Category Archives: Professional

ADHD Grows Up: New perspectives on ADHD

 

ADHD, Executive functions, emotions, and comorbidities.New perspectives on ADHD plus a Video tour

Compiled by Joan Jager

 

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.

ADHD and Executive Function

Most notably, by adulthood, Hyperactivity and Impulsivity are often no longer overtly physical. Instead, they become internalized with age and are better described as Emotional 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.

ADHD and Emotionality: What’s the Connection?

 

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)

Getting diagnosed and treated in adulthood can change lives. This 3-minute video depicts one man’s  Adult ADHD Treatment Success Story.

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.

Cultivating Habits of the Heart

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)

 How ADHD Grew Up as ADHD Kids Grew into ADHD Adults   (11-minutes)

References

  1. Could my Child’s ADHD Symptoms follow Him or her into Adulthood? (60%) (U.S.News & World Report, April 26, 2017)…” (Link works) http://health.usnews.com/health-care/patient-advice/articles/2017-04-26/could-my-childs-adhd-symptoms-follow-him-or-her-into-adulthood Harvested August 31, 2017 – Also see CHADD’s Fact Sheet about ADHD (75%) http://www.chadd.org/Portals/0/Content/CHADD/NRC/Factsheets/aboutADHD.pdf  Numbers have changed over time and can vary by how it is measured. – Harvested October 24, 2017
  1. Is there an ADHD Spectrum? By ADDitude Editors, Janice Rodden, Joel Nigg. Ph.D. https://www.additudemag.com/is-there-an-adhd-spectrum/ Harvested August 31, 2017)
  2. More Than Just Genes: How Environment, Lifestyle, and Stress Impact ADHD by Joel Nigg, Ph.D. ADDitudeMag https://www.additudemag.com/epigenetics-and-adhd-how-environment-impacts-symptoms/ Harvested August 31, 2017
  3. Lazy Kid or Executive Dysfunction –  LD online – http://www.ldonline.org/article/6311 – Harvested June 13, 2017
  4. Emotional Dysregulation and ADHD in Adults by Steven V. Faraone – http://adhdinadults.com/emotional-dysregulation-and-adhd/ – Harvested June 13, 2017
  5. ***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
  6. 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.
  7. YouTube description of Cultivating Habits of the Heart – Harvested June 24, 2107 https://www.youtube.com/watch?v=5LUJv1Wnfbc
  8. YouTube description of How ADHD Grew Up. – Harvested June 13, 2017 https://www.youtube.com/watch?v=KBx9QTtcvC0

Common conditions that often co-exist with AD/HD (10)

Disruptive Behavior Disorders
(CD, ODD)
Learning disabilities
Mood disorders
Tourettes
Tourettes/OCD
Anxiety

Health Risk Behaviors:
Smoking
Abnormal risk-taking and impulsive behaviors
Risk for injury (what types)
Substance abuse
Criminality

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.

10. From ADHD Long-term Outcomes: Comorbidity, Secondary Conditions, and Health Risk Behaviors – Center for Disease Control –  https://www.cdc.gov/ncbddd/adhd/workshops/outcomes.html – Harvested June 13, 2017

Photo Credits:

 

(Title photo from facebook/Credit unknown) Modified on Canva

 

This is How you Treat ADHD with Russell Barkley, Ph.D.

ADHD is the most treatable disorder in psychiatry... The biggest problem is, most people don't get treatment.This is How you Treat ADHD based on Science with Russell Barkley, Ph.D.

How to refuel your Fuel Tank and be less ADHD. Create external scaffolding to support Executive Functions. Behavior modification techniques work for children. Cognitive Behavior Therapy (CBT) or coaching works for adults. Develop specific strategies for time and organization management that work for the individual.

13-minute video from Part 2 of the 2012 Burnett Lecture – Includes slides and lecture on same clip.

“The back and front parts of the brain involve two processes, knowledge and doing. ADHD splits them apart… I don’t care what you know, you won’t be able to do them… You’ve got a real problem on your hands.”

“ADHD is a performance disorder. A disorder of intention, not attention. It’s an executive function disorder (EF)…. It’s time blindness. You won’t be able to aim your behavior toward the future to care for yourself as effectively as other people can…”

“They know what to do. They just can’t do it. It ends up looking like a problem with motivation… The only way to deal with executive deficits is to re-engineer the environment around them to help them show what they know… All treatments must be out there, in their lives, where you have to build that scaffolding…”

“Build that “ramp.” You must reinforce external reminders and consequences. Put them “in the now…”

“EF deficits (Executive Function) are neuro-genetic in origin. Therefore, medications may be essential for most (but not all) cases. Meds are neuro-genetic therapies.”

“ADHD is the diabetes of psychology. It’s a chronic disorder that must be managed every day to prevent the secondary harms it’s going to cause… ADHD is the most treatable disorder in psychiatry… The biggest problem is, most people don’t get treatment.”

 

See links to the complete lecture below the embedded video.

Link back to article: https://addfreesources.net/this-is-how-you-treat-adhd-with-russell-barkley-ph-d/

 

ADHD Video Presentations: 3 Minutes to 1 Hour

0 Video Presentations by ADHD Experts

 

ADHD Experts Speak.

Watch and learn. 

 

 

 

Dr. Russell Barkley on ADHD Meds and how they all work differently (7-minutes)

This is How you Treat ADHD based on Science – Russell Barkley, Ph.D. – 13-minute clip with powerpoint plus access to the entire 2 1/2-hour lecture for the 2012 Burnett Lecture series at Chapel Hill University

Understanding Emotions & Motivations in High School and College Students with ADHD/LDWith Dr. Thomas E. Brown for the 13th Annual Timothy B. and Jane A Burnett Seminar for Academic Achievement (2014) Parts 1, 2 and 3 with Q&A

CADDAC Conference ina BoxCan’t attend an ADHD conference? You can still learn about ADHD from experts in the field. Best of all, you can view them on your own time and for no charge.

*Best of the Web –2009 and 2010 CADDAC Conferences videos- Look under Educational videos to choose the clips that are most applicable to your needs. A wonderful gift from – The Centre for ADD/ADHD Advocacy of Canada- (CADDAC) Choose from a number of presentations filmed over both days.

The 30 Essential Ideas Every Parent Needs to Know (about ADHD),  by Dr. Russell Barkley
This is the 3-hour video presentation from the CADDAC conference (found above), broken up into 27 manageable parts with an average length of 6 to 7 minutes.  It’s  far easier to watch.  To take a saying from Barkley, “Small Chunks, Frequent Breaks.”

ADHD Neurology and Genetic Research 6 short videos with Professor Philip Shaw from NIH (National Institute of Health) DNA Learning center series – Makes difficult concepts more readily understandable.

You, Me and Adult ADD with Gina Pera – 7clips containing Gina’s talk for CADDRA’s 2009 Conference. Find on ADHD Rollercoaster’sYouTube Channel

Classroom Interventions for ADHD Video with Russell Barkley (3 ½ minutes)

TedTalks on ADHD

ADHD: Undiagnosed in Millions, Do You Have it? (4 minutes) Alan Brown gives us a call to action to be advocates to bring awareness and attention to ADHD so individuals do not fall through the cracks and have the safety net they need to succeed.

Dr. Russell Barkley’s Continuing Education Courses and Videos 35 hours of lectures on ADHD at ADHDLectures.coms. Available for Free viewing in Spanish.

Dr. Charles Parker’s ADHD Medication Tutorials (Link works) 8 short videos by Dr. Charles Parker – about a ½ hour in total – Matching Article: Finding the Therapeutic Window *TOP tips – Open a regular dialogue with your patients and measure the effectiveness of the medications. See his YouTube channel (Link works)

 

“Image courtesy of iosphere/FreeDigitalPhoto.net” Poster created on Canva.com

Supplemental Treatment Providers for ADHD

Treatment for ADHD is multi-faceted

Treatment for ADHD is multi-faceted

This article is part of the series: Find Treatment and Support. You may want to start there.

Finding a doctor for diagnosis is only the initial step in managing your ADHD symptoms. The list of additional resources below can help you move forward in your understanding of yourself and the challenges of ADHD. For optimal treatment for ADHD, you may find a need for a variety of professionals from different fields.

See Find Treatment for diagnosis, medical or psychological providers. These include:
Child Psychiatrists, Psychiatrists, Child Psychologists, Clinical Psychologists, Psychologists, General Practitioners, Pediatricians, Neurologists, Behavioral Neurologists, Therapists, Marriage and Family Therapists, Clinical Social Workers, Social Workers and Counselors.

Other types of professionals/services may include ADHD Coaches, Professional Organizers, Support groups, Lawyers, Educational Consultants, Advocates, Information and Parent support organizations, Private Schools, Tutors,  and Residential Treatment Facilities. Professionals with an interest in or specialize in treating ADHD will often list their services in ADHD Directories as well.

Find an ADD Coach or Coach Training

Find an Organizer

Find Support – Make in person or online connections

You may find advocates, tutors, a few coaches, legal help and more here:
Wright’s Law – Yellow Pages for Kids with Disabilities Listings for educational consultants, advocates, advisors, psychologists, diagnosticians, health care specialists, academic tutors, speech/language therapists, and attorneys. You’ll also find government programs, grassroots organizations, disability organizations, legal and advocacy resources, special education schools, and parent support groups. A good resource for finding help for kids, but there’s no sort for ADHD specific providers

Find a Lawyer/ Advocates for IDEA or 504’s – Council of Parent Attorneys and Advocates The Council of Parent Attorneys and Advocates (COPAA) can provide a list of lawyers who specialize in disability rights. Visit their Web site or call in Washington DC 202-544-2210.

Advice on finding an attorney from CHADD’s National ADHD Resource.Center

National Disability Rights Network – (Link works) Every state and territory of the United Sates has an organization designated to provide independent protection and advocacy services to eligible people with developmental and other disabilities and/or mental illness. Cover both school and workplace rights. Services include: Information and Referral, Training and Publications, Legal Representation, System Impact Litigation and Abuse or Neglect Intervention.

Center for Parent Information – Every State has at least one Parent Center that provides information and training to parents of children with disabilities, birth to 26. Find your State’s Parent Center and connect with a world of expertise and resources

LAW HELP – helps low and moderate income people find free legal aid programs in their communities, and answers to questions about their legal rights.

Legal Services Corporation – Government site – Legal Aid programs – Look for Find Legal Aid in the upper right corner of the page

Private Schools and Treatment Facilities

National Association of Private Schools for Exceptional Children (NAPSEC) (Link works)
NAPSEC is a nonprofit association of private special education schools that serve both privately and publicly placed individuals with disabilities. Free referral service.

Note: Many private schools and treatment centers advertise in ADDitude Magazine (Bound version or in their ADHD Directory) as well as in CHADD’s Provider Directory or their Attention 2.0 on-line magazine.

Educational Consultants – Struggling Teens – Directory of educational consultants who specialize in helping parents find appropriate places for children with behavioral and/or emotional problems. When you have a need for specialized placement, they know what’s available and for how much.

In need of intensive care? Oppositional Defiant Disorder or the more severe Conduct Disorder are common comorbidities. Later in life, addictions can be a problem.

Psychology Today’s Facilities Guide – Detailed listings for residential treatment facilities, treatment programs, wilderness programs, therapeutic services and young adult programs

Treatment 4 Addiction – (Link works) Drug Rehab Resource Page contains the SAMHSA (Substance Abuse and Mental Health Services Administration) database, as well as many private treatment centers, therapists, and addiction professionals.

Tutors/ Advocates

You may find tutors and/or advocates listed in an ADHD Directory, but chances are you’ll need to ask for referrals from local groups, do a computer search and or try the phone directories. Again, ask questions about their general experience and specific knowledge of ADHD. (I don’t know of any professional directories for these fields. If you do, please let us know.)

An article with tips on Choosing a tutor for a child with LD. Understood has a collection of articles about tutoring for learning disabilities as well as attention difficulties.

Quick Links:
Find Treatment and Support
Find Support
Finding Mental Health services

For more information, see our Pinterest page on Finding Help and Support

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