ADHD Solutions

The holiday season is a test of everyone’s patience.  People with ADHD – adults and children alike – tend to be less patient than most.  We hate waiting in line.  We want everyone to get right to the point (although some of us struggle with that ourselves).  We want our food right now.  Dang it, where is that waitress?!

Maybe it’s our impulsivity.  Maybe it’s our hyperactive minds.  Maybe it’s because we have so many things going on in our lives, or our impaired sense of time.  Regardless of the cause, our need for instant gratification can be highly irritating to ourselves and the people around us.

What to do?   Here are a few suggestions:

•    Always have something to keep yourself occupied. If you’re going to a place where you might have to wait, bring something to do.  Perhaps a book, or a crossword puzzle, or a notebook to write out your grocery list or brainstorm ideas for your next project.  Keep an audio book on your iPod.

•    Run errands at non-peak times. The lines at the grocery store are much shorter at 8PM than they are at 5.  Avoid the mall until January.

•    Get an estimate. It can be excruciatingly difficult to wait for something when you have no idea when it will happen.  You end up looking at the clock every 30 seconds.  But if you know in advance how long it will be, you can go find something else to do during that time.  Similarly, if you have to do something maddening, it can be much easier to tolerate if it’s not open ended.  If you can’t get an estimate, make one up: “I’ll wait for ten more minutes, then I’ll go see what’s happening.”

•    Ask for the bottom line. If you find yourself getting impatient with someone you’re listening to, there’s nothing wrong with politely interrupting and asking them to get to the point.  “John? (pause and wait for response) I’m starting to get lost in the details.  Can you just give me a quick summary please?”  If you’re talking with someone who has a habit of rambling, you might want to have a separate conversation with him about his monologuing.  You’re probably not the only one who gets impatient with it.

•    Communicate your limits. If your kids – or coworkers - ask one maddening question after another, decide how many questions you’ll answer before you say “no more”.   Tell them when the quota has almost been reached.  Don’t be afraid to stand your ground if you’ve been reasonable and provided fair warning.  This is much better than blowing up at them because you can’t take it any more.

•    Release your grip. Accept that sometimes things will be what they will be, no matter what you do.  Try to let go of the things you can’t control.  As a Caribbean native told me years ago, “When you’re in a hot country, you’ve just got to move sloooooooooooow.”  Prone to road rage?  I like to think of slow traffic as more time to spend with my traveling companion.

•    Remove the obstacles. If you’re impatient with your own progress, try to identify what’s slowing you down.  Then figure out what you need to do to quicken the pace.  This is one time when impatience can work in your favor!

•    Find compassion. Try to understand why a person is acting the way she is, or why a situation is unfolding the way it is.  There’s nothing like walking in someone else’s shoes to make you appreciate the complexity of the situation and be more relaxed about it.  This goes for yourself too:  Be compassionate when you find yourself impatient with your own ADHD.

I’ll end with this quote from a sign that used to hang in my godmother’s kitchen:  “The hurrier I go, the behinder I get!”

I’m pleased to announce that I’ve been awarded the Certified ADHD Coach (CAC) credential by the Institute for the Advancement of ADHD Coaching (IAAC)!  I’m the first ADHD Coach ever to receive the CAC designation, which the IAAC began offering in March of this year (see my blog post from March 31).

The IAAC is the only independent worldwide credentialing organization for ADHD coaches. It was formed to promote excellence within the ADHD coaching profession by providing credentialing, a set of core competencies, and ethical guidelines.

Getting this certification is a significant milestone in my career. The credential is important to me because I want potential clients and referral partners to know I meet an extremely high standard. It’s a milestone for the ADHD coaching profession too, because credentialing hasn’t been available until now except to the 66 coaches who were grandfathered in last year.

Here’s the writeup from the Central Penn Business Journal: http://www.centralpennbusiness.com/view_release.asp?aID=3328

I’ve always been an advocate of exercise in order to lessen ADHD symptoms.  Here is a terrific interview with Dr. John Ratey, published by  Medscape Psychiatry & Mental Health (www.medscape.com) on  10/08/2009.  It’s long, but worth the read.

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Editor’s Note:

Attention-deficit disorder (ADD), also called attention-deficit/hyperactivity disorder (ADHD), is often surrounded by controversy over medication use and is perceived by many as a condition that is overtreated. John J. Ratey, MD, advocates that exercise should be included in the treatment regimen, and that exercise can even reduce or eliminate the need for medication. An Associate Clinical Professor of Psychiatry at Harvard Medical School, Cambridge, Massachusetts, Dr. Ratey is author of the book Spark: The Revolutionary New Science of Exercise and the Brain, as well as several related books in the popular press. He also has consulted on clinical studies pertaining to exercise and psychiatric conditions.

Medscape: Can you start with some background about ADD, and how exercise affects the brain?

Dr. Ratey: First, ADD affects at least 8%-10% of children, and almost as many adults. It’s now considered a biological brain disorder and may have genetic components.

There are 2 basic ways of thinking about ADD in relation to exercise: One is about the neurotransmitters norepinephrine and dopamine, both believed to be drivers of the attention system. Exercise increases the concentration of both dopamine and norepinephrine, as well as other brain chemicals. I have always said that a dose of exercise is like taking a bit of methylphenidate (Ritalin®) or amphetamine/dextroamphetamine (Adderall®); it’s similar to taking a stimulant.

Second, over time, exercise helps build up the machinery to increase the amount of neurotransmitters in the brain as well as their postsynaptic receptors. Chronic exercise eventually causes growth of the system. The more fit that you are, the better the system works.

Medscape: Where do these findings come from?

Dr. Ratey: Exercise has been one of the hot topics for the past 15 years in neuroscience. The initial studies on exercise and dopamine came out in the 1960s and 1970s. I’d like to add that exercise activates the frontal cortex in all age groups. Many ADD symptoms are related to the brain’s executive functions, which are located in the frontal cortex.

Medscape: Are there studies looking specifically at exercise and ADD?

Dr. Ratey: There are numerous studies about dopamine and norepinephrine and exercise, but when it comes to ADD, clinical studies with exercise are just starting.

Medscape: What got you interested this area?

Dr. Ratey: I had several marathoners for patients who had stopped marathoning because of injuries. These particular patients first got depressed, and then some presented with ADD symptoms for the first time in their lives. This was back in the early 1980s, before we really thought much about ADD — in kids or in adults.

Medscape: ADD isn’t something that can just materialize later on in life, is it?

Dr. Ratey: No. In the case of the runners, they would have had ADD before, but their exercise regimens served to keep it under control. What’s been observed over the past 30 years is that athletic people who played regular sports in high school went to college but stopped exercising, and then saw the first major signs of ADD. They may have had some hint of ADD in the past, but in college it came on like gangbusters.

Medscape: How do other people in psychiatry react to the idea of prescribing exercise?

Dr. Ratey: People are just beginning to pay attention to this. It was only 2 years ago that the American Medical Association (AMA) president, in his inaugural address, said that “exercise is medicine.” He said that every physician, no matter their specialty, should ask every patient at every meeting about their exercise regimen and encourage them to pursue this.

Neurology is paying more attention to exercise, with whole conferences looking specifically at exercise and Parkinson’s disease, for instance. If exercise can help protect against some of the symptoms in Parkinson’s disease, then it should also affect ADD, because the diseases have overlapping features.

Medscape: Is exercise starting to get respect as a treatment option?

Dr. Ratey: Yes. Historically, it started in cardiology studies. Then psychologists noted that the people in cardiac rehab were improving emotionally as well as physically. They looked at depression, anxiety, hostility, aggression, and stress in people who started an exercise regimen for cardiac protection or healing. Duke University researchers were leaders in measuring the effects of exercise on the emotional side. Exercise is now studied in practically every specialty.

Medscape: How often should patients with ADD exercise, and how intensely?

Dr. Ratey: There are a variety of exercise programs and regimens out there. Some schools have exercise breaks every hour or two, but other regimens may work, too. Someone with ADD could benefit from an exercise break of 10-15 minutes every hour or so. It helps everyone, not just patients with ADD.

Medscape: Does exercise need to be done several times daily?

Dr. Ratey: Yes, but it doesn’t have to be for very long each time. Just enough to get the heart rate up for at least a few minutes. Benefits persist for a while after exercise. We know there are improvements with low levels of exercise, such as walking for 20 minutes. Of interest, a number of people at various companies, such as Merrill Lynch and Google, now have standing desks.

Medscape: Dr. James Levine, a researcher from the Mayo Clinic, mounted his desk on a treadmill so that he can walk while he works. Would walking while working help ADD?

Dr. Ratey: That’s the Tread Desk and would be excellent for both adults and kids. It certainly has the potential to keep ADD in check.

Medscape: For Medscape readers, what advice should doctors give to patients?

Dr. Ratey: They should advise patients to exercise daily. Whatever medical treatment has begun, exercise needs to be included, too. It should be daily. Aerobic and strength training is fine. Balance training is important in patients with ADD and can be accomplished with yoga, tai chi, or balance exercises. Exercise needs to become a lifestyle, a habit.

Medscape: Would regular exercise affect the medication needs of patients with ADD?

Dr. Ratey: It often does. A number of the patients described in my book got off medication completely. In people who have trouble finding the right medication regimen, exercise can really help. The exercises chosen should be fun so that people will want to do them.

Medscape: Does exercise become a chronic medication?

Dr. Ratey: Yes. However, this isn’t for everyone. There is a spectrum of severity in ADD. There are plenty of marathoners who still need medicine, but maybe they need less than they would if they didn’t run. A number of superathletes have ADD. A prime example today is Olympic swimmer Michael Phelps who was diagnosed at the age of 9 and put on medicine. He found it impossible to stay still in school because of ADD. Then he began swimming. When he got up to 3 hours of daily exercise, he didn’t need medication anymore.

Many of these kids develop “learned helplessness syndrome.” They’ve failed so much in the past that they now expect to fail. They get depressed, use drugs, or play video games all day. Exercise prevents people from getting into that. Animal studies have shown that exercise makes it tougher to develop learned helplessness.

Medscape: Isn’t there a certain amount of positive reinforcement? If you’re running from point A to point B, when you get to point B you’ve gotten there. You’ve achieved something.

Dr. Ratey: Yes; the effects on self-efficacy are huge. Although exercise helps balance brain chemistry, there are helpful incidental effects, such as self-efficacy.

Medscape: It sounds as if patients with ADD can’t go wrong getting into an exercise habit.

Dr. Ratey: Them, and everyone else, although most patients with ADD will still need some medication. People can find out more from my Website www.johnratey.com.

Medscape: Thanks very much for your time today.

Interviewer: Pippa Wysong, Freelance Writer

Interviewee:  John J. Ratey, MD, Clinical Associate Professor of Psychiatry, Harvard Medical School, Cambridge, Massachusetts

Medscape Psychiatry & Mental Health © 2009 Medscape, LLC

I learned a valuable lesson on vacation the other week.  Even though it happened on vacation, it’s a lesson that applies to any journey away from home.  Here’s the story…

Rhode Island was our destination.  None of us had ever been there before and we were excited about going to a new place.  Wanting to be spontaneous, we didn’t do much planning.

On the first full day of our trip, we had donuts for breakfast.  What a treat!   We then spent the day exploring the area.  The roads were poorly marked and didn’t match the directions we pulled up on the mobile phone’s tiny browser screen.  We were chronically lost and incredibly frustrated.  I ordered what I wanted when we stopped for lunch: a cup of chowda and homemade white bread.  Yummy!  By dinner time, after getting lost a few more times, my brain was so overloaded that I had a great deal of difficulty coping with the unfamiliar grocery store.  I hadn’t made a shopping list, so I didn’t pick up anything with nutritional value.

Can you spot my mistakes?  I did, but only after recovering from a complete meltdown.  Here they are:

• Junk food.  Since I was on vacation, I felt justified in eating whatever I felt like.

• No exercise.  Similarly, I abandoned my exercise regimen.  Not that I could have exercised much in the car during the 8-hour trip.  But I could have a found a way when we arrived.

• Insufficient sleep.  Not having exercised, and being in a strange place, it was hard to sleep the first night.

• No supplements.  I failed to unpack my supplements and put them next to the coffee filters (so I bump into them in the morning) like I do at home.

• No printed maps.  My coping strategy to avoid getting lost is to print and review maps ahead of time.  Since we were being spontaneous, we didn’t do that.  Can you believe that not one of the 47 maps in my glove box included the state of Rhode Island?

• No planning time.  I’m very good at planning when I take the time to do it.  When I don’t, I get overwhelmed by an unlimited array of choices.

All of this added up to a very unpleasant evening as my ADHD symptoms collided into one big emotional mess.  Thankfully, my son and my boyfriend were extremely patient and supportive.  Thanks guys!  I was able to regroup the next day and enjoy the rest of the trip.

Don’t make the same mistake I did.  When you go away somewhere – whether it’s vacation, a weekend getaway, a business trip, or off to college -  remember to take your ADHD coping strategies with you.

Someone said to me recently, “I can only imagine how your results will soar when your confidence rises to the level of your expertise.”

Confidence? Hm? I haven’t thought of myself as lacking confidence for a long time. But he could be right. There are still times when I procrastinate, or avoid doing something entirely, because of self doubt. For example calling a nationally renowned psychiatrist to introduce myself. Or  approaching the folks at ADDitude magazine about carrying my blog.

I’m an expert in my field, with years of training and experience. I get accolades from nearly everyone I work with. How could I still be struggling with this? Confidence issues are so high school.

Hm, high school. Maybe that’s the answer. I had severe undiagnosed ADHD (early ’80s, rural Pennsylvania, we’d never heard of it). My nickname was “Dizzy” even though I had an IQ of… well I won’t reveal that. My Mom was constantly asking me, “How can someone so smart be so STUPID?!?”

Naturally I grew up believing I was completely inept.

Let’s trace the confidence lifecycle of the typical ADHDer:

Infant: Doesn’t do much besides eat, sleep, and poop. She’s pretty confident she can handle those responsibilities.

Elementary school: Begins to take risks, begins to notice failures, begins to wonder why she’s different than other kids.

Middle/high school: Hits the wall. “Other kids don’t struggle like this, what’s wrong with me?” If an ADHD diagnosis is made, now she has a label, probably an IEP, and maybe a behavior chart. If the disorder is not explained thoroughly and compassionately to her and everyone she interacts with, self esteem issues are compounded. But happily, when she starts getting the help she needs, her confidence improves.

College and early adulthood: Finds her niche, discovers something she excels at. Confidence soars. But early wounds may still lurk beneath the surface.

How to improve confidence? I’m not a fan of avoiding the “f-word” (failure) to boost self esteem. There’s huge pride in failing at something, trying again (perhaps repeatedly), and eventually succeeding. If you only do the easy stuff, you aren’t going to feel very good about yourself in the long run.

Here are some ways to boost your confidence as an ADHD adult:

* Set up situations where you can fail safely. A martial arts class, for example.

* Stretch. Do something that’s just a little outside your comfort zone every day.

* Visualize your successes, past and future.

* Solicit and re-read testimonials and fan mail, even if they’re from your mom.

* Fake it til you make it. Act like you’re confident, and soon you will be.

* Dress the part. Wear clothes that make you feel powerful.

* Prepare. If it’s information you need, get it. Practice.

Try some of these tips before going into situations that require confidence, such as public speaking. Also call on them to help you take the chances in life that will move you towards your goals.

Looking for an affordable alternative to one-on-one ADHD coaching?   I’m excited to announce a new group ADHD coaching program starting in June.

Coaching helps you overcome your ADHD-related challenges and thrive.  It’s about discovering where you are, where you want to be, and actually getting there.   You’ll develop the systems and strategies you need to be successful.

Here are the highlights of this innovative new program:

* Each group will have between three and six members.

* The group will meet twice per month.

* In addition to the group meetings, you’ll get two 15 minute, one-on-one “laser sessions” every month.

* Ongoing email support and accountability check-ins are included.

* As part of the registration process, each participant will complete an Issues Inventory to ensure that the issues and goals of all members are compatible.

* Cost is just $75 per month.

Two groups for adults are forming now:

* Every other Tuesday at 10:00 a.m. Eastern, beginning June 16

* Every other Tuesday at 7:00 p.m. Eastern, beginning June 16.

Working in a group has other advantages as well: you’ll meet people with similar issues, get different insights and perspectives, and know that you’re definitely not alone.

Click here for more information and to sign up.

ADDitude magazine, one of the world’s leading ADHD publications, has asked me to write a blog for their web site.  It’s called “Works for Me” and is a mix of advice and personal experience from a coach’s perspective.  Check it out!

Here’s a terrific article by Dr. Ari Tuckman,  renowned author and ADHD specialist:

People with ADHD often feel others are trying to control them.  This includes family members, romantic partners, bosses, coworkers and friends.  Why won’t they just get off your back? Don’t they have anything better to do?

Attempts to exert control can be obvious, like when your spouse bans you from the checkbook, or more subtle, such as unsolicited advice.  I assume these actions are well intentioned, but that doesn’t make them fun when you’re on the receiving end.  So why are these people in your life so often trying to influence what you do?  Are they control freaks?  Do they enjoy bossing you around?

When I speak with family members and romantic partners of people with ADHD, I often find they’re really trying to control their own anxiety.  They feel nervous when the bills aren’t paid or when there’s a lot of clutter.  They get on your case hoping to make themselves feel better by removing whatever’s making them anxious or uncomfortable.  They don’t intend to make you miserable, even when that’s what happens.

There are two ways to deal with uncomfortable situations - external and internal anxiety management.  External anxiety management requires that you change the world around you to eliminate the source of the discomfort.  If your spouse is worried about late fees, she will ask you… repeatedly… to pay the bills.  Once the bills are paid, she doesn’t need to worry about it any more.  Problem solved. However, while this works well in some situations, it doesn’t work well in every case.

External anxiety management breaks down in situations that can’t be resolved, or not immediately.  For example, you can’t pay bills while you’re driving.  We all encounter many situations where we must wait before acting.  The other potential problem is that being too insistent can strain the relationship.  Nagging may get the job done, but nobody is happy about it.  This is common when one person in a couple or family has ADHD - the non-ADHD person does a lot of reminding/nagging, and it’s rarely appreciated.

By contrast, internal anxiety management is finding a way to be comfortable with something in your life that you don’t have as much control over as you would want.  For example, the spouse without ADHD can decide that she will stop worrying over the occasional late fee because it isn’t worth all the fighting.  She’s not happy about the late fees, but she recognizes that being upset about them is making her miserable and ruining the relationship.  She decides to let this one go (for the most part) and focus her energy on things she is more likely to affect positively.

For people with ADHD, this means that, although it can look like these other people are trying to control you, they’re really just trying to control their own anxiety - using external anxiety management.  It may or may not be effective, but it probably causes more bad feelings than either one of you would want.

Usually, the best scenario is a balanced internal and external approach.  In therapy with a couple or family where one person (or more) has ADHD, I tackle the situation from both sides.  I try to help the person with ADHD be more consistent and reliable, so the other person indeed has less to worry about. But I also work with the non-ADHD person to learn ways to manage his or her anxiety internally.

The non-ADHD spouse can reduce anxiety by picking battles that really matter, and tolerating things that aren’t worth a battle.  By working it from both sides, there’s less conflict and both parties can better deal with all the usual stuff that comes up in relationships, as well as the unusual stuff that comes up in couples where someone has ADHD!

The next time you’re feeling controlled, remember that the other person may just be trying to control his or her own anxiety.  This might help you take a step back, calm down and deal with the situation more productively.  Of course, if you find yourself doing the controlling, consider whether an internal anxiety management strategy might give better results.

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Dr. Ari Tuckman is the Vice President of ADDA.  He is a psychologist in private practice in West Chester, PA.  His second book, More Attention, Less Deficit: Success Strategies for Adults with ADHD will be available in May 2009.