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Living Your Best Life with ADHD

Chances are you have heard of the diagnosis of ADHD before. It’s not altogether uncommon to know of someone who is dealing with it. But how much do you really understand about the diagnosis beyond a young child with too much energy?

Even when you look within the medical and mental health community you will find similar confusion. If you ask enough medical and mental health professionals about the diagnosis of ADHD you will soon find, it might be the most misunderstood conditions.

Is it a medical condition? Is it emotional? Attentional? What causes it? It seems like there might be more questions than answers.

Although there are many researchers studying the causes, implications and treatment of ADHD, there remains scant information out there on how it really impacts people. There is further confusion when you consider that there are three variations of the diagnosis. In fact, there’s even debate as to whether adult ADHD even exists (it does, although it does not present the same as childhood presentations).

In many instances, the people who have been diagnosed with ADHD, their families (parents, siblings, spouses), and those who work with them (teachers, supervisors, co-workers) don’t fully know what ADHD is and how to effectively deal with it.

WHAT EXACTLY IS ADHD?

The full neurobiological explanation is far more in-depth than we will delve into here. Instead, we will focus on some of the most important points that people dealing with ADHD (as well as those who live or work with them) should know.

If you look at a brain scan of a child diagnosed with ADHD, you will find that certain parts of the brain (particularly the prefrontal cortex, the area right behind your forehead) are lagging behind in development. While these brain structures are growing in size and strength, they are slightly behind that of their like-aged peers.

For example, it has been described by leading researchers that certain structures of the brain lag about 2 years behind a typically developing brain. So a 16-year-old will have the development in those areas of a typical 14-year-old. As a result, the jobs performed by those parts of the brain are not being done at the level desired or expected. If your high school sophomore has the prefrontal cortex development of a middle schooler, you probably still have the expectations of someone preparing for success in college in two years’ time.

The responsibilities of the brain structures most readily impacted by ADHD are responsible for what are commonly referred to as Executive Functioning. These functions include:

  • Planning complex step-by-step behaviors
  • Goal setting
  • Decision-making
  • Figuring out and engaging in appropriate social behavior
  • Directing thoughts and actions to achieve desired goals
  • Differentiating and deciding between conflicting thoughts
  • Imagining future consequences of actions
  • Creating expectations
  • Predicting outcomes
  • Maintaining attention (especially with competing thoughts and an always-changing world around them)
  • Keeping important information in mind (with new information constantly being thrown at them)
  • Time management
  • Suppressing urges and impulses

It becomes easy to see why tweens and teenagers dealing with ADHD on top of the pressures of growing up can become stressed.

AREAS OF LIFE THAT MAY BE AFFECTED BY ADHD

Because of these deficits, ADHD can influence someone’s schooling, safety awareness, job performance, career development, financial stability, driving skills, self-care, and compliance with societal expectations and rules. It also has implications for someone’s ability to socialize appropriately, family relations, romantic relationships, and involvement in group activities.

What’s more, people with ADHD are more likely to have learning disabilities, anxiety, depression, substance abuse, defiant behaviors, bipolar disorder, eating problems (including binging), Autism, and antisocial tendencies.

THE THREE VARIATIONS OF ADHD

ADHD is way more than a young child who just can’t sit still.

The most commonly known version is the Hyperactive/Impulsive presentation. Some of the characteristics of this type include fidgeting/restlessness, difficulty staying seated, acting as if driven non-stop by a motor, excessive talk, inability to wait for their turn, interrupting inappropriately, and not waiting for permission to do something. This is most likely what comes to mind when you think of someone who has been diagnosed with ADHD.

The Inattentive presentation can be just as impactful as the Hyperactive/Impulsive type. This variation is much more “invisible” than the louder, fidgety variety, therefore leading to frequent misdiagnosis of something else. The most common characteristics for the Inattentive type include careless mistakes, difficulty maintaining focus (with the exception of highly desired or greatly enjoyed activities - think Fortnite or Youtube), mind wandering, incomplete tasks, not following instructions as provided, overlooked details, missed deadlines, poor time management, disorganization/losing track of important items, failing to follow a specified order of actions, difficulty sustaining effort for an expected period of time (again, highly desired activities don’t count here), easy distractibility by thoughts or occurrences in the environment, and forgetfulness (unless it is part of a very well-rehearsed routine). People with ADHD can have one type of these and not the other.

The third type is when someone has both, which is called Combined presentation.

WHAT ADHD IS NOT

In many respects, this is far more important information to review with individuals who have been diagnosed with ADHD and their families.

ADHD is not indicative of someone’s intelligence or potential for success in life. While intelligence is a measure of someone’s academic capability (usually average, if not better), ADHD can affect their ability to reach it. Someone might be very capable of learning, but this is limited if they have to do it in a room with an overwhelming number of people and a lot of distractions. Someone might possess a terrific knowledge base on a particular subject, but be unable to access and use that information based on factors specific to that situation.

ADHD is not laziness. People with ADHD usually do not lack motivation (often, they might not even realize that). It’s all in the follow-through. ADHD affects how well someone can initiate or maintain their action towards a desired goal. They want to do what is expected of them, but something is interfering with their ability to make that first step happen.

ADHD is not intentional. The part of the brain in charge of accomplishing tasks is not at full size or strength. This is not their fault and its important for the people around them not take it personally. ADHD can cause a person to be inconsistent and frustrate the people around them. But with the right gameplan, their true abilities can be unleashed.

ADHD is not a lack of goals. People with ADHD can identify their goals and desires as well as anyone else. Where they may struggle is in formulating and executing the plans they need to accomplish their goals. Again, with the right strategies in place, they are very capable of reaching their goals.

ADHD is not being broken. It means a different style of approaching life is needed for someone to reach their true potential.

FIRST, A WORD ABOUT THE MOST COMMON TREATMENT FOR ADHD

A number of different strategies have been shown to improve outcomes for people living with ADHD. Research has shown that stimulant medication is highly effective. That said, it’s not the only intervention that leads to improvements. However, it does lead to a lot of noticeable improvement when it is the right type and dosage.

MY ADHD TREATMENT APPROACH

What I do to help people (and their families) with their ADHD is teach coping skills, compensation strategies, and environmental/routine hacks necessary to accomplish their goals with or without ADHD medication. I include information regarding what medication treatment can and can not accomplish.

We work together to develop strategies for maximizing someone’s ability to accomplish a number of important life skills, including:

  • Better attentional abilities
  • Improving organization
  • Keeping track of assignments and deadlines
  • Learning unspoken social rules and making adjustments to their actions in different social situations
  • Improving time management
  • Developing helpful routines that enhance someone’s ability to achieve goals
  • Refining real-time decision-making skills
  • Decreasing tendency towards distraction
  • Handling urges/impulsivity
  • Retaining important information
  • Managing hyperactivity/restlessness
  • Fully completing tasks with the appropriate attention to detail

There will be some degree of trial-and-error to find what ultimately works best for you. Most people experience substantial improvement in fulfilling the expectations that others place upon them or those you place upon yourself.

We also work on skills and approaches for addressing the other problems that individuals with ADHD may encounter. These include techniques for effectively dealing with mood (anxiety, depression, anger, frustration, mood swings), relationship difficulties (communication, collaboration, connecting, prioritizing, co-parenting), and improving lifestyle (establishing an exercise routine, decreasing substance use, healthier eating, developing financial responsibility, safer driving).

There are skills and techniques for everything that ADHD affects, by working together closely with your ADHD therapist, you will learn them.

I don’t weigh in as to whether you should or should not take a medicinal approach to treatment. However, I provide individuals and their families with a plethora of information, including pros and cons of medication treatment. This helps people make an informed decision for themselves or their children. My approach to this process is to provide research-based information as you make a decision for your situation.

COMMON ADHD QUESTIONS

The prefrontal cortex’s ability to function improves tremendously in very specific circumstances. Dopamine is a brain chemical (called a neurotransmitter) that helps information go back and forth between neurons in the brain. It is a key component of reward-motivated behavior and plays a role in regulating attention, learning, memory, emotional responses, and body movement. It helps us take action (using all the brain and body’s capacities) to pursue desired outcomes.

When the dopamine is flowing, we accomplish goals and feel pretty good. When it’s not, the opposite is true. With ADHD, the dopamine system is more sluggish than in a typical brain. However, in the ADHD brain, certain things can stimulate dopamine production, like stimulant medication or exercise.

In fact, the dopamine system works quite well in those with ADHD when they are involved in internally-motivating activities. When a person with ADHD is involved in something they love doing, the executive functioning skills improve.

People with ADHD will say that their ability to attend to a task, their capacity for sustaining focus and effort and information processing are heightened when they are involved in activities they are passionate about.

In addition, it has been reported that the ability to process information while in a stressful situation is better for someone with ADHD than without. Some have even disclosed that they feel that chaos has a calming effect on them. Nobody is particularly good at multitasking (contrary to what they may believe), but people with ADHD might actually be better at it than most.

Originally, it was believed that children diagnosed with ADHD would “outgrow” the diagnosis before reaching adulthood. It was thought that it was just a problem that affects children. That it was something people would progress beyond.

That has been shown not to be the case. The data is mixed on what happens to children with ADHD as they get older. In most cases, hyperactivity does decrease as someone ages. However, inattention stays roughly the same. In typically developing people, the prefrontal cortex is fully developed by around age 25. For people with ADHD, it may continue developing for years beyond that.

According to information published by ADHD expert Russell Barkley (“Taking Charge of ADHD: The Complete Authoritative Guide for Parents” and “Taking Charge of Adult ADHD”), roughly half of children diagnosed with ADHD do not meet full criteria as adults. They may still have deficits and issues with attention and other executive functioning skills, but not at diagnostic levels.

Some type of additional assistance (through compensation strategies, coping skills, and/or medication) may still be necessary. Those who still meet diagnostic criteria (in either of the three presentations) will likely need to keep using the strategies and approaches that have been working and perhaps acquire new compensation strategies as they age.

  • Deadlines, keeping up with responsibilities, being organized, interacting with co-workers, dealing with supervisors, prioritizing job tasks, and in-the-moment decision-making may plague adults with ADHD.
  • Distractions like your cell phone texts or the constant barrage of visual information on the road can impair someone’s driving.
  • Being unable to consistently meet someone’s expectations can affect an adult with ADHD’s ability to enjoy healthy relationships (romantic or parenting).
  • Impulsive spending can cause problems for someone who is trying to establish financial independence and security.
  • Self-care can also be impacted, as it is not easy for anyone to develop habits such as regularly going to the gym, avoiding unhealthy foods, going to sleep at a regular time, and getting enough sleep each night.

To get the diagnosis right, which is key for getting the right type of treatment in place, the testing needs to be thorough. It can’t and shouldn’t be done:

  • By an observation or questionnaire alone
  • In a 10-minute conversation
  • Based solely on level of responsiveness to a trial of stimulant medication

There are a number of issues that can result in impaired attention, increased energy level, inappropriate social behaviors, and/or other characteristics that are common with ADHD. An evaluator should get a detailed history that spans numerous settings (looking for ADHD characteristics and clear evidence of impairment in different domains), ask about current self-care behaviors (sleep amount and quality, eating habits, activity level), and assess for intellectual ability, academic achievement, memory, executive functioning, motor skills, emotional struggles, and behavioral difficulties.

School evaluations are rarely thorough enough and districts usually avoid making any kind of definitive diagnosis. Having your child referred to an outside and unbiased neuropsychologist, psychologist, neurologist, or psychiatrist will usually address both these problems. Pediatricians are often unable to take the time and/or possess the specialization needed to deeply dive into mental health issues that can look like or co-occur with ADHD.

There are a number of other diagnoses that may present similarly to ADHD. Disorders like generalized anxiety, depression, OCD, sensory integration, language processing problems, and many others may look like ADHD, but in fact, be something very different. This is why a thorough and detailed evaluation is a must. This evaluation, even as a second opinion, has little downside and can usually be very informative and beneficial.

A FINAL WORD ON ADHD

Life with ADHD is very manageable with the right diagnosis and treatment. It’s important that you or your child receive a proper diagnosis in order for your ADHD psychologist to work with you to find the right treatment. We can work together to ensure you or your child get what you need to live your best life.

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