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from the editors of

ADHD 101

$14.95

Everything you need to know about attention deficit — from symptoms and diagnosis to treatment and life skills

Special Report A trusted source of advice and information for families touched by attention-deficit disorder— and a voice of inspiration to help people with ADHD find success at home, at school, and on the job.

adhdreports.com TERMS OF USE Copyright © 2015 by New Hope Media. All rights reserved. No part of this report may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, faxing, e-mailing, posting online, or by any information storage and retrieval system, without written permission from the Publisher.

Founder: Ellen Kingsley (1951-2007) Editor In chief: Susan Caughman Editor: Wayne Kalyn

staff consulting creative Director: Susan Dazzo consulting art Director: Ron Anteroinen Managing Editor: Eve Gilman

All trademarks and brands referred to herein are the property of their respective owners. All references to ADDitude magazine, ADDitudeMag.com, and ADDConnect.com are trademarks of New Hope Media.

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LEGAL NOTICES ADDitude does not provide medical advice, diagnosis or treatment. The information offered here is for informational purposes only and is not intended to substitute or replace professional medical advice, diagnosis, or treatment. Always consult with your physician or other qualified health-care professional or educational consultant for questions about the health and education of you, your child, and family members. Do not disregard, avoid or delay obtaining medical or health related advice from your health-care professional because of something you have read here. If you think you may have a medical emergency, call your doctor or 911 immediately. ADDitude does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned in ADDitude publications or web sites. Reliance on any information provided by ADDitude is solely at your own risk.

Circulation: Sue Sidler Copy Editor: Gene Jones contributing Editors:

Carol Brady, Ph.D., and John Taylor, Ph.D. (Children) Edward M. Hallowell, M.D. (Life) Sandy Maynard, M.S. (Coaching) Michele Novotni, Ph.D. (Adults) Larry Silver, M.D. (Health) Ann Dolin, M.Ed., and Sandra F. Rief, M.A. (Education) administrative assistant: Madalyn Baldanzi

scientific advisory board Chairman: Larry Silver, M.D. Georgetown University Medical School Washington, DC

Russell Barkley, Ph.D. Medical University of South Carolina Charleston, SC Carol Brady, Ph.D. Baylor College of Medicine Houston, TX Thomas E. Brown, Ph.D. Yale University School of Medicine New Haven, CT William Dodson, M.D. ADHD Treatment Center Denver, CO Edward M. Hallowell, M.D. The Hallowell Center Sudbury, MA

Peter Jaksa, Ph.D. ADD Centers of America Chicago, IL Peter Jensen, M.D. Columbia University College of Physicians and Surgeons New York, NY Harold Koplewicz, M.D. New York University Medical School New York, NY Michele Novotni, Ph.D. Wayne Counseling Center Wayne, PA Roberto Olivardia, Ph.D. Harvard Medical School Boston, MA Patricia Quinn, M.D. National Center for Gender Issues and AD/HD Washington, DC

Introduction

T

his eBook is a comprehensive overview of attention deficit disorder designed for anyone new to the condition — caregivers who suspect ADHD in their children, parents or adults who have just received a diagnosis, educators, significant others, family members, and beyond. It provides the latest information about getting an accurate diagnosis and the important steps you need to take afterward. Preschoolers, elementary school children, kids with ADHD and learning disabilities, adults, and women and girls all have unique concerns and challenges that are addressed in detail here. Our experts will help you make well-informed moves during and after diagnosis. How do ADHD symptoms differ from normal, active childhood behavior? What can you expect if and when you take medication? What about non-drug therapies, like omega-3 fatty acids, a low-sugar diet, and working memory training — do they work? And behavior therapy — how can you use it to encourage good behavior in your child? We spell out the efficacy of each treatment. Many adults use coaching or cognitive behavioral therapy to help them overcome unproductive habits, like forgetfulness or tardiness. Will these approaches work for you? How can an ADHD coach help? You probably have many questions about ADHD — How long does it take to feel different once you start medication? Why does your child find it difficult to fall asleep? How do you know if depression, learning disabilities or some other related condition is playing a part? Dr. Larry Silver, ADDitude’s chief medical advisor, addresses your concerns in straightforward language. Bottom line: You are not alone. Best practices for diagnosing and treating children and adults with ADHD do exist — and this eBook is an excellent place to find them. Sincerely, The ADDitude Editors

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ADHD 101 Contents Chapter One: Myths & Truths About ADHD . . . . . . . . . . . . . . . . . . . . . . 5 Chapter Two: ADHD in Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Diagnosis & Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Choosing ADHD Professionals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 ADHD in Preschool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 The Medication Decision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Chapter Three: ADHD in Adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Post-Diagnosis To-Do List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Conditions Related to ADHD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 ADHD in Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Moving Ahead After Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

Chapter Four: Treatment Options for ADHD . . . . . . . . . . . . . . . . . . . 59 Medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Exercise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Supplements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Brain Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Behavior Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Ask the Doctor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 ADHD Coaching . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84

Chapter Five: Personal Essays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Additional Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105

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Chapter One

7 Myths & Truths About ADHD It’s typically not until you or your child is diagnosed with ADHD, that you realize your friends and family have mistaken beliefs about the condition. Here are seven common myths — and the truths you can use to debunk them. By the ADDitude editors

Myth 1: ADHD isn’t a real medical disorder. ADHD has been recognized as a legitimate diagnosis by major medical, psychological, and educational organizations, including the National Institutes of Health and the U.S. Department of Education. The American Psychiatric Society recognizes ADHD as a medical disorder in its Diagnostic and Statistical Manual of Mental Disorders (DSM-V) — the official mental-health “bible” used by psychologists and psychiatrists in helping to diagnose the condition.

“One size does not fit all and I hope more physicians learn to look at the whole picture instead of trying a method that only pacifies symptoms and does not help an individual learn to manage and cope with them.” — Renee, an ADDitude Reader

Attention-deficit hyperactivity disorder (also known as ADHD) is biologically based. Research shows that it results from an imbalance of chemical messengers, or neurotransmitters, within the brain. Its primary symptoms are inattention, impulsiveness, and, sometimes, hyperactivity. People with ADHD typically have a great deal of difficulty with aspects of daily life, including time management and organizational skills.

Myth 2: ADHD is the result of bad parenting, too much sugar, and too much TV. When a child with ADHD blurts things out or gets out of his seat in class, it’s not because he hasn’t been taught that these behaviors are wrong. It’s because he cannot control his impulses. The problem is rooted in brain chemistry, not discipline. In fact, overly strict parenting practices — which may involve punishing a child for things he can’t control — can actually make ADHD symptoms worse. Professional interventions, such as drug therapy, psycho-

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therapy, and behavior modification therapy, are usually recommended, and required to change these problems. It’s true that the American Academy of Pediatrics (AAP) has urged parents to eliminate all TV viewing for children under age 2 and to limit screen time (including computer use) for older kids to no more than an hour or two a day. However, no research today has shown a direct correlation between TV use and ADHD. In other words, children who watch no TV are no more or less likely to be diagnosed with ADHD than are kids who watch too much TV. The same goes for video games. Overuse of either can lead to attention problems, but not to an ADHD diagnosis, per se. As for sugar, some studies show that consuming refined sugars and food dyes can make children hyperactive due to amped up blood glucose levels. However, there is no scientific proof that sugar actually causes ADHD.

Dig Deeper

Learn more about your child’s rights under the IDEA: http://additu.de/idea

A new study1 by the Yale School of Public Health has found an association between students’ consumption of energy drinks and higher-than-average hyperactivity and inattention — hallmark symptoms of ADHD in children. Energy drinks were linked to a 66% higher risk for these behaviors, compared to a 14% increased risk after consuming other sweetened drinks like soda or juice. Energy drink companies market their products to consumers through highadrenaline sports sponsorships and high-octane ad campaigns, making them tempting for many children. Most experts recommend that children with ADHD cut back on sugary energy drinks to help keep their symptoms under control.

Myth 3: Children who are given special accommodations because of their ADHD have an unfair advantage. The federal Individuals with Disabilities Education Act (IDEA) requires that public schools address the special needs of all children with disabilities, including children with ADHD. Special accommodations, such as extra time on tests, simply level the playing field so that kids with ADHD can learn as successfully as do their non-ADHD classmates.

Myth 4: Children with ADHD eventually outgrow it. More than 70 percent of the individuals who have ADHD in childhood continue to have it in adolescence. Up to 50 percent will retain symptoms into 1. Schwartz, Deborah L., Kathryn Gilstad-Hayden, Amy Carroll-Scott, Stephanie A. Grilo, Catherine Mccaslin, Marlene Schwartz, and Jeannette R. Ickovics. “Energy Drinks and Youth Self-Reported Hyperactivity/Inattention Symptoms.” Academic Pediatrics 15.3 (2015): 297-304. Web.

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adulthood. Though estimates say that six percent of the adult population has ADHD, the majority of those adults remain undiagnosed; only one in four seeks treatment. Yet, without help, adults with ADHD are highly vulnerable to depression, anxiety, substance abuse, and even premature death. They often experience career difficulties, legal and financial problems, and troubled personal relationships when living with undiagnosed and untreated ADHD.

Myth 5: ADHD affects only boys. Girls are just as likely to have ADHD as are boys, and gender makes no difference in the symptoms caused by the disorder. But because this myth persists, boys are more likely to be diagnosed than are girls. This can lead to a lifetime of low self-esteem, anxiety, and depression for girls who have no medical explanation for sometimes debilitating symptoms beyond their control.

Myth 6: Children who take ADHD medication are more likely to abuse drugs as teenagers.

Fact

According to the National Institute of Mental Health, girls’ symptoms of inattentive ADHD are far less likely to be recognized by parents, teachers, and medical professionals than are boys’ symptoms of hyperactive ADHD.

Actually, the opposite is true. Living with untreated ADHD increases the risk that an individual will abuse drugs or alcohol. Appropriate treatment reduces this risk of self-medication. The medications used to treat ADHD have been proven safe and effective over more than 50 years of use. These drugs don’t cure ADHD, but they are highly effective at easing symptoms of the disorder. The drugs do not turn kids into addicts or “zombies.”

Myth 7: People who have ADHD are stupid or lazy — they never amount to anything. People with ADHD are often of above-average intelligence, according to recent studies. They certainly aren’t lazy. In fact, many well-known, highachieving historical figures are thought to have had ADHD, including Mozart, Benjamin Franklin, Abraham Lincoln, George Bernard Shaw, and Salvador Dali. The list of high-achieving ADHDers in business today includes top executives, such as David Neeleman, founder of JetBlue Airways, and Paul Orfalea, founder of Kinko’s.

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Chapter Two

ADHD in Children How Common is ADHD? For as long as ADHD has been recognized by the medical community, the rate at which it occurs in children has been disputed, ranging from as low as 3 percent to as high as 14 percent. The conflicting numbers confuse parents, patients, and doctors, who struggle to determine if the condition is overdiagnosed — and over-medicated — or under-diagnosed. A recent study1 published in Pediatrics claims to have identified a benchmark estimate for the worldwide rate of ADHD in children. The study’s authors analyzed data from 175 studies from around the world to reach their overall estimate: Approximately 7.2 percent of children worldwide have ADHD. “Providing an accurate diagnosis is arguably the single most important thing a clinician can do for a patient,” the researchers said. By using this rate as a benchmark, medical professionals can begin to determine if over- or underdiagnosis of ADHD has occurred in their community.

ADHD Worldwide

“There is no convincing difference between the prevalence of (ADHD) in the USA and most other countries or cultures.” — World Psychiatry, June 2003 http://additu.de/global

What Are the Symptoms of ADHD? Doctors diagnose ADHD according to detailed criteria spelled out in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. (DSM-V).2 In its entry on ADHD, the DSM-V lists nine symptoms that suggest inattention and nine that suggest hyperactivity/impulsivity in children: 1. Thomas, R., S. Sanders, J. Doust, E. Beller, and P. Glasziou. “Prevalence of Attention-Deficit/ Hyperactivity Disorder: A Systematic Review and Meta-analysis.” Pediatrics 135.4 (2015): n. pag. Web. 2. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Arlington, VA., American Psychiatric Association, 2013.

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Inattention

1. Fails to give close attention to details or makes careless mistakes 2. Has difficulty sustaining attention 3. Seems not to listen when spoken to 4. Has trouble following through on instructions or finishing tasks 5. Has difficulty organizing tasks and activities 6. Is reluctant to engage in tasks that require sustained mental effort 7. Often loses things 8. Is easily distracted 9. Is forgetful in daily activities

ADHD Mama

For more on the challenges of parenting a child with ADHD, read the heartfelt memoir Boy Without Instructions by ADDitude blogger Penny Williams.

Hyperactivity/Impulsivity

1. Fidgets with hands or feet, or squirms in seat 2. Leaves seat in classroom 3. Runs about or climbs excessively 4. Has difficulty playing quietly 5. Often seems “on the go” or acts as if “driven by a motor” 6. Talks excessively 7. Blurts out answers before questions have been completed 8. Has trouble taking turns 9. Interrupts or intrudes on others

Almost every child will exhibit one or more of these symptoms at some point. A child should be diagnosed with ADHD only if he or she exhibits at least six symptoms from one or both of the lists above, and if the symptoms have been noticeable for at least six months in two or more settings — for example, at home and at school. What’s more, the symptoms must significantly impair the child’s functioning, and at least some of the symptoms must have been apparent before age 12. Anyone evaluated after age 17 need only exhibit five of the symptoms above before age 12 to meet the DSM-V criteria for an ADHD diagnosis.

Supplemental Resource

To learn more about the 9 conditions most commonly diagnosed alongside ADHD, visit http://additu.de/ebook4

A child can meet all the diagnostic criteria for ADHD without actually having the disorder. Perhaps she is just unusually “spirited.” Maybe he isn’t eating right, or getting enough exercise. Another possibility, of course, is that

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the child doesn’t have ADHD at all — but is affected by one or more “lookalike” conditions. Physical conditions (such as pinworms, hearing loss, or an allergy) or another medical disorder (such as auditory processing disorder, sensory integration disorder, bipolar disorder, or depression) can present symptoms that look a lot like those of ADHD.

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Diagnosing and Treating ADHD in Children How children are diagnosed with and treated for attention deficit disorder. By Natalie Engler

Imagine a child whose ADHD has been diagnosed and who is getting appropriate treatment. His symptoms are under control, and he’s doing reasonably well, socially and academically. Let’s call this “Point B.” Now imagine the same child before receiving a diagnosis. He’s getting in trouble at home and falling behind at school. Let’s call this “Point A.” How do you get from A to B? There’s no definitive diagnostic test for ADHD — no blood analysis, no brain scan, no genetic screen — so it’s not easy to tell whether a child has the disorder or perhaps a related condition. And doctors vary in their abilities to recognize, diagnose, and treat the disorder, so it’s easy to go down blind alleys before getting the help your child needs. The good news is that, if you take matters step by step, as outlined below, you can avoid the pitfalls — and make it to Point B more smoothly than you might have imagined possible.

Recommended Reading

Worried about your child’s future after he’s diagnosed with ADHD? Check out Square Peg, an uplifting memoir about how perseverance, innovation, and out-of-the-box thinking can help kids with ADHD thrive.

The “Aha” Moment

The ADHD journey inevitably begins with the “Aha” moment when it dawns on you that your child’s problems may be caused by ADHD, learning disabilities or another related condition. For some parents, this moment comes when a teacher calls to say that the child is disruptive in class or falling behind academically. For others, it comes after they read an article about ADHD or see something about it on TV — or talk to another parent whose child has been diagnosed with the disorder. Whatever triggers your “Aha” moment, seek help at once. Without a prompt diagnosis, a child with ADHD risks being branded “slow” or “lazy” (or worse). Such labels undermine self-esteem and can lead to years of perceived underachievement and family turmoil. But don’t panic. With an appropriate diagnosis and treatment, ADHD children can do well — and go on to become successful adults. Jennifer Haus, of Clinton, Mississippi, knew that her young son’s shoe-tossing, bookcase-toppling meltdowns weren’t normal. But friends and family members repeatedly told her that Mitchell’s tantrums resulted from poor discipline. She tried time-outs, reward charts, withdrawal of privileges — nothing worked. Then, one day Mitchell came home from school crying. He

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said that he felt “different” from his classmates. “That,” Haus recalls, “is when I called his pediatrician.”

Consulting the Doctor

After your “Aha” moment, your first impulse may be to consult your child’s pediatrician. That makes sense. “Most pediatricians are comfortable diagnosing and treating ADHD,” says Larry Silver, M.D., clinical professor of psychiatry at Georgetown University Medical School in Washington, D.C. “Usually, that’s the only medical professional you need.” Still, just because your pediatrician feels comfortable doesn’t mean you should. Before agreeing to have your child treated, “ask how many other cases of ADHD the doctor has treated, and what the plans and outcomes were,” says Russell Barkley, Ph.D., research professor of psychiatry at SUNY Upstate Medical University in Syracuse, New York. If the doctor has handled only a few cases, you might be better off going to a developmental pediatrician, a child psychiatrist, or another specialist who has significant experience with ADHD. “Regardless of how experienced your pediatrician is,” says Barkley, “you should strongly consider a medical specialist if your child’s ADHD is accompanied by another diagnosed disorder, such as oppositional defiant disorder, depression, anxiety, bipolar disorder, or learning disabilities — or if there are urgent issues involved, such as your child’s hurting himself or getting kicked out of school.” Your pediatrician or health insurer can probably steer you to a specialist. If not, contact your local chapter of Children and Adults with Attention-Deficit/ Hyperactivity Disorder (CHADD) or visit chadd.org. Ask friends for their recommendations, too.

Dig Deeper

Learn more about how the DSM-V is used by health care professionals to diagnose ADHD: http://additu.de/dsm-v

How Is ADHD Diagnosed?

To diagnose a child with ADHD, a doctor must complete several kinds of assessments to determine whether six or more symptoms from the DSM-V have been present since age 12 — and are disruptive to a child’s everyday life:

• Behavioral history. Your initial meeting with the doctor (pediatrician or specialist) should focus on your child’s behavioral symptoms. Leave your child at home, and bring along written or verbal descriptions of your child’s behavior from current or former teachers, as well as copies of any psychological test results you might have.

You’ll be asked where and when your child’s symptoms occur and when you first noticed them. In addition, the doctor may ask you (and your

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child’s teachers) to complete the Conners’ Rating Scale, a questionnaire that helps determine the nature and severity of your child’s symptoms. And don’t be surprised if the doctor asks you and your spouse about family or marital stresses that could be making your child anxious, since anxiety can have symptoms similar to those of ADHD.

• Medical history and exam. If your answers convince the doctor that

your child’s symptoms are chronic and pervasive, he or she will probably take down a detailed medical history. The goal here is to rule out depression, sleep problems, seizure disorders, vision or hearing problems, and other medical conditions that can mimic ADHD. Certain medications can also cause symptoms of hyperactivity or distractibility in some children, so be sure to be upfront about any medications or supplements your child is taking. Some of this history may be taken in the initial parent-doctor interview, but the doctor will also schedule an appointment to examine your child.

• Review of records. The doctor should review relevant school reports

and medical records. (If you didn’t bring copies of the records to your initial appointment, call the school and have them sent to your doctor.) The doctor will want to have at least one phone conversation with your child’s teacher or school psychologist.

Heroes with ADHD

For an imperfect protagonist your child can relate to, grab the Hank Zipzer series by Henry Winkler, about a bright boy who overcomes learning challenges.

Awaiting the Diagnosis

You want the answer to one big question: “Does my child have ADHD?” But don’t expect an answer overnight. The diagnostic process can take a week or two. As you await the diagnosis, inform your child’s teachers and any other school officials that your child is being evaluated for ADHD. Ask for a meeting with the school psychologist or special education teacher to discuss having your child evaluated for learning disabilities (which affect 30 to 50 percent of kids with ADHD). If your school is unable or unwilling to administer the appropriate testing, you may have it done by a private educational psychologist — typically at a cost of several hundred dollars.

The Treatment Plan

A month or so into your journey, your child’s diagnosis should be complete. Now, you, your child, and your doctor are ready for the treatment phase. If your child has been evaluated by a specialist, he or she will likely take the lead in formulating a treatment plan (which should be communicated to your pediatrician and other caregivers). If your child was evaluated by a psychologist, he or she should confer with your pediatrician about a treatment plan — which will most likely include an ADHD medication.

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Studies show that ADHD medications are safe and effective for about 80 percent of the children who take them. Many experts feel that treatment with medication is essential: “If your child had a cavity, wouldn’t you treat it?” asks Joseph Biederman, M.D., head of pediatric psychopharmacology at Massachusetts General Hospital in Boston. “Medication management represents the most important component of the treatment of ADHD.” Dr. Silver agrees. “Sometimes medication is all it takes to solve the problem,” he says. “Even if it isn’t, it’s important to evaluate how the child is doing on medication before you start dealing with other psychosocial issues.” Given the risk of side effects — and the persistent stigma surrounding the use of psychotropic medications — parents are often reluctant to start their children on drug therapy. In some cases, family members oppose drug therapy — a perfectly natural reaction — before they learn all of the facts. Drug therapy is a treatment option that warrants thorough research and discussion by the caregivers, the doctor who would prescribe the drugs, and, depending on his or her age, the child.

“I have been told that my ADHD son is a wise old soul in a young body. The questions he asks and the things he points out make people stop and think.” — Beth, an ADDitude reader

Finding the Right Medication

If you do decide to move forward with medication, some patience is required. With most pediatric medications, the proper dosage depends upon the age and/or weight of the child. But with the medications used to treat ADHD, proper dosage depends upon how rapidly the child’s body metabolizes the drug — body weight is seldom the deciding factor. Consequently, finding the right dosage — and the right drug — typically involves trial and error. At first, your child may need to see the doctor every few days or so. If your child becomes unusually irritable or tearful or seems to be “in a cloud,” the dosage should probably be reduced. If side effects continue, or if there’s no change in your child’s behavior, a different medication should be tried — ask your doctor about moving to a nonstimulant after trying more than one stimulant. In most cases, the right drug and dosage can be discovered within a month. But there are exceptions. For Mitchell Haus, the process took eight months. During that time, says his mom, Mitchell suffered insomnia and “zombielike” behavior. But once the right medication was found, she says, “Mitchell’s behavior calmed down. His ADHD symptoms haven’t disappeared, but they’re manageable.”

Medication Reviews

Parents and adults share their experiences with the major stimulant and non-stimulant ADHD medications on ADDConnect: http://additu.de/reviews

It’s worth noting that medical scientists are working on a solution superior to trial and error. Several companies are developing genetic tests that promise to determine which medication works best with a patient’s unique ge-

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netic makeup and rate of metabolism. These solutions are just beginning to hit the market. Talk with your doctor to see if this kind of test would be right for you or your child.

Beyond Medication

Medication isn’t the only treatment option for ADHD. We recommend that you discuss other forms of treatment with your doctor. For example, your family might benefit from sessions with a family therapist — especially if family members disagree about how the child should be treated. Your child might benefit from sessions with a child psychologist who specializes in behavioral therapy. In addition, many parents utilize “parenttraining” classes, in which they learn ways to set and reinforce rules governing their child’s behavior.

DIY Behavior Therapy

To find parent-training classes in your area, go to taalliance.org.

If you live outside of a major metropolitan area, you know that finding local ADHD specialists is seldom easy. But now parents can confidently look beyond their geographic region for psychiatrists, therapists, and consultants who offer their services via video conference, according to new research. The new Children’s ADHD Telemental Health Treatment Study3 (CATTS) found that new telehealth programs — like therapy sessions delivered through real-time videoconferencing — are a successful way to improve ADHD symptoms in kids. Children who worked with remote psychiatrists (in addition to local doctors), experienced a greater decrease in ADHD symptoms than did children who saw only a primary care doctor. This research suggests that telehealth services can be used to treat children with ADHD in communities where access to specialty mental health services is limited, making treatment more universal — regardless of geography. On top of that, eating a healthy, nutritious diet optimizes the ADHD brain and can help reduce some symptoms. According to Sandy Newmark, M.D., the author of ADHD Without Drugs and the medical director of the Osher Center for Integrative Medicine at the University of California, San Francisco, there are important ADHD-specific strategies that adults diagnosed with ADHD and parents raising a child with ADHD should know. 1. Avoid artificial colors, flavors, and preservatives in processed foods. Also avoid certain preservatives such as nitrites, BHA and BHT, sodium benzoate, and artificial sweeteners. 3. Myers, Kathleen, Ann Vander Stoep, Chuan Zhou, Carolyn A. Mccarty, and Wayne Katon. “Effectiveness of a Telehealth Service Delivery Model for Treating Attention-Deficit/Hyperactivity Disorder: A Community-Based Randomized Controlled Trial.” Journal of the American Academy of Child & Adolescent Psychiatry 54.4 (2015): 263-74. Web.

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2. Consider an elimination diet. Food sensitivities and allergies are surprisingly common in individuals with ADHD. According to Newmark, 25 to 50 percent of all children with ADHD have some kind of sensitivity or allergy to dairy, gluten, corn, soy, eggs, nuts, citrus, or any product with artificial colors, flavors, or preservatives. The only real way to know if certain foods are affecting concentration or impulsivity is to remove the food from your diet and carefully observe the results by using an “elimination diet.” Work with your pediatrician or specialist when starting an elimination diet. 3. Take an omega-3 fatty acid supplement. Children with ADHD have lower omega-3 levels than do non-ADHD children. Though the optimal dose and ratio of EPA to DHA (the most crucial omega-3s for ADHDers) varies by person, Newmark recommends the following: • Use a product that contains more EPA and than DHA • Give 700-1,000 mg. a day to children under seven years of age • Give 1,500-2,000 mg. a day to older children 4. Test for deficiencies in key minerals — iron, zinc, and magnesium. Children with ADHD may be low in these minerals, all of which are key to normal neurological function. All three can be accurately measured through a blood test administered by your doctor. If levels are below normal, changes in the diet as well as supplementation can correct them. This simple intervention could make a big difference in your child’s life.

Evaluation for School Accommodations

There are two laws governing special services and accommodations for children with disabilities: the Individuals with Disabilities Education Act (IDEA) and Section 504 of the Rehabilitation Act of 1973. All schools receiving federal funding are required to provide services under Section 504, but IDEA applies to all students, even those in private schools that do not receive federal funding. Children with ADHD often receive services under Section 504 because the requirements for IDEA are more stringent.

The ADHD Diet

Learn more about the best (and worst) foods for the ADHD brain in this special report: http://additu.de/nutrition

If your child has been diagnosed with ADHD and/or a learning disability, and you think he or she may benefit from academic accommodations spelled out in an Individualized Education Plan (IEP) or 504 Plan, begin by requesting that your school conduct an evaluation. Begin by sending a letter to your district’s head of special education, with a copy to your child’s principal. Some schools have a 504 or IEP application

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available online or in the guidance counselor’s office that you may need to fill out and include with your letter. • Include any backup documentation — a diagnosis from a doctor, notes and e-mails from your child’s teacher, and copies of schoolwork or exams that you have put in your file. • Explain your child’s academic challenges and the measures the teacher and you have taken. • Request an assessment for a suspected LD, as well as social or emotional challenges or speech and language problems, if appropriate. Remember that accommodations can also address behavioral problems that prevent your child from learning in the classroom.

Sample Letter

Use this template when crafting the letter requesting special services from your child’s school: http://additu.de/dj

• Send the letter by certified mail or hand-deliver it and request a receipt. You need documentation that it was received, so the process can go forward. You do not need to choose between an IEP or a 504 Plan at this point. When the school evaluates your child for services, the school team will determine which law and services best apply to your child. You must sign a consent form before the school evaluates your child. From the moment you sign the form, the school has 60 days to determine whether services are appropriate. Sometimes a school doesn’t meet that deadline. If your child is not assessed within that time frame, contact the superintendent of your school district. If you do not receive an answer, call or send a letter to your state’s Department of Education. Schools may request a conference with parents and teachers before completing, or agreeing to complete, the evaluation. This is usually because they want more information to decide whether a child needs special education or related services or accommodations. If your school requests a conference, it’s important that you attend. Bring documentation to back up your request for the evaluation: • Samples of homework • Report cards • Teacher communication • Copies of tests • Doctors’ reports, including recommendations for testing (if you have

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an official diagnosis and the doctor has suggested an evaluation) • Previous testing results (if applicable) Invite the medical professional who diagnosed your child to the conference with you. He can answer detailed questions that the accommodation team may have. If he can’t attend, invite a good friend or relative to the meeting. He or she will provide moral support, contribute to the discussion, and offer further insights as to why your child should have an evaluation. If your child has been diagnosed with ADHD, the assessments will be different than they would be for a child who has been diagnosed with ADHD and dyslexia. Assessments can cover health and development, intellectual abilities, motor abilities, vision, hearing, language function, general abilities, academic performance, social and behavioral issues, interests, and/or self-help and vocational abilities. The assessment should be comprehensive enough to identify all of your child’s special education needs. When the school accepts your request for an evaluation, you will receive an assessment plan, which outlines all of the evaluations that will be done. You can request specific assessments if they are not included in the plan. If the school district does not have the personnel to complete a specific assessment that is deemed appropriate, they must request an outside professional to complete the assessment. The school district must pay for these services. Parents should not be charged for any part of the assessment.

Step-by-Step Guide

Learn how to create, implement, and maintain an IEP or 504 Plan for your child at http://additu.de/iep

If you did not have a pre-assessment conference, you can request to meet with the person responsible for implementing the assessment and share information about your child — test scores, report cards, teacher communications, and doctors’ reports. This information will be made part of the assessment. You have the right to receive a copy of the complete assessment. You might need to follow up on this request to be sure you receive a copy before any meetings about specific services and accommodations are scheduled. Then you wait until the school sends you a letter to schedule a meeting to discuss their assessment conclusions and recommendations for services and/or accommodations. Don’t be shy about asking the school for “reasonable accommodations” for your child, even if you don’t choose to pursue an Individualized Education Program (IEP) — for example, letting her sit at the front of the class to minimize distractions or permitting occasional breaks for physical activity.

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Within three months of your “Aha” moment, this is how things should look: • If you have decided to put your child on medication, you should now be calling in monthly to your pediatrician (or other physician) to get the prescription renewed, with visits scheduled every few months to monitor progress. • All of the supplemental treatments (psychotherapy, parenting training, and so on) should also be up and running, if not completed. • If appropriate and helpful, you have requested that the school evaluate your child for an IEP or 504 Plan containing academic accommodations to help him succeed at school with ADHD. Whew. You’ve made it — welcome to Point B! Natalie Engler is a freelance health writer in Sudbury, Massachusetts. Winning Accommodations

Learn the best strategies and services to include in your child’s IEP or 504 Plan, at http://additu.de/14a

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Questions to Ask the Doctor Before agreeing to start your child on drug therapy, be sure to get answers to the following questions:

• What is the diagnosis? • What is the medicine, and how does it work? • Have studies been done on it? • Which tests need to be done before my child starts the medication?

• How soon will I see an improvement? • How often will my child have to take the medicine? • How will the decision be made to stop it? • What are the negative side effects of the medicine? • What will happen if my child doesn’t take it? From Making the System Work for Your Child with ADHD, by Peter S. Jensen, M.D. (© 2004 Guilford Press, reprinted with permission).

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Assembling Your Team of Professionals Working with doctors you trust can help you parent with confidence. Here’s how to find the best team for your child. By Perri Klass, M.D., and Eileen Costello, M.D.

In a perfect world, you would rely on an erudite and sensitive team of experts who would come to your child without preconceptions and take the time to get to know him. Their recommendations would be realistic and practical, and the evaluation and follow-up appointments would be fully covered by your insurance. Sorry — we don’t have the map to that world. As you’ve perhaps discovered, with so many diagnoses to choose from, and a dizzying lineup of specialists to do the choosing, parents of quirky kids can lose time, money, and sleep and still find themselves knowing no more than they knew at the beginning — and perhaps trusting their instincts less. Well, we may not have a map, but our goal here is to help you get most, if not all, of what you need as you put together your team of experts. Whether you’re still looking for a diagnosis that makes sense to you, or are well down a treatment path, the following advice will help you make informed choices about the team of professionals you use to treat your child.

THE HELP YOU NEED

Start your search for a doctor or ADHD specialist at http://directory. additudemag.com/

The Starting Point

Parents typically start with their child’s primary health-care provider — a pediatrician, family practitioner, or nurse practitioner. Some pediatricians have additional training in behavior and development, and many others have at least a special interest in the area. But every pediatrician spends much of his time looking at babies and young children, and probably has some idea of the range of normal — and of the varieties that lie on the fringes of that range. If you’ve expressed a concern about your child to your pediatrician — and he has listened carefully, interacted with your child, and examined him, but is not alarmed — consider letting yourself be reassured. It’s not a guarantee, of course, but it may well mean that what you’re looking at is more in the going-through-a-phase category. It can be hard to judge whether a two-yearold is off the charts in oppositional behavior and tantrums, especially if the two-year-old is your first child. If you like and trust your doctor, you might consider letting it rest here, at least for a few months. There is probably no single vital test that needs to be done as soon as possible to get any one essential answer. (Obviously, we’re not talking about diagnosing a child who’s deaf or a child with classic autism or seizures. It is always important that children with major psychiatric or

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medical disorders be diagnosed — and treated — as rapidly as possible.) But if you’re really worried about your child’s development, communicate that to your pediatrician. Stop him, look him in the eye, tell him you’re worried, and tell him exactly why. Then schedule a visit to talk about your concern. Don’t try to discuss it during, say, a visit for an ear infection. Your concerns should prompt your pediatrician to do some kind of systematic developmental assessment, not just “eyeball” your child. If you don’t feel you’re being listened to, get a second opinion. Most pediatricians will be open to referring your child to a behavioral and developmental pediatrician if you are truly worried. Beware the Brush-Off

Finding a Specialist

When faced with a pediatrician who keeps telling you there’s nothing to worry about, you should probably request a referral to a specialist in child development and behavior, so your child can be fully evaluated. Depending on your financial situation and your health insurance, you may prefer to locate a specialist or clinic on your own and make the appointment yourself. But if your health insurance requires a referral from your primary-care pediatrician, as many plans do, remember that you are completely within your rights to request it.

Pediatricians tend to be conservative when it comes to acknowledging behavioral disorders. If your concerns are dismissed out of hand, do not assume that the doctor knows best. Find another doctor.

A reliable place to look is at the nearest children’s hospital or major university medical center. Most metro areas should have at least one or the other, if not both. There will be a Pediatric Developmental Assessment Clinic at either type of facility. If you’re looking for a recommendation to a certain type of specialist, and your pediatrician can’t or doesn’t provide one that satisfies you, try networking. Ask an official at your child’s school or a neighbor with a child who has learning differences, or someone else you trust who has experience in developmental issues. It won’t take long for you to discover that there is a broad spectrum of help available. There are many kinds of specialists — with different training, different orientation, different assessment tools — who can offer you different kinds of information. Some may be more oriented toward practical, everyday function, others more attuned to recognizing syndromes and making diagnoses. You can find experts in a school setting or at a medical center, working alone or as part of a larger organization. Early Intervention programs, federally funded services for children with developmental needs in the first three years of life, are available in every state. For children under age three, your insurance company may insist on an EI evaluation before it will pay for any other kind of testing.

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Another option is to pursue a school evaluation, either because you think it will help provide some answers or because your insurance company requires it or because the school usually covers the expense. School evaluations are often reasonable places to start, but we offer several cautions: Waiting lists can be long; the quality of the evaluators varies immensely; there is no guarantee that any one of the evaluators will have experience with the needs of the quirky child. We have heard parents complain about school evaluations that seemed rushed, or superficial, or focused on fitting every child into one of a few categories. On the other hand, we have also worked with plenty of gifted school-based professionals who have helped many families enormously. The school-based perspective can direct the evaluation specifically at learning issues that are vitally important for children. Bottom line: Although you may need or want to start with a school evaluation, and it may yield valuable information, you might need to go further in your quest.

“Our family’s pediatrician sent us to a psychologist for the official diagnosis and confirmation of the doctor’s thoughts.” — Amy, an ADDitude Reader

Managing the Maze

As you move through this maze of experts, your job will be to track and evaluate the information offered and to make important decisions about when to look further and when to pause. Understand the cast of characters. Ask the specialists you see about their qualifications and their particular fields of expertise. It’s important to know whether you’re dealing with a neurologist or a neuropsychologist. Even if you aren’t completely sure how to integrate the specialist’s background with the assessment and the advice you receive, your pediatrician and the other specialists you see may better understand the opinions you’ve already collected if you can fill them in on who was doing the evaluating. Talk! Ask questions! Take notes! Some parents just don’t — or can’t — get their questions answered in detail by the professionals evaluating their child. Sometimes this happens because there are still tests to be scored or conversations that need to take place among members of the evaluation team. At the very least, you should come away knowing when you will hear and how you will hear assessment results. Someone who has just spent some time with your child should be able to give you a few reactions. It is reasonable to let evaluators know that you’d like a few minutes at the end of the session to get a sense of what they think. Take notes, so you don’t have to remember exactly what you did or didn’t hear. Ask to have unfamiliar terms spelled out and explained, and request

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sources of information you can consult. If you’ve had a multi-specialty evaluation done, consider making an appointment to come back in and discuss the results. Keep a notebook. As time goes by, you will think of questions you want to ask, observations about your child that seem significant, ideas for further assessment. Write them all down in a notebook. There you can also make note of the specialists you see, the tests they perform, the information they give. Jot down phone numbers of programs you learn about from other parents, as well as contact data for someone who isn’t that helpful now but may be in a few years. A notebook will help you track your child and your own understanding. It will also help you use your time with the specialists to ask the questions you’ve been wanting to bring up. Trust your instincts. Go into this process with an open mind but also with a healthy degree of skepticism. If someone tells you something that absolutely does not fit with your sense of your child, consider it objectively. If it’s nonsense, forget it. Don’t let someone who can’t answer questions to your satisfaction pursue a long-term therapeutic relationship with your child, no matter how grand or glorious his degrees or reception room. Don’t expect a “eureka” moment. We’ll say it again because it’s so important: By and large, quirky kids don’t fit neatly into diagnostic categories. The ongoing process of having your child assessed and considering different diagnoses can be valuable if it points the way to helping your child. Still, it’s probably not going to yield a single, illuminating conclusion when you find out what’s “really” going on.

“My daughter was misdiagnosed with ADHD/ODD when she was 7. She’s 15 now. It wasn’t until last year that we found out she actually has a verbal processing disorder, among other things.” — Toni, an ADDitude Reader

Some specialists or clinics will give almost anyone a diagnosis. If you look hard and long enough, you will come across someone who will pin a label on your child — perhaps because it’s the same label everybody gets at that particular clinic. Be especially wary of labels that carry immediate recommendations for expensive therapists. Don’t let anyone prey on your desire to help your child. It’s worth getting a second opinion or discussing the recommendation with your own pediatrician. Most of the professionals you will encounter as you look into assessment and diagnosis will be honorable. It must be said, however, that there is something of an industry out there in providing diagnoses and therapies to kids with developmental variations. This brings us, once again, to our preference for the academic medical center. Finally, don’t forget that the point of all this — the workup, the testing, the consideration of your child by multiple experts — is not to come up with

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the right label, the right name, the right answer on some cosmic medicalstudent exam. It’s to help your child — as well as to help you help your child. DRS. PERRI KLASS and EILEEN COSTELLO are primary-care pediatricians in New York and Boston. They trained together and have practiced pediatrics together for 10 years. Dr. Costello is on the board of the Asperger’s Association of New England, and Dr. Klass is on the faculty of New York University. They are coauthors of Quirky Kids: Understanding and Helping Your Child Who Doesn’t Fit In—When to Worry and When Not to Worry (Ballantine), from which this article was adapted with permission from Random House.

Choosing a Course Ask these questions as you consider potential therapies and therapists:

• Does the therapy target the problems that are getting in my child’s way? Keep in mind what you are targeting. What skills do you want him to gain, or which behaviors would you like to decrease?

• How will we know if it’s working? Ask this question during an

initial evaluation. How does the therapist decide? What kinds of assessments are done at the beginning, and how often is the child reassessed?

• What if it isn’t helping? Can you trust the therapist to let you

know if she believes that the program isn’t working or that she and your child aren’t a good match?

• How much commitment is required? Is there any danger in

stopping the program cold turkey if it isn’t effective? If it’s group therapy, how important is it for your child to stick it out for an entire semester or year? How would it affect other kids in the group if she didn’t?

• How long will it take? • Is my child the right age? There is good evidence to suggest that,

the younger the age you start addressing troublesome behaviors, the more progress the the child will make.

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Who Can Diagnose — and Treat — ADHD?

Choosing the appropriate professional for diagnosis and treatment can be hard. Each specialty has strengths and weaknesses. Here is a short list of who does what when it comes to diagnosing ADHD. Advantages

Disadvantages

Psychiatrist A psychiatrist, an M.D. who treats the brain, may prescribe medication or other treatment.

• Trained in diagnosis • Able to diagnose, prescribe medication, and treat

• Fees usually start at about $200 an hour and go up from there • While psychiatrists can diagnose and treat, they may not be trained in counseling, especially in the areas of day-to-day life skills that may be needed by the person who has ADHD

Psychologist A psychologist understands how the mind works, but is not an M.D. and cannot prescribe medications. If the psychologist feels that medications are called for, he or she will have to refer the patient to either a medical doctor or a psychiatrist.

• Trained in diagnosis • Trained in counseling • Costs less than a psychiatrist

• Cannot prescribe medications • Patient must be referred for an MRI or any other test that could assist in diagnosis

Family Doctor Most family physicians know of ADHD but may lack the extensive knowledge of more specialized professionals.

• Is already familiar with you and your medical history • Is usually easier to see for an appointment • Can prescribe medications if needed • Less expensive than a psychiatrist

• May have limited experience with ADHD, especially in adults • Cannot offer counseling • Brief office visits often mean a hurried diagnosis

Neurologist A neurologist is a doctor who specializes in treatment of the brain and central nervous system.

• Can determine if other conditions, such as seizure disorder, are present

• Expensive • EEG testing for ADHD isn’t needed for diagnosis or treatment • Patient must be referred for any counseling or therapy

Master Level Counselor A master level counselor has a master’s degree in psychology or counseling. He or she may be able to do an initial assessment if he or she has the appropriate training.

• Is able to provide counseling, behavior management, and problem solving • Less expensive than psychiatric care

• May have trouble with a differential diagnosis (identifying other possible problems) • Will need to refer patient to a doctor or other professional • Cannot prescribe medication

Social Worker A Master of Social Welfare (MSW) or a Licensed Clinical Social Worker (LCSW) is often employed by an agency (for example, public health care resources) to provide counseling to people served by the agency.

• Inexpensive

• May have trouble with a differential diagnosis (identifying other possible problems) • Will need to refer patient to a doctor or other professional • Cannot prescribe medication

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ADHD In Preschool Revised guidelines give doctors the go-ahead to diagnose and treat ADHD in younger kids, but are parents comfortable evaluating preschoolers for attention deficit? By Laura Flynn McCarthy

Ann Marie Morrison suspected that her son had ADHD when he was three. “John’s temper tantrums were more intense than those of other three-yearolds, and they came out of nowhere,” says Morrison, of Absecon, New Jersey. “It took forever to get him out the door. He had to dress in the hallway, where there were no pictures or toys to distract him. He couldn’t sit still, and he tore apart every toy. I carried gift cards in my purse, so that when he destroyed a toy at a friend’s house, I could hand the mom a gift card to replace it.” When Morrison discussed John’s hyperactivity and impulsive behavior with his doctors, her concerns were dismissed. “He’s just an active boy,” they said. “One pediatrician said, ‘Even if he has ADHD, there’s nothing we can do until he’s at least five years old,’” recalls Morrison. “That’s like saying, ‘Your son has a serious illness, but we can’t treat it for another two years.’ What was I supposed to do in the meantime?” The family moved to another part of the state when John was five years old, and, by chance, their new pediatrician was an expert in ADHD. She had been diagnosed with ADHD herself and had raised a son with the condition.

“I wish I had gone with my instincts. I listened to the school, and they told me not to worry. It wasn’t until my son hit junior high that he finally got any help.” — Sally, an ADDitude Reader

“At John’s checkup, she was taking a medical history and John was, as always, unable to sit still. She stopped and asked, ‘Have you had him tested for ADHD?’ I started to cry. I thought, ‘Oh, thank God. Someone else sees it,’” says Morrison. “After years of being told by relatives that I needed to discipline him more, after years of feeling physically and mentally exhausted, and thinking I was a horrible parent, someone realized what we were dealing with.” A thorough evaluation of John, which included input from John’s teachers and family, led to a diagnosis of ADHD. Soon afterward, he was put on medication, which has helped him focus and improved his impulse control. Treatment has changed John’s and his family’s life. “If John had been diagnosed earlier, it would have helped a lot,” says Morrison. “I don’t know if we would have given him medication when he was three or four, but I would have learned techniques for getting him organized, disciplining him, and helping him establish a routine, without having to figure it out by myself. If I had known earlier that he had ADHD, I would have taken better care of myself, too. I wasn’t prepared. It’s not just the child who’s affected by ADHD. It’s the whole family.” Today, it’s likely that children like John will be diagnosed and helped earlier in life, thanks to new guidelines from the American Academy of Pediatrics

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(AAP, aap.org). The findings include recommendations for evaluating and treating preschool children and adolescents ages 4 through 18 years. Earlier guidelines, released way back in 2001, covered children ages 6 through 12. The new guidelines also include consideration of behavioral interventions, especially for younger children. “The AAP committee reviewed the research on ADHD done over the last 10 years, and concluded that there are benefits to diagnosing and treating ADHD in children younger than age 6,” says Michael Reiff, M.D., professor of pediatrics at the University of Minnesota, who served on the committee that developed the new guidelines.

New ADHD Diagnosis and Treatment Guidelines

The new AAP guidelines1 specify that diagnoses should rule out other causes of the behaviors while assessing for coexisting conditions — anxiety, depression, conduct disorder, or oppositional defiant disorder. The diagnosis should include input from people in the child’s life — teachers, care providers, and the immediate family — to be sure that the symptoms of ADHD are present in more than one setting. When a child has been diagnosed with ADHD, based on criteria in the Diagnostic and Statistical Manual of Mental Disorders (V), the AAP offers these age-specific treatment recommendations:

• For children ages 4 to 5, the first line of treatment should be behavior “When I first diagnose therapy. If such interventions are not available, or are ineffective, the physician should carefully weigh the risks of drug therapy at an early age against those associated with delayed diagnosis and treatment.

• For children ages 6 to 11, medication and behavior therapy are rec-

ommended to treat ADHD, along with school interventions to accommodate the child’s special needs. Evidence strongly indicates that kids in this age group benefit from taking stimulants.

a child with ADHD, I tell the parents they need to learn behavior techniques, whether I’m prescribing medication or not.” — Patricia Quinn, M.D.

• For adolescents ages 12 to 18, doctors should prescribe ADHD medication with the teen’s consent, preferably in combination with behavior therapy.

Why Parents Worry About Early Treatment

While some experts and parents welcome the news of earlier diagnoses and treatment, others are concerned. Many parents believe that children are already overdiagnosed and overmedicated. Won’t expanding the guidelines only exacerbate the problem? “The goal of the new guidelines is not more diagnoses, it is more accurate 1. ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of AttentionDeficit/Hyperactivity Disorder in Children and Adolescents.” Pediatrics 128.5 (2011): 1007-022. Web.

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diagnoses,” says Ari Tuckman, Ph.D., a psychologist and author of Understand Your Brain Get More Done: The ADHD Executive Functions Workbook (Specialty Press). Still, some parents hesitate to have their children evaluated before they are school-age. Here are four common reasons why they wait: 1. “I’m afraid to medicate my four-year-old.”

The new AAP guidelines say that when a preschool-aged child has been diagnosed, the first line of treatment should not be medication but behavior therapy. The guidelines do not mandate using medication. They merely inform families and clinicians that using medication in younger groups has been shown to be helpful and safe. If behavior therapy has been tried (usually in an 8- to 12-week program) and found not to work, only then should a doctor consider putting a four- or five-year-old on medication. “Medication, at any age, is never a magic bullet,” says Reiff. “However, if your child exhibits dangerous behaviors that significantly impair his daily living, it seems reasonable to consider the possibility of medication management.” “Parents should ask, ‘Would it be helpful to my child to explore what medications have to offer?’” says William Dodson, M.D., head of the Dodson ADHD Center, in Greenwood Village, Colorado. “As one pediatrician said, ‘We’re not talking about a tattoo on your child’s face. We are going to see what medication has to offer and then decide, based on knowledge rather than fear.’”

“I found my biggest frustration came from how very little my son’s teachers knew about ADHD. We heard a lot of ‘Why does he act like that?’ ‘He knows better,’ and ‘If only he would try his best.’ It’s very frustrating.” — Lauren, an ADDitude Reader

2. “Behavior therapy doesn’t work.”

“Behavior therapy won’t change the wiring of a child’s brain,” says Tuckman. “It can, however, minimize distractions and change the tone of the interactions between a child and parents or teachers. Behavior therapy enables a child with ADHD to function better, as changing the way a diabetic’s diet can help him feel and function better without changing his ability to process sugar.” 3. “I don’t want my child to be labeled.”

Your child will be less likely to be labeled a “troublemaker,” a “bad kid,” or a “daydreamer” if you address his ADHD early. “One study showed that a child with untreated ADHD received 20,000 negative messages in the first 10 years of life,” says Dodson. “If a child mostly hears, ‘You’re a little monster, you’re impossible to deal with,’ it affects how the child thinks about himself. Treating ADHD can help your child function and behave better, and will most likely build his self-esteem.” 4. “It’s normal for preschoolers to be hyperactive and have short attention spans.”

Preschoolers are naturally active and usually can’t focus as long as older children can, but there are differences between kids with ADHD and those with-

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out it. “Preschoolers with ADHD run out into the street without thinking,” says Patricia Quinn, M.D., a developmental pediatrician in Washington, D.C., and the director of the National Center for Girls and Women with ADHD. “Very young children with ADHD have more broken bones, more stitches, and more emergency room visits than children who don’t have the condition.” Another difference is something Quinn calls “up and away activity.” “Say the preschool teacher asks the students to glue cotton balls to paper to create clouds. The non-ADHD child may glue on 10 cotton balls. Children with ADHD may glue on two and get up and walk away. Or they’ll pull out a toy, touch it, and walk away. There is a lack of purpose to their activity. They’re the kids who spin around in a chair incessantly or jump up and down on a sofa. Having your child diagnosed and treated in preschool will help her manage symptoms and will likely keep her safe and sound.”

Try Behavior Therapy First

As a speech therapist who works with children, Joe’L Farrar, of Wilburton, Oklahoma, recognized symptoms of ADHD in her daughter, Carey, at age one and had her diagnosed at age three. Because Farrar was already using many behavior therapy strategies, Carey’s doctor suggested a trial of medication when she was four. It didn’t go well. “The side effects were too much for Carey,” says Farrar. “We took her off medication and focused on behavioral modifications for a couple of years — and put her back on meds at six.” Now 10, Carey takes Strattera, which Farrar says is helpful in managing Carey’s hyperactivity and inattentiveness, but less effective in improving her impulsivity.

It can be difficult finding the right treatment for your child. For tips and a moving personal story, check out Katherine Ellison’s ADHDthemed memoir, Buzz: A Year of Paying Attention.

Despite mixed success with medication in Carey’s early years, Farrar is glad she had her daughter diagnosed at three. She was able to get accommodations Carey needed at school. “When her kindergarten teacher said that Carey didn’t like to take naps, we arranged for the special-ed teacher to take her to another room during naptime to do calm activities together.” Carey has done well in school, as well as in cheerleading and choir. Farrar has also put a positive spin on her daughter’s ADHD. “I explained to her that there were chemicals missing in her brain that made it harder for her to sit still in a chair like other kids did,” says Farrar, “but that didn’t mean she wasn’t as smart as they were.” “The earlier parents intervene, the greater the chance that we can make a difference,” says Quinn. “Earlier diagnoses may increase the chances that young children with ADHD will make friends and do well in school. The new AAP guidelines can prevent a lot of pain and suffering in the lives of individuals who have ADHD.” Laura Flynn McCarthy is a freelance writer based in Bow, New Hampshire.

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The Preschool ADHD Treatment Study (PATS)1 Sponsored by the National Institute of Mental Health, and conducted by a consortium of researchers at six sites, PATS is the first long-term, comprehensive study of treating preschoolers with ADHD. The study included more than 300 three- to five-year-olds with severe ADHD (hyperactive/impulsive, inattentive, or combined type). Most exhibited a history of early school expulsion and extreme peer rejection.

Stage 1: Parent Training

Families underwent a ten-week parent-training course in behavior modification techniques, such as offering consistent praise, ignoring negative behavior, and using time-outs. Result: More than a third of the children (114) were treated successfully with behavior modification and did not proceed to the medication stage of the study.

Stage 2: Medication

Children with extreme ADHD symptoms who did not improve with behavior therapy (189) participated in a double-blind study comparing low doses of methylphenidate (Ritalin) with a placebo. Result: Treatment resulted in significant symptom reduction, as measured by standard rating forms and observations at home and at school. Notable Findings

• Lower doses of medication were required to reduce ADHD symptoms in preschoolers, compared to elementary school children.

• Eleven percent ultimately stopped treatment, despite improvements in ADHD symptoms, due to moderate to severe side effects, such as appetite reduction, insomnia, and anxiety. Preschoolers appear to be more prone to side effects than elementary schoolers.

• Medication appeared to slow preschooler growth rates. Children in the study grew half an inch less and weighed three pounds less than expected. Long-term data on this subject is in the process of being collected.

Preschoolers with severe ADHD experience marked reduction in symptoms when treated with behavior modification only (one-third of those in the study) or a combination of behavior modification and low doses of methylphenidate (two-thirds of those in the study). Although medication was found to be generally effective and safe, close monitoring for side effects is recommended. A follow-up to PATS, released in 2013, found that the ADHD diagnosis persisted in 89 percent of the subjects, with a diagnosis of comorbid ODD increasing the chance of persisting ADHD by 30 percent. 1. Riddle, Mark A., Kseniya Yershova, Deborah Lazzaretto, Natalya Paykina, Gayane Yenokyan, Laurence Greenhill, Howard Abikoff, Benedetto Vitiello, Tim Wigal, James T. Mccracken, Scott H. Kollins, Desiree W. Murray, Sharon Wigal, Elizabeth Kastelic, James J. Mcgough, Susan Dosreis, Audrey Bauzó-Rosario, Annamarie Stehli, and Kelly Posner. “The Preschool Attention-Deficit/Hyperactivity Disorder Treatment Study (PATS) 6-Year Follow-Up.” Journal of the American Academy of Child & Adolescent Psychiatry 52.3 (2013): n. pag. Web.

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How Young Is Too Young for Diagnosis and Treatment? ADDitude readers weigh in on getting their young children diagnosed and treated with medication. “My son took ADHD medication at six. If a child needs glasses, you get them. If a child needs insulin, you give it to him.” — Andi, Illinois “As a psychologist, I am cautious about diagnosing a child at three or four. Many children at this age have behaviors that mimic the symptoms of ADHD.” — An ADDitude Reader “My son was diagnosed with ADHD at four years old. He is now 11, and I am grateful for the early diagnosis. We have been through years of family and individual counseling and have tried different medications to help my son thrive.” — Deidra, Utah “Putting very young children on medication? I’m not so sure. It depends on a lot of things, but, most important, a child should be treated by a doctor who has experience with ADHD. My son started his meds in fourth grade. They helped a little.” — Diane, Virginia “My son is now eight years old, and he displayed symptoms of ADD at an early age. We have not put him on medication, and he is doing well without it. We will medicate if things change for him.” — F. Chery, Connecticut “Children who have severe ADHD symptoms may be treated at age four. Why would you wait for a child to fail at school, if you know something can help?” — Heather, Michigan “ADHD can be accurately diagnosed at age four, but giving a child medication at that age seems unnecessary, unless the problems are severe.” — Kristen, Connecticut

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Deciding Whether to Use Medication Worried about putting your child on medication? Read on before committing to — or rejecting — the idea. By Ned Hallowell, M.D. One of the most difficult decisions a parent must make is whether to treat his or her child’s ADHD symptoms with medication. I’ve been there myself. Two of my three children have ADHD, and, although my wife and I eventually decided to try medication — which, by the way, has helped both of them immensely, without any side effects — arriving at that decision took careful reflection. When it was suggested that my kids try medication, I had my concerns. I know that ADHD drugs are safe and effective, but I worried that perhaps, for some unknown reason, they might harm my children’s health. Although stimulant medications have been with us for more than 60 years, I wondered if some new side effect might emerge. I countered those concerns by worrying about the potential “side effects” of not taking the medication: namely, my children struggling to stay focused and getting frustrated when they couldn’t. After envisioning that scenario, the decision became far less difficult.

“The decision to medicate was one of the hardest I have had to make. Of all the factors I considered, the biggest was quality of life for my son. He was missing out on so much because of the ADHD. That is what convinced me.” — Liz, an ADDitude Reader

Take Your Time

Each parent — and child — comes to the question of medication with different assumptions. My strong advice is to take your time, honor your feelings, and find a doctor who will remain patient, a professional who will provide information — not hurried commands — as you wrestle with your decision. From a medical standpoint, the decision is obvious. Medication is by far the most proven, safe, and effective treatment for ADHD. Careful, controlled studies have established that a trial of medication makes sense following a diagnosis. Remember that a trial of medication is just that — a trial. Unlike surgery, it can be undone.

Do Some Fact-Finding

From a personal, parental standpoint, though, the decision is anything but easy. It takes time and requires talking with your doctor and other experts. You might want to research the medication online and find out what the latest studies conclude about it. Get all the facts, and make a scientific, rather than a superstitious, decision. But I urge you never to start your child on medication until you’re comfortable doing so. Don’t feel that you’re trying your doctor’s patience or that your questions are foolish. Nothing done out of love for your child is foolish.

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However, I also urge you not to reject medication out of hand. Many parents have heard so many bad things about ADHD drugs that they’re willing to travel to Tibet to find an alternative treatment before giving medication a try. It’s very important to do your homework and separate the facts from the myths before dismissing the treatment.

Honor Your Feelings

When I give lectures, people often ask me if I “believe in” medication for children and adults with ADHD. My reply is that medication isn’t a religious principle; it’s a medical treatment. My feelings about ADHD medications are similar to those about medications in general: They’re great when they’re used properly, and they’re dangerous when they’re not. Sometimes it takes months or even years before parents decide to put their child on medication. Every parent has his or her own timetable. Stick with yours.

Recommended ReadING

For perspective and advice on raising your ADHD child, check out Not What I Expected: Help and Hope for Parents of Atypical Children, by Rita Eichenstein.

Edward (Ned) Hallowell, M.D., has ADHD himself, and is a practicing psychiatrist and founder of the Hallowell Center for Cognitive and Emotional Health, with several locations around the country. An instructor at Harvard Medical School, he is the author of 10 books, including the bestsellers, Driven to Distraction (Touchstone), Delivered from Distraction (Ballantine), and most recently, Positively ADD (Walker).

Children in Charge “I never recommend forcing a child to take medication,” says Ned Hallowell, M.D. “It’s a recipe for bad outcomes.” He suggests having your child do the following:

• Share what he’s heard about the medication, pros and cons. • Learn the facts about the medication. • Talk about any fears he may still have about the drug or the

potential embarrassment of going to the nurse’s office at school to take a pill (long-lasting drugs that work all day should eliminate the latter concern).

• Participate in making the final decision.

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How to Pick an ADHD/LD Camp for Your Child 6 questions to ask when selecting a camp for your child.

There are hundreds of special-needs camps in the U.S. How do you find the right one for your child? Start with the ADDitude Directory and CampParents.org online. Once you’ve narrowed your list — based on location, cost, and focus (social skills, academic reinforcement, travel and adventure) — pose the following questions to the director of each camp. The answers you get will help you make your final selection.

1. Is the camp accredited?

The American Camp Association (campparents.org) is the authority in camp accreditation. It sets the standards (including those for counselor qualifications and for dispensing medication) for both mainstream and special-needs camps.

2. What is the ratio of counselors to campers?

Mainstream camps usually have one counselor for every six to 10 campers; the ratio at special-needs camps is often closer to 1:3. The lower the ratio, the more opportunities counselors have to work with kids on an individual basis.

3. Does the staff have special training?

Senior staff should include psychologists, social workers, and teachers, and all should have expertise outside the program working with ADHD and LD kids. Junior staff members should have shown an interest in special-needs (for example, by studying psychology or social work). The camp should train counselors in working with ADHD/ LD kids, including how to handle social or behavioral problems that may arise.

4. How are meds supervised?

Each accredited camp has its own system for managing and dispensing meds. In general, camps should have at least one registered nurse on staff, in addition to an auxiliary medical staff composed of nursing assistants, local doctors, psychologists, and so on.

5. What is a typical day like?

ADHD/LD camps mix traditional camp activities, such as hiking, archery, and crafts, with social skills training. A typical day might also include some academic instruction, to make sure kids hold on to the gains they made over the last school year. Camps should be able to provide a detailed sample schedule, which you can review with your child.

6. How do you handle homesickness?

Some camps make phones or email available to campers. Others have found that a nocommunication policy helps kids adjust better to being away from home. Find out what procedure will be followed if your child runs into a problem.

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Chapter Three

When You Have ADHD: Living with Adult Attention Deficit Symptoms and Diagnosis in Adults: Why Adult ADHD Is Commonly Misdiagnosed or Undiagnosed There is no arguing with the facts. Nine million adults in the United States have ADHD. Unbelievably, 85 percent of them don’t know that they do. What does that mean for the undiagnosed millions? “Untold personal misery, in many cases,” says Alan Brown, founder of ADD Crusher, a program of videos and tools to help adults deal with symptoms. Brown was once part of the 85 percent. For many adults living with undiagnosed ADHD, daily life isn’t always pretty. They have an increased chance of becoming an alcoholic or a drug user, of being fired from a job (many jobs, actually), of getting divorced, of committing a crime and going to prison. In women, undiagnosed ADHD increases the chances of developing an eating disorder and, most sadly, taking their life.

“I wish I’d known the reason I was so ‘flaky,’ or ‘flighty,’ or ‘smart but not living up to my potential.’ My diagnosis was not until my late 30s and, looking back, it made so many things make sense.” — Elizabeth, an ADDitude Reader

Cultural forces have something to do with the legion of undiagnosed adults. Many doctors, and a good portion of the public, think that ADHD is only a childhood disorder. In fact, in most cases, ADHD in childhood sticks around in adulthood. Millions of adults are at a dead end in their job and their relationships, with no hope of turning their life around. And they don’t know why. If you think you may have ADHD (taking our self-test below is a good first step in finding out), get evaluated by a good ADHD doctor and start a solid treatment plan. If you wind up not having attention deficit, no harm done. If you do, diagnosis and treatment could very well change your life.

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Keep in mind that several other mental health disorders can mimic ADHD, or even coexist with the condition. Check out “Is It More Than ADHD?” below, to get the facts on common comorbid conditions.

Adult ADHD: Take This Self-Test

Habitually disorganized? Always running late? Struggle to manage money and relationships? Take this test to learn more about your ADHD symptoms. Check each of the following statements that apply to you. If you answer yes to 15 of these questions, it is likely that you have attention deficit disorder. However, you may have ADHD even if you answer yes to fewer than 15 of these questions. This informal test is intended as a general guide only.

Click and Share

For an online version of this diagnostic quiz, visit http://additu.de/vp

Adults who think they may have ADHD should consult with a physician or other licensed mental health practitioner. Treatments are available that can help you manage these symptoms. 1. I have difficulty getting organized. 2. When given a task, I usually procrastinate rather than doing it right away. 3. I work on a lot of projects, but can’t seem to complete most of them. 4. I tend to make decisions and act on them impulsively — like spending money, getting sexually involved with someone, diving into new activities, and changing plans. 5. I get bored easily. 6. No matter how much I do or how hard I try, I just can’t seem to reach my goals. 7. I often get distracted when people are talking; I either tune out or I drift off. 8. I get so wrapped up in some things I do that I can hardly stop to take a break or switch to doing something else. 9. I tend to overdo things even when they’re not good for me — like compulsive shopping, drinking too much, overworking, and overeating. 10. I get frustrated easily and I get impatient when things are going too slowly.

“My mom thought that I just didn’t like school or that I just didn’t care — and I believed it. Then, I finally got diagnosed with Inattentive ADHD as an adult and now I see the light at the end of the tunnel.” — Julian, an ADDitude Reader

11. My self-esteem is not as high as that of others I know. 12. I need a lot of stimulation from things like action movies and video games, new purchases, being among lively friends, driving fast, or engaging in extreme sports.

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13. I tend to say or do things without thinking, and sometimes that gets me into trouble. 14. I’d rather do things my own way than follow the rules and procedures of others. 15. I often find myself tapping a pencil, swinging my leg, or doing something else to work off nervous energy. 16. I can feel suddenly depressed when I’m separated from people, projects, or things that I like to be involved with. 17. I see myself differently than others see me, and when someone gets angry with me for doing something that upset them, I’m often very surprised. 18. Even though I worry a lot about dangerous things that are unlikely to happen to me, I tend to be careless and accident-prone. 19. Even though I have a lot of fears, people would describe me as a risk-taker. 20. I make a lot of careless mistakes. 21. I have blood relatives who suffer from ADHD, depression, bipolar disorder, or substance abuse.

“I wish I’d known that my symptoms weren’t character defects or moral failings or an inability to ‘just apply’ myself.” — Kimberly, an ADDitude reader

Diagnosis: What to Know When You Go

When you suspect you have ADHD, schedule an appointment with an ADHD specialist — a primary care physician, psychologist, psychiatrist or clinician. And plan to arrive at your appointment with some understanding of treatment and knowledge about what should happen — now and longterm. Harold Meyer, director of the New York City chapter of CHADD, offers these tips: 1. Be specific when describing your problems. Figure out what concerns you want to address in your consultation. For instance: “At work, I find that I can’t stay on task or complete projects.” “I can’t find anything at home.” “I’m constantly late for appointments.” 2. Consider your stance on medication before your appointment. If you’re opposed to taking medication, state your philosophy up front and ask your doctor if he can recommend other treatment options. Medication is entirely up to you — if he insists on writing a prescription despite your aversion to medication, don’t be afraid to see someone else! Then, if you have decided on medication, remember that the prescription process varies with the individual. It’s likely that you’ll need to try more than one brand and experiment

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with different dosages to find the right one for you. 3. Ask the doctor to talk about meds. You want someone who will not just write a prescription, but who will also discuss, in detail, the diagnosis and treatment with you. The following questions should be addressed: What medications are under consideration? Why start with a particular medication? What can you expect to happen? How should you evaluate the effect of the medication? 4. D  iscuss follow-up. Your doctor should lay out a course of action, including treatment and follow-up appointments. Make sure that he’s accessible. You’ll need to talk with him on the phone in the weeks following the diagnosis as you work to find the right medication dosage. Will he be available? Will he charge you to consult? Will he prescribe medication refills by phone, or do you need to go to his office every time you’re running low? 5. Learn about alternatives to medication. Find out about behavioral therapies and modifications you might try. Can your doctor work with you on these? Is your doctor sympathetic to non-medical treatment? You may benefit from a referral to a psychologist who can offer behavioral help, such as ways to deal with problems at work, time-management techniques, and so on.

“I always knew I had ADHD but was only officially diagnosed at 41 years old. Medication finally enabled me to truly relax, but it is my broken spirit that is taking so much time to heal.” — Becky, an ADDitude reader

6. Ask if he will meet with your family. A diagnosis of ADHD affects those you live with. Your spouse and children need to learn about the condition and how you will manage it. In fact, people with ADHD are not good at observing their own behavior, so it’s best to have someone close to you monitor your behavior while on medication and let you know if they observe changes. Many with ADHD claim that their medication isn’t doing anything, while those around them report marked improvements in various behaviors.

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A To-Do List for Newly Diagnosed Adults For most adults, a diagnosis brings a cathartic sense of relief, effective treatment, and the promise of a better life. By Maureen Connolly

You’re in your 30s, 40s, or 50s — and you’ve just been given the diagnosis you’d long suspected: You have adult ADHD. What happens now? For the thousands of Americans who live this scenario every year, an ADHD diagnosis in adulthood rarely comes as a complete surprise, and often carries with it a mixed bag of emotions. Mixed, because many know that ADHD isn’t all about problems. Called “a wonderful condition,” by expert Ned Hallowell, M.D., who has ADHD himself, it has led to highly energetic, creative, original thinkers, some of whom are the great entrepreneurs of our day. At the same time, most adults with ADHD know that they have more difficulties than others with organization, focus, and productivity. “As far back as I can remember, I’ve always felt out of step with the rest of society,” says Debra Brooks, a 48-year-old, Portland-based business consultant and mother of three, who was diagnosed several years ago. “I just didn’t know there was a name for it.” Those diagnosed often feel relief at knowing why they are the way they are, but this can be tinged with regret for past struggles, and for what might have been had they been diagnosed earlier in their lives. “I love my parents,” says Thomas Snodgrass, age 33, of Forest Hill, Maryland, who was diagnosed with ADHD. “But I was angry at first that they did not see my ADHD traits as a child.” Today, he remembers school years filled with angst because of his inability to focus. “I was in the smartest classes, but I always got the lowest grades,” he says. He was told again and again by his teachers that he wasn’t working up to his potential.

ADHD Like Me

For an insightful and heartfelt look into the life of an ADHD parent raising ADHD children, check out ADDitude’s Family Guy blog.

In fact, it’s a child’s diagnosis that often leads a parent to be tested for and diagnosed with ADHD. A parent may see her beloved son or daughter struggle at school in ways that remind her of her own school days. If her child is diagnosed with ADHD, the parent will probably learn that the condition is hereditary, with a 40 percent chance that one or both parents has ADHD as well. Her ongoing struggles with attention, organization, or forgetfulness might lead to a willingness to be tested, as well. Other newly diagnosed ADHD adults may be carrying heavier baggage. “Research shows that adults with ADHD are more likely than non-ADHD adults to have been left back a grade, make less money, smoke, and depend on alcohol and drugs,” says Lenard Adler, M.D., an associate professor of psychiatry and neurology and the director of the adult ADHD program at

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New York University. In fact, a diagnosis of adult ADHD sometimes occurs when a person is undergoing psychological evaluation to determine the causes of ongoing depression, a failing marriage, or problems at work. Even if there are no major problem areas in their life, a diagnosis of ADHD can throw adults off balance, because the condition in adulthood is still little known (it was only recently acknowledged in the latest edition of the DSM). Experts estimate that about 80-85 percent of adults with the disorder — roughly 5 million — haven’t been officially diagnosed. “Doctors used to be taught that ADHD affected only children,” explains Dr. Adler. “But now we know that, although hyperactivity may wane, symptoms such as inattention and impulsivity continue into adulthood.”

To Treat or Not to Treat?

Studies show that adult ADHD can be treated successfully with a combination of medication and behavior therapy. But not all diagnosed adults embrace treatment. Many see their ADHD-related traits of creativity, multi-tasking, and entrepreneurial energy as key to or as integral to who they are and their successes in life. “People worry that treatment will change how they work and how others view them — and they’re afraid of what the changes in themselves will bring,” says David Fassler, M.D., a clinical associate professor of psychology at the University of Vermont College of Medicine in Burlington. As JetBlue Airways founder and out-of-the-box thinker David Neeleman has said, “If someone told me you could be normal or you could continue to have your ADHD, I would take ADHD.”

“I just got my test results today, at age 44. I grew up feeling weird and lost. Now that I know what was behind it, I will definitely get help for my son and not deny him the right to feel good.” — Fani, an ADDitude reader

Debra Brooks was another holdout — at first. Depressed about her diagnosis, she says, “For about six weeks, I flailed. I resisted starting medication. But then I remembered what the neurologist who diagnosed me had said: ‘Why did you pay me $1,400 if you didn’t want my advice?’” For those who take the plunge and start treatment, it can take time to find the right professional help and therapy — usually medication and/or behavior modification. Whether going for a diagnosis or treatment, it’s best to have some knowledge of the condition and what a clinician should do for you (see “Diagnosis: What to Know When You Go,” above). Even under the care of an experienced physician, it may take weeks or even months to find the medication and dosage that work best for you. As a result, says Harold Meyer, director of the New York City of CHADD, “It can take six months to a year to see major improvements.”

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Despite this caveat, many people report positive results from treatment almost immediately. After much deliberation, Brooks started a stimulant medication. “The first day was like, who pulled up the shades?” she remembers. “They’ve been covering my eyes my whole life. Already, I’m much more organized and on top of things. I can remember what time I told my teenagers to be home. And I notice things I never did before. I got mad at my husband for walking on the white carpet with muddy boots. Before medication, I wouldn’t have noticed — or cared.” Daniel Zogott, age 43, a stay-at-home dad in the Bronx, says he easily accepted his recent diagnosis. He says he’s fit the typical ADHD profile for as long as he can remember, struggling in high school, starting but not finishing college, being disorganized at home and at various jobs. When his wife came across a book about ADHD, the signs became clear. Since his diagnosis and treatment, Zogott is finally accomplishing what he set out to do 20 years ago. “I’m completing the requirements for my English degree and also getting certified to teach high school English,” he says. “I sometimes think about what I missed in school because I didn’t know I had ADHD. But I try not to be angry about the past — especially when I have so much to look forward to.”

Getting the Right Support

Once a newly diagnosed person has started on a treatment plan (with medication or without), he or she should also begin working with an experienced psychologist, psychiatrist, or life coach, says CHADD director Meyer. These professionals can help people with ADHD learn behavioral, time management, and organizational strategies to enhance their quality of life. Meyer offers these tips for the newly diagnosed among us: 1. Know your legal rights. Having ADHD means you’re protected under two federal laws that apply to individuals with disabilities.

Free Webinar Replay

Learn about your rights, how to tweak your workplace to suit your ADHD, and more with ADDitude’s expert webinar, “The Career Clinic for ADHD Adults.”

2. Seek support. Attend meetings of your local chapter of CHADD, a nonprofit advocacy and education organization (click “Local support and services” on CHADD’s home page, chadd.org). 3. Don’t feel compelled to tell your boss. “There’s more understanding about ADHD now, but that doesn’t mean that supervisors are happy to learn that one of their employees has the condition,” says Meyer. If, however, you think accommodations — closing your office door, taking more breaks — will help you improve your job performance, you may want to discuss these with your employer.

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4. Diversify your support system. Adults diagnosed with ADHD may not want to rely as heavily on spouses, coworkers, friends, and relatives. “Plenty of people with ADHD are happily married, with kids, and successful in their work,” says David Goodman, M.D., an assistant professor of psychiatry at Johns Hopkins School of Medicine and the director of the Adult ADHD Center in Baltimore. “Usually, they’ve set up effective support at work, such as a really good assistant, and at home as well.” Thomas Snodgrass was one of those people who’d always looked like he had it all together — and for the most part, he did. Several years ago, he and his wife were about to have their first child. At the same time, he’d just taken on a new full-time job and was also attending graduate school. That’s when his coping techniques — such as pulling all-nighters to write papers he’d ignored until the last minute, and working twelve-hour shifts on four hours of sleep — started to backfire. “I had way too much on my plate,” recalls Snodgrass, who works on a transplant team at Johns Hopkins Hospital. “I wasn’t sleeping at all — I’d just lie there and go over everything I had to do. I’d forget to take off work on the days I was supposed to watch the baby. I was always losing my keys and my cell phone.”

Never Too Late

Learn more about diagnosing and treating ADHD in adults here: http://additu.de/adult-adhd

Tired of feeling disorganized and overwhelmed, Snodgrass looked through his insurance company’s list of participating doctors, picked a psychologist’s name, and called for an appointment. “I basically said to the doctor, ‘You can tell me I have ADHD.’” A series of conversations, followed by a clinical evaluation, confirmed his suspicions. “I kind of liked having ADHD. I could do a thousand things and get nothing done!” he says, half-jokingly. But he’s noticed that lots of good has come from treatment. “One of my biggest problems has always been saying the wrong thing at the wrong time. I’d be sitting in management meetings, and all of a sudden I’d blurt out something totally off the topic. Now, I have much more control.” Maureen Connolly is a health journalist who lives with her family in Montclair, New Jersey.

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Is It More Than ADHD? Conditions Related to Attention Deficit Many conditions, including depression and learning disabilities, often coexist with ADHD. Find out if you or your child has one or more of them. By Larry Silver, M.D.

A woman goes to the family doctor because she’s always tired and lacks energy. The doctor notes that the linings of her eyelids are pale and concludes that she has iron deficiency anemia. The doctor prescribes iron supplements. In another instance, a mother hears from her daughter’s teacher that she isn’t sitting still and paying attention in class. The teacher fills out some rating scales that confirm this observation. The mother takes these comments and forms to her daughter’s pediatrician, who says, “Why don’t we put her on Ritalin (or Adderall or Dexedrine or Strattera....)?” In each case, the doctor has observed symptoms that suggest a problem. However, before treatment is started, it’s critical to clarify the specific cause of it. Clearly, in the first case, the doctor would conduct several diagnostic tests before concluding the cause of anemia and starting a treatment plan. This approach is just as critical in making a diagnosis of ADHD.

Free Webinar Replay

What to treat first? Dr. Larry Silver explains treating depression, anxiety, and other related conditions in concert with ADHD: http://additu.de/6k

Yes, you or your child might be overactive, inattentive, and/or impulsive. But these behaviors could be caused by anxiety, depression, academic frustration, family problems, or even pinworms (which can cause itchiness around a child’s rear end). The physician needs to explore and find the cause of the behavior (see “Don’t Rush the Diagnosis”).

Not Just Attention Deficit

While it’s essential for a physician to make a definitive diagnosis of ADHD, it’s equally important for him or her to look for other problems that often coexist with it. These are called comorbidities. Once a diagnosis is made, starting treatment with the appropriate medication is critical. But medication isn’t the sole answer. In fact, patients who are only on medication have less successful outcomes than those who receive help for other problems they might have. Your family doctor may not know this. So you must be informed to shape the evaluation process and treatment plan. Toward that end, here is what you should know about the most common conditions associated with ADHD and a basic treatment plan for each: 1. Learning Disabilities

Fifty percent of children and adolescents with ADHD also have some type

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of learning disability (LD), such as dyslexia or auditory processing disorder — and these conditions can cause problems into adulthood. An LD may explain why someone on medication can sit still and stay focused and yet do poorly at school. There could also be another reason for academic failure. If the ADHD diagnosis isn’t made until the fourth or fifth grade, it’s possible that a child will have gaps in basic skills, especially math and language arts, prior to receiving treatment for ADHD. While this student may not have a learning disability, he will need academic interventions. Course of action: Speak with your school professionals about assessing your child to see if he or she has a learning disability. If they refuse — and they are legally required to provide a reason for doing so — you might try getting a private assessment. If your student has an LD, he/she will need special-education services, along with appropriate accommodations in the classroom. 2. Mood Disorders

Fifty percent of those diagnosed with ADHD will have so-called mood disorders — difficulty regulating their emotions. Some might struggle with anxiety, possibly having panic attacks, while others may experience periods of depression. Others may have trouble controlling their anger, while still others might have difficulty regulating their thoughts and behaviors, which can result in obsessive-compulsive disorder. Some patients have trouble controlling their motor behavior (tics are a common symptom). Such problems are caused by faulty wiring in an area of the brain other than that involved in ADHD. If you or your child has any of these problems, and if they have been chronic and pervasive, it’s essential that they be diagnosed.

Free Webinar Replay

Dr. William Dodson explains the telltale signs of depression and mood disorders in adults and kids with ADHD: http://additu.de/mood -disorder

Course of action: Speak with your family doctor and request a referral to a mental-health professional. (Since medication may be needed, it would be efficient to see a psychiatrist, who can prescribe medication.) If you or your child has a regulatory problem, a selective serotonin reuptake inhibitor (SSRI) may help significantly. However, alternative treatments like Cognitive Behavioral Therapy (CBT) have also shown to be effective — talk to your treatment team about all your options. 3. Behavioral Problems

Unlike regulatory problems, these behaviors usually begin at a certain age — third grade or middle school — and seem to occur in certain settings, such as the classroom or when doing homework. They’re often caused by frustrations a child has experienced before his or her ADHD was diagnosed. Some kids deal with emotional pain by externalizing their problems. They blame others and take no responsibility for their behaviors. This syndrome is called oppositional defiant disorder or oppositional conduct disorder (ODD). Some children keep the pain inside and have a poor self-image. They might

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show clinical evidence of anxiety or depression. Course of action: Seek a consultation with a mental health professional, preferably one who is familiar with ADHD. Treatment often requires that the child work with a therapist, along with his parents and siblings. 4. Social Skills Problems

If you or your child acted oddly or inappropriately with friends or colleagues before you received treatment for ADHD, it’s often hard for your peers to shake that image of you. You or your child might need help relearning social skills. For others, difficulty in relating to peers may have other causes, which should be both explored and diagnosed. Course of action: Once again, seek a consultation with a mental-health professional familiar with ADHD. Interventions might include counseling, group therapy, or participation in a group that focuses on teaching social skills. If it’s your child, the school counselor can often play a significant role in these interventions. 5. Family or Personal Problems

Don’t rule out real world problems as a possible cause for additional symptoms. Parents of a child with ADHD symptoms may be overwhelmed by managing their child’s behavior or conflicted about a course of action, for example. The stress often causes marital problems that may adversely affect a child. Similarly, marital problems or difficulties at work may lead to symptoms of depression or anxiety in ADHD adults. Course of action: Seek a mental-health professional who specializes in marital or family counseling. 6. ADHD, OCD, and Tourette Syndrome Share Genetic Links

In the largest study1 of its kind, research conducted over 16 years has confirmed that Tourette Syndrome (TS) often occurs alongside other psychiatric disorders. Most commonly, TS is diagnosed with ADHD, obsessive compulsive disorder (OCD), or both. Seventy-two percent of the group studied had TS with ADHD or OCD. Nearly one third of the group had all three conditions.

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The study, conducted by the Tourette Syndrome Association International Consortium for Genetics (TSAICG), followed 1,300 TS patients from 1992 1. Hirschtritt, Matthew E., Paul C. Lee, David L. Pauls, Yves Dion, Marco A. Grados, Cornelia Illmann, Robert A. King, Paul Sandor, William M. Mcmahon, Gholson J. Lyon, Danielle C. Cath, Roger Kurlan, Mary M. Robertson, Lisa Osiecki, Jeremiah M. Scharf, and Carol A. Mathews. “Lifetime Prevalence, Age of Risk, and Genetic Relationships of Comorbid Psychiatric Disorders in Tourette Syndrome.” JAMA Psychiatry 72.4 (2015): 325-33. Web.

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to 2008. Researchers interviewed participants, and reviewed diagnostic information from parents, siblings, and other relatives that did not have TS to examine how these conditions may be passed through family lines. They found mood disorders, anxiety disorders, and disruptive behavior also prevalent among the patients studied, with 30 percent receiving one of these diagnoses alongside TS. Additionally, the study found that these comorbid conditions present at an earlier age in TS patients than they do in the general population, sometimes even before the tic disorder is diagnosed. For example, anxiety and depression show up in TS patients as young as five — 10 to 20 years before they are commonly seen in the population at large.

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Learn more about common diagnosis mistakes, in our free “It’s Not ADHD” download.

The researchers believe that the common concurrence of the disorders demonstrates a genetic relationship between ADHD, OCD, and TS. Scientists hope that this new data will lead to earlier screening and more accurate diagnoses. The statistics on how commonly TS is diagnosed with ADHD and OCD could help physicians tease out which conditions are causing symptoms, and provide clues for additional screenings when they hit a dead end. This study lays bare the full spectrum of diagnostic possibilities that physicians should know when treating a patient with TS.

Larry Silver, M.D., is the author of many books, including Dr. Larry Silver’s Advice to Parents on ADHD and The Misunderstood Child: Understanding and Coping with Your Child’s Learning Disabilities (Harmony).

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Don’t Rush the Diagnosis Make sure that your physician takes a thorough history of you or your child before making a diagnosis. Here are some guidelines to keep in mind when talking with the doctor and before starting a course of ADHD medication:

• Symptoms and behaviors due to anxiety or depression — not ADHD — start at a specific time or occur only in certain circumstances.

• A diagnosis of ADHD requires three steps: 1) showing that the behaviors exist

2) showing that they are chronic (you probably would have noted symptomatic behavior since preschool, or at least age six) 3) showing that they are pervasive (symptoms occur in two or more life situations, including at home, at school, with friends)

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Common Comorbid Conditions Half of all ADHDers are affected by “comorbid” condition. Here’s what to look for — and where to go for help. Symptoms

Resources

Learning Disabilities

Difficulty mastering reading, writing, and/or math skills; difficulty with memory, mastering new academic concepts, and/or reasoning.

The Misunderstood Child: Understanding and Coping with Your Child’s Learning Disabilities, by Larry Silver, M.D. (Three Rivers Press); Learning Disabilities Association of America (ldaamerica.org).

Language Disabilities

Difficulty understanding what is said; difficulty organizing thoughts and finding the right words when speaking.

Childhood Speech, Language & Listening Problems, by Patricia McAleer Hamaguchi (Wiley); American SpeechLanguage-Hearing Association (asha.org).

Fine and Gross Motor Difficulties

Difficulty with fine motor skills (writing, tying shoes); difficulty with gross motor skills (running, playing, eye-hand coordination, riding a bike).

The Source for Nonverbal Learning Disorders, by Sue Thompson (LinguiSystems); The Out-of-Sync Child, by Carol Stock Kranowitz; Nonverbal Learning Disorders Association (nlda.org); American Occupational Therapy Association (aota.org).

Tic Disorders (motor, oral, Tourette Syndrome)

Patterns of motor (or vocal) tics that come and go and may change form.

Tics and Tourette Syndrome, by Uttom Chowdhury (Jessica Kingsley Publishers); Tourette Syndrome Plus (tourettesyndrome.net).

Anxiety

Specific or generalized fears beyond what would be expected given a child’s age; panic attacks.

Worried No More, by Aureen Pinto Wagner, Ph.D. (Lighthouse Press); Anxiety Disorders Association of America (adaa.org).

Depression

Persistent moodiness, fatigue, or loss of appetite; unexplained feelings of guilt; unexplained agitation or irritability.

The Childhood Depression Sourcebook, by Jeffrey A. Miller, Ph.D. (McGraw-Hill); American Academy of Child & Adolescent Psychiatry (aacap.org).

AngerControl Problems

Uncontrollable anger or rage lasting five to 30 minutes or longer; irrational during “meltdown”; often remorseful afterward.

The Explosive Child: A New Approach for Understanding and Parenting Easily Frustrated, Chronically Inflexible Children, by Ross W. Greene, Ph.D. (Harper); aacap.org.

Obsessivecompulsive Disorder (OCD)

Ritualistic, goal-directed behavior, such as counting or repeating, or picking at sores or scabs or pulling out hair; need for extreme order or cleanliness; need to collect or hoard objects.

Freeing Your Child from Obsessive-Compulsive Disorder, by Tamar E. Chansky, Ph.D. (Three Rivers Press); International OCD Foundation (iocdf.org).

Bipolar Disorder

Mood swings from calm to rage and/ or from depression to manic (high energy) state.

The Bipolar Child, by Demitri Papolos, M.D., and Janice Papolos (Broadway); Depression and Bipolar Support Alliance (dbsalliance.org).

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Women and ADHD: Distinct Considerations Review this symptom checklist for women with your doctor.

Do you have ADHD? Only a mental-health professional can tell for sure, but completing a do-it-yourself symptom checklist will give you an idea. The more questions you answer in the affirmative, the more likely you are to have ADHD. Be sure to share your completed checklist with a doctor. 1. Do you feel overwhelmed in stores, at the office, or at parties? Is it impossible for you to shut out sounds and distractions that don’t bother others? 2. Is time, money, paper, or “stuff ” dominating your life and hampering your ability to achieve your goals? 3. Are you spending most of your time coping, looking for things, catching up, or covering up? Do you avoid people because of this? 4. Have you stopped inviting people over to your house because you’re ashamed of the mess? 5. Do you have trouble balancing your checkbook?

ADHD Self-Test for Women

To take an online version of this quiz, go to http://additu.de/3y

6. Do you often feel as if your life is out of control, that it’s impossible to meet demands? 7. Do you feel that you have better ideas than other people, but are unable to organize them or act on them? 8. Do you start each day determined to get organized? 9. Have you watched others of equal intelligence and education pass you by? 10. Do you despair of ever fulfilling your potential and meeting your goals? 11. Have you ever been thought of as selfish because you don’t write thank-you notes or send birthday cards? 12. Are you clueless as to how others manage to lead consistent, regular lives? 13. Are you called “a slob” or “spacey”? Are you “passing for normal”? Do you feel as if you are an impostor?

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Understanding How ADHD Is Different for Women Women and girls with ADHD are not only less frequently diagnosed than their male counterparts. ADHD girls and women often require genderspecific treatments to help manage symptoms, succeed at school and work, and have successful relationships. By Katherine Ellison

Finally — 31 years after “Attention Deficit Disorder” first appeared in the bible of psychiatry, the Diagnostic and Statistical Manual of Mental Disorders (DSM), front-line clinical therapists say that increasing awareness of the condition has led to many more girls being diagnosed while they’re young. Even so, while girls and boys currently are diagnosed at a ratio of about 1 to 3 — up from about 1 to 8 in the 1990s — the rate for diagnoses of adult women and men is about 1 to 1. “It’s only a matter of time before we find this is an equal-opportunity disorder, although a less glaringly obvious one for girls,” says psychologist and author Kathleen Nadeau, Ph.D., a pioneering expert on women with ADHD. That’s not a unique opinion, nor is it unanimous. Some experts — including psychologist Stephen Hinshaw, Ph.D., head of a major longitudinal study of girls with ADHD, and psychologist and author Russell A. Barkley, Ph.D., — believe the current 1 to 3 ratio of girls to boys diagnosed with the condition is accurate. “Boys seem to be more vulnerable to psychopathology,” Hinshaw says, citing rates of childhood autism that are also dramatically higher for boys — on the order of 5 to 1. Hinshaw, author of The Triple Bind: Saving Our Teenage Girls from Today’s Pressures, speculates that higher rates of ADHD in adult women might be explained by women having a variation of the disorder that lasts longer than it does in males.

“It can be difficult at times being a woman with ADHD because all of the things that go along with being traditionally ‘feminine’ are not easy for us. I feel lucky every day of my life that I have a caring and wonderful partner who loves me for who I am and encourages me every step of the way.” — Janie, an ADDitude Reader

It’s well known by now, he explains, that boys with ADHD are more likely than girls to demonstrate hyperactivity and impulsivity. More girls than boys are diagnosed with the “inattentive,” day-dreamy type of the disorder. Yet several longitudinal studies show that symptoms of activity fade during adolescence, whereas underlying problems with attention and organizational skills usually persist through adulthood. Still, other factors might also explain why the male-female rates change in adulthood, Hinshaw says. Perhaps women are more honest than men about attention problems in adulthood. Moreover, he suspects that Nadeau and other experts may be right in suggesting that many young girls with ADHD are under the radar, to be identified only as adults.

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Indeed, hyperactivity, and often aggression, goes along with many cases of ADHD. It usually gets more boys with ADHD noticed, and helped, while girls turn their frustration inside. The cost for women is years of low selfconfidence and psychological damage.

How Undiagnosed ADHD Puts Girls at Risk

“Girls with ADHD are in deep trouble in a lot of ways,” says Hinshaw. Recently, he and his team analyzed results from 10-year, follow-up interviews of 140 girls who were aged seven to 12 when first surveyed. His data, along with other reports over the last five years, show that girls with ADHD are at significantly increased risk for problems ranging from low academic achievement to drug and alcohol abuse, and even suicide attempts. Females, in general, suffer greater rates of anxiety and depression than males, and it appears that the rate is even more pronounced when ADHD is a factor.

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A study1 published in 2010 in the Archives of General Psychiatry found that girls with ADHD were at far higher risk than other girls, or than boys with the disorder, for depression and suicide attempts. Another report,2 published a few years ago in the American Journal of Psychiatry, revealed that girls with ADHD were more likely than others to engage in antisocial and addictive behavior, and to suffer from anxiety. What’s clear from his follow-up, Hinshaw says, is that girls with ADHD share with boys the strong risks of school failure, rejection by peers, and substance abuse. Unlike boys, they also have a particularly high risk for developing depression, self-injuring behavior, and eating disorders. “In other words, girls with ADHD appear to show a wider range of difficult outcomes than do boys,” he says. Hinshaw says girls are harmed by earlier, and more effective, socialization. They are trained from an early age not to make trouble, and to disguise mistakes and miscues. They turn their frustration on themselves, rather than others. Often, parents worry that their teen daughter is depressed, but it’s much rarer to suspect that she may have an attention disorder. Girls with inattentive ADHD will probably be diagnosed later than boys, and for something entirely different. 1. Chronis-Tuscano, Andrea, Brooke S. G. Molina, William E. Pelham, Brooks Applegate, Allison Dahlke, Meghan Overmyer, and Benjamin B. Lahey. “Very Early Predictors of Adolescent Depression and Suicide Attempts in Children With Attention-Deficit/Hyperactivity Disorder.” Archives of General Psychiatry 67.10 (2010): 1044-051. Web. 2. Biederman, Joseph, Carter R. Petty, Michael C. Monuteaux, Ronna Fried, Deirdre Byrne, Tara Mirto, Thomas Spencer, Timothy E. Wilens, and Stephen V. Faraone. “Adult Psychiatric Outcomes of Girls With Attention Deficit Hyperactivity Disorder: 11-Year Follow-Up in a Longitudinal CaseControl Study.” American Journal of Psychiatry 167.4 (2010): 409-17. Web.

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Meanwhile, girls with the hyperactive type of ADHD are stigmatized more than boys with the same diagnosis. Kids on the playground regard impulsivity and distraction as boyish. Boys are more likely to get a pass from other kids and teachers, especially if their symptoms aren’t severe. Girls get ostracized. For many young women, the anxiety, stress, and low self-esteem that comes with ADHD feels intolerable by early adulthood. The structure of school is gone, a positive for boys but a loss for girls, who fare better with rules and routines, according to Hinshaw. When women with ADHD marry and have kids, many of them hit what psychotherapist and author Sari Solden calls “a terrible wall of shame.” Society expects tremendous feats of memory and organization from moms, from keeping track of critical facts about teachers and pediatricians to organizing meals and multiple schedules. And without treatment, or a “wife” of their own, many women can’t cut it.

Is ADHD in Women and Girls Hereditary?

ADHD is strongly hereditary, and many women seek help as adults because a light bulb goes off when they have a child who is diagnosed. This was the case with Joy Carr. Watching her preteen son fill out his diagnostic questionnaire brought a flood of memories — of her own messy lockers, lost textbooks, and teachers who called her bright but lazy. Following a familiar pattern for young adults with ADHD, Carr, who lives near Buffalo, New York, dropped out of college as a junior, got married at 22, and had her first child one year later.

Resource Center

Learn the truth about ADHD in women, at http://additu.de/women

For many years, her domestic duties overwhelmed her. She’d start out on a chore, from a list her husband prepared, then get sidetracked, ending up with tasks half-done. “I’d throw a load of laundry in and forget about it for days,” says Carr. “By then, it would smell musty, so I’d wash it again. And then I’d forget about it again.” However, Carr’s life took a turn for the better after she got her ADHD diagnosis and started taking ADHD medication. “The roaring, racing thoughts in my head quieted down,” she says. That same year, she went back to college to complete her undergraduate degree. After coping with her son, she apologized to her mother for the grief she gave her as a child. Women tell sad stories of showing up for diagnoses. Kathleen Nadeau, who diagnosed herself in her 30s, had been an undergraduate at four different colleges. Sari Solden, who was 42 when she figured out she had ADHD, says her diaries testify to decades of wondering what was wrong. Was she immature? Did she have a brain tumor? Narcolepsy? Trying stimulants after years

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without them was like “greasing my brain,” Solden says. “I remember going to a dinner that night. I was asked a question, and I actually told a story.”

ADHD in Women: Different Gender, Different Treatment

ADHD not only presents different symptoms in boys and girls, but it often requires a different treatment strategy, says Nadeau. Both genders benefit from stimulant medications, she says, but girls may need treatment for anxiety. They frequently cannot tolerate stimulants without extra pharmaceutical support. Hinshaw says he’s not convinced that girls need extra meds to tolerate stimulants, compared to boys. He notes that, to the extent that girls are likely to develop depression and anxiety, evidence-based cognitive behavioral therapies may be helpful. Nadeau also recommends group therapy, as a genderspecific strategy, to encourage girls and women to use their verbal skills to give one another support, develop coping strategies, and not feel isolated.

“Just when you think you’ve got a handle on it... hormones change. Joy!” — Janet, an ADDitude reader

Hinshaw’s study, as well as other research that follows girls into adulthood, offers hope for more interventions over time, but, for now, parents and teachers have to work to help girls who are struggling with distraction — spotting them at home and in classrooms, and supporting them in getting diagnoses, even if they may not precisely fit the symptom profile. Women with ADHD should spread the word. While a little adversity makes you stronger, imagine what women with ADHD could accomplish if we could turn the energy we use to beat ourselves up to going out and changing the world.

ADHD Symptoms Checklist for Girls

Psychologist Kathleen Nadeau has devised a symptoms checklist3 for girls suspected of having ADHD. It should be filled out by girls themselves, not parents and teachers, because girls experience ADHD more internally than boys, who get attention with unruly behavior. Many of Nadeau’s questions apply to boys, since they pertain to problems with productivity, general distractibility, impulsivity, hyperactivity, and sleep problems. The excerpts that follow, however, are particularly oriented toward girls:

“If only I knew what was going on years ago when I was younger. Isn’t it great to have an explanation for these feelings and behaviors — instead of just feeling flawed or weird?” — Laura, an ADDitude Reader

Anxiety and depression

• I often feel like I want to cry. • I get a lot of stomachaches or headaches. 3. Nadeau, Kathleen G., Ellen Littman, and Patricia O. Quinn. Understanding Girls with AD/HD. Silver Spring, MD: Advantage, 1999. Print.

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• I worry a lot. • I feel sad, and sometimes I don’t even know why. School anxiety

• I dread being called on by the teacher because, often, I haven’t been listening carefully. • I feel embarrassed in class when I don’t know what the teacher told us to do. • Even when I have something to say, I don’t raise my hand and volunteer in class. Social-skill deficits

• Sometimes, other girls don’t like me, but I don’t know why. • I have arguments with my friends. • When I want to join a group of girls, I don’t know how to approach them, or what to say.

“I have two daughters with ADHD. Every year the teachers are surprised they have it because their symptoms are not the typical stereotype.” — Pamela, an ADDitude reader

• I often feel left out. Emotional over-reactivity

• I get my feelings hurt more than most girls. • My feelings change a lot. • I get upset and angry more than other girls.

Parents & Teachers: Does This Sound Like a Girl You Know?

Five telltale signs that your daughter or student may have ADHD — according to Kathleen Nadeau: • Does she often lose personal items, her keys, or her backpack?

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• Is her room always messy — even 15 minutes after you clean it up? • Does she often feel anxious about getting school assignments in on time? • Does she talk excessively? • Does she behave well at school, and come home and explode at the end of the day? Can she be pushed over the edge by trivial provocation? Katherine Ellison is an award-winning, veteran investigative reporter, and the author of Buzz: A Year of Paying Attention (Voices; 2010).

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Moving Ahead After Diagnosis Strategies for dealing with your ADHD during the first year. By Edward Hallowell, M.D.

Receiving a diagnosis of ADHD can change your life for the better. It can also trigger strong, polar emotions — everything from joy to sadness, anger to forgiveness. You are happy: “I finally have a name for all of those symptoms.” You are sad: “Why did I have to struggle for so many years not knowing what I had?” Go ahead and grieve! It is sad that you struggled, particularly because knowledge about ADHD is the first step in controlling its symptoms. You may also feel anger — at doctors, parents, or yourself — for not figuring it out sooner. Those emotions are an important part of moving forward. Once you acknowledge your pain — and that you did the best you could at the time — you can create a bright future.

Start Your New Life

As you fashion your new life, realize that the first year after diagnosis is confusing and hard work. So it is important to keep the following advice in mind:

“When I got my diagnosis, I cried with relief as I finally knew the reason I was always an outcast in school and in life.” — Dawn, an ADDitude reader

Ask your spouse, partner, doctor, or coach to track how you are doing. It isn’t always easy for you to assess how well treatment is working. One of my patients takes medication that he can “barely feel,” yet his wife and coworkers report that he no longer has outbursts of anger, is more focused, and is better able to start and finish projects. Honest feedback can keep you focused on treatment and give you the determination to try new methods if the old ones aren’t working. Look to a supportive spouse or insightful coach to help you find your hidden treasures, which may have been overshadowed by your ADHD symptoms. What do you do best? What do you love most? One of the most exhilarating, and perhaps scariest, parts of treating ADHD is reorganizing your life around your strengths, rather than your weaknesses. If you look back at your life, you’ll notice that it has often been defined by what you can’t do. But what happens when your life is defined by what you do well? Be aware that your spouse may initially reject your diagnosis of ADHD. “Your ADHD is just an excuse for not doing what you’re supposed to be doing!” he might say. She may be angry about your not following through on chores or being too distracted to focus on her and her needs. Learning all about ADHD, along with gradual changes in your own behavior, can convince your partner that your diagnosis is indeed accurate. He will learn to

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separate you from your symptoms, becoming more patient and empathetic as you search for the best treatment.

Be Patient with Treatment

While medication can help manage symptoms, it won’t immediately turn around your life. ADHD medication helps alleviate some of the most aggravating symptoms — the inability to initiate, focus on, or complete tasks. But just because you’re better able to focus doesn’t mean you have the skill set to stay organized! People who have had ADHD all their lives usually haven’t learned skills that their non-ADHD counterparts take for granted — organizational or social skills, for example. It takes time, practice, perhaps a coach, and a sense of humor to master these. Medication alone won’t do it. Getting impatient with treatment is normal. The question almost everyone asks is: “Why aren’t my symptoms going away?” You may need to try different medications, at different dosages, to see which works best. You may need to look into complementary therapies as well. Learn how aerobic exercise or nutrition can work with medication to manage symptoms.

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ADHD and the Workplace

When it comes to the job, the newly diagnosed often wonder, “Whom should I tell?” and “What should I say?” It’s probably best to tell no one. Get your symptoms under control at home and see whether that solves some of the problems you’re having at work. Not everyone is positive, or knowledgeable, about ADHD, and you don’t want your boss thinking you are making excuses. Instead, look at your work challenges through the lens of your ADHD diagnosis. Have you left projects uncompleted or missed meetings? Now that you know ADHD is playing a role, hire a coach or personal assistant or lobby for assignments at which you can excel. You can do all of these things without raising the topic of ADHD. Treating ADHD will transform your outlook on life. With your diagnosis comes hope. Remember that treatment can be one step forward, two steps back. Keep at it, though, and you may well find the rainbow after the storm has passed! Edward (Ned) Hallowell, M.D., has ADHD himself, and is a practicing psychiatrist and founder of the Hallowell Center for Cognitive and Emotional Health, with several locations around the country. An instructor at Harvard Medical School, he is the author of 10 books, including the bestsellers, Driven to Distraction (Touchstone), Delivered from Distraction (Ballantine), and most recently, Positively ADD (Walker).

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Chapter Four

Treatment Options for Children and Adults 10 Things You Should Know About Stimulants Parents of ADHD children and ADHD adults have lots of questions before starting on medication. Here are the answers. By Laura Flynn McCarthy

1. How can I tell if my child or myself really needs medication?

Experts agree that medication should be considered for anyone — child or adult — whose symptoms interfere with his social, emotional, or academic life. Behavioral therapy and other non-drug treatments can be helpful for controlling symptoms, but, in most cases, experts say, these approaches are not powerful enough to replace medication.

Stimulant Guide

Dr. Larry Silver reviews the pros and cons of popular ADHD medications at http://additu.de/meds-guide

It’s essential that the diagnosis of ADHD is a reliable one. ADHD-like symptoms can be caused by a range of disorders, including anxiety, depression, and obsessive-compulsive disorder. In some cases, symptoms arise from the frustration of struggling with a learning disorder. Make sure the doctor uses the diagnostic criteria spelled out in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, commonly referred to as the DSM-V. If the patient is a child, the doctor should get input from teachers as well as from parents.

2. Are the medications safe?

The stimulants commonly prescribed for ADHD are considered among the safest of all psychiatric medications. “The risks of using these medications are very low,” says William W. Dodson, M.D., a Denver-based psychiatrist who specializes in ADHD. “The risks involved in not treating ADHD are very high. These include academic failure, social problems, car accidents, and drug addiction.”

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As with many prescription drugs, of course, stimulants can interact dangerously with certain other medications. Be sure to alert the doctor about any other drugs you or your child are taking. Parents of ADHD children are often more skeptical of medication than adults. A 2004 study1 indicated that, between 1999 and 2003, 19 children died while taking either methylphenidate or amphetamine, the two most commonly prescribed stimulants. The FDA concluded that the number of deaths was no greater than would have been expected, given the large number of kids taking these medications. In addition, five of the children who died had a structural heart defect. In 2006, the FDA decided to require a label warning that stimulant medications may cause cardiovascular problems. According to Steven E. Nissen, M.D., the FDA panel member who championed the stiffer warning, “stimulant medications raise heart rate and blood pressure, neither of which is good for the heart. A 12-year-old who is not able to focus at school should be able to get medication that helps him. I just want doctors to think carefully before they write a prescription.”

Resource Center

Your essential guide to ADHD medications: http://additu.de/meds

Serious complications from these medications, though, are rare, affecting only four out of the 2.5 million children on stimulants each year. Regardless of whether the medication is for yourself or your child, your doctor should check for heart palpitations, irregular heartbeat, and fainting spells, as well as a family history of sudden cardiac death or irregular heartbeat. If any of these factors are present, the patient should be evaluated by a cardiologist before taking a stimulant. New research suggests that leaving ADHD symptoms untreated may be far more dangerous than treating them with medication. Danish researchers found earlier this year that accidents are the leading cause of death among people with ADHD, who are more than twice as likely to die prematurely as are those without the disorder. The risk is greatest among adults diagnosed later in life who have gone without treatment for their symptoms.

3. What about side effects?

Stimulants can cause a range of side effects, notably appetite suppression and weight loss. But these effects tend to be transient, recent studies suggest. Appetite suppression, for example, has shown to go away in about six months, in most cases. However, parents often remain worried about their child getting enough calories — giving your child a big meal after medication has worn off may be enough to compensate. 1. Read the FDA Safety Review at: http://www.fda.gov/ohrms/dockets/ac/06/briefing/20064210b_07_01_safetyreview.pdf

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Stimulants can also cause headaches or lead to difficulty falling asleep. Lowering the dosage or switching to another drug may ease these problems. In rare cases, patients taking a stimulant experience visual or tactile hallucinations, or develop a tic, such as blinking uncontrollably. “No one should have to tolerate side effects,” says Larry Silver, M.D., clinical professor of psychiatry at Georgetown Medical Center in Washington, D.C. “After all, the problem can usually be solved with a simple adjustment to the medication dosage or schedule.”

4. Will medication stunt my child’s growth?

Researchers have long suspected that consistent use of stimulant medications slows a child’s growth. With three years of data from the Multimodal Treatment Study with ADHD (MTA)2, researchers were able to confirm this theory. On average, kids taking stimulants lagged behind peers on their growth curves by 3/4 of an inch in height and by six pounds in weight. Each time a child goes in for a checkup and a new prescription, a parent should have the doctor monitor the child’s height and weight.

5. How does the doctor know which ADHD medication to prescribe?

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Check out ADDitude’s free download: 9 Rules for Using ADHD Medications Safely and Effectively.

There is no evidence that any particular drug is best. “Treatment of ADHD should begin with an oral stimulant, either an amphetamine or a methylphenidate-based formulation,” reports Treatment Guidelines, a highly respected newsletter for physicians about prescription drugs. “None of these drugs is inherently more effective than another…The choice of a specific drug should be based on its rapidity of onset, duration of action, and effectiveness in a given patient.” Most patients with ADHD do very well on one of the methylphenidatebased (Ritalin, Metadate, or Concerta) or amphetamine-based (Adderall, Vyvanse, or Dexedrine) drugs. If one med doesn’t seem to work — or if it works only at a high dosage that causes serious side effects — the doctor may prescribe another drug.

6. How long do the medications last?

The short-acting forms of methylphenidate, amphetamine, and mixed amphetamine salts last about four hours. Each also comes in an eight-hour form, and methylphenidate comes in a 12-hour form. The methylphenidate skin patch (Daytrana) works for up to 12 hours. It’s critical that you or your 2. Abikoff, Howard B., C. Keith Conners, Laurence L. Greenhill, Stephen P. Hinshaw, William E. Pelham, and James M. Swanson. “Multimodal Treatment Study of Children With Attention Deficit and Hyperactivity Disorder (MTA).” PsycEXTRA Dataset (2008): n. pag. Web.

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child be “on” medication whenever hyperactivity, inattention, or impulsivity threatens to interfere with important duties — including work, school, or outside activities.

7. What options are available for those who have trouble swallowing pills?

Methylphenidate is available in liquid and chewable forms, as well as in pill form. It’s also possible to get stimulants in capsules, which can be opened and the contents sprinkled on food. Another option is the Daytrana patch.

8. How does the doctor determine the correct dosage?

It is determined not by the patient’s weight or age, but according to how efficiently his body metabolizes the medication. Thus, a seven-year-old who tips the scale at 50 pounds might need a dosage higher than the one that works for a 200-pound adult. Most doctors start with a very low dosage of a particular stimulant, and then raise it every week or two until the benefits level off, or side effects become a problem (honest feedback from patients, parents, teachers, and spouses is very important). Then the previous dosage is usually deemed to be the best one for that patient. Some doctors alternate methylphenidate and amphetamine, to see which is preferable. “I always have my patients try both types of stimulant medication, because people tend to prefer one over the other,” says Dodson.

Medication Reviews

ADDitude readers share their experiences with the major stimulant and nonstimulant ADHD medications: http://additu.de/reviews

9. Do stimulants work for everyone?

Some people don’t respond to stimulants. Others respond but are unable to tolerate the side effects. What’s more, stimulants may be inappropriate for those who take inhaled steroids for asthma, or anyone who has bipolar disorder, a history of drug addiction, seizure disorder, or an eye condition known as narrow-angle glaucoma. And, of course, people with certain heart conditions should not take stimulants. For these ADHDers, doctors sometimes prescribe non-stimulant medication, tricyclic antidepressants, or the antidepressant bupropion (Wellbutrin).

10. Are “drug holidays” a good idea?

Some experts, including Copps, are dubious of this practice. For children in particular, “One-third to half of your child’s education occurs outside of school,” he says. “If he can’t pay attention, he can’t learn.” Silver says patients often tell him that they or their child don’t need meds at home because they can “handle” these behaviors outside of a school or work setting. However, under deeper questioning, he says they often report that the problem be-

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haviors still cause problems outside of work or school — in which case, he argues, medication is definitely still necessary. On the other hand, patients who have used a stimulant successfully for some time might be given a brief trial off the drug, to see if it is still necessary. This should be done only when your life is as in order as possible — and, of course, only with a doctor’s supervision. Laura Flynn McCarthy is a freelance writer who specializes in parenting and children’s health. She lives with her family in Bow, New Hampshire.

Exercise: An Alternative ADHD Treatment Physical activity may be good for focus. And it’s inexpensive, self-prescribed, and accessible to everyone. By the ADDitude Editors

“Think of exercise as medication,” says John Ratey, M.D., an associate clinical professor of psychiatry at Harvard Medical School. “For a very small handful of people with ADHD, it may actually be a replacement for stimulants, but, for most, it’s complementary — something they should absolutely do, along with taking meds, to help increase attention and improve mood.” While most of us exercise as a way to trim our waistlines, the better news is that routine physical activity firms up the brain. “Exercise turns on the attention system, the so-called executive functions — sequencing, working memory, prioritizing, inhibiting, and sustaining attention,” says Ratey, author of Spark: The Revolutionary New Science of Exercise and the Brain (Little, Brown). “On a practical level, it causes kids to be less impulsive, which makes them more primed to learn.”

Resource Center

An exercise and weight-loss guide built specifically for adults with ADHD: http://additu.de/new-year

The latest news about exercise is that it helps patients push through past failures and attack things they didn’t succeed at before. “The refrain of many ADHDers is, ‘No matter what I do, I’m going to fail,’” says Ratey. “Studies involving rats show that exercise reduces learned helplessness. In fact, if you’re aerobically fit, the less likely you are to learn helplessness.” So how, exactly, does exercise deliver these benefits to the ADHD brain? When you walk, run, or do a set of jumping jacks, your brain releases several important chemicals. Endorphins, for one, hormone-like compounds that regulate mood, pleasure, and pain. That same burst of activity also elevates the brain’s dopamine, norepinephrine, and serotonin levels. These brain chemicals affect focus and attention, which are in short supply in those with ADHD. “When

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you increase dopamine levels, you increase the attention system’s ability to be regular and consistent, which has many good effects,” explains Ratey, like reducing the craving for new stimuli and increasing alertness. You don’t have to be a marathoner, or even a runner, to derive benefits from exercise. Walking for 30 minutes, four times a week, will do the trick. For parents, Ratey suggests, “Get your child involved in something that he finds fun, so he will stick with it.” Team activities or exercise with a social component are especially beneficial. Studies have also found that tae kwon do, ballet, and gymnastics, in which you have to pay close attention to body movements, tax the attention system. “These activities are a very good thing for kids and adolescents with ADHD,” says Ratey. Some companies are starting to introduce workplace health and exercise initiatives, and many schools are including exercise in their curricula to help kids do better in the classroom. Google, for example, has a lap pool for employees to take a dip on their lunch breaks. A school in Colorado starts off students’ days with 20 minutes of aerobic exercise to increase alertness. If kids act up in class, they aren’t given time-outs but time-ins — 10 minutes of activity on a stationary bike or an elliptical trainer. The results have been phenomenal. Adults and children — ADHD or not — have been able to better themselves and their performance through exercise. “That’s empowering,” says Ratey.

The Good News About Fish Oil Omega-3s, along with a balanced diet, may minimize ADHD symptoms. By Karen Barrow Countless studies have centered on the potential benefits of nutritional supplements as treatment for ADHD. Vitamins, minerals, and even some oddsounding plant compounds — vinpocetine, a derivative of the periwinkle plant, and yerba mate, derived from evergreen trees in South America — have been studied for their ability to boost mental focus. But so far only a few supplements seem to have some evidence supporting their use for ADHD — and the most powerful one by far is omega-3 fatty acids.

Easy to Swallow

Find fish oil products tested — and approved — by kids: http://additu.de/omega-3

Found mainly in cold-water, fatty fish, such as sardines, tuna, and salmon, omega-3s are believed to be important in brain and nerve cell function. The body cannot make omega-3 fatty acids by itself, and because the American diet is heavy on beef and chicken — not fish — most people don’t consume

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enough of them to derive benefits. “I tell my patients that there are two things they need to do for their health: exercise and consume omega-3s,” says John Ratey, M.D., associate clinical professor of psychiatry at Harvard Medical School and coauthor of Driven to Distraction (Touchstone). While omega-3 fatty acids seem to improve anyone’s mental focus, the compounds may be especially helpful to those with ADHD. One study,3 published in Nutritional Neuroscience, showed that omega-3s tended to break down more readily in the bodies of patients with ADHD. Another study,4 published in The Journal of Nutritional Biochemistry, suggested that children with ADHD were more likely to have low blood levels of omega-3 fatty acids than children with no symptoms of the condition. Although both studies were small, the results led scientists to surmise that increasing omega-3s in the diet can help control ADHD symptoms. Edward Hallowell, M.D., founder of the Hallowell Center for ADHD in Massachusetts, recommends that all of his patients take omega-3 supplements and notes that “it seems to help most with mental focus, not hyperactivity or impulsivity.” Ratey advises that it may take up to six weeks for patients to begin seeing benefits.

Recommended Reading

Looking for more on natural treatments for ADHD? Check out ADHD Without Drugs: A Guide to Natural Care, by Sandford Newmark, M.D.

Picking the Right Pill

If you decide to add omega-3s to your diet, how do you determine which brand is best? There are two main types of omega-3 fatty acids in fish oil: eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Both seem to help brain function, but, because they are slightly different compounds, they work in different ways. Early studies on omega-3s that tested the impact of either EPA or DHA on attention problems produced mixed results. Only recently have researchers begun to look at supplements that combine the two. In a small study,5 published in Nutrition Journal, for example, nine children with ADHD were given supplements containing both EPA and DHA every day. After eight 3. Germano, Michele, Domenico Meleleo, Gigliola Montorfano, Laura Adorni, Manuela Negroni, Bruno Berra, and Angela M. Rizzo. “Plasma, Red Blood Cells Phospholipids and Clinical Evaluation after Long Chain Omega-3 Supplementation in Children with Attention Deficit Hyperactivity Disorder (ADHD).” Nutritional Neuroscience 10.1-2 (2007): 1-9. Web. 4. Chen, Jiun-Rong, Shiou-Fung Hsu, Cheng-Dien Hsu, Lih-Hsueh Hwang, and Suh-Ching Yang. “Dietary Patterns and Blood Fatty Acid Composition in Children with Attention-deficit Hyperactivity Disorder in Taiwan.” The Journal of Nutritional Biochemistry 15.8 (2004): 467-72. Web. 5. Sorgi, Paul J., Edward M. Hallowell, Heather L. Hutchins, and Barry Sears. “Effects of an Openlabel Pilot Study with High-dose EPA/DHA Concentrates on Plasma Phospholipids and Behavior in Children with Attention Deficit Hyperactivity Disorder.” Nutrition Journal 6.1 (2007): 16. Web.

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weeks, the children showed significant improvements in ADHD symptoms. The most popular omega-3 supplements differ in the amounts of EPA and DHA they contain. Based on the most recent research, Ratey recommends that you choose a supplement that has at least three times the amount of EPA to DHA. “The data seem to show that those using supplements containing higher ratios of EPA get a better response in ADHD symptoms, including mood swings and aggression,” says Ratey. Be aware that high doses of omega-3s may cause nausea, diarrhea, and other gastrointestinal discomfort. Consult your doctor before adding this supplement to your routine. Karen Barrow is a freelance health and science writer based in New York City.

Zinc: A Ritalin Boost? Researchers have studied an alphabet soup of minerals and vitamins for their impact, if any, on ADHD. Very few, though, have been tested on patients who also take ADHD drugs, such as Ritalin, Concerta, and Adderall. One mineral that has been studied in conjunction with medication is zinc. A study6 published in BMC Psychiatry followed 44 children with ADHD, half of whom were given 55 mg. of zinc sulfate, as well as methylphenidate, the active ingredient found in both Ritalin and Concerta. After six weeks, ADHD symptoms in all of the children improved; however, those who took zinc showed even greater improvement in their symptoms of hyperactivity and impulsivity. “Zinc, in addition to Ritalin, seems to manage ADHD symptoms even more than Ritalin alone,” says Ratey. Zinc is involved in the regulation of dopamine, a neurotransmitter that helps control mood. So, while this study is small, Ratey believes that zinc sulfate may make a drug like Ritalin more effective by improving the brain’s response to dopamine. Speak with your doctor before adding this supplement to your or your child’s diet, since it can cause side effects in high dosages. 6. Akhondzadeh, Shahin. “Zinc Sulfate as an Adjunct to Methylphenidate for the Treatment of Attention Deficit Hyperactivity Disorder (ADHD) in Children: A Double Blind and Randomised Trial.” BMC Psychiatry 4.9 (2004): n. pag. Web.

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Balanced Meals, Better Behavior Hyperactivity has long been associated with sugary sodas and cheeks full of candy. It is no surprise, then, that food seems to play a major role — good and bad — in ADHD. Choosing the right foods — or cutting back on the wrong ones — may be a proactive way to prevent ADHD symptoms from swinging out of control. “The role of nutrition in the treatment of any chronic condition is important,” says Helen Rasmussen, Ph.D., a research dietician at Tufts University. Faye Berger Mitchell, a registered dietician from Bethesda, Maryland, has a nine-year-old daughter who was diagnosed with ADHD five years ago. While her daughter takes stimulant medicine to control her ADHD, Mitchell concluded that a pill is not enough. She finds that when her daughter eats a well-balanced diet, including vegetables, carbohydrates, fruits, and plenty of protein, her behavior tends to be more consistently under control. “The biggest challenge is to get my daughter to eat protein,” she says. Protein is key, says Mitchell, because it can prevent surges in blood sugar, which may increase hyperactivity. For Mitchell, something as simple as slipping a little chicken or lean beef into every meal (and even into snacks) has made a difference for her daughter.

Read more about ADHD-friendly nutrition at http://additu.de/adhd-diet

“Her overall behavior is so much better,” she says. Dr. Edward Hallowell advises all of his patients to think about their plates when preparing a meal. Half of the plate, he recommends, should be filled with fruits and vegetables, one-fourth with a protein, and one-fourth with carbohydrates. This combination is a balanced diet, and it may control swings in behavior caused by hunger, surges in blood sugar, or a shortfall of a particular nutrient. In addition to the balanced plate, Hallowell advocates eating several servings of whole grains each day to prevent blood sugar levels from spiking and then plummeting, and cutting back on foods that contain dyes and excess sugar. Several studies have suggested that artificial food coloring and sugar may cause increased hyperactivity in some patients with ADHD.

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Treat ADHD Symptoms with Brain Training Learn how to treat ADHD symptoms with neurofeedback, and meditation — brain-training alternatives to ADHD medication for children and adults. By Pamela Michaels, Maggie Jackson, and Carl Sherman, Ph.D.

For many adults and children with ADHD, the biggest daily challenge is paying attention — at work, in class, in the middle of conversations... Even the non-ADHDers among us could benefit from some attention training from time to time. And now new evidence suggests that alternative ADHD treatments like meditation and working-memory training can improve attention and focus across the board. One study1 found that, after just five days of computer-based brain training, the brains of six-year-olds begin to act like those of adults on one crucial measure of attention. Another study suggested that boosting short-term memory seems to improve children’s ability to stay on task.

Play Attention

Learn more about video games designed to build focus at http://additu.de/ow

We do not yet know how long these gains may last, or the best methods for developing attention. But the demand is clear: Dozens of schools nationwide are already incorporating some kind of attention training into their curricula. And as this new arena of research helps overturn long-standing assumptions about attention and memory, it offers intriguing possibilities. Find out about the specific brain training practices here:

Neurofeedback

What it is: Neurofeedback is an alternative ADHD treatment that uses brain exercises to reduce impulsivity and increase attentiveness. How it works: Neurofeedback is based on a simple principle: training the brain to emit brain-wave patterns associated with focus (as opposed to those waves associated with day dreaming. The result: Some ADHD symptoms — impulsivity, distractibility, and acting out — are less detectable. Treatment: First, a practitioner takes a detailed history of the patient and then maps the patient’s brain by having him wear an electrode-lined cap while performing a complex cognitive task, such as reading aloud. The brain activity is fed to a computer, which then maps the areas of the brain where there is too much or too little brain-wave activity — the sources, theoretically, of the patient’s ADHD symptoms. The patient then trains those areas of the brain that are under-aroused by 1. Rueda, M. R., M. K. Rothbart, B. D. Mccandliss, L. Saccomanno, and M. I. Posner. “Training, Maturation, and Genetic Influences on the Development of Executive Attention.” Proceedings of the National Academy of Sciences 102.41 (2005): 14931-4936. Web.

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controlling a computer or video game by producing short bursts of sustained brain-wave activity in the target areas. The games only run when the patient exercises that portion of the brain that is deficient in focus. Cost: While sessions are brief (approximately 30 minutes) and painless, they are expensive. The average course of treatment can range from $2,000 to $5,000.

Meditation

What it is: Mindful awareness, or mindfulness, involves paying close attention to your thoughts, feelings, and bodily sensations; in other words, developing a greater awareness of what’s going on with you from moment to moment. It can be used as a tool to foster wellness, especially psychological well-being. Similar techniques have been used to lower blood pressure and to manage chronic pain, anxiety, and depression. How it works: Meditation improves your ability to control your attention. In other words, it teaches you to pay attention to paying attention. Mindful awareness can also make people more aware of their emotional state, so people with ADHD won’t react impulsively as often.

Download This!

Read ADDitude’s special report on using mindfulness to treat ADHD symptoms: http://additu.de/mindfulness

Treatment: The basic practice is very simple: sit in a comfortable place and spend five minutes focusing on the sensation of breathing in and breathing out—pay attention to how it feels when your stomach rises and falls. If your mind wanders to something else—your job or some noise you just heard— label these thoughts as “thinking,” and refocus your attention on your breath. This practice should be done daily, and every couple of weeks patients should increase the length of time spent on the exercise—up to 20 or more if they feel they can. Apply the same thinking throughout each day, focusing on your breath for a few minutes as you walk from place to place, or when you’re stopped at a red light or sitting at the computer. The meditation sessions are important practice, but the key is to use mindfulness throughout your daily life, always being aware of where your attention is focused while you are engaged in routine activities. For example, you might notice while you drive that your attention wanders to an errand you must run later that day. Lots of people practice mindfulness while eating. Once you get used to checking in with yourself and your body, you can apply the technique anytime you start to feel overwhelmed.

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Getting formal training in meditation by taking a class, signing up for a program, or going online can also help explain these basic concepts, and keep you on track. Cost: $0 if you do it on your own, but training programs and books are available for purchase.

Considerations and Benefits Things to keep in mind: • It’s the nature of the mind to be distracted. Mindful awareness isn’t about staying with the breath, but about returning to the breath. That’s what enhances your ability to focus. And this emphasis on re-shifting your attention, of outwitting the mind’s natural tendency to wander, is what makes experts think this technique could be especially helpful to ADHD children and adults. • With a long history but little scientific data on its effects, more research is still needed to confirm these early findings. Benefits: • Some studies show promising results with significant improvements in both inattention and hyperactivity for adults with ADHD. • In cognitive tests, the participants got better at staying focused, even when different things were competing for their attention. Many of them also felt less anxious and depressed by the end of study.

Mobile Mastery

10 brain-training apps that build stronger focus, longer memory, and organized thoughts: http://additu.de/ae

Attention Training in School and Beyond

If focus skills can be groomed, as research has begun to hint, the important next question is whether, and how, attention should be integrated into education. Will attention become a 21st-century ‘discipline’, a skill taught by parents, educators, even employers? Already some educators are showing interest in attention training, mostly through the practice of meditation. But with the field of attention training still in its infancy, scientists don’t know whether any current teaching brings long-lasting gains — or, for that matter, which practices work best. Nonetheless, with global use of ADHD medications tripling since the early 1990s, and evidence mounting that attention can be strengthened, researchers are permitting themselves cautious excitement at the prospect that attention training could work. Pamela Michaels is a freelance writer and editor. Maggie Jackson is the author of Distracted: The Erosion of Attention and the Coming Dark Age (Prometheus Books). Carl Sherman, Ph.D., is a freelance health writer in New York City.

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Tools for Encouraging Good Behavior Though meds are indispensable for many kids with ADHD, parents are finding behavior therapy to be surprisingly effective. By Sandra G. Boodman

What non-drug treatments work to combat ADHD in children? While play therapy, cognitive therapy, psychotherapy, and special diets have been regarded as promising, only behavioral therapy has been shown to work. A study,2 funded by the National Institute of Mental Health, found that the best outcomes in children with ADHD — measured by parental satisfaction and some academic standards — were the result of “combination’’ treatment: medications that reduce hyperactivity and improve concentration, along with behavior therapy to address some of the more subtle symptoms, such as difficulty with organizational and social skills.

How Behavior Therapy Works

A behavior therapy regimen can be developed by a pediatrician, a school psychologist, or another mental-health worker. Based on a structured system of rewards and consequences — such as increased or decreased TV privileges — the program also includes changes in a child’s environment to minimize distractions. Parents also receive training in giving commands and reacting when a child obeys or disobeys. The goal is to incrementally teach children new ways of behaving by rewarding desired behavior, such as following directions, and eliminating undesired actions, such as losing homework, notes Ginny Teer, a spokeswoman for Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD). Parents often “have an inappropriate expectation of what medications can do,’’ observed pediatrician Patricia Quinn, M.D., who has specialized in treating ADHD in Washington, D.C., for more than 25 years. “Drugs don’t improve self-esteem, time management, or organizational skills. But the problem is that most parents don’t have enough time or energy’’ for behavior therapy or are inconsistent about applying it. Sometimes, Quinn says, they complicate the regimen with too many rules. The trick, she adds, is to keep things simple. Experiencing success reinforces the desired behavior.

“Many of our children’s ‘bad’ behaviors are them communicating feelings and thoughts that they can’t verbalize!” — Jovi, an ADDitude Reader

Hand-in-Hand Treatments

There is an added benefit from combination treatment, says child psychiatrist Thomas Kobylski, M.D., who is chairman of the Washington area chapter of the American Academy of Child and Adolescent Psychiatry. Studies have found that children treated with behavior therapy can take a lower dose of medication, Kobylski says. 2. Read about the full study at: http://www.nimh.nih.gov/funding/clinical-research/practical/mta/ the-multimodal-treatment-of-attention-deficit-hyperactivity-disorder-study-mta-questions-andanswers.shtml

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Public relations executive Susannah Budington, who lives in Chevy Chase, Maryland, began using behavior therapy several years ago, shortly after Allison, the oldest of her five children, was diagnosed with ADHD and started taking a stimulant. “She’s such an enthusiastic, wonderful kid. I would never want to medicate that away,’’ says Budington. Medication, she says, enables Allison to be less impulsive and more cooperative, but behavior therapy has helped the 12-year-old “operate as part of our family and to do things with her friends. It’s extremely important.’’

In Sync with the School

Trish White, a manager at CHADD, says that involving her son’s school in his behavioral program has been critical to his progress during the two years since a pediatrician told her he had ADHD. Once a child is diagnosed with the disorder, many parents look into devising an Individualized Education Program (IEP) that accommodates the disability. That plan often includes elements of behavioral treatment, but cooperation by teachers and school systems varies, experts say. At his Anne Arundel County, Maryland, public school, White’s eight-yearold son sits near the teacher to minimize distractions. When she senses his attention is wandering, she taps lightly on his desk to remind him to focus. Every day she sends home a simple, color-coded behavior chart telling his parents how his day went.

Learn more ADHD parenting techniques at http://additu.de/pr

White adds, “We continue to struggle.’’ Reading remains difficult for her son, but he is better at following directions and seems more adept at making friends. Quinn, who has seen concern about ADHD medications wax and wane during the years she has treated hundreds of children with the disorder, regards growing interest in behavior therapy as a positive development. “Drugs,’’ she says, “can do only so much.’’ Sandra G. Boodman is a Washington Post staff writer. Originally published in the Washington Post. Reprinted with permission.

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Ask the Doctor Dr. Larry Silver gives you the latest, most reliable answers to your ADHD questions. Q: I’ve just been diagnosed with ADHD. Am I entitled to special accommodations at work?

Under the Americans with Disabilities Act, you are entitled to workplace accommodations if you can document the diagnosis. Ask your physician or psychiatrist to write a letter attesting to the diagnosis. It’s helpful if the letter specifies the criteria used to make the diagnosis — symptoms that are chronic and pervasive, for example, and which are not caused by another medical or psychiatric disorder. The physician should also identify the accommodations you’re requesting and why they’re necessary. Q: W  ho should diagnose my child with ADHD — a school counselor or a pediatrician?

ADHD is a medical diagnosis. Although it’s often a teacher or family member who first suspects ADHD — and feedback from teachers, therapists, and parents is vital in helping a doctor establish a chronic and pervasive history of hyperactivity and/or inattention and/or impulsivity — a medical doctor must make the formal diagnosis. Start by seeing your child’s pediatrician. Q: My primary care physician told me she doesn’t “do” adult ADHD, and wants me to go off the medication prescribed by my previous doctor. What should I do?

Find another doctor. If you know any adults who are being treated for ADHD, find out who their doctors are. If you don’t know other ADHDers, ask the members of a support group in your area for physician recommendations. You can find support group directories at ADDConnect.com, chadd.org, and add.org. Q: M  y 10-year-old son has ADHD. Is it OK to talk with him about it?

Absolutely. He needs to understand his problems and any treatments in place. Make sure you understand the disorder first, and then begin the discussion. If he is hyperactive, speak of “brakes” in his brain that don’t work as well as they should. If he’s distractible, speak of the “filter systems” in the brain that are not working well. If he’s impulsive, speak of the brain’s difficulty with stopping to think before speaking or acting. End each discussion with an encouraging comment. Explain what is being done to help. Stress that ADHD is not something he caused. Then sit back and listen to his questions. You might have explained everything he

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Expert Video

An inspired way to explain ADHD to your child, by Dr. Edward Hallowell: http://additu.de/yp

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wanted to know. If not, he will ask. Q: I ’m 14 years old and have trouble sleeping at night. It’s starting to interfere with my performance in school. Is this caused by my ADHD?

Some children and teens with ADHD have difficulty going to sleep at night because they “can’t turn their head off.” They are fidgety and active in bed. They hear every sound in the house and can’t ignore these sounds. For these people, using a medication like Ritalin, Dexedrine, or Adderall at night might be a great help in getting to sleep. (Yes, everyone thinks these medications cause sleep problems. However, when ADHD prevents you from going to sleep, being on these medications counteracts those symptoms.) If this is not the answer, ask your parents to discuss your problem with your family doctor or a child and adolescent psychiatrist. Q: My son was recently given a higher dosage of medication because of his growth. Now he seems to be having trouble with his eyes. Is this permanent or will the twitching go away?

You do not specify the medication. I will assume it is a stimulant, such as Ritalin, Dexedrine, or Adderall. This type of medication can cause motor tics, which sounds like the behavior you’re describing. The tics should stop if the medication is discontinued. Then, another medication should be considered. We do not continue on these medications when they cause a tic disorder.

Fine-Tuning Treatment

For more on getting the most out of your ADHD medication, check out “Say No to Side Effects,” on ADDitudeMag.com.

Q: My 11-year-old has been taking a stimulant for two years. How much longer should he stay on it? I worry that taking the drug over a long period of time may cause adverse effects.

Your son should stay on the medication as long as symptoms interfere with his success in school, at home, or socially. Some individuals “outgrow” ADHD in adolescence, but many continue to have symptoms throughout their lives. Stimulant medications have been used to treat ADHD since the 1950s. So far, we have found no adverse long-term effects. Q: My five-year-old son just started taking ADHD medication. How can I tell if it’s working?

Because your son is only five, he probably won’t be able to articulate whether he “feels” different. Thus, you should rely on close observation. Consider the behaviors that prompted you to evaluate him for ADHD in the first place. Do you see any reduction in those behaviors? Solicit feedback from teachers, school aides, and others who have had contact with

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him before and since going on medication. Q: Therapists and teachers have suggested that my son has ADHD, but he’s always been too embarrassed to see a psychiatrist. He’s 21 now and struggling in college. How can I get him to reconsider?

Since your son is now an adult, you cannot force him to get help. You might try asking his advisor at college, or a teacher he liked in high school, to sit down with him and explain why they think he has ADHD. Or send him a book or an article about ADHD and the effectiveness of treatment, possibly highlighting passages that you think describe him. Once he’s convinced that he really does have a problem, and that treatment is available, he might be willing to get help. Q: S  hould stimulants be prescribed for inattentive ADHD? My doctor prescribed Adderall, but I’m not hyperactive.

Although ADHD remains the official term for all attention-related disorders, it is divided into Hyperactive, Inattentive (previously referred to as simply ADD), and Combined types. The medications prescribed for ADHD work against all ADHD symptoms, but they affect people differently. I urge you to try a medication before making any assumptions about its effectiveness. Q: I’m an adult who was just diagnosed with ADHD. I’ve been taking a stimulant for two days, but I don’t feel more focused. How long should this medication take to work?

Stimulants usually start to work within an hour, so it may be that your dose is too low. Stimulant doses are based on how quickly the body metabolizes the drug, not on the patient’s weight, height, or age, so there’s no way to predict the correct dose for any particular person. Doctors usually start by prescribing a low dose, say 5 mg. If one week passes with no improvement, the dose can be increased. Your doctor probably asked you to check in after a few days of starting the medication. If not, call anyway to report that there has been no effect. Q: I was excited to read about a recent study that shows that children outgrow ADHD. Does this mean that my child will not need to take medication when he reaches a certain age?

ADHD College Guide

Read this blueprint for undergraduate success: http://additu.de/college

Older studies, like one published in 2007 in Proceedings of the National Academy of Sciences,1 suggested, but did not confirm, that a developmen1. Rubia, K. “Neuro-anatomic Evidence for the Maturational Delay Hypothesis of ADHD.” Proceedings of the National Academy of Sciences 104.50 (2007): 19663-9664. Web.

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tal delay in the brain’s cortex may cause ADHD symptoms. Once the cortex matures, many ADHD kids seem to outgrow the disorder. While headlines in the press proclaimed “ADHD Riddle Solved,” most articles left out researchers’ warnings that the findings should not be taken as permission to stop ADHD medication. In fact, a 2013 study2 found that only about a third of ADHD children were really free from their ADHD symptoms by the time they reached adulthood, so the definitive answer remains unclear. In the meantime, brain imaging is helping us learn more about ADHD. But, until we know more, if medication helps your child, keep administering it. Q: My 14-year-old son has been diagnosed with ADHD, learning disabilities, and a conduct disorder. He seems to believe that, if he doesn’t acknowledge them, his problems will go away. How can I get him to accept some help?

Many young adolescents find being different so painful that they deny any problems, even at the price of causing themselves more difficulty. I would suggest taking him to see a therapist who specializes in adolescent behavior. With good counseling, your son will see what his problems are and accept them. Until he does, make sure he knows you’re going to stand by him and support him. Q: I’m worried about my 10-year-old. He hasn’t gained any weight in the two years he’s been taking a stimulant, even though we’ve worked with a nutritionist to add calories to his diet.

Get Cooking!

Find fast, easy dinner recipes even picky eaters will love: http://additu.de/kj

I share your concern. Appetite loss, a common side effect of stimulant medications, usually goes away within a few weeks (or, as you know, can be managed by ensuring that enough calories are taken in). Since it’s been two years, and calorie supplementation hasn’t helped your son, I urge you to speak with your physician about starting your child on another medication. Some children who experience appetite loss while taking one stimulant do fine on a different one. If switching stimulants doesn’t help, ask the doctor about a nonstimulant. Q: My 13-year-old is doing well on the stimulant-Strattera combination his doctor prescribed, but my insurance company is unwilling to pay for both meds. Any advice?

Appeal the decision (consult your insurer’s benefits handbook or its website to find out how). The doctor may be required to justify prescribing 2. Barbaresi, W. J., R. C. Colligan, A. L. Weaver, R. G. Voigt, J. M. Killian, and S. K. Katusic. “Mortality, ADHD, and Psychosocial Adversity in Adults With Childhood ADHD: A Prospective Study.” Pediatrics 131.4 (2013): 637-44. Web.

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two meds, either in writing or by phone, so give him a heads-up. Most insurance companies will respond to your appeal quickly. If your appeal is rejected, move up the chain at the company and ask about the next step. Don’t let your insurance company practice medicine. Leave it to your physician to decide which drugs your son should take. Q: C  an you have SOME of the symptoms of ADHD and still be diagnosed with the condition, even in adulthood?

There are three behaviors found with ADHD. Some will have one; some two; some all three. One ADHD symptom is hyperactivity. This is usually seen in adults by fidgety, restless behaviors. The second is inattention. This is experienced by either auditory distractibility, visual distractibility, and/or internal distractibility. The third is impulsivity, problems waiting before speaking or doing certain behaviors.

“When I was younger, none of the teachers believed in ADHD. I was just ‘bad.’ At 32 I’m just now learning how to deal with this all the right way.” –Jennifer, an ADDitude reader

If you have one or more of these AND they have been present for most of your life AND they exist in two or more areas of your life (work, home, social), you might have ADHD. If you think so, see a professional who is familiar with adult ADHD. Q: My 12-year-old son was diagnosed with ADHD, OCD, and Tourette Syndrome, and may show signs of Asperger’s syndrome. He has never had tests other than an interview and psychiatric observations — so how do I determine if these diagnoses are correct?

When a child has a complex pattern of disorders, it is important to get a thorough evaluation. This evaluation probably would require seeing a child and adolescent psychiatrist, plus possibly other studies (e.g., psycho-educational testing, neuro-psychological testing, etc.). It is not always easy to clarify if a child has Asperger’s, which is a type of Pervasive Developmental Disorder, and a learning disability, along with ADHD, OCD, an anxiety disorder, or other problems. I would encourage you to seek such an assessment. The treatment approaches for each disorder are similar in some areas, but very different in others. Q: W  hat’s the youngest age at which a child can be diagnosed with and treated for ADHD? Like his older siblings, who have been diagnosed with the disorder, my three-year-old is hyperactive, and I worry about his safety.

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It’s unusual for a child to be diagnosed before the age of five. But since your son is showing signs of ADHD (and considering the strong family history), there’s no need to wait. Have the doctor who diagnosed your other children evaluate your three-year-old, and ask about starting medication. The latest research from the National Institute of Mental Health shows that, at the appropriate dosage, stimulants are safe and effective even for preschoolers. Q: O  ur family has a history of heart trouble, but my 10-year-old son has no heart problems that we know of. Does the new stimulant warning mean it’s unsafe for him to take one of these drugs?

The warning, which the FDA mandated in August of 2006, indicates that children or adults who have heart disease or a structural heart defect should not use stimulant medications. It does not suggest that stimulants can cause heart trouble, and it advises further cardiac evaluation only for children with a family history of sudden death or irregular heartbeat (ventricular arrhythmia). If your family doesn’t have such a history, and the doctor is convinced that your son shows no sign of heart trouble, he can prescribe any of the stimulants. If your son goes on medication, the doctor should check his heart rate and blood pressure and listen to his heart at every check-up. Q: I have a nine-year-old with ADHD. School is a struggle for him; his vocabulary is mature, but he has a hard time with phonics and breaking down words. Is this typical?

About 30-40 percent of children with ADHD also have a learning disability. Your descriptions of your child’s problems with phonics, reading, and writing suggest that he also has a learning disability. The difference between the two is that a learning disability interferes with how a person processes information; thus they are unable to learn without special education help. ADHD often makes the person unavailable for learning because of inattention or impulsivity.

Reluctant Readers

If your child struggles with reading, check out these engaging books designed for kids with ADHD or LD: http://additu.de/148

Try to get your school professionals to evaluate your child for a possible learning disability; then try to get the necessary services. Medication might help the ADHD, but it will not help the learning disabilities. Larry B. Silver, M.D., senior medical advisor to ADDitude, is a child and adolescent psychiatrist in the Washington, D.C., area. For more than 30 years, his work has focused on the impact of neurologically based disorders on young lives.

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Change How You Think (About ADHD Therapy) An ADHD-friendly form of cognitive behavioral therapy promises to help ADHD adults better manage their symptoms. Could it help you? By Karen Barrow

Josh, a 35-year-old journalist, struggled with undiagnosed ADHD for most of his life. He had trouble managing personal commitments and organizing his time at school. “I was hopeless,” he said. “My education, employment, and finances were in jeopardy.” Early last year, however, Josh discovered that he had inattentive-type ADHD and began to take stimulant medication to control his symptoms. A few months later, he also began a new style of cognitive behavioral therapy (CBT), which was developed for those with ADHD. Originally used to help people cope with anxiety and depression, CBT aims to change irrational thought patterns that get in the way of staying on task or getting things done. For an ADHDer who thinks “This has to be perfect or it’s no good” or “I never do anything right,” CBT challenges the truth of those cognitions. The ADHD-specific version of CBT also tries to change people’s thoughts. It does this by instilling practical strategies and instruction to solve three of the most common ADHD problems: time management, organization, and planning.

The 411 on CBT

ADHD adults, listen to our expert webinar “Control Your Life with Cognitive Behavioral Therapy” to learn how to reframe negative thoughts and build on strengths.

In the program that Josh entered, which was created by Dr. Mary Solanto, Ph.D., associate professor of psychiatry at the Mt. Sinai School of Medicine, adults with ADHD learn in small group settings. The first half of each twohour session begins with a review of the home exercise that was assigned at the end of the previous session. Here, individuals share the difficulties and successes they had with the task, and with other challenges they may be having. For many participants, this is the most important part of the class. “The knowledge that I am not going through this alone allowed me to be a little easier on myself,” says Brian, a 46-year-old publicist, who completed Solanto’s CBT course last summer. During the rest of the session, the group’s mediator leads participants through a discussion of ADHD-related problems, followed by exercises to teach them how to set up a schedule and keep track of time. Some of the in-session exercises are based on simple ideas: “Many people with ADHD don’t wear a watch,” says Solanto. However, remembering to wear a watch, placing clocks all over the house, and keeping a detailed

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log of the day helps a lot with time management. How does someone with ADHD remember to do all that? Simple mantras (“If it’s not in the planner, it doesn’t exist”) are basic forms of CBT. They serve as reminders to change one’s thought patterns. “We teach them that, if they are having trouble getting started on a project, the first step is too big,” says Solanto. A year later, this mantra has stuck with Brian. “‘I’ll never get this done’ can paralyze you,” he says. “Now I don’t get overwhelmed.”

Evidence for Cognitive Behavioral Therapy and ADHD

A study,1 published in the American Journal of Psychiatry, compared the effectiveness of Solanto’s CBT program to basic, supportive therapy. After finishing the 12-week program, the 41 CBT participants reported better organization and attentiveness than the 40 participants who had received basic therapy.

The ADHD Directory

Search for ADHD specialists in your area here: http://additu.de/zu

Solanto believes that her program is effective because it directly addresses patterns of behavior that are common problems among those with ADHD. And solutions are designed to have an immediate impact. For example, Solanto advises her participants to enter into their ADHDfriendly planners every task they have to do in a given day — from important appointments to everyday errands. She asks clients to link checking the planner to routine activities, like brushing your teeth, eating lunch, walking the dog, and so on. This helps someone with ADHD stay on task throughout the day, and prioritizes the things to get done. “People with ADHD spend a lot of time putting out fires, instead of thinking ahead to prevent those fires,” says Solanto, who has recently outlined her work in Cognitive-Behavioral Therapy for Adult ADHD: Targeting Executive Dysfunction. The book teaches therapists how to apply and use Solanto’s brand of CBT in their own practices. For Josh, it wasn’t so much the specific strategies that were taught that helped him, but the other people in the class giving him the motivation to change. “You hear from others with problems like yours, and it helps you make your own strategies for managing those problems,” he says. Solanto believes that CBT is most effective when combined with other forms of treatment, and Josh agrees. Josh says that stimulant medication allowed him to benefit from the class, because it helped him stop and think about 1. Solanto, Mary V., David J. Marks, Jeanette Wasserstein, Katherine Mitchell, Howard Abikoff, Jose Ma. J. Alvir, and Michele D. Kofman. “Efficacy of Meta-Cognitive Therapy for Adult ADHD.” American Journal of Psychiatry 167.8 (2010): 958-68. Web.

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how ADHD affected him day to day. “In order to change, you have to be able to learn from experience,” he says.

How to Find a Cognitive Behavioral Therapist for ADHD

Because CBT is still commonly used to treat anxiety and mood disorders, make sure to find out whether a prospective CBT therapist has worked with people who have ADHD before making an appointment. Solanto says that sessions should focus on ways to prevent the problems ADHD is causing day to day. She hopes that more therapists will adopt her program into their practices. “Our goal is to help people develop good habits and maintain them,” says Solanto. “And, just as important, to give support to encourage their use.”

Find a Therapist

To find a CBT practitioner near you, visit the Association for Behavioral and Cognitive Therapies at abct.org.

Josh certainly sees the method’s impact. After starting graduate classes 15 years ago, he finally completed his graduate degree last year. He feels more productive in his career, and says that he has read and written more in the last year than ever before. “I’m more hopeful,” says Josh. “I’m more confident.” Some names have been changed. Karen Barrow is a freelance health and science writer based in New York City. She holds a master’s in biomedical journalism from New York University and a bachelor’s degree in biology from Cornell University.

Do-It-Yourself Change If formal therapy is not an option for you, you can try some of the principles of cognitive behavioral therapy on your own to change problematic habits.

Stop Procrastination

Many ADHDers put off paying bills, completing chores, and doing other things they consider boring. But other ADHDers put off doing tasks they are convinced they cannot do — often because of past experience. If you’ve failed at something many times in the past, you may be reluctant to try again. J. Russell Ramsay, Ph.D., of the University of Pennsylvania, says, “Ask yourself what you are assuming will happen if you try. Is there another way this could turn out? If a friend had ADHD, how would you advise and encourage him? Why as-

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sume that the same thing wouldn’t work for you?” Another way to beat procrastination is to cut tasks into pieces. If going through a pile of papers makes you think, “I’ll never get it all done,” commit to going through half the pile. “Keep reducing the piece of the task until you can say, ‘I can do this easily,’” advises Mary Solanto, Ph.D., director of the AD/HD Center at Mount Sinai Medical Center in New York City. “Once you get started, you may be buoyed by the results and continue spontaneously.”

To-Do List Tips

For common time-management mistakes, check out “The Never To-Do List” at http://additu.de/wv

A similar approach is the “10-minute rule.” Commit to working on a large job for only 10 minutes. Tell yourself you can stop after that, guilt-free. Since getting started is often the hardest part, you’re likely to keep going. That will give you a sense of accomplishment, not to mention a smaller job to finish.

Track To-Do Lists

“People make to-do lists but never commit to doing things at a particular time on a particular day,” says Dr. Solanto. In CBT, she says, “we have a saying: ‘If it’s not in the planner, it doesn’t exist.’ We ask people to schedule the things they want to accomplish, and tell them to carry the planner with them at all times.” Keep all your to-do lists in a single notebook. Link checking it to routine activities, like brushing your teeth, eating lunch, walking the dog, and so on. That way, you’ll check the lists regularly.

Stay Focused

To focus more easily, Steven Safren, Ph.D., of Harvard University, recommends the following: Each time you sit down to tackle a boring task, set a timer for as long as you think you’ll be able to stay focused. Whenever a distracting thought comes to mind (typically, something else you need to do), jot it down in a notebook. Tell yourself, “I’ll do this later,” then go back to work. When the timer goes off, review your list. If the items you wrote down don’t need to be dealt with right away, work a bit longer on the task. Go back to your list at the end of the day. Another way to stay focused, says Safren, is to place colored stickers on sources of distraction, like the telephone or computer. Each time you spot a dot, ask yourself, “Am I doing what I’m supposed to be doing?”

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Monitor Goals

People with ADHD have trouble achieving long-term goals. And no wonder: It can take years to save for a new home, whereas splurging on a new outfit feels good right away. This kind of thinking can lead to a lifetime of unfulfilled ambitions. “You have to make distant rewards more present,” says Solanto. “One way to do this is by visualization. Imagine what it would be like to accomplish your goal, until it becomes so real, so visceral, you can almost taste it.” A student who is tempted away from writing a paper by friends who want to party might think ahead to how good it would feel to ace the course.

Our Favorite Apps

The ADDitude editors recommend time management apps that work for ADHD adults here: http://additu.de/10

Focus on Strengths

Years of low self-esteem engender a defeatist attitude: If you’re no good at it, why try? “People tend to focus on their weaknesses, and overlook their strengths,” says Lily Hechtman, M.D., director of ADD research in the child psychiatry department at McGill University in Montreal. To overcome this problem, she recommends writing a list of your positive attributes — things that other people might consider your strengths. Then identify one personal shortcoming — and do something about it. For example, if you seldom finish projects, come up with a task that takes several days. Set a deadline, and do your best to meet it. Each incremental success gives your self-image a boost.

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One-on-One Support The ADHD coach is like having a personal trainer for your brain. Here’s how to find, hire, and work with one. By the ADDitude Editors

What is an ADHD coach?

An ADHD coach is a person who is trained to help the ADHD client reach his or her personal goals.

What are the characteristics of a good coach?

A good coach is one who knows how to encourage people, help resolve problems, and who provides the support necessary to allow the client to accomplish his or her goals. Discussions between you and the coach should be about finding solutions, not assigning blame. The coach should use language that encourages you to concentrate on specific actions, rather than on those which make you feel irresponsible.

Before hiring an ADHD coach, make sure you ask these important questions: http://additu.de/coach-qs

Is an ADHD coach a therapist?

Coaching and therapy are two different things. “Psychotherapy deals with inter- and intra-personal issues as well as cognitive and behavioral issues. The focus is often on the individual’s past history and how it relates to his development,” says ADDitude contributor and coach Sandy Maynard. “Coaching helps you achieve specific goals.”

Is coaching cheaper than therapy?

Costs are comparable to therapy, and can range from pro bono sessions up to $1,500 a month, with the average falling between $300 and $600 a month.

Why couldn’t I just ask a friend to do this for free?

Is your friend going to understand how and why ADHD makes you do certain things? How are you going to feel about him when he demands to know why you didn’t reach a particular goal or deadline? Coach Nancy Ratey feels that parents, spouses, or friends should not coach loved ones. “Because coaching focuses on the client’s agenda, it is best to have someone who is removed from the situation.”

Does coaching involve a long-term commitment?

It depends on your goals. If you’re using a coach for a specific project — like getting organized at work — then that will determine how long you commit to the process. If you are using a coach for general self-help, it could become a long-term relationship if you want it to be. Most coaches ask for a three- to six-month commitment.

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What happens if I get into this and find that coaching doesn’t work for me?

Many coaches use written agreements and expect payment up front. Discuss that option with the coach before you sign on the dotted line.

Can anyone be a coach?

Technically, yes, because there are currently no university degrees in coaching. Three top-rated institutions that offer training for ADHD coaches are: ADD Coach Academy (ADDCA); Optimal Functioning Institute (OFI); and the American Coaching Association (ACA). A better question would be “Can anyone be an effective coach?” in which case, the answer is “no.” This is a specialized field, and you need to hire a coach who has experience working with ADHD clients. One caveat: While a prospective ADHD coach should have experience working with clients and knowledge of the condition, the chemistry that grows between you and your coach is ultimately more important. One coach might have the ability to motivate you, while another will leave you frustrated.

How do I find a coach?

A good starting point is your local chapter of CHADD, your doctor, or your psychologist. They can identify candidates in your area or long-distance coaches, whom you can work with on the phone. The International Coach Federation (ICF) certifies life coaches — not specifically those trained in ADHD, but it can be a good place to start looking. The ADHD Coaches Organization (ACO) has a coach referral service. It lists 150 life coaches who have additional training in ADHD.

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Chapter Five

Personal Essays

So This Is What “Normal” Feels Like! After half a lifetime of struggling at home and at work, and dreading each new day, I feel as though a new me has been born. By Donna Surgenor Reames

I’m sitting in the nurses’ station, staring at neat piles of completed paperwork. It’s only 1:30 a.m. and I’m done already. Work that used to have me scrambling to finish before the day-shift nurse came in at 7 a.m. is finished. Not just finished: done right, with a clear focus. I smile, leaning back in my chair. “So this is what ‘normal’ feels like,” I think, amazed. All my life, I had struggled with a vague sense that something was different about me. I felt inferior, inadequate, undisciplined, and hopelessly disorganized — all feelings that have been, at one time or another, reinforced by others in my life. “Donna, can’t you ever be on time?” “I couldn’t live in this clutter.” “How can you not know where your daughters’ birth certificates are?” “Maybe you’re just one of those people who can’t stay organized.” I had gotten used to feeling tired before I even got out of bed, of dreading the new day and its various obligations. I was exhausted, struggling at work and at home with my kids. It took every ounce of physical, mental, emotional, and spiritual strength to live my life — until I finally met someone who listened to my story and gave me a

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chance to do something about it. He didn’t hand me a planner or a book on organization. He didn’t lecture me on slothfulness or give me parenting advice. He handed me a prescription. “Take this and see what happens,” he said. “I think you have adult ADHD.” He was the first person ever to believe me when I said that there was something wrong beyond depression or a fundamentally disorganized personality. I had always sensed that there was a part of me that could be structured, that could be organized, that could function with ease. I just didn’t know where it was or how to access it.

A New Mom

As we pulled into a gas station the other day, another car pulled in front of us. The driver was shouting and cursing. At the station, I walked over to her. “Hey, I’m sorry if I irritated you,” I said. “I’m taking my kids to school, we were talking, and maybe I didn’t give you enough space.” The woman calmed down noticeably and shook her head. “No, it’s my fault,” she said. “I’m tired this morning and I got mad. Don’t worry about it.” As I got back in our car, my oldest daughter, Zoë, stared at me, eyes wide open. “Mama,” she said eagerly, “I can’t believe how nice you were!” (How embarrassing to realize what a jerk your kids thought you were, in the throes of daily ADHD-related irritability.) I grinned. “You’ve got a new mama, girls!” I said as we continued on our way. In the past, a situation like that would have caused me to erupt. I’d fuss and fume and blare my horn. I used to think I had a problem with anger. Now I know that my nerves were just stretched to their limits, and things that rolled off other peoples’ backs were intolerable to me. Our life has slowed down at home. We eat in more often, and my girls actually enjoy my cooking. I’m not trying to do 15 other things while making dinner anymore, so I don’t end up burning it. I’ve also come up with my own system to organize my cabinets — and it works! I now understand that I have a disorder that requires me to do things a little differently, so I can do them without feeling that I’m stupid or lazy. In fact, I’ve discovered that I can be highly organized and disciplined if I let myself be. My medicine has calmed something down inside of me, allowed me to take a deep breath and live at a slower pace.

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I Can Do This!

I enjoy being a mother for the first time in 11 years of motherhood. Don’t get me wrong: I love my girls and am totally committed to them. But I used to wonder why my daily interactions with them left me so frustrated. By the time they went to bed, I was often near tears. Life was hard that way for 44 years. When I look at old photos of myself, I’m shocked: I look drained and pinched, even when I was smiling for the camera. I never used to have fun, even on vacations. The simple act of packing for trips used to depress me. But since I’ve been treated for ADHD, I’m surprised over and over by how easy life can be. It’s no big deal to a non-ADHDer to sit through an entire movie without getting up five times to “check on something.” But for me, it’s a different world, and I love it! The only thing that bothers me about adult ADHD is that so many people — even doctors — still think it’s a myth. Years ago, I actually suggested to a doctor that I might have it, but I was told that if I had done well in elementary school, there was no way that I could. I was never hyper or aggressive or disruptive at school, but I cried in my bedroom nearly every night because each tiny decision felt like a giant hurdle. Deciding how to put my hair up could leave me in tears. Since I’ve been diagnosed, I have the same responsibilities as before. I’m still a single mom working full-time to support three daughters. I still live paycheck to paycheck, drive my same old station wagon, and, sometimes, I still get frustrated when things don’t go my way. The difference is that nothing seems overwhelming anymore. If the car breaks down, I can handle it — without hysteria. If the money’s short, I figure out how to get by — without breaking down. Things don’t have to be black or white any more. I’ve learned to see and live with gray. Come to my house for a cup of coffee, hot chocolate, or tea; I’ll know where the cups, spoons, tea bags, and cocoa are. You can sit in a chair that does not have piles of laundry on it, waiting to be put away. You can talk with me and I will listen, instead of chattering non-stop about myself. And while you’re talking, I won’t jump up to take care of something I forgot to do earlier. Mostly, I’ll have fun being with you, which means you’ll have fun too. My life works for me now, instead of me having to work for my life. And that’s worth the world to me. Donna Surgenor Reams is a pediatric R.N. working in a child/adolescent psychiatric unit at the Medical University of South Carolina. She lives in Charleston with her three girls.

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“That’s Just Fine in Our Clan”: Building Strong, Supportive ADHD Families What’s the key to raising a happy, well-adjusted ADHD family? According to expert Larry Silver, M.D., it’s supporting — and celebrating — each other through the challenges of attention deficit. By Larry Silver

I wrote my first column for ADDitude many years ago, for the inaugural issue. With one exception — an article about my granddaughter — my writing has focused on general topics, giving information for people with ADHD. This is only my second time writing about my family. You see, I have ADHD, as does one of my three daughters, and three of my seven grandchildren. I also have learning disabilities, as do that daughter and two of those three grandchildren. Three generations — yes, there is a genetic theme. When all 15 of us get together — my wife and I, our three adult daughters and their husbands, and our seven grandchildren — as we do on many weekends during the year and for a week each summer, we enjoy one another’s company. To be sure, the behaviors caused by ADHD are hard for others to deal with — and, at times, the person with ADHD can be a pain. But we are family. We love each other unconditionally — and we accept the special qualities each of us has. Family is where children learn to understand and to accept themselves — and to develop skills that don’t come naturally to them. This sense of self helps children move out into the world. My wish is that each of my children and grandchildren will find ways to emphasize their strengths as they learn to compensate for their weaknesses.

Building Family Ties

Last summer, we all spent a week together in a large house on the ocean. My grandchildren are the stars. Joan,* 18, started college last September. Aaron, 14, started high school last year, and Nathan, 12, is in middle school. Joan takes medication during the school year, but prefers to be off it during the summer. Aaron tried medication, but didn’t like the way it made him feel. He manages his ADHD without it. Nathan was on stimulants briefly, but also did not like taking them. He was off medication during vacation. If you were a fly on the wall at our summer house, you’d be amused — and warmed — by the conversation. Here’s a sample:

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Aaron to me: “Grandpa, either take your medicine or sit down. All of your up-anddown and walking around is tiring me out.” Robbie, my 15-year-old grandson, to his sister, Joan: “Stop talking so fast. I can’t understand you. Did you take your meds?” Joan to Robbie: “But I like being hyper. I don’t want to take medication on vacation.” Nathan: “Me too. I also like being hungry!” Joan, interrupting Nathan: “Why did the chicken cross the road? Because she has ADHD.” The previous summer our family went on vacation to Italy. Joan and Aaron, who have learning disabilities, came along. They have gotten help for their disability, are working hard, and are succeeding. We had a great time. Coming home on that long flight, Joan and Aaron sat in the row behind my wife and me. They talked all night, each speaking so fast that it was hard to follow the conversation. They spoke about science and the universe. They discussed black holes and wormholes. Each was fascinated by the topic and had read extensively about it. People sitting near them must have wondered about their rapid-fire words. I grinned with satisfaction. I didn’t hear nonstop chat. I heard their excitement about life and about learning. Each took joy in being able to share the same interest with someone else.

ADHD Doesn’t Define You

In our family, ADHD is not who you are; it’s just something you have. Each member of the family knows about ADHD, and it is a frequent topic of discussion. With us, medication is not a “secret” that others shouldn’t know about. It is a way to minimize the behaviors of ADHD. Each grandchild with ADHD has the option to take medication or not. Each also understands that, if his or her behaviors interfere with school, friends, or activities — and they cannot change their behaviors on their own — medication must be considered. No one punishes them for their ADHD behaviors. I remember my seven grandchildren sitting around a table playing Texas Hold-’em. It was Aaron’s turn, and he was in outer space, looking out the window. My oldest grandson said, “Earth to Aaron. Earth to Aaron. Come in, Aaron.” Joan, who was sitting next to Aaron, poked him.

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He looked startled, then quietly said, “I raise you five.” His mind had drifted, but he knew exactly what was going on in the game. We enjoy being together. Each member of the family has his or her areas of strength and difficulty. That’s just fine in our clan. But even though love is unconditional, accepting someone’s hyperactivity or impulsivity can be hard. It is necessary for someone with ADHD to know whether his behavior has a negative impact on others and to be responsible for improving it.

Mixed Blessings — And Mixed Feelings

Is it all happiness for me? No. I wish I hadn’t passed the ADHD gene on to my family. Yes, they will do well in life; that is my daily prayer. But the real world is not like our vacations. Each of us with ADHD has had teachers who snapped, “Stop tapping your pencil” or “Raise your hand before you speak.” Each has had problems making and keeping friends. Part of me is pleased that my grandkids’ parents accept and love their child with ADHD. Part of me feels guilty. Still, no matter how well you understand and accept your child or grandchild, the real world often will not. I try to minimize their pain, but I cannot protect them from it. I look into the future and see great things for them, but I also see potential problems. We are doing everything we can to teach our grandchildren to succeed, but we can’t eliminate the bumps in the road on the way to their destination. Sometimes I watch them and remember my own childhood. When someone tells me to sit down or take my pill, memories of fourth grade spring up. One day my teacher brought in some rope and tied me to my seat because I wouldn’t stay in it. The class laughed. I held back my tears. Any parent can understand why I don’t want my grandchildren to go through what I did as a child. Yet every time I try to slip in a helpful suggestion about managing ADHD, I get the same answer: “I love you, Grandpa. But I don’t want you to be my psychiatrist.” While my ADHD grandkids’ parents love and accept them unconditionally, they are also committed to helping them manage symptoms and problems that arise from the condition. If medication is needed, they make sure the kids take it. If a child needs a 504 Plan, they fight to get one for her. If a teacher reacts inappropriately, they talk with the teacher on their child’s behalf.

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We speak openly about how wonderful our ADHD grandkids are. ADHD is not their personality; it is a set of behaviors. Through the years, their cousins without ADHD have embraced those positive messages from parents and grandparents. They are as supportive and accepting as the grownups. I am reminded every day that only family can help children understand and accept themselves. I wish you success with your family. *Names have been changed.

Larry Silver, M.D., is the author of many books, including Dr. Larry Silver’s Advice to Parents on ADHD and The Misunderstood Child: Understand- ing and Coping with Your Child’s Learning Disabilities.

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Finding My Wings: Mastering Life as an ADD Adult Life as an ADHD adult presents more than its fair share of challenges. ADDitude blogger Frank South writes about jumping these hurdles and starting to soar. by Frank South

Does this sound familiar? For most of your life as an ADHD adult, you have had no idea what’s going on. Everyone else was flying toward goals you didn’t understand, on big, wide confident wings. Neurotypical people navigated hard winds that blew you out of the sky. Bruised, confused, and tired of losing, down in the dirt for the zillionth time, you take stock. Your wings aren’t big, wide, feathered, or muscled. They’re fakes. And not good fakes — just balsa wood and thin paper, held together with Scotch tape. Almost every neurotypical adult slips a mental gear once in a while. “Lost my train of thought there for a second,” the normal will say in the middle of a conversation. Or, “I just got brain freeze!” With a laugh, the person picks up where he or she left off. If you’re the ADHD adult in the group, you’re thinking, “You call that brain freeze? You have no idea what real brain freeze is.” You don’t say that; you don’t say anything. For personal or professional reasons, you don’t want to reveal that you’re ADHD, and that you have a “disorder” label slapped on you that might color everything you do or say around these people forever. That’s what the docs call it, a disorder. No wonder you keep it a secret. Sure, there are ADHD adults who are “out,” like comic Howie Mandel or Olympic swimming champion Michael Phelps, but they’re accomplished and famous already. To be honest, their well-deserved success doesn’t as much inspire you as make you jealous. Even worse is the thought of trying to describe to your friends or coworkers what real brain freeze is. That could lead to your telling them what it felt like a few years ago, when you went to get help with your insomnia. You thought that was probably what caused your memory glitches, increasing irritation with friends and coworkers, and trouble sustaining a relationship or keeping a job. You needed some sleep. Maybe cut down some on the alcohol and caffeine. Then you saw the docs, took some tests, and “disorder” came into your life.

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Fly Right?

You told yourself, “OK, I’ve got this.” It takes a month or so, but you accept your diagnoses. You understand that you’ve got ADHD — or bipolar 2, dyslexia, OCD, or ODD, with generalized anxiety or clinical depression along for the ride. The point is, you say “fine” to whatever the docs say about your brain wiring. You’re not fighting it or denying it anymore. Knowing is better than not knowing. You are irritated, though. The old you would have told these docs to shove it. Still, you sit in your acceptance seat, using your “listening ears,” just like Mom used to say when you were a kid. Today, grown up and determined to fix yourself, you nod as you listen to the doc explain what’s what in your frontal and temporal lobes. You hold on to your prescription of meds, diet, exercise, coping skills, therapy, or all of the above. You Google psych sites until dawn, and order paperbacks with your diagnoses in the titles on Amazon. A month later, after being on meds, making appointments, picking up tips and tricks, it looks like all of your panic, self-loathing, and confusion is behind you. Notice how calm you are. In through the nose, out through the mouth slowly on a 10 count — the breathing exercises work. Ushering you out of the office, your therapist assures you that you’re through the hardest part. “It’ll take time,” the shrink says, “but now that we have a handle on what the problem is, we can work on it and get things under control.” Breathing and counting as you walk down the carpeted hallway toward the receptionist, you think that your therapist is exaggerating the tough part. It’s easy once you get your head junk screwed down. You’re beginning to feel it’s possible for you to start to live with a future like a normal person. You pull out your wallet, breathe and count, and step up to the receptionist to make your next appointment. She asks if next Wednesday, the eighth, at 9 a.m. is good for you. The numbers throw you off your count, but you nod. Then she asks if you could please call your insurance company about your copay for extended treatment, since there seems to be some confusion about your coverage. Can you pay the full amount today? “What?” you say. “Seventy-nine,” she says. Your count is gone. Breathing? There’s no breathing. That’s the trouble with putting something in the conscious control booth; it forgets how to work automatically.

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And you forgot that you said you’d pick up your girlfriend at work (a half-hour ago) because her car is in the shop. Wait — was that today or did we just make the plan today? And your car has to go in, too. Was that the plan for today or was it the other one? Stop. Doesn’t matter. Focus. Besides, you know you promised her you’d pick up something somewhere special for dinner. Not Panda Chinese, not what’s the name of the Italian place near Best Buy? Olive Garden — not that one. Some place she read about. You wrote it down on half of an envelope and put it in your wallet, no, maybe your coat pocket, shirt, pants? The receptionist smiles at you, waiting for an answer to god knows what. You don’t remember, you can’t say, your brain is frozen, every door is locked. It was just a simple, stupid question. Say something! Slapping all over your body searching for that scrap of envelope, your hands go numb and your chest tightens. You grimace in her direction, trying to hide your misery as those old winds of panic, self-loathing, and confusion blow away your fancy new wings. Fake is still fake, just like you, and you plummet out of the normals’ blue sky.

Thriving with Adult ADHD

Even with supportive med or non-med therapy, exercise, diet, meditation, and all the planners and apps in existence, it’s hard to thrive as an ADHD adult. The world is geared to the linear neurotypical who soars ahead as you puzzle over where somebody with your disorder can possibly fit. I have three puzzle pieces that might help. 1. We can fit anywhere we want to fit. First, we have to do some work on how we see ourselves. We often hide our diagnoses — a big part of who we are — from others because we fear judgment, stigma, lower expectations, or pity. But we’re our own harshest, most unfair, and most unforgiving judges. Every time we fail, it’s more evidence that our disorder hobbles us, makes us less. But it doesn’t. We do that to ourselves. Take that word — disorder. We can turn that word into a positive force if we want to. The “order” of the neurotypical world could use some help if you ask me. The disordered insight of non-linear minds — prone to hyperfocus, sensitive to other stimuli and alternate ways of seeing, hearing, and thinking — can expand everyone’s understanding of everything, from art to science to being a better human being. Our disorder helps us see through the cracks of accepted, ordered reality and glimpse stuff the linears fly right over.

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2. In order to get into a position to thrive, we have to make our own fake wings, use them, and trust them. We have to work hard to glide with the social norms — getting to work on time, listening to and remembering things that are important to others, but not to us. When we mess up, we fly back again with our fake wings, without excuses and without sabotaging ourselves with self-loathing. We have to work harder than others to get where we want, but we’ll take surprising leaps and have startling insights along the way. 3. Watch for people you admire, and learn from them. The more I’ve gotten down to the nitty-gritty work with my ADHD, the more grateful I am to people like Michael Phelps and Howie Mandel, who have had the courage to tell their ADHD stories. The jealousy was just for a while. Two guys I worked for way back when I was a writer in showbiz were the people who inspired me to paste my fake wings back together and keep working at the seemingly impossible balance between creative and crazy. I suspect both Robert Altman and Aaron Spelling had ADHD brain wiring, or something like it. I have no proof. Back then I wasn’t diagnosed, but I felt an instant connection with them. They were different in some ways — Altman the film artistdirector, Spelling the TV juggernaut. They had hyperfocus nailed, so I listened to what they said and tried to work as hard as they did. Both knew how to strap on those fake wings and fly in the normal world. As practiced and professional as they were, they had to work much harder at the parties, the studios, the appointments, the schedules and budgets, than they did when they were in a story conference, their eyes afire with discovery, challenge, and risk. From these guys, I learned how hard you have to work your fake wings to fly in the linear world and to find a place where you can stretch your real wings and soar. Frank South is an ADDitudeMag.com blogger, a writer for stage and screen, an educator, an ADHD adult, and the father to two ADHD teens.

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How I Learned to Love My Child’s ADHD After years of wishing my son could just be “normal,” it took a father-son camping trip to delight in his wonderful, inquisitive brain. By Wendi Nelson

My son came into the world without a sound. He seemed perfect from the start, with bright, curious eyes that scanned the room, absorbing every detail. My wife and I named him Drew — meaning “intelligent,” according to our baby name book — because we sensed he was a smart one. As I held him for the first time, I felt lucky to be the father of this perfect little boy. Years passed, and I watched with dismay as Drew changed from that perfect child in the delivery room into a boy with significant attention problems and developmental delays. He would hit his friends to let them know he was happy, no matter how many times we told him not to. When he entered school, we noticed that he was slower than his peers at understanding abstract ideas. I vividly recall the evening my wife, Wendi, patiently explained the concept of death to Drew. When she finished, she asked if he had any questions. “Yes,” he replied. “Did you ever die?” Still, Wendi and I wouldn’t admit to ourselves the severity of his delays until we finally heard a doctor say, “He’s years behind where he should be.” I went from wondering how I was going to pay for a Harvard education to watching Drew climb aboard the special-ed bus each morning. There was no denying that Drew was different from other kids, but I was convinced that if I tried hard enough, I could make him “normal.” At age six, Drew joined a T-ball league. But he seemed to spend most of his time picking dandelions in the outfield. He couldn’t understand why his teammates were running all over the place to catch a ball when there were so many beautiful flowers to gather. Drew moved on to soccer, but he proved less interested in chasing the ball than in playing with the drinking fountain at the edge of the field. In karate class, he spent most of his time putting the other kids in headlocks — something his instructor frowned upon. Nothing really engaged him except building Lego masterpieces.

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At age seven, Drew was officially diagnosed with attention deficit disorder (ADHD). His odd behavior continued. Still, I was determined to find something he could do like any other little boy. So I signed him up for Boy Scouts, volunteering to be the troop leader.

The ADHD Experience

We started off with a series of weekend hikes. Halfway through each outing, I found myself carrying Drew’s backpack, along with my own, as he kept stopping to examine anthills or use a stick to trace pictures in the dirt. By the time we made it to the campsite, the other kids had long since pitched their tents and were gathered around the campfire. My co-leader would optimistically remark on how great Drew was doing. I felt like screaming but comforted myself with the belief that scouting was helping Drew have a happy childhood. Still, I was really looking forward to our next outing: a 30-mile canoe trip down the Colorado River. The first day was magnificent, perfect weather for a float trip. But Drew wasn’t much of a paddler. He didn’t so much stroke as he simply stirred the water. Despite my best efforts at teaching Drew how to paddle correctly, we fell far behind the other canoes. It was a long first day. When we finally reached our campsite, I lost my footing getting out of the canoe and toppled into the water. Drew ran off without a word — he hadn’t even noticed. Exhausted and cold, I quickly inhaled some food and said goodnight to Drew, who seemed captivated by the moths circling our lantern. The next morning, I felt re-energized. If I paddled harder, I reasoned, Drew and I would be able to keep up with the other canoes. But, once again, we fell behind, losing contact with the nearest canoe barely two hours into the trip. Drew and I were alone on the river. As I sat there in the blazing sun, I felt more frustrated than ever. Drew, oblivious to my disappointment, was peering into the water, looking for fish. Why me, I wondered. Why couldn’t Drew be like any other boy who could paddle a canoe, kick a goal, or hit a home run? Then I began to wonder: What in the world was I doing? Why was I obsessed with having a son like everyone else’s? Drew pointed at a butterfly that had perched atop his shoe and gave me a big smile. And there it was, right in front of me: It didn’t

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matter that Drew had no interest in hitting a home run or being the fastest down the river. He was too busy discovering the world around him. No, this wasn’t the little boy I’d had such hopes for in the hospital so long ago. But he was happy. In camp that evening, Drew watched as a pair of dragonflies danced above his head. He turned to me and said, “This is the best trip ever.” In that moment, for the first time in a very long while, I felt lucky to be Drew’s dad. Wendi Nelson lives in Poway, California, with her husband Chris Nelson, and their four sons.

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I Am Not My ADHD Diagnosis As doctors learn more about ADHD, they’ll probably slap new labels on us. Here’s my suggestion: “misunderstood genius.” by Rick Hodges

I am a misunderstood genius. Or so I like to think. Sometimes it takes a little superiority to get me through those days when I can’t seem to make any progress or I’m feeling like a failure. I’m not the one with the disorder, I tell myself. My brain works better than average. If others can’t see that, well, that’s their problem. It’s egotistical thinking, for sure, and though it makes me feel better, it doesn’t help me get my work done. But is it so far off the mark? After all, the two places you’re likely to find adults with ADHD are at the highest ranks of leadership — visionary entrepreneurs, brilliant artists, superstar entertainers — and on our nation’s couches, unemployed and discouraged. ADHD can be an enormous advantage if the situation is right. Unfortunately, the world is full of wrong situations. I’ve managed to avoid many of these most of my life, without quite knowing how. However, it was a very wrong situation — an employer suddenly made radical changes to my job, adding administrative tasks and lots of minutiae — that led to my diagnosis of ADHD, inattentive type, at age 36. I was astonished (isn’t that about hyperactive kids?), but when I read a list of symptoms, I laughed out loud at some and cried at others. I could have written that list. My diagnosis helped me figure out the right work scenario — I am my own boss now — but it also renewed my struggle to find my place in the world. I have always felt I was living in a slightly different universe than everyone else, my own little planet spinning on an axis tilted just a little past Earth’s. Knowing about my ADHD has helped me understand what planet I’m from. Now I’m working on communicating better with the earthlings. I’ve learned to second-guess my perceptions, to stop and think about whether I heard everything someone said to me and perceived it the way it was intended. I’ve learned to read instructions twice, to stop myself before I blurt out something just to jazz up a conversation, to ask questions instead of letting my brain automatically fill in the blanks. In a noisy restaurant, I glue my eyes to my companion’s lips and try to catch every word instead of listening to the people at the next table (when I say, “I couldn’t help overhearing you,” I mean I really couldn’t help it). I’m also figuring out how to enjoy living on my home planet and taking some pride

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in it. I’ve learned that people with ADHD have enormous powers of observation. That’s part of our problem — we’re observing everything around us instead of what’s right in front of us. But in doing so, we see things that others miss. On a nature hike, I’m the one who first hears the woodpecker’s call, or notices the tiny, strange fungus, or spots the bear in the brush while everyone else walks right past him. There’s more to this than observing simple reality. Many with ADHD can find a subtle beauty and value in ordinary things. We often describe ourselves as “always bored,” but I don’t think it’s boredom as much as high expectations for every little thing in a world bursting with fascinating stuff. I now have the courage to appreciate and use other strengths, too, like the ability to see the big picture and to get things done on my own schedule — which usually means productive bursts between long periods of languishing. I’m more confident about working independently, doing what I’m good at, and making my own career instead of modeling it on everyone else’s. I am now a freelance writer/handyman/ substitute teacher — and I’ve only just begun. The term for our condition is still evolving. Doctors first called it “Morbid Defect of Moral Control” (that fits me sometimes). For a while researchers thought it was brain damage and called it “Minimal Brain Dysfunction.” ADD became the official term in 1980, morphing to ADHD in 1994. But I don’t think that process is over yet. New research is finding links to other conditions, such as autism, and broadening the understanding of what causes ADHD and what it’s all about. As researchers begin to grasp the full range of gifts that ADHD brings, I think they will look for a new label again. May I suggest “Misunderstood Genius”?

Rick Hodges is a freelance writer in Arlington, Virginia.

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My ADHD Diagnosis...Over Dinner A man she barely knew diagnosed her ADHD on a second date — and everything after that changed for the better. By Maureen Connolly

When Blythe Stagliano was diagnosed with ADHD, at age 26, the Philadelphia– based human resources manager finally had an explanation for the unease she’d lived with since grade school. But life did not fall into place after the diagnosis. Instead, learning that she had ADHD turned out to be the beginning of a difficult three-year journey of self-discovery. Blythe Stagliano: About four years ago, I was out on a second date with a nice guy. Halfway through the evening, he told me that he thought I had ADHD because I’d paid inconsistent attention to him at dinner. I’d had difficulty organizing and completing tasks for years, but I thought that, if I just worked hard enough, I would overcome these problems. I worked in an open cubicle, and I found it so hard to concentrate that every day was a struggle to be productive. And just that week I’d had a car accident, after I got distracted, and plowed into the stopped car in front of me. But when a man I hardly knew could see the inattentiveness I’d been hiding for years, it was the last straw. Soon thereafter I consulted a doctor, who diagnosed me with ADHD. I began therapy sessions but, as much as I wanted to change my behavior, I didn’t seem able to do it on my own. I decided to try medication, but a year and a half later, I still hadn’t found the right one for me. One medication made me spacey. Another gave me mood swings. I tried three or four antidepressants, but none were right. During this time I also tried homeopathic medications and biofeedback, but neither treatment had much impact on my ADHD. I’ve recently begun taking a slow-release stimulant, and I’m noticing improvements: It’s easier to initiate tasks, and I don’t put projects off the way I used to. At work I can move from one project to another much more easily. Feeling productive makes me happier and makes work much less frustrating. Barbara Fowler, Blythe’s therapist and coach: Blythe first saw me to get help with organization. But in our first meeting, it became clear that she was tremendously sad. It was a tough time in her life. She’d lost her job, had had major surgery on her knee that left her temporarily unable to get around, and had been diagnosed with ADHD. Although she’d known for years that she was “different,” she now felt sure

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that she had a mental illness and would never be OK. She felt defective. For a year or so, Blythe and I met once a week. Blythe’s first task was to recognize how sad she was and take steps to address it. Anyone who loses a job also loses an important social network. And for people with ADHD, the loss can be devastating. ADHDers function best when they have commitments. If an entire day is free, an ADHDer can easily accomplish...nothing. With no place to go and no accountability to anyone, Blythe didn’t know where to start. First, Blythe needed to feel better about herself. Instead of focusing on what she perceived as the failures in her life, she needed to identify what brought her pleasure. Blythe reestablished neglected friendships and started exercising regularly. As her knee began to heal, she attended a weekly yoga class. With these two accomplishments behind her, she started to feel better about herself. Blythe: Barbara taught me how important it is to be around people who like me the way I am. My friends accept me, even though I’m frequently late, and I sometimes talk too much. In the meantime, I’m making progress on my chronic lateness. I’ve learned that I usually underestimate how long it will take me to get ready. If I notice, for example, that my jewelry box needs to be reorganized, I’ll get absorbed in doing that. Barbara has taught me to make a mental checklist each night, detailing what I have to accomplish before I walk out the door in the morning, and to stick to that list. I’ve also found a job that is more ADHD-friendly than my last one. The manager at my last job noticed if I was even a minute late. Messy desks were scowled at. Now I can close my office door when I need to. It helps me avoid distractions. Barbara: Blythe’s new job is in human resources, and she’s expected to do a number of things at one time. Instead of getting frazzled by the demands, she loves the variety, because it helps her stay interested. We’ve also made progress on Blythe’s work habits. Even though she works best later in the day, she realizes that arriving early shows commitment. She’s set up rewards for herself, such as buying a fancy latte when she gets to work on time. Instead of answering each email the minute it arrives, she checks her email only four times a day. This saves her time.

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I want Blythe to recognize her great talent for getting people to work together. She’s spent too many years listening to her own negative comments, like “I’m an idiot” and “I can’t get to work on time.” Now she’s recognizing that ADHD has positive traits and learning to praise herself for what she accomplishes. Blythe: It’s hard to cope in a world where everyone else’s brain works in a different way than yours. The three years following my ADHD diagnosis have been the hardest of my life by far. But it’s been worth the work, because I’m finally learning to accept myself for who I am. Maureen Connolly is a health journalist in Montclair, New Jersey.

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Chapter Six

The Last Word 25 Things to Love About ADHD by Bob Seay • Generosity with money, time, and resources. • The drive of hyperfocus. • Resiliency. • A sparkling personality. • Insomnia makes for more time to stay up and surf the net. • Ingenuity. • Always being able to provide a different perspective. • Willingness to take a risk. • Making far-reaching analogies that no one else understands. • Spontaneity. • Possessing the mind of a Pentium — with only 2 MBs of RAM. • Pleasant and constant surprises due to finding clothing (or money or spouses) you had forgotten about.

• Being funny. • Being the last of the romantics. • Being a good conversationalist. • An innate understanding of intuitive technologies, such as computers or smartphones.

• Honestly believing that anything is possible. • Rarely being satisfied with the status quo. • Compassion. 105

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• Persistence. • Joining the ranks of artists, musicians, entrepreneurs, and other creative types.

• A strong sense of what is fair. • Willingness to fight for what you believe in. • Excellence in motivating others. • Being highly organized, punctual, and generally responsible (OK, so “It may take my ADHD we lied!).

Additional Resources ADHD Symptoms & Diagnosis Channel on ADDitudeMag.com — Everything you need to know about ADHD, including stats, treatment options, and more additudemag.com/channel/adhdsymptoms-diagnosis/index.html.

brain a little longer to arrive at a solution, but when I do, you can bet it will be inventive and effective — and it will stick!” — Patti, an ADDitude reader

ADDitude Directory — Find a wide range of professionals, products, and services relating to ADHD and learning disabilities in our searchable directory at directory.additudemag.com. ADDConnect — Need some advice from other parents and adults who’ve “been there?” Log on to our community to instantly connect with thousands of readers from across the country at connect.additudemag.com. ADDitude Blogs — Share in the daily joys and frustrations of life with ADHD. Read Web diaries written by adult ADHDers and parents raising kids with the condition at additudemag.com/adhdblogs/index.html. Free e-Newsletters — Get ADDitude’s e-newsletter delivered to your inbox each week. Go to additudemag.com/newsletters.html to sign up for lists targeted by topic (adult ADHD, parenting, ADHD at school, etc).

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Additional Resources Diagnosis and treatment books recommended by the editors of ADDitude magazine

ADHD Without Drugs, by Sandford Newmark, M.D.

Many parents hesitate to medicate their child’s ADHD — often out of fear of growth delays, sleep problems, or other unpleasant side effects. Most want to try a more natural approach, but don’t know where to turn. Do omega-3 supplements work? How much protein is too much protein for an ADHD brain? How can I help my hyperactive child sleep without medication? Dr. Newmark answers all these questions — and many more — in this wellresearched and integrative manual for natural treatments. Well-written, practical, and with easy-to-implement strategies, ADHD Without Drugs is a go-to resource for any parent curious about non-medical approaches to attention deficit.

Adult ADHD: A Guide for the Newly Diagnosed, by Stephanie Moulton Sarkis, Ph.D.

Books for Kids

Looking for ADHD-friendly books for your child? Check out ADDitude’s top picks at http://additu.de/books

Author, fellow ADDer, and ADDitude contributor Stephanie Sarkis lays out the nuts and bolts of diagnosis and treatment, and shares simple solutions on everything from dealing with ADHD in the workplace to making lifestyle changes.

Driven to Distraction, by Ned Hallowell, M.D. and John Ratey, M.D.

One of the original ADHD “bibles,” Driven to Distraction is just as relevant now as it was at publication over 20 years ago. Hallowell and Ratey break down ADHD in simple terms, explaining what it looks like, how to treat it, and why ADHDers act the way they do. If friends or family members insist to you that ADHD “doesn’t exist,” offer them this book — it may change their mind.

Delivered from Distraction, by Ned Hallowell, M.D. and John Ratey, M.D.

The book is aimed at adults with ADHD, since “millions of people, especially adults, have the condition, but don’t know about it and, therefore, get no help for it.” There are chapters on “Sex and ADD” and “What Kind of Mate Is Best If You Have ADD?” and a laundry list of helpful tips for grownups on the go.

The Misunderstood Child: Understanding and Coping with Your Child’s Learning Disabilities, by Larry B. Silver, M.D.

This completely revised edition of the bestselling guide for parents of children with learning disabilities — between 30-50% of individuals with ADHD

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also have learning disabilities — gives parents a full understanding of positive, effective treatment strategies to use at home and at school.

A New Understanding of ADHD in Children and Adults, by Thomas Brown, M.D.

ADHD has been around for over 100 years, and our understanding of it has constantly evolved. What was once viewed as a simple behavioral problem is now understood to be a more complex developmental disorder, with new and more effective treatments becoming available every year. Dr. Brown’s in-depth book answers important questions about these newly developed treatments, as well as hyperfocus, ADHD’s emotional challenges, and common myths about ADHD. If you think you know everything about ADHD, think again — Dr. Brown delves into the most recent theories about attention deficit in this readable, thorough, and insightful book.

Taking Charge of ADHD: The Complete, Authoritative Guide for Parents, by Russell Barkley, Ph.D.

A treasured parent resource since its publication 15 years ago, this book provides authoritative information on ADHD and its treatment. From internationally renowned ADHD expert Russell A. Barkley, the book arms parents with a step-by-step behavior modification plan, school strategies, advice on managing stress, and updated medication information.

“Life is a puzzle, and if you put a puzzle in front of an ADHD person, they will solve it or die trying. Give them as many pieces as you can!” — Patti, an ADDitude reader

Taking Charge of Adult ADHD, by Russell Barkley, Ph.D.

Russell Barkley is known throughout the ADHD-verse as one of the most relatable and easy-to-understand ADHD experts around. In this practical, readable guide, he details step-by-step plans for any adult whose ADHD has made relationships, work, or organization an uphill battle. This authoritative book is a critical resource for any ADHD adults looking to take charge of their condition — and their lives.

Women with Attention Deficit Disorder: Embrace Your Differences and Transform Your Life, by Sari Solden

Women have long known that fluctuating hormones affect the way we feel. What we didn’t know 20 years ago is that estrogen affects the same neurotransmitters (dopamine, serotonin, norepinephrine) that contribute to ADHD. Thus, when estrogen levels rise or drop with pregnancy, menopause, or PMS, ADHD symptoms appear to get better or worse. If you’d been wondering why your medication seems less effective at certain times of the month, Solden’s book will help you understand.

Your Defiant Child, by Russell Barkley, Ph.D.

ADHD doesn’t often travel alone. In many cases — particularly in children — it brings oppositional defiant disorder, or ODD, along for the ride.

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Children with ODD are rude, argumentative, and aggressive, and can push parents to the edge of their sanity. Since children with ODD don’t respond to traditional discipline, parents need a new approach — like Dr. Barkley’s 8-step plan for proven parenting. Inside, you’ll learn how to use positive attention, effective incentives, and calm consistency to get through the defiance — and reconnect with your child.

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Webinar Replay

“Your brain is a Ferrari… with bicycle brakes” — and other great ways to explain ADHD, presented in Dr. Ned Hallowell’s free ADDitude webinar! http://additu.de/ferarri

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More ADDitude Special Reports Available Now www.adhdreports.com

A Parent’s Guide to ADHD Diet and Nutrition The foods, vitamins, minerals, supplements, and herbs than can help your child.

The connection between the food your child eats and his or her hyperactivity, impulsivity, and distractibility is not always clear. Here, the editors of ADDitude have assembled science-based information about foods and additives to avoid; how omega-3s, iron, and zinc boost the brain; why protein is so critical, and much more. >> Learn More About this Special Report: newhope.leadpages.net/dietnutrition-adhd/

Mindfulness & Other Natural Treatments The best non-medical treatments for ADHD, including exercise, green time, and mindful meditation.

Learn how mindfulness works on ADHD brains, and how to begin practicing it today. Plus, research the benefits of other alternative treatments like yoga and deep breathing exercises — including some designed especially for kids — as well as the science behind each natural therapy. >> Learn More About This Special Report: newhope.leadpages.co/mindfulness-adhd-ebook/

FREE ADDitude Downloadable Booklets It’s Not ADHD: 3 Common Diagnosis Mistakes

Doctors are sometimes too quick to diagnose ADHD. Read up on common misdiagnoses.

Does My Child Have ADHD?

Think you see signs of ADHD in your child? Read this comprehensive checklist of symptoms.

ADHD Vitamins and Supplements

Find out which herbs, vitamins, and nutritional supplements may help control symptoms of ADHD.

9 Rules for Using Medication Safely

Before starting any medication regime, check out these 9 rules for medication safety.

You Know You Have ADHD When…

9 Conditions Often Diagnosed with ADHD

Real ADHDers share personal stories highlighting the lighter side of living with attention deficit.

Depression. Bipolar Disorder. Anxiety. OCD. And five more conditions that often show up alongside attention deficit.

Smart Comebacks

About 80 percent of individuals with ADHD are diagnosed with at least one other psychiatric condition at some time in their lives. This in-depth special report looks at the nine most common, outlining symptoms, treatment strategies, and differentiating features of each. Plus, strategies for living well with any mental health condition. >> Learn More About This Special Report: newhope.leadpages.co/ 9-conditions-like-adhd/

Witty responses to ADHD doubters.

Find these and many more free ADHD resources online at: http://additu.de/ freedownloads

To purchase additional copies of ADHD 101 or other ADDitude Special Reports, go to adhdreports.com

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FREE ADHD Webinar Replays from ADDitude: Healing the ADHD Brain: Interventions and Strategies that Work >> http://additu.de/healing

There’s no one-size-fits-all approach for treating ADHD. Here, Daniel G. Amen, M.D., explains treatment options ranging from medication and supplements to diet and exercise.

10-Step Plan for Moms of ADHD Kids: How to Feel Supported, Understood and Not Alone >> http://additu.de/ww

Raising a child with ADHD can be isolating. The world doesn’t always understand and resentment builds up fast. Here, Kirk Martin helps parents tackle defiance, disrespect, bullying, sibling fights, and more. All with the parents’ health and sanity in mind.

Minecraft and ADHD Kids: Brain Boosting or Attention Busting? >> http://additu.de/minecraft-webinar

FREE ADHD Newsletters from ADDitude

Sign up to receive critical news and information about ADHD diagnosis and treatment, plus strategies for school, parenting, and living better with ADHD: http://additu.de/email Adult ADHD and LD

Expert advice on managing your household, time, money, career, and relationships.

Parenting Children with ADHD or LD

Behavior and discipline, time management, disorganization, making friends, and more critical strategies for parents.

Whether it’s Minecraft or Mario Kart, our kids are especially prone to extremes — playing as much as they can and reacting terribly to limits. Here, Randy Kulman, Ph.D., and James Daley, explain why kids with ADHD get addicted to video games, how to set reasonable limits on play time, and how to ensure smoother transitions when time is up.

ADHD and LD at School

The Toxic Impact of Stress on Learning and Behavior

Treatment options including medications, food, supplements, brain training, mindfulness, and other alternative therapies.

>> http://additu.de/stress

School life involves planning and organizing, prolonged periods of focus, and high-pressure testing — all stressful tasks for kids with ADHD and LD. Here, Jerome J. Schultz, Ph.D., explains how chronic stress can adversely affect brain functioning, behavior, social skills, and learning. He also recommends accommodations to alleviate stress.

How to get classroom accommodations, finish homework, work with teachers, find the right schools, and much more.

Treating ADHD

How Executive Functions Affect ADHD Symptoms in Children and Adults >> http://additu.de/j-

Executive function. It’s a set of skills working in concert to help us plan, organize, and execute projects. It’s also often lacking in children with ADHD, which explains all the lost homework, missed deadlines, and unfinished projects. Here, Ann Dolin, M.Ed. offers homework, test-taking, and focus strategies that work for students with ADHD.

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