionals can educate parents about ADHD and how it impacts a family. They also will help the child and his or her parents develop new skills, attitudes, and ways of relating to each other.
Parenting skills training helps parents learn how to use a system of rewards and consequences to change a child’s behavior. Parents are taught to give immediate and positive feedback for behaviors they want to encourage, and ignore or redirect behaviors they want to discourage. In some cases, the use of “time-outs” may be used when the child’s behavior gets out of control. In a time-out, the child is removed from the upsetting situation and sits alone for a short time to calm down.
Parents are also encouraged to share a pleasant or relaxing activity with the child, to notice and point out what the child does well, and to praise the child’s strengths and abilities. They may also learn to structure situations in more positive ways. For example, they may restrict the number of playmates to one or two, so that their child does not become overstimulated. Or, if the child has trouble completing tasks, parents can help their child divide large tasks into smaller, more manageable steps. Also, parents may benefit from learning stress-management techniques to increase their own ability to deal with frustration, so that they can respond calmly to their child’s behavior.
Sometimes, the whole family may need therapy. Therapists can help family members find better ways to handle disruptive behaviors and to encourage behavior changes. Finally, support groups help parents and families connect with others who have similar problems and concerns. Groups typically meet regularly to share frustrations and successes, to exchange information about recommended specialists and strategies, and to talk with experts.
Tips to Help Kids Stay Organized and Follow Directions
Schedule. Keep the same routine every day, from wake-up time to bedtime. Include time for homework, outdoor play, and indoor activities. Keep the schedule on the refrigerator or on a bulletin board in the kitchen. Write changes on the schedule as far in advance as possible.
Organize everyday items. Have a place for everything, and keep everything in its place. This includes clothing, backpacks, and toys.
Use homework and notebook organizers. Use organizers for school material and supplies. Stress to your child the importance of writing down assignments and bringing home the necessary books.
Be clear and consistent. Children with ADHD need consistent rules they can understand and follow.
Give praise or rewards when rules are followed. Children with ADHD often receive and expect criticism. Look for good behavior, and praise it.
What conditions can coexist with ADHD?
Some children with ADHD also have other illnesses or conditions. For example, they may have one or more of the following:
A learning disability. A child in preschool with a learning disability may have difficulty understanding certain sounds or words or have problems expressing himself or herself in words. A school-aged child may struggle with reading, spelling, writing, and math.
Oppositional defiant disorder. Kids with this condition, in which a child is overly stubborn or rebellious, often argue with adults and refuse to obey rules.
Conduct disorder. This condition includes behaviors in which the child may lie, steal, fight, or bully others. He or she may destroy property, break into homes, or carry or use weapons. These children or teens are also at a higher risk of using illegal substances. Kids with conduct disorder are at risk of getting into trouble at school or with the police.
Anxiety and depression. Treating ADHD may help to decrease anxiety or some forms of depression.
Bipolar disorder. Some children with ADHD may also have this condition in which extreme mood swings go from mania (an extremely high elevated mood) to depression in short periods of time.
Tourette syndrome. Very few children have this brain disorder, but, among those who do, many also have ADHD. People with Tourette syndrome have nervous tics, which can be evident as repetitive, involuntary movements, such as eye blinks, facial twitches, or grimacing, and/or as vocalizations, such as throat-clearing, snorting, sniffing, or barking out words inappropriately. These behaviors can be controlled with medication, behavioral interventions, or both.
ADHD also may coexist with a sleep disorder, bed-wetting, substance abuse, or other disorders or illnesses. For more information on these disorders, visit the NIMH website.
Recognizing ADHD symptoms and seeking help early will lead to better outcomes for both affected children and their families.
How can I work with my child’s school?
If you think your child has ADHD, or a teacher raises concerns, you may be able to request that the school conduct an evaluation to determine whether he or she qualifies for special education services.
Start by speaking with your child’s teacher, school counselor, or the school’s student support team, to begin an evaluation. Also, each state has a Parent Training and Information Center and a Protection and Advocacy Agency (link works) that can help you get an evaluation. A team of professionals conducts the evaluation using a variety of tools and measures. It will look at all areas related to the child’s disability.
Once your child has been evaluated, he or she has several options, depending on the specific needs. If special education services are needed and your child is eligible under the Individuals with Disabilities Education Act, the school district must develop an “individualized education program” specifically for your child within 30 days.
If your child is considered not eligible for special education services—and not all children with ADHD are eligible—he or she still can get “free appropriate public education,” available to all public-school children with disabilities under Section 504 of the Rehabilitation Act of 1973, regardless of the nature or severity of the disability.
For more information on Section 504, consult the U.S. Department of Education’s Office for Civil Rights, which enforces Section 504 in programs and activities that receive Federal education funds.
Transitions can be difficult. Each school year brings a new teacher and new schoolwork, a change that can be especially hard for a child with ADHD who needs routine and structure. Consider telling the teachers that your child has ADHD when he or she starts school or moves to a new class. Additional support will help your child deal with the transition.
Do teens with ADHD have special needs?
Most children with ADHD continue to have symptoms as they enter adolescence. Some children are not diagnosed with ADHD until they reach adolescence. This is more common among children with predominantly inattentive symptoms because they are not necessarily disruptive at home or in school. In these children, the disorder becomes more apparent as academic demands increase and responsibilities mount. For all teens, these years are challenging. But for teens with ADHD, these years may be especially difficult.
Although hyperactivity tends to decrease as a child ages, teens who continue to be hyperactive may feel restless and try to do too many things at once. They may choose tasks or activities that have a quick payoff, rather than those that take more effort, but provide bigger, delayed rewards. Teens with primarily attention deficits struggle with school and other activities in which they are expected to be more self-reliant.
Teens also become more responsible for their own health decisions. When a child with ADHD is young, parents are more likely to be responsible for ensuring that their child maintains treatment. But when the child reaches adolescence, parents have less control, and those with ADHD may have difficulty sticking with treatment.
To help them stay healthy and provide needed structure, teens with ADHD should be given rules that are clear and easy to understand. Helping them stay focused and organized—such as posting a chart listing household chores and responsibilities with spaces to check off completed items—also may help.
Teens with or without ADHD want to be independent and try new things, and sometimes they will break rules. If your teen breaks rules, your response should be as calm and matter-of-fact as possible. Punishment should be used only rarely. Teens with ADHD often have trouble controlling their impulsivity and tempers can flare. Sometimes, a short time-out can be calming.
If your teen asks for later curfews and use of the car, listen to the request, give reasons for your opinions, and listen to your child’s opinion. Rules should be clear once they are set, but communication, negotiation, and compromise are helpful along the way. Maintaining treatments, such as medication and behavioral or family therapy, also can help with managing your teenager’s ADHD.
What about teens and driving?
Although many teens engage in risky behaviors, those with ADHD, especially untreated ADHD, are more likely to take more risks. In fact, in their first few years of driving, teens with ADHD are involved in nearly four times as many car accidents as those who do not have ADHD. They are also more likely to cause injury in accidents, and they get three times as many speeding tickets as their peers.24
Most states now use a graduated licensing system, in which young drivers, both with and without ADHD, learn about progressively more challenging driving situations.25The licensing system consists of three stages—learner’s permit, during which a licensed adult must always be in the car with the driving teen; intermediate (provisional) license; and full licensure. Parents should make sure that their teens, especially those with ADHD, understand and follow the rules of the road. Repeated driving practice under adult supervision is especially important for teens with ADHD.
Can adults have ADHD?
Some children with ADHD continue to have it as adults. And many adults who have the disorder don’t know it. They may feel that it is impossible to get organized, stick to a job, or remember and keep appointments. Daily tasks such as getting up in the morning, preparing to leave the house for work, arriving at work on time, and being productive on the job can be especially challenging for adults with ADHD.
These adults may have a history of failure at school, problems at work, or difficult or failed relationships. Many have had multiple traffic accidents. Like teens, adults with ADHD may seem restless and may try to do several things at once, most of them unsuccessfully. They also tend to prefer “quick fixes,” rather than taking the steps needed to achieve greater rewards.
How is ADHD diagnosed in adults?
Like children, adults who suspect they have ADHD should be evaluated by a licensed mental health professional. But the professional may need to consider a wider range of symptoms when assessing adults for ADHD because their symptoms tend to be more varied and possibly not as clear cut as symptoms seen in children.
To be diagnosed with the condition, an adult must have ADHD symptoms that began in childhood and continued throughout adulthood.26 Health professionals use certain rating scales to determine if an adult meets the diagnostic criteria for ADHD. The mental health professional also will look at the person’s history of childhood behavior and school experiences, and will interview spouses or partners, parents, close friends, and other associates. The person will also undergo a physical exam and various psychological tests.
For some adults, a diagnosis of ADHD can bring a sense of relief. Adults who have had the disorder since childhood, but who have not been diagnosed, may have developed negative feelings about themselves over the years. Receiving a diagnosis allows them to understand the reasons for their problems, and treatment will allow them to deal with their problems more effectively.
How is ADHD treated in adults?
Much like children with the disorder, adults with ADHD are treated with medication, psychotherapy, or a combination of treatments.
Medications. ADHD medications, including extended-release forms, often are prescribed for adults with ADHD.27
Although not FDA-approved specifically for the treatment of ADHD, antidepressants are sometimes used to treat adults with ADHD. The antidepressant bupropion (Wellbutrin), which affects the brain chemical dopamine, showed benefits for adults with ADHD.28 Older antidepressants, called tricyclics, sometimes are used because they, like stimulants or atomoxetine, affect the brain chemical norepinephrine.
Adult prescriptions for stimulants and other medications require special considerations. For example, adults often require other medications for physical problems, such as diabetes or high blood pressure, or for anxiety and depression. Some of these medications may interact badly with stimulants. An adult with ADHD should discuss potential medication options with his or her doctor. These and other issues must be taken into account when a medication is prescribed.
Education and psychotherapy. A professional counselor or therapist can help an adult with ADHD learn how to organize his or her life with tools such as a large calendar or date book, lists, reminder notes, and by assigning a special place for keys, bills, and paperwork. Large tasks can be broken down into smaller, more manageable steps so that completing each part of the task provides a sense of accomplishment.
Psychotherapy, including cognitive behavioral therapy, also can help change one’s poor self-image by examining the experiences that produced it. The therapist encourages the adult with ADHD to adjust to the life changes that come with treatment, such as thinking before acting, or resisting the urge to take unnecessary risks.
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If you have ADHD and you struggle to fall asleep, you’re not crazy, you’re not being bad and most of all, you’re not alone. Several studies have revealed that people with ADHD are more likely to have irregular circadian rhythms. What’s a circadian rhythm? According to the National Institute of General Medical Sciences, “circadian rhythms are physical, mental and behavioral changes that follow a roughly 24-hour cycle, responding primarily to light and darkness in your environment.”
Are You Out of Sync?
Circadian rhythms are the changes that happen in your body that make you sleepy at night (when it gets dark) and make you want to wake up in the morning as it grows light. As many as 70% of adults with ADHD complain they have difficulty falling asleep, wake up tired (or not at all without enormous effort) and feel out-of-sync with the rest of the world.
If you work independently and don’t need to follow the same schedule as the rest of the population (perhaps you live on a desert island?!), this may not be a problem. (Sounds pretty lonely though!) However, if you must interact with family, friends, peers, customers or anyone else who’s not on the same schedule as you while they’re awake, this can cause problems.
It’s Not Just “Beauty Sleep”
Falling asleep at 1 or 2 AM may not be a problem if you’re a freelancer who answers to no one in real time and you can wake up at 9:30 or 10 AM, but if you have a day job or if customers expect you to answer the phone between 9 AM and 5 PM, you’ll have to cut your sleep short to make it to the office on time. The resulting lack of sleep will affect your ability to focus, your capacity to deal with and manage stress and the functioning of your working memory.
If you’re “tired” of struggling (wink! wink!) luckily, studies show that you can adjust your circadian cycles with a few relatively simple techniques. As someone who has struggled all my life with insomnia, I have tried many of these strategies myself. Here are a few that have the biggest impact.
Humans are like plants; our internal clock is usually set with daylight. When daylight hits your eyes, your brain signals your body to increase your body temperature and starts secreting hormones, like cortisol, to modify the electrical activity in the brain. In the evening, when the light begins to dim, this triggers the production of the sleep-inducing hormone, melatonin. In ADHDers, however, melatonin production is often delayed.
Manage Your Light
If you struggle to fall asleep, start dimming the lights at home as early as right after supper. Stay away from blue-light-emitting sources, like computer screens at least 3 to 4 hours before you need to fall asleep.
Many of my clients with ADHD report dramatically better sleep quality with earlier sleep onset when they engage in cardiovascular exercise (not at bedtime, but during the day!). Cardiovascular exercise is any activity that makes your heart beat faster for at least 20 minutes, such as jogging, taking a brisk walk, moderate biking, aerobics, cross-country skiing, hockey, basketball, skating, etc. Pick one or more sports you enjoy and do at least 20 minutes each day. You’ll find your sleep will come more easily.
Top Up on Melatonin
Studies have shown that supplementing melatonin with light management can advance sleep onset. You can find melatonin supplements at some pharmacies and certainly at health food stores. They work even better when you use them in combination with light management.
Zone into Sleep with Sound Waves
Research shows that the brain is frequency-following, that is, you can train it to fall into a certain brainwave pattern by listening to sounds in that frequency. Our brain regulates our state of wakefulness by changing the amplitude and frequency of brain waves. To fall asleep, we produce Delta waves in lengths of 0.5 to 4 Hz. Some sounds induce our brain to fall into Delta waves. I use the sounds of the ocean and find that it really works for me. My youngest daughter, Kyrie, and ADHDer, had problems falling asleep until we started playing ocean sounds, along with improving her sleep hygiene, at bedtime.
Change Your Mind
Many ADHDers find their thoughts churn at bedtime, which keeps them from falling asleep. By thinking about what happened today or what will happen tomorrow, you’re activating certain hormones that keep you awake. Changing what’s going on in your mind might be as simple as reading stories – not work-related stuff – before bed. If you struggle to put a novel down, read short stories like the ones you’d find in Readers’ Digest.
Do a Mind Dump
If you’re still plagued by concerns over what you have to do, dump all those thoughts in a notebook that you place next to your bed. “Dumping” will help you avoid staying awake because you’re afraid you’ll forget.
ADHDers need to be vigilant about taking care to engage in good sleep hygiene. Lack of sleep DOES NOT CAUSE ADHD; however, lack of sleep can make your symptoms worse, so taking care of your brain and its creative genius by sleeping enough can help reduce your struggles. Everyone, whether or not they have ADHD, needs 7.5 to 9 hours of sleep per night; less sleep than that and you’re not able to tap into your brain’s potential.
If you find that one of these strategies has helped you, or if you have your own approach that works wonders, please share it in the Comments section below.
And have a lifetime of great night’s sleep!
By Linda Walker, PCC, B. Admin. Linda is a certified ADHD Coach who helps adults with ADHD overcome the special challenges of Attention Deficit Disorder (ADHD) they encounter at home and in the workplace. She is the creator of The Maximum Productivity Makeover for Creative Geniuses, a training program for adults with ADHD and the author of With Time to Spare. Coach Linda Walker
“Image courtesy of freelart/FreeDigitalPhotos.net” – Modified on Canva
A series of short articles by Sarah Jane Keyser. Follow the links.
ADD has strengths as well as weaknesses; like heads and tails, you can’t have one without the other.
Attention Deficit 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 ADD – 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 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.
ADD 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 ADD brain can help you value your strengths and structure your life.
Celebrating ADD – Learn to appreciate the passion and sparkle which are the gift of ADD.
Published by Sarah Jane Keyser, Copyright 2006, all rights reserved. Learn more about ADHD at Coaching Key to ADHD
Permission is granted to forward or post this content in full for use in a not-for-profit format, as long as this copyright notice and full information about the author, Sarah Jane Keyser, is attached intact. If any other use is desired, permission in writing is required.
*** 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
The core symptoms of ADHD are hyperactivity, impulsiveness, distractibility and inattention as evidenced by problems organizing, planning, procrastinating, and time management. But doesn’t everybody have these problems? Yes, but for the diagnosis to be applicable, the doctor will consider the severity and duration and the extent to which your problems interfere with the quality of your life. For a diagnosis, you must see a doctor who is knowledgeable in ADHD and related problems. The principle tool for diagnosis is the interview.
Before seeing your doctor, take some quiet time to think about what is really bothering you and write it down. (People with AD/HD often forget the key things to say). If your office looks like the aftermath of a hurricane and you feel depressed, be sure to tell the doctor both facts. You may be depressed because you can’t deal with the office, or your office may be a disaster because you are depressed. Which came first?
“Pills? I don’t take pills!”
Well, you aren’t alone. Many people feel that way. Consider for a moment. Do the pills make you a different person? Is it not you, if you take a pill? Who is the real you?
That person who loses his temper at the slightest excuse,
the nerd who walks past his best friend without saying “Hello”,
the wife who is too tired to clean up the mess and greet hubby with a smile and kiss when he comes home?
Or are you the smiling affable, competent person you know is inside trying to get out?
Let’s go back to our car. Do you expect your car to run without oil or gasoline? Would you drive a car that worked on two or three of its four cylinders? Your brain needs fuel.
Ideally, every brain would produce just the right amount of all the ingredients it needs, but there is no such thing as an ideal brain. Some brains are chronically undersupplied with the chemicals they need to function properly. Clinical trials have shown that medication is the most effective method of dealing with an under functioning brain
There are a number of medications available. Your doctor may need to try more than one, to find the right one for you. He will probably start with a low dose to see if you tolerate it and then increase the dose to find the most effective dosage and timing. So don’t be discouraged if you don’t get a positive result immediately.
When you start taking the medication it would be a good idea to keep a record of the time you take it and any sensations you may feel and the time when they occur. Be sure to tell your doctor about all the effects. Some unpleasant effects like a headache or dizziness may, in fact, be what are called rebound effects which occur when the medication wears off. The problem can often be resolved by changing the timing of the next dose or even by increasing the dosage. Help your doctor to know what’s happening and he can help you to find the best solution for you.
For information about medication, you must see a doctor who has experience with ADHD.
For treatment guidelines and which medications are available, see
A PHYSICIAN’S PERSPECTIVE on ADHD Medications by Theodore Mandelkorn, MD
Editor’s note: Not everyone wants to take medication or is helped by traditional ADHD medications. Nor is medication alone enough. Some type of outside intervention, however, is usually helpful. You may prefer to try cognitive behavior therapy, coaching, diet changes, supplements, mindfulness meditation or any number of holistic or alternative treatments. Many treat their ADHD with a combination of these, searching for the right mix. Please see the Pinterest boards listed below for examples.
An ADHD diagnosis is far more common in males than females. However, many girls are often undiagnosed in childhood and only later in life realize that they, too, fit the diagnostic criteria. This lack of timely diagnosis and treatment has the potential to create far-reaching consequences academically, psychologically and socially, particularly in teenage girls. Why aren’t girls diagnosed with the same frequency as boys? The answer is that ADHD has a tendency to look very different in girls.
ADHD in females is often far more subtle and doesn’t fit neatly into the common stereotypes because girls tend to be less hyperactive and more compliant than boys, making ADHD more difficult to spot. Girls are far more likely to drift along in elementary school and struggle less than boys academically while, at the same time, falling far short of their potential and flying under the radar for referrals. By the middle and high school years, teenage girls often experience more apparent academic and social problems due to the increased demands and pressure to succeed.
What does a teenage girl with ADHD look like? The answer is; it depends on the girl. Some girls with ADHD may, in fact, be hyperactive and drawn to activities that are typically thought of as boyish. They tend to be disorganized, messy, rushers and risk takers, and tend to be viewed as undisciplined and unmotivated academically. Others fit into the daydreamer category. They are often shy and overlooked. Also, although they may appear to being paying attention, their minds are often elsewhere. The diagnosis of ADHD/Inattentive is an easy one to miss. These girls are quiet and not really bothering anyone, although they may be struggling tremendously internally. They tend to be anxious, self-critical and often appear depressed. Another form of ADHD seen in girls is a combination of both the hyperactive and inattentive types of ADHD, although these girls are often more hyper-talkative than hyperactive. Girls with a combined type diagnosis may present as active, excitable and emotional, have difficulty staying quiet in the classroom, interrupt others frequently and jump from topic to topic due to difficulty with organization of their thoughts. They tend to be risk-takers and often fall short of their potential academically.
Interestingly, teenage boys with ADHD tend to externalize their symptoms. They blame others for their poor grades, blame the stupid test they didn’t do well on, they act out and they act up. Boys with AHDH are usually difficult to ignore and are far more likely than girls to get the academic services and accommodations they need to succeed. Teenage girls, however, tend to be internalizers. They are more likely to blame themselves and turn their anger, frustration and pain inward. Without proper diagnosis, an understanding of how their unique brains work and without support for their skill deficits, every failure becomes evidence of their inadequacy. Girls often harbor feelings that they don’t belong, believe they are not smart enough, and view themselves quite simply as not being good enough. The price teenage girls with ADHD pay is far too often that of poor self-esteem, chronic stress, depression, anxiety and a constant feeling of being overwhelmed. These feelings arise from the very nature of the disorder itself; disorganization, poor time management, chronic lateness, difficulty sustaining attention, weak emotional control, distractibility and generally poor executive skills. What do teenage girls with ADHD need to thrive? Knowledge and support. Knowledge becomes power as the true nature of the ADHD diagnosis is revealed and its power to impact all life areas is uncovered. This self-knowledge sets the stage for change and self-advocacy. Support is essential to the successful management of ADHD. Skills need to be developed and turned into habits. Negative mindsets need to be reset. Structure must be created to develop routines. A sense of resiliency and mindfulness must form. And, compassion and understanding must prevail within the self and within the environment. ADHD is different for girls, but while it may be more subtle and not fit the common male stereotype of ADHD, it is no less debilitating and much more emotionally devastating in females.
ADHD is often thought of as a childhood diagnosis that magically disappears in late adolescence. In fact, this disorder, which affects upwards of 10% of the population, often persists into adulthood and typically causes individuals to continue to struggle with core symptoms of impulsivity, inattention, and hyperactivity. Despite this, until the last couple of decades the ADHD Adult diagnosis simply did not exist.
As adults, we often stumble upon our own or our partner’s ADHD diagnosis after one or more of our children is diagnosed with the disorder. As diligent parents, we learn much about ADHD and how it affects our children, many of us finding our own “ah-ha” moment somewhere along this journey. This is hardly surprising given that ADHD is a highly inheritable disorder. It is also not surprising that many adults who were never diagnosed as children continue to remain undiagnosed or misdiagnosed as adults. One reason for this is that adults who have ADHD commonly also have co-existing symptoms of anxiety and depression, which compound the diagnostic difficulty. If after reviewing the common symptoms presented in this article you suspect that you or your partner has undiagnosed ADHD, it is essential to receive a comprehensive ADHD evaluation. The key to effective treatment for ADHD, as with any disorder, is an accurate diagnosis.
Knowledge is Power
Just what is Adult ADHD and how might it be impacting your daily life? First, it is important to know that ADHD, despite what some may believe, is real. ADHD is a neurological disorder. It is not the result of laziness, lack of willpower or a creation of the pharmaceutical industry. The information that follows is intended to present an overview of the common symptoms of Adult ADHD.
Difficulty Concentrating and Staying Focused
Adults with ADHD often have difficulty maintaining focus and are easily distracted. This is the “oooh, look at the shiny ball over there” symptom that derails concentration and causes you to bounce from one activity to another. You may find yourself having difficulty paying attention, zoning out without realizing it, having trouble staying focused while reading, struggling to complete even simple tasks, overlooking details, listening poorly and having a hard time remembering conversations or directions.
Disorganization and Forgetfulness
With Adult ADHD, your life may seem out of control as you struggle to stay on top of daily responsibilities. Staying organized, setting priorities, keeping track of tasks and schedules, managing time effectively and remembering what needs to be accomplished are extremely challenging. You may have poor organizational skills at home or work which is often evidenced by extreme clutter in one’s home, office or car. You may have a tendency to put things off and procrastinate due to difficulties with getting tasks started. You may forget appointments, commitments, or work deadlines. You may constantly misplace things, be chronically late or underestimate the time needed to complete tasks.
This is the “ready, fire, aim” response commonly seen in individuals with ADHD, who may act first, and, think later. Adults with ADHD may interrupt others, act or speak before thinking, blurt out thoughts that are rude or inappropriate, talk excessively loud, have poor self-control, display addictive behaviors, and may behave or drive recklessly without regard for consequences.
Just as it is hard for individuals with ADHD to regulate impulses and attention, it is also often difficult to regulate emotions. Many adults with ADHD have difficulty managing their feelings, particularly when they are angry or frustrated. Often, adults with ADHD have poor self-esteem, deal with frustration poorly, tend to be insecure, have spotty relationships, are easily stressed-out, irritable, hypersensitive to criticism, have short fuses, frequent mood swings, and a pervasive sense of underachievement.
Hyperactivity in childhood often morphs into a sense of inner restlessness in adults. Some adults may still be “driven by a motor” but, for many, the symptoms become subtler. Adults with ADHD may feel agitated, become easily bored, have racing thoughts, trouble sitting still, talk non-stop, crave excitement, and take excessive risks.
The Adult ADHD Impact
Maintaining one’s balance in our complex world can be a challenging balancing act for any adult. As a child, you may have been able to compensate for the symptoms of ADHD, only to find that your symptoms increased as you faced the increasing responsibilities of adulthood. Managing careers, homes, children, spouses and other types of relationships places greater demands on your ability to focus, stay organized and remain calm. The more balls you have in the air, the harder they become to juggle.
The Good News
No matter how challenging the struggles in your life may seem, Adult ADHD can be managed through accurate diagnosis, education and effective treatment. With support, structure and knowledge, it is possible to turn ADHD weaknesses into strengths, longstanding limitations into achievements and dreams into realities. One pathway to success lies in utilizing a coach to guide you through this process. Renowned author, Ned Hallowell, in his groundbreaking book Driven to Distraction “particularly likes the idea of an ADHD Coach…keeping the player focused on the task at hand and offering encouragement along the way…. the coach can stave off habits of procrastination, disorganization, and negative thinking.”
Editor’s note: There are no quick and easy answers with ADHD. Although medication helps, there are no magic pills. Strategies for providing effective treatment abound, but no SINGLE treatment will be enough. Your own needs will be unique and the ideas that you used so effectively one month might not work the next. It will take effort and experimentation to find what works best for you. A good place to start would be 16 Steps to Better Self-Esteem with ADHD by Kari Taylor-Hogan or 6 Steps to Survive ADHD Overwhelm – Learn to Plan Your Day by Sarah Jane Keyser.
According to Russell Barkley, Ph.D., “ADHD is not a problem with knowing what to do, rather it is a problem with DOING what you KNOW— the performance part.” You need someone to remind you of how special you are WHILE they help you put together the to-do lists, planners, and calendars that work for YOU. It’s so good to have someone to keep you accountable and cheer you on while you build routines and habits that will help the days go smoother. That’s where ADHD coaching comes in.