This is the time when most of us reconnect with family and friends and make new goals for the coming year. The problem is that the reality may not live up to our expectations. We may take on too much to prepare, disrupt our own or family routines and forget that self-care comes first. And for the New Year, you may strive hopelessly to meet your goals and abandon them after your first failure.
My best advice is to take care of yourself first, cut your goals in half or more and stop striving for perfection. Aim for peace and progress instead. Don’t give up after your first failure, try again another day without judging yourself. And if you have ADHD or any other physical or mental challenge, it all starts with self-care
I visited my Doctor again this month and found a new poster about living a healthy life. Diet, exercise, and other traditional self-care started the list, but his final advice is to “Love yourself. Only when you love yourself are you able to love others and be worthy of love in return.”
We have three guest post articles this month. Both authors address universal themes and share their work without copyright.
From Leo Babauta, we have Unconditional Acceptance of Yourself which proposes that self-acceptance is a vital aspect of loving yourself. “What if we took a good look at ourselves, our body, our thoughts, our feelings, our actions, and said, “You are perfectly OK. You are perfectly good”? “Acceptance isn’t stagnation — you will change no matter what. You can’t avoid changing. The question is whether that change comes from a place of acceptance and love, or a place of self-dislike and dissatisfaction. I vote for unconditional love.”
Don’t confuse basic self-care with pedicures, bubble baths and time out with your friends or a for settling down with a good book or movie. When just getting out of bed in the morning is difficult, it’s time to admit that “Everything is Awful and I am NOT Okay.” You may have seen this article before, but these “Questions to Ask Before Giving Up” are worth repeating. We should all personalize our own set of questions for getting through the day. Let’s keep our physical and mental health intact and prepared to make it through another day, maybe this time without undue stress.
And don’t assume that having ADHD is a benign nuisance. Depending on the severity of symptoms and the number and type of additional mental disorders, ADHD can be debilitating, even deadly. One of my online coaching groups just lost a member to suicide. Other less shocking behavior also contributes to how well we live and even die.
At the ADHD Conference last month, Russell Barkley, Ph.D. presented research, ADHD and Life Expectancy, that shows that ADHD can even contribute to a lower lifespan – from 8 to 13 years fewer years. ADDitude Mag reports: “Using an actuarial database calculator from the University of Connecticut (UConn), they determined exactly how each risk factor may translate into years of lost longevity. Impaired behavioral inhibition was the primary factor, but several risk factors can be altered, including:
Many of these involve self-care and all too many are problems consistently higher in people with ADHD. It took me years to quit smoking and drinking and to get sleep, and exercise under control. I still struggle with my weight but I’m working on it. Altogether, I am in a much better place than I was before I found out about having ADHD and beginning treatment. With treatment, you too may see positive and life-saving changes occur in your life.
I also found another article from Leo that pertains to my own home situation “Living in Peace with a Packrat.” He answers the question, “I live in a big house with tons of things, mostly my husband’s….Damn shame I adore him so. Any suggestions for finding peace with a pack-rat?”
Once again finding support has proved invaluable in my journey towards wellness. I found a Hoarder’s support group in Tacoma which has helped me stop being permanently angry at my husband for the mess of “stuff” he can neither process nor let go of. With “collectors,” it’s all about understanding what you’re dealing with and setting boundaries that protect your own space.
Another good article for living withsomeone that has “too much stuff” is Space for Everyone Else from Homes are for Living.com. They remind us that, “The person that hoards cannot see the problem. The denial and “clutter blindness” is a HUGE part of THE PROBLEM.”
“Their lack of boundaries causes them to take over the ENTIRE HOUSE. Our lack of boundaries lets them take over the whole place. We desire to keep the peace, so we let them take over.”
If YOU are the one with too much stuff, see my Pinterest board Letting go of Clutter. “Clutter builds up for a number of reasons. Failing to get rid of things that are no longer used or in poor condition is a major one. Yet de-cluttering can be fraught with difficulty. The greater the financial investment and emotional connection to the object, the harder it is to let go.”
Our video this month is This is How you Treat ADHD based on Science also from Russell Barkley provides specific strategies for time and organization management that work. These include creating external scaffolding to support Executive Functions as well as a few behavior modification techniques. Enjoy this 13-minute video as well as some transcribed sections of what Barkley covers.
Hope you are well this season. I especially hope that you have avoided the illnesses that have struck my own family this past month. I have been thrown off-balance for over six weeks. First I cared for my mother, then myself, my husband, and finally helped a friend. Yet I was judging myself and feeling ashamed of what I HAD NOT done when I found peace in a note about priorities that I spied in the Doctor’s office.
This month I am also inspired by two articles dealing with grief and acceptance of ADHD:
Most people have only a vague understanding of what ADHD means. Current DSMV diagnosis standards assume that a lack of attention, distractibility, and hyperactivity are the basic symptoms of ADHD and assign impairment based primarily on those issues.
This avenue of diagnosing ADHD fails to recognize that ADHD is not a deficit of attention, but rather an inability to regulate that attention, an inability to self-regulate, to focus mind and body movement according to the importance of the task. According to William Dodson, M.D, for a child or adult with ADHD, movement toward a future goal is instead “turned on” by an interest-driven brain.
NO amount of remediation is enough to control all the negative effects of ADHD. Instead, we must each define and use our interests, values, and strengths to find that “zone” where we can do our best work. When we can define the “Why” in a project, we are inspired and empowered to meet our own goals. There’s been some speculation that the symptoms of ADHD, themselves, convey certain strengths. Although I am also inspired by such memes as Awesome Qualities of ADHD from Laurie Dupar, I’ve challenged this viewpoint before in Self-Advocacy for ADHD: Know Yourself.
“In 2015, the VIA Institute on Character, in conjunction with the ADD Coach Academy, conducted a research study to identify whether there are indeed specific strengths of people who have been diagnosed with ADHD. (1) Instead, but not surprisingly, the study found that most people with ADHD had shared difficulties in areas related to impulsivity and sustaining attention. Their weakest ”Strengths” were Prudence, Self-regulation [self-control] and Perseverance. Although the qualities of Creativity, Humor, Kindness, and Teamwork did rank slightly higher in people with ADHD, their highest “Character Strengths” were uniquely individual. (2)
What was a revelation, however, was that when individuals worked in accordance with their highest values, their weaknesses proved to be situational. That is, they were far less of a factor in getting things done when interest inspired action. As David Giwerc explains, “When you focus on what ignites your heart and your positive energy, you will always be able to self-regulate.”
We’re lucky to have two articles from LuAnn Pierce, LCSW that explain just a few of the intricacies of diagnosing and treating ADHD.
The first is Adult ADHD: Soft Signs and Related Issues. Don’t be surprised if you didn’t know about these additional signs to look for. Many clinicians lack the knowledge as well due to inadequate training in school or lack of interest in getting additional training later
Hypersensitivity/ Sensory Overload
Overwhelm or Over-stimulation
OCD-like Coping Skills
Rejection Sensitive Dysphoria – Overwhelmed and emotionally devastated by any perceived or real criticism or rejection
LuAnn Pierce also covers a lot of territory in ADHD Success at College and Work. She is in good company when she writes that “ADHD is NOT just for Kids – at a minimum, 50-65% of us continue to have symptoms into adulthood. The symptoms may be to a lesser degree or change a bit, but they are ever-present…”
“Perhaps the most confusing thing about ADHD is that it occurs in some situations but not others.”
The key is creating an environment that allows you to do what you love best and accommodate for those areas where you struggle. There is no cure for ADHD, but there are ways to deal with the worst of its effects. Diet and exercise, creating habits and building routines as well as more specific ideas for college and workplace concerns can help you be to be effective, productive and successful at work:
Creating that space where you can recharge and help your symptoms fade away is the key to managing ADHD. Accepting your unique strengths and challenges is a work in progress for all of us, but there is a lot of good advice in LuAnn’s article. She finishes with these self-help basics:
Do not over-schedule – leave extra time between all tasks and leave 15 minutes early for work, etc.
Work with your symptoms – find a job that fits your skills and create a schedule that fits your sleep patterns.
Stop trying to be perfect – recognize limits and own your mistakes.
Make it okay to be different – celebrate your differences and help others understand your needs and strengths.
If the kids get bored this summer, the ADHD Kids Page has lots of things to do, watch and read.
In the Northwest, we’ve been luckier than others around the country this winter. Although it’s been wet, our mild winter is already yielding to spring. I’m already enjoying the hours of light lengthen each day and watching crocuses and other early bulbs emerge.
Hope good weather arrives soon for you as well.
ADHD in the Family: Working Together for Peace, Love, and Understanding
ADHD impacts everyone in the Family. Understanding the complexity of ADHD and developing strategies for your home and personal life are important steps to coming to accept and deal with challenges.
This month, I have a mix of articles for both parents and adults. The first celebrates keeping peace in the family and love alive in your relationship. Next is an extensive article I’ve been working on detailing the new perspectives on ADHD. If you prefer watching videos to reading, I’ve included a few short clips that further expand on the topic. The final articles offer ideas you can tailor to fit your own needs, like using music to keep on task and decluttering your home and/or office. Hope you find some “treasures” this month.
“What I found most frustrating is that I thought I had no control over anything.”“Once I learned that there were some things I could do to make life with ADHD better for all of us, the building process began and the frustration diminished.” (Note: Duane Gordon is the current President of ADHD for Adults) ADD.org
Attention problems, Hyperactivity and Distraction symptoms for diagnosis in childhood are just the tip of the iceberg. Many aspects of ADHD, especially in adults, are now better defined as developmentally delayed Executive functions and poor emotional control. Coexisting conditions or comorbidities further compound the issue.
This realization has been slowly changing how we understand ADHD and its expression throughout the lifespan. (Article features a number of videos for further information. )
Music helps with many challenges of kids with ADHD. Studying music can teach listening skills, patience and the ability to pick up on cues. Music can not only get one’s brain moving, but it also helps with psychical coordination.
ADHD or Attention Deficit Hyperactive Disorder looks different in adults. This realization has been slowly changing how we understand ADHD and its expression throughout the lifespan.
Inattention, hyperactivity, and impulsivity have long been considered the classic hallmarks of ADHD, but those symptoms change as the brain matures. We once thought that children with ADHD “outgrew” it in their teens. Any lingering problems were dismissed or thought to be better explained by other disorders. However, further research has shown that about 60% to 75% percent of children with ADHD continue to demonstrate symptom persistence and impairment in some area of their adult life. (1) Researchers and other experts on ADHD began to realize that Adult ADHD presented as a much more complex disorder than was reflected by the current diagnostic guidelines for ADHD in children. Furthermore, these discoveries are rewriting our entire perspective on ADHD.
We now realize that the symptom called inattention is better described as Variable Attention. This is true both for children and adults. When a person with ADHD is interested, challenged, or under the right amount pressure, they can indeed focus. Indeed, they may be so involved that they go into hyper-focus and ignore everything else. This explains how kids can spend hours playing Minecraft and other video games, but feel overwhelmed by homework that has no intrinsic reward.
ADHD has long been thought of as neurobehavioral condition but has since been reclassified as a neuro-developmental disorder. —- That is, certain brain structures are up to 10% smaller in someone with ADHD and connections in the brain’s neural network are underdeveloped. (2) New research posits that ADHD is a disorder of self-regulation. That is, the ability to control one’s attention, impulsivity, and emotions, is significantly delayed in the ADHD brain. Research has also shown that although “ADHD is a genetic disorder, DNA is not working alone. Stress, diet, and environmental toxins change the brain as well” according to researcher Joel Nigg, Ph.D., writing for ADDitude Magazine. (3)
The core issue with ADHD is perhaps better described as Executive Dysfunction. These are constructs that describe “problems of a neurobiological nature that particularly affect “planning, flexibility, organization, and self-monitoring.” (4) Getting out the front door on time, being able to find the tools that you need, attending to the work of the day without getting off track, and finishing small tasks that lead to project completion over time are all important skills. This is called self-regulation, the ability to control your attention and take action towards future goals. Russell Barkley, Ph.D. explains this concept well in this 3-minute video.
Most notably, by adulthood, Hyperactivity and Impulsivity are often no longer overtly physical. Instead, they become internalized with age and are better described asEmotional Dyscontrol, a major, albeit often overlooked symptom of ADHD. Emotional dysregulation, as Steven V. Faraone, Ph.D. describes it, is “the failure to modify emotional states in a manner that promotes adaptive behavior and leads to the success of goal-directed activities.” This may involve just feeling impatient and getting frustrated. Or you may be paralyzed by not knowing how to proceed, lose your temper or be so overwhelmed that your ability to get started or to finish a project is short-circuited. In other words, our ability to suppress our emotions or express them appropriately is poor. (5)
For further information, watch this 3 ½ minute video with Dr. Farraone.
It’s important that we acknowledge that ADHD is a complex and highly comorbid disorder. (Comorbidity or co-occurring, means having two or more diagnosable and related conditions at the same time) (6) Indeed, researchers are discovering that ADHD “seldom rides alone.” Studies suggest comorbidity rates of between 50% and 90%. This complex interplay between ADHD and its commonly occurring comorbid psychiatric disorders complicates diagnosing and treating ADHD. (7) “Knowing that ADHD symptoms transform over time, offers researchers and clinicians new opportunities for treating ADHD symptoms and ADHD adults new opportunities for understanding their own gifts and challenges.” (8)
Medication can help. Learning coping skills adds to our bag of treatment ideas – Writing everything down, setting timers, creating habits and routines to help with organization and planning all help. But we’d be remiss if we focused merely on improving our ability to get things done. Too often being productive is the only measure by which we judge a man. But success can come in many forms. Focusing on our inner values and strengths is another way to approach finding our purpose in life.
David Giwirec of the ADD Coach Academy (ADDCA) notes “Who you are and your associated self-worth is not based on how well you do things. Who you are is who you choose to be based on your important, heartfelt, character values and strengths. Learn how to focus on what’s important, so you don’t get emotionally hijacked by the expectations of inconsistent performance.” (9) His 3-minute video explains more.
Ron Kessler, Ph.D. of Harvard and the World Health Organization promoted his presentation comparing ADHD in kids to their behavior of kids with ADHD to adults at the American of Professional Society of ADHD and Related Disorders (APSARD) conference in 2015. I have hit the high points above, but the video is also worth watching. Much of it is presented as slides accompanied by the transcribed interview. If you prefer reading to watching, APSARD offers a full transcription. (9)
***ADHD and Comorbidity: What’s under the tip of the iceberg? by Carol Watkins – I recommend this quite readable exploration of a difficult subject. http://ncpamd.com/add-comorbidity/– Harvested June 13, 2017
ADHD in Children With Comorbid Conditions: Diagnosis, Misdiagnosis, and Keeping Tabs on Both – By Stephen V. Faraone, PhD; Arun R. Kunwar, MD – Medscape (Link works) http://www.medscape.org/viewarticle/555748 Harvested June 13, 2017 – See list of common co-existing conditions below.
Health Risk Behaviors:
Abnormal risk-taking and impulsive behaviors
Risk for injury (what types)
There’s a good Venn Diagram from an article by Joseph Biederman and Stephen Faraone, Harvard Mahoney Neuroscience Institute Letter – Winter 1996 Volume 5 Number 1 – Found at http://ncpamd.com/add-comorbidity/ July 20, 2017 – I wasn’t able to copy it.
I didn’t discover that I had ADHD until my mid-thirties, but the clues had been there. At school, teachers saw a noisy space cadet who failed to wait her turn or stand in line. I struggled in a number of different areas as well, especially writing and homework. “Fails to meet expectations” was always the first comment on my report cards.
College and young adulthood brought additional responsibilities and more opportunities to fail. With marriage and children, my ability to manage my life effectively was marked by dumb mistakes and last-minute efforts that remained incomplete as often as not. None of my earlier “foibles” had been resolved and managing and maintaining a house while keeping myself on track was beyond my ability. I began to search for answers.
Through pure luck, I found a local support group with monthly speakers and a growing library of books, audio, and videotapes. The director of the group, Cynthia Hammer, MSW provided inspiration and help with her handout The ADD Journey: Help for the Road Ahead. Cynthia outlined 4 steps to the process – from first realizing there may be a problem through what holistic treatment for ADHD can do for you or your family. It’s a long article but covers what it means to find success with ADHD quite well.
Discovery and Diagnosis
For many of us, hallmarks of ADHD are Chronic Disorganization of our environment, a lack of awareness of time, and problems with starting and finishing tasks. Medication and other treatments help. For more on that, see A PHYSICIAN’S PERSPECTIVE on ADHD MedicationsbyDr. Ted Mandelcorn.But additional strategies to manage your life effectively are necessary. The rest of the Newsletter provides more specific strategies for restructuring your life and environment. You CAN live a better life with ADHD, but as the saying goes, “Pills don’t teach skills.”
At the age of 62, I’ve tried a number of ideas on how to keep my life and household on track. Some worked, but many were not very useful with ADHD symptoms confusing the issue. My feature article this month is a collection of resources I’ve collected that ARE suited to the way the ADHD mind works.
Manage your Life, House, and Home with ADHD– What I know now that I wish I knew then. –I’ve included ideas for Planning, To-do lists, De-cluttering, Developing Systems, Creating Habits, and building Routines. I’ve also included pertinent Pinterest Boards and a few videos. Many of the ideas, but not all, deal with keeping your house, home and family under control.
You might also like these Unusual ADHD Coping Strategies You Haven’t Tried. It includes 80 ADHD strategies for living a better life with ADHD from ADDitude Magazine readers. Adults and parents devised, modified, and refined these ideas themselves to work for them. They also recommend a few APPs.
Best tips for adults: For Disorganization, impulsive moments, and getting things done.
For parents: Discipline tips, getting teachers on your team, and tips for getting kids to sleep.
APPs 4 U: To do more each day, calm down, and to manage time.
“Too often being productive is the only measure by which we judge a man. But success can come in many forms…. “Who you are and your associated self-worth is not based on how well you do things…Learn how to focus on what’s important, so you don’t get emotionally hijacked by the expectations of inconsistent performance.” ~ ADHD coach David Giwirec
Enjoy ADDA’s TADD Talks (Talking about ADD) They are like TED Talks, only shorter, with presenters from the conference speaking. Two of my favorites each run about 8 to 10-minutes.
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 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 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 1930s, 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, wrongly copied 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 the 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 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’s 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, mega-vitamins, 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