Tuesday, April 26, 2011

Have you told people you know about your ADHD?

I was diagnosed with ADHD as an adult.  I had always suspected there was something not quite right with me, but always chalked it up to character flaws, or just needing to try harder.  When I got the news that I did have ADHD and that it likely was a big part in my life's struggles I wanted to tell the world!  It was a big deal for me!  I knew what the problem was and I could do something about it.  Then reality sunk in a little.  Sure my family was pleased that I was taking steps to treat my ADHD; I mean, I had engaged in completely frustrating behavior for years why wouldn't they be?  The thought occurred to me that maybe I should tell my Boss.  It would explain a lot, and maybe it would help me get back on track at work.  I also thought about telling a few friends, and maybe a couple of people that I'd had some dealings with in the past that had been complicated by ADHD.  But then I heard the phrase that stopped me dead in my tracks: "aren't you just using this as an excuse?".

I hate hearing people say that.  It's a lose-lose question because there's no good answer anyone can give.  If you say it's not an excuse, they reply will be "well, it sounds like you're trying to use it as one anyway", and the other option is that you are using it as an excuse.  People who ask you that question might as well say "there is no excuse for your past mistakes or omissions, and by the way you're making it worse by telling me this."  Implying that someone is using ADHD as a means to deny or avoid responsibility is making a moral judgement about that person.  Adults who have lived with undiagnosed ADHD are ripe for falling into the trap of accepting those moral judgements.  They have damaged self esteem, and they readily accept criticism as legitimate.   I was no different.  I avoided telling anyone outside of my immediate family for quite some time.

I don't have an issue telling people now.  I saw a therapist who helped me to understand that I could accept responsibility for my mistakes without accepting moral condemnation.  I became better at meeting my obligations, and seeing where I have trouble doing so.  I gained insight into who I was, and why some things had gone so wrong in the past.  Finally, I came to the conclusion that the only person's opinion that really mattered was my own.  If I was comfortable with who I was I didn't really care if anyone else outside of my family was.

My suggestion to anyone struggling with this question would be to proceed slowly.  Learn to forgive yourself for any mistakes you have made.  See a qualified therapist if you are struggling with issues related to self esteem or self confidence.  Take pride in the work you are doing to treat your ADHD and the courage you are displaying for taking the first few steps.  Become comfortable with who you are.  When you're ready to tell people you'll know.  It will be as easy as telling someone you wear contact lenses.  And it should be that easy for everyone, but for now we just have to work hard every day to educate the world about ADHD.

Tuesday, April 19, 2011

The key to managing a crisis? Quiet the inner critic.

If you have ADHD you probably have had a number of crisis situations that have been caused by a lack of attention, a lack of timely action, forgetting about an obligation, or a combination of any of these three things.  I use the word crisis because that's what it feels like; we are in a situation that can cause a near panic in some.  It is no coincidence that people with ADHD frequently suffer from anxiety and it's darker sibling depression.  There have been so many instances in people's lives that something has gone wrong that they are always waiting for the other shoe to drop.  One of the problems is that ADHD causes our brains to overload easily.  When faced with three tasks that all seem equally urgent a state of paralysis can set in.  It is not unusual to hear people relating stories of nearly being foreclosed upon not because they couldn't pay their bills, but but because they just didn't.  Their checking account had all kinds of money, but they just couldn't handle sorting through all the paperwork and accounts to figure out what needed to get paid.

I have observed that all people tend to be fairly self critical, or at least most of the people that I come into contact with.  But when you have ADHD you have a wealth of "evidence" to back up some of the self criticism and reinforce it.  "This is just like that time you forgot to mail the tax returns and had to pay penalties", or "can't I do anything right?".  Many times that critical voice inside our head sounds like a stern  parental or authority figure.  We fear that voice, and yet we also desperately want it's approval.  I have written elsewhere that one of the keys to treating ADHD is self forgiveness.  That critical voice in our head is simply us; we want to be a better person, we just don't know how.

Diagnosis can bring a reprieve for some.  For others the voice continues, chastising us for using ADHD as an excuse.  When we are under stress, and a situation arises where we have to take action, the inner voice can hinder us terribly.  It can dredge up old emotions, old failures, and feelings of anxiety.  This is just what we don't need!  To effectively manage all aspects of your life with ADHD you need to quiet the inner critic.  You need to infuse your mind with calm rational thoughts.  Here are some techniques that I use, and also work with my clients on:

1. Breathe.  Take ten deep, slow breaths and count to ten.  Close your eyes while your doing it.  Exhale deeply each time.  Your problems are still there, but you have now calmed yourself to a degree.

2. Get up and move.  Exercise reduces stress and increases focus.  Sometimes during a walk or a run a new thought or approach to a problem will occur to me.  Endorphins released by exercise will help calm you and get your mind to a more productive state.

3. Break it down: problems and personal crises can seem huge and overwhelming.  Break it down into manageable parts.  For example: I have a client that was very worried about finances.  In our conversations "finances" kept coming up as a big issue.  I asked what "finances" meant.  My client was surprised by the question.  We spent the rest of the call breaking down all the pieces that went into their financial situation, and then we formulated a plan: a. balance the checkbook and see how much money there actually is, then b. Sort the bills and see how much you owe.  Happily, my client realized that they had enough money to cover their bills, and was deeply relieved to have gotten rid of the worry about money.

4. Check emotions at the door: this can be a hard one.  Sit down and analyze the situation.  What needs to be done?  What can you do?  What help can you ask for?  What resources are available? Who else is going to be impacted?  Once you have this mapped out the choices can become much more clear.

5. Be willing to accept responsibility for any mistakes you may have made or things you may have forgotten to do.  Then, do what you can to make amends.   I have found people very willing to forgive someone who admits to their errors, and offers to make it up.

Hopefully someone with ADHD is doing their best to better manage their day to day affairs so these crisis points become less frequent.  But if you find yourself in a tight spot tell the inner critic to zip it; you have things to take care of.

Friday, April 15, 2011

The Stigma Persists: Why we need to keep advocating for our kids and ourselves

There have been numerous articles published recently about the FDA's warning that many commonly prescribed medications for ADHD are currently in short supply.  On most news sites people are encouraged to comment on articles, and this can often be a place where you get some lively debate as well as some insight into what the prevailing attitudes are about the subject of the article.  On MSNBC.com, the article about the medication shortage elicited well over a thousand comments.  (You can read the article and the comments by clicking here ).  What the comments revealed to me was that there is still a shocking amount of stigma and ignorance surrounding the diagnosis of ADHD in general, and the use of medications to alleviate the symptoms.

Here's a few choice thoughts from the readers of this article where I have emphasized certain phrases:

"If parents would teach their children how to eat healthy and play outside instead of just eating sugar & caffeine while playing virtual sports, there would be less need for ADD / ADHD drugs. "

"A lot of the ADD/ADHD is liberal pansy teachers, not wanting to deal with healthy active young boys. My son was pretty much a normal active boy, but his teachers pushed until we finally relented and put him on Adderall. WORST mistake we ever made rasiing him."


"While I will not argue that some kids (and adults) truly have ADD/ADHD, I still feel it is the most over-diagnosed "disease" among children. Schools and teachers that do not want to be bothered dealing with a kid who is a little more active label the kid as ADD/ADHD. They then force the parents to medicate the kids. Those that say the school can not force you to medicate your child naive. They give you two choices, either you drug your kid into submission or we will throw him out of the school." (this comment was truncated by me as it was quite long).


Finally my favorite: 


"Did someone say "self control"? Next thing you know they will be saying "personal responsibility".  I thought we abolished those and left all decisions to the state and our behavior to medication.  Maybe I should repost this in a few years. But seriously, you have to learn how to control your mind. You have to be able to be alone with your thoughts. This is basic human stuff.  You have to learn how to focus. Many times these kids are just alot quicker than their parents or their teachers. If they can focus that mental ability, what we call genius emerges.  Medicated focus isn't the same thing.  Obviously, parents were able to control children with these problems long before there was medicine for it.  And despite the massive amounts of medications handed out for this "condition" the problem just keeps expanding every year.  Earlier I read an article about a child who was given one alcoholic drink, one time by accident at an Applebees.  It was considered SO dangerous.  Compared to giving a kid SPEED everyday for life?"
To be fair, there were many comments that were accurate in their description of ADHD and the benefits of medication.  Also to make a full disclosure, I did not read every single comment.  I also deliberately did not show you some of the crazier comments some people made, but they make for an amusing read if you click over to the article. 
The key thing these comments showed me is this:
1. There are still significant numbers of people who don't realize or believe that ADHD is a neurobiological condition that requires treatment.  It is not a failure of parenting or willpower. 
2. There is still a tremendous stigma associated with a diagnosis of ADHD and the use of medication to treat it. 
3.  Those of us in the ADHD community (healthcare providers, therapists, coaches, parents, educators, and researchers) need to continue to educate the public about this condition, and how it's treated.  
Willful ignorance of factual data seems to be in vogue with certain political and religious groups these days; we must be vigilant against allowing uninformed opinion to perpetuate myths and stereotypes about ADHD.  While much progress has been made from the looks of the comments above, much more needs to be done.  

Tuesday, April 12, 2011

Enabling vs. Empowering kids with ADHD: an examination of Jodi Sleeper-Triplett's method

I have the opportunity to meet many different parents and kids doing the kind of work I do.  I also get to see first hand how different people handle different situations that arise in their children's lives.  One of the great challenges for me as a parent has been drawing the line between showing my kids how to do something (and expecting them to do it) or doing it for them.  Last week was my oldest daughter's eighteenth birthday, and as she has been fondly pointing out, she is now an adult.  I am proud of her because she is a hard working responsible kid that my wife and I can rely on to do the things she needs to do.  Not all parents are as lucky as we are.  For those parents who have a child with ADHD it can be a constant source of worry.  How will they manage in the world?  How can they go to college if they can't even find their shoes in the morning?  Today I wanted to talk about the need to empower our children to take responsibility for themselves, and also talk about the methods that are being taught to ADHD coaches by Jodi Sleeper Triplett of the Edge Foundation.

In her book Empowering Youth with ADHD  (you can learn more about the book on Amazon.com by clicking here) Jodi discusses the difference between  enabling someone with ADHD and empowering them.  For example, a student may need extra help with a subject in school.  In order to get that help, an appointment must be made with a student support staff member.  If the student has ADHD they may have a history of procrastinating or forgetting to do things of this nature.  So for the parents, there are two approaches to the situation.

The first would be to assume the student will never make the appointment if left to their own devices.  The Parent steps in and makes the appointment.  Then, the parent assumes the child won't show up for the appointment, so he or she rearranges their schedule, and makes sure the student arrives at the right place at the right time.  The Parent in this situation has sent the following messages: 1. I don't trust you to do anything for yourself, and 2. Don't worry, I'll make sure everything gets done that needs to get done.  This is perfectly fine when the child in question is very young; no one expects a first or second grader to manage this kind of task.  However, when we are discussing a student in High School it is perfectly reasonable to ask them to take more responsibility for their own school work regardless of whether they have ADHD or not.  So how does a parent move away from enabling their child to continue down this path?  Jodi explains that the secret is empowering the student to take action for themselves.

Empowerment looks something like this:  take the same scenario above only this time the parents decide that the student must be responsible for setting and keeping the appointment with the support staff member.  The parents sit down with their son or daughter and ask how they can best support their child in getting this important task completed.  They make it clear that the student is responsible for making the appointment, and for making arrangements to be at the appointment.  They further state that they would like the student to let them know when they have completed these two tasks, and what kind of reminder the student would like them to employ if they have not heard anything by a certain date or time.  Once they have come to an agreement on this the parents must abide by their word and let the student accomplish the task on their own.   There are very different messages being sent here than in the first scenario: 1. I trust you to handle this.  2. You can count on me for support if you need it, and 3. You are the only person accountable for getting things done that impact your life.

What this model teaches is that to enable your child may be the easier path, but in the long run does more harm than good.  To empower someone involves an element of letting go; of being willing to let natural consequences happen regardless of how painful they may be in the short term.  In the long run parents are doing a far greater service to their children by teaching them to take responsibility for themselves and their actions, to accept that they will not always be immediately successful in everything, and to help them develop resilience in the face of obstacles and setbacks.  Too often in our society Parents feel the need to shield their children from the truth that sometimes life is difficult, and that they will suffer disappointments. Empowering our kids with the knowledge that they can roll with the punches and take action for themselves gives them a far greater gift than a few idyllic years free from the cares of the world while they grow up.  Being a good parent involves making tough decisions.  Make the right decision the next time you are faced with an opportunity to empower your son or daughter.

Monday, April 11, 2011

Having an off day? With ADHD it can happen easily.

Are you having an off day where nothing seems to come easily?  Are you finding hared to stay on track or focus on your work even though you've taken your medication?  Do you feel like you're running with lead weights on your ankles? Everyone has an off day from time to time, and for most of people no harm is really done.  You simply say to yourself that it's one day and you'll be back at it tomorrow.  For people with ADHD an off day is a little more complex.

Prior to getting diagnosed you may have felt like every day was an off day, and you had a few really good days sprinkled in.  Once you got the diagnosis though, you could clearly feel the differences made by some of the new strategies you began employing (medication, exercise, better rest, organization, etc.).  So when you have an off day it can feel like a really off day.  You may be struggling to get things done and also getting very frustrated with yourself.  There's a lot that can happen to throw us off our game, and with ADHD it can really be fairly easy to set yourself up for a bad day.  Here are a few red flags to watch out for:

1. Lack of a restful full night's sleep.  The brain and the body need rest to recover and be prepared for the next day.  Not getting enough sleep, or sleeping poorly can really do a number on anyone.  If you have ADHD, you have trouble with focus, maintaining consistency in activities, and other areas of Executive functioning.  Anyone who is overtired has difficulty with this, so it's critical to ensure you're well rested if you have an innate tendency to struggle with Executive Functions anyway.
2. A break in the routine. It has been shown that structure is one of the best things for someone with ADHD.  If you have a plan in place for the week to go food shopping on Monday, and something disrupts that plan, the mind of the person with ADHD has a hard time regrouping and adjusting.  Worse still, once the structure of a plan has been disrupted, it can derail the whole planning process.
3. Changes in your environment. The human mind and body can be very sensitive to changes in the physical world around them, and it doesn't need to be a big change to have an impact.  Having a house guest can make life a little less routine for some, but for someone with ADHD it can really create a situation where distraction is the norm,  Other environmental factors could involve seasonal changes, new activities you or your family are involved in, new colleagues or responsibilities at work, and any other thing which introduces a new wrinkle to your day to day life.
4. Lack of a clear schedule or plan for the day. Do you have a day off and intend to get a lot done around the house?  If you have ADHD and you don't have a plan in place for the day you will not be getting much done.
5. Medication Management hasn't been done for a while.  When was the last time you met with your Doctor to discuss your medication?  have you been taking the same dose for a long time?  Is it still providing the same benefits as it used to?  If you're having a lot of off days, this may be an area to consider looking at.

Off days are inevitable, but they don't need to happen once or twice a week.  Be aware that you need to be proactive if you have ADHD to prevent off days.  Get plenty of rest, be aware of things happening in your daily life that can be disruptive, and make sure you have a plan and a back up plan for the day.  Finally, make an appointment to see your Doctor to discuss your medication if you haven't done that in a while.  Remember that a life is a series of days.  Make the most out of each day and you make the most out of life.

Monday, April 4, 2011

The heart of the matter: PROCRASTINATION!

I do a weekly online radio show with another ADHD coach called "ask the ADHD Coaches",  (if you're interested in hearing any of the shows you can click here for our page on Blog Talk Radio).   Today we were discussing procrastination, and as often happens when you're talking about something the thought occurred to me that I typically experience three different kinds of procrastination.   I wanted to post on the subject and add a little more detail than I had time to do during a fifteen minute podcast.  Most of what I'm going to detail here relates to personal experience, but I'm fairly sure this will resonate with other people with ADHD and those that love them, or are frustrated by them as the case may be.

As anyone with ADHD knows procrastination is the absolute heart of the matter when it comes to the challenges of daily life.  I can think of a thousand examples from my personal life about how procrastination has made my life difficult, angered people I care about, caused me tremendous stress, and has led to what is likely thousands of dollars in money lost to things like late fees, bounced check fees, interest charges, and missed opportunities.  As you can see these are significant impacts.  One of the most vexing aspects of ADHD is impairment of task initiation regardless of how simple that task may seem.  Just because it's easy to go to the video store and return that DVD, doesn't mean it happens when it should.

So what are the three kinds of procrastination?  Let's take a look at each:

1. Procrastination because you don't know how to start: You may be assigned a project at work, or an assignment at school, or may simply need to handle something related to your personal life.  Every time you think about whatever it is you feel lost.  You're not sure what the process is you should follow, and you may not even be sure who to ask.  People with ADHD need structure.  If the directions are vague, the looked for results unclear, or the hoped for end product isn't understood there is an excellent likelihood that whatever thing this is won't get done very well.  Actually, there's a damn good chance it won't get done at all.

2. Procrastination because you don't know where to start: Sometimes an assignment or project is absolutely clear, but the size and scope are overwhelming.  People with ADHD have a hard time planning and prioritizing.  For example, I want to clean out my basement, but every time I go down there, it's such a mess that I can't even begin to work on it.  I just don't have a clue what to do with everything.  This happens to a lot of people.  They know they need to work on a report, and they know the parameters of the assignment, but the scope of it just undermines their ability to plan out a strategy to accomplish the task.

3. Procrastination because you don't know when to start: Time is a very tricky thing for people with ADHD.  We simply have no idea how long something will take, or how much time has passed at any given moment.  You may feel you have all sorts of time to accomplish a home repair project.  Unfortunately, you didn't account for the time it would take to get all the materials, find all your tools, and the fact that your kids have activities you need to drive them too.  You also forgot your in-laws were coming over for dinner.  Suddenly that eight hour window you thought you had dwindled to two hours.  Failing to account for and understand all the demands on our time can lead to starting things far too late, or assuming certain tasks can be accomplished in far less time then they require.

As you can see, procrastination takes many forms.  It's not one thing every time.  I also want to emphasize that it's not because you are lazy, inconsiderate or irresponsible either, but I'm sure plenty of people would like to ascribe it to that.  Procrastination is the end result of difficulties with Executive Functioning in the brain.

My advice: recognize your limitations in terms of time.  If you have been assigned a task, break it down into small manageable pieces with due dates for each.  If the parameters or goals of an assignment are  unclear make sure you have a standard disclaimer about needing specifics in order to achieve good results, and make sure you ask a lot of questions about what will be needed and what resources are available for you.  Finally, keep a day timer or online calendar that notes all of your commitments.  Budget time for travel to and from places.  Schedule appointments to accomplish mundane tasks like laundry.  Finally, find someone you trust who can be your center of accountability for keeping to your plans.  Make sure that person isn't judgmental or angry about it, but let them know that you appreciate them keeping you honest and pointing out when you're getting off track.

Procrastination is tough, and it's going to take some time to  build new habits to combat it.  But, in order to have a better life you have to start doing things differently today.  Now, if you'll excuse me, I need to start on my basement!