Tuesday, July 31, 2012
Friday, July 27, 2012
Controlling Anxiety
Larry Silver, M.D.
Q: "My 18-year-old becomes very anxious as her long-acting stimulant wears off. She asked about taking a higher dose. What do you think is going on here?"
A: The anxiety might be a rebound effect, which sometimes happens as medication wears off, or it might be her reaction to the return of her symptoms (especially if it wears off during class or at another inconvenient time). You may want to discuss a dose increase with her doctor. See if this lasts longer and doesn't cause anxiety. One other caution: If your daughter has an anxiety disorder [see "When AD/HD Is Only Part of the Story"], the stimulant could be exacerbating this. If so, this condition must be treated in addition to AD/HD.
Thursday, July 26, 2012
When to Give Kids Another Dose
Larry Silver, M.D.
Q: "My seven-year-old son takes Adderall. He is fine while on the medication, but when it wears off, he becomes defiant and mean. Is this a side effect of the medication?"
A: One possible side effect for Ritalin, Dexedrine, or Adderall (or any of the stimulant medications for ADHD) is “rebound.” This means that, about 30 minutes after the last dose wears off, the child or adolescent becomes very irritable (or hyper or loud or aggressive). These behaviors typically last for an hour.
The solution might be to add an additional, short-acting dose so that the medication wears off only at bedtime, or to decrease the last dose to see if the rebound is less severe. If giving an additional dose late in the afternoon, you should carefully monitor your child’s appetite in the evening (when many children with ADHD eat their largest meal), to ensure that appetite suppression doesn’t interfere with proper nutrition. If neither approach works, it may be necessary to try a different medication.
(additudemag.com)
Stand Up for Your Child with ADHD
How parents can explain ADHD to doubters both in and outside the family.
by Edward Hallowell, M.D.
You are sitting on the sidelines of the soccer field watching a melt down from your daughter with attention deficit disorder (ADHD). She stomps off the field, throws her water bottle on the ground, and argues with a teammate — all because she missed a kick.
You’re not surprised. It’s 4 p.m., and her ADD medication is wearing off. It’s a difficult time of day for her, and you’ve learned to joke together about late afternoon, calling it the witching hour.
Then the mother next to you mutters, “Someone ought to get that kid under control!” and your blood boils. You’d love to set her straight, but you hold your tongue.
You are less likely to hold back when the criticism comes from family. You expect support from those you love. So when your sister says, “Really Mary, you ought to discipline that child!” you probably don’t want to let her comments go unanswered.
You’ve told them a dozen times that she has ADD, but they “don’t believe in it” or “don’t get it.” Their criticisms are an unfair indictment of your parenting skills — and of your child. You know you’re not incompetent, and they should, too. What to do?
Talk Down Your Family
Unless you want to be forever banned from your sister’s house, take a just-the-facts approach. Tell her that it’s important to you that she learn about ADHD, so that she can better understand her wonderful niece. You can facilitate her education by giving her a book about attention deficit or by explaining what you know about the condition.
Another option is discussing your daughter’s doctor’s appointments with your sister. Sharing information about the ADHD diagnosis tests, as well as the doctor’s opinions, may help her understand that ADD is real and that it is the cause of your daughter’s behavior.
You might take the same approach with a mother-in-law, but let your husband do the talking. If that doesn’t work, there might be other reasons why she resists your daughter’s diagnosis. Her behavior might remind her of your husband’s behavior at that age — and evoke anger or unpleasant memories.
You can figure this out by asking some “why” and “what” questions: “Why don’t you believe what we are telling you?” “What is it, specifically, that is bothering you?” are good starting points. Your mother-in-law’s anger is valid, but it should not invalidate a diagnosis of ADHD.
Educate Your Friends When a close friend says something about your child that upsets you, avoid inflammatory debate. Instead, offer guidance to help her respond supportively.
If a friend says, “David would do fine in school, if he would just try harder,” point out that David is trying very hard, but that it takes him longer to acquire the study, time management and organizational skills that come easier to other children.
Explain the key elements of David’s ADD, and the efforts that your family is making to support him. If you need help, there are a number of good resources, including my own Delivered from Distraction and A User’s Guide to the Brain, by Dr. John Ratey.
Finally, ask your friend if she might be willing to accept your daughter for who she is. In doing this, your friend gets a “two-for”—she expands the circle of people who are cheering your daughter on, and she recognizes the effort that you are making on your child’s behalf.
Don’t Forget About You
Supportive friends and extended family are only part of the picture. Make sure that your child knows, every day, how much you love her. Several studies suggest that loving acceptance by parents is the most important thing teens with ADD need in dealing with symptoms.
Showing your love and affection will buoy your child’s sense of hope and help the family weather any criticism that will be directed their way.
The Meaning of ADD/ADHD
The more children know what ADD/ADHD means, the better. Here's how and why you should explain the meaning of ADD/ADHD to your child.
by Larry Silver, M.D.
Your son or daughter has been diagnosed with attention deficit hyperactivity disorder (ADD/ADHD). You’ve done your due diligence, learning about the condition and how the symptoms affect him, academically and socially. Great. But have you shared what ADD/ADHD means with your child? Does she understand why she does things that upset others? Does he know why he is taking medication and how it works? Saying, “You are so hyper all of the time” makes your child feel he is doing something wrong. Saying, “Sometimes your brakes don’t work so well, so you say and do things that might upset your friends” is better.
How Well Should You Explain What ADD/ADHD Means?
Explaining ADD/ADHD to your child, and giving him the words to tell you how his symptoms affect him, will allow you to work more effectively with doctors, teachers, and family members. Martha’s third-grade teacher tells her mom that she is not paying attention during math period. Martha knows how ADD/ADHD affects her and knows the reason for her inattention. “I sit next to a window in math class, and I can’t filter out the noises coming from the playground. The noises make it hard for me to listen to the teacher.” Martha’s mom asks the teacher to move her daughter away from the window. Her grades improve.
Alex, a fourth-grader, gets into trouble running around and bothering the other kids during lunchtime. Like Martha, Alex knows about ADD/ADHD and knows how to talk about it. His dad asks him why he is acting up. “Dad, my brakes work fine until around 11:30. Then, they don’t work too good, and it is hard for me not to run around.” His dad asks, “When do your brakes start to work again?” Alex says, “When I go back to class after lunch.” Alex’s dad realizes that his morning dose of medication wears off around noon and that his afternoon dose doesn’t kick in until he returns to class. That explains his hyperactivity in the cafeteria. He asks Alex’s doctor to switch to a longer-acting medication, and the lunch-period problems stop.
If your child doesn’t understand how ADD/ADHD affects him, he can’t tell you what’s bothering him. Worse, he feels bad about his behaviors because he doesn’t know what’s causing them.
Using the Right Words to Explain the Meaning of ADD/ADHD
There are three groups of behaviors that you may need to explain. Some kids will have one of these, some two, and others all three.
- Hyperactivity: difficulty sitting still; being fidgety and squirmy.
- Inattention: This might be noticed as distractibility (difficulty blocking out unimportant auditory or visual stimulation, having a short attention span); lack of attention (difficulty blocking out internal thoughts); executive function difficulties (problems with organization of materials and thoughts, resulting in losing, forgetting, or misplacing things; difficulty organizing and using information; difficulty with time management).
- Impulsivity: speaking or acting without thinking.
Once you know which behaviors your child exhibits, use the right words to describe them. Here’s what I tell patients:
Explaining Hyperactivity to Children With ADD/ADHD
“Our brain is amazing. It has one area that makes our muscles move. I think of the pedal in a car that makes the car move. It’s called the accelerator. Next to this pedal is another one called the brake. The brakes slow down the car. Some children have a problem with their brakes, so the motor is always running and it is hard to slow down or stop the car. When your brakes don’t work well, it is hard to slow down your body.”
Explaining Distractibility to Children With ADD/ADHD
“Our brain is always reacting to things we see and hear. If we paid attention to everything around us, we couldn’t pay attention to the teacher’s words or to what Mommy is asking you to do. Our brain has a way of blocking out what is not important, so that we can pay attention to what is important. I call this part of the brain the filter. One set of filters blocks out unimportant sounds and another blocks out unimportant sights. Your filter for blocking out unimportant sounds is not working well. So anything you hear comes right in and gets your attention, distracting you.”
Explaining Inattention to Children With ADD/ADHD
“In addition to being able to block out unimportant things we see or hear, we often have to block out unimportant thoughts. When I ask you to hang up your coat, you may be busy thinking about the play date you will have with your friend. Our brain has filters to block out unrelated thoughts, so that we can focus on what we should be paying attention to. If this filter is not working, you seem to be distracted because you are focusing on other thoughts.”
Explaining Executive Function Problems to Children With ADD/ADHD
“There is a part of the brain that helps children keep track of their things. I call this the organizer. Sometimes your organizer does not work as well as you would like. So you might lose, forget, or misplace things.”
Explaining Impulsivity to Children With ADD/ADHD
“Our brains have lots of thoughts and ideas running around in them. Some thoughts are helpful; some aren’t. It is important to think about all of them and to pick the right ones to act on. To do this, our brain has a part I call the pause button. When you press it, you tell your brain to wait until you have considered all of the ideas floating around in your head. If your pause button is not working well, you act on your first thoughts. Only later do you realize what you have done or said, and wish that you had thought more about it.”
Explaining Medication to Children With ADD/ADHD
“Your brakes don’t always work well, so Mommy and the teacher get upset with you. This medicine will help your brakes work better, so that you are not as active. People will not be so upset with you, and you will feel more relaxed.”
When your child understands her ADD/ADHD and how it impacts her, life becomes less unpredictable and confusing. She will understand why certain behaviors happen, and not get down on herself for having them. Find your own words for communicating with your child. You -- and she -- will benefit.
Tuesday, July 3, 2012
Indulging My Inner Three-Year-Old
When my symptoms peak and stress levels rise, I unleash the toddler within.
Adult ADHD Blog (A Woman's Perspective) | posted by Jane D.http://www.additudemag.com/adhdblogs/1/9625.html
The Right Way to Fight: ADHD Relationship Advice
Relationship advice from experts who say that "fighting fair" keeps dust-ups from turning destructive in an ADHD marriage.
by Michele Novotni, Ph.D.
Filed Under: ADHD and Marriage, ADHD and Relationships, ADHD Communication Skills, ADHD Dating,ADHD Social Skills
It's no secret that people with attention deficit disorder (ADD ADHD) have trouble regulating their emotions. This can lead them to jump to the wrong conclusion or to take offense where none was intended. Mild disagreements can quickly turn into bitter fights.
Before your anger gets the best of you, follow this ADHD relationship advice -- tested by real marriages -- to make your union stronger.
When one or both "halves" of a couple have ADHD, anger, resentment, and quarreling are all too common. But don't take it from me. Consider these statements made to me recently by some of my clients in ADHD marriages:
"Tom can go from zero to 100 in 10 seconds," says Tom's wife. Unfortunately, she isn't talking about driving. She's talking about his anger.
"There's just no reasoning with her when she gets upset," John says of his wife. "It's like quicksand. The more I struggle to escape, the deeper I sink."
"I don't understand why she gets so upset," says Bob. "Out of the clear blue, my wife gets mad and stomps out of the room, slamming the door behind her."
If people with ADD are to minimize strife in their relationships, they must "fight fair" and be willing to compromise. After all, in most disagreements neither partner is entirely right or entirely wrong.
Understand each other's values
What matters most to you? What matters most to your partner? If you take the time to find out where your values coincide - and where they diverge - your disagreements will be less likely to take a nasty turn.
Imagine a couple having a discussion about housekeeping. One partner (who values time above money) wants to hire someone to clean the house once a week. The other partner (who values money above time) considers that an extravagance. There's no right or wrong here - just a clash of values. So, rather than argue their positions, the partners talk about the values that underlie them. They compromise, and hire a cleaning person to come in once every two weeks.
Establish ground rules
These should govern how, when, and where arguments will proceed. If you or your partner takes ADD medication, for example, it's probably a good idea to limit potentially explosive conversations to times when impulsivity and other symptoms are fully controlled. If you have a hard time controlling your temper in conversations, perhaps you could agree to hold conversations via e-mail.
One couple I've worked with decided to discuss difficult issues only after the children had gone to bed.
Another couple agreed to wait until the weekend to have difficult discussions - because during the week they're simply too tired to think clearly.
One ground rule, above all others, is especially important: Stop any discussion right away if you or your partner becomes angry. Take a breather and return to the discussion 30 minutes later, after the anger has dissipated. Go for a walk, visit a neighbor, or play with a pet. You might consider this a time-out for grown-ups.
It's not always easy to delay discussions - especially if you or your partner tends to be impulsive. But it's a skill worth cultivating, for the sake of your relationship.
Restate your partner's words
If your partner says something with which you violently disagree, stifle the urge to pounce. Consider the possibility that you have missed - or misinterpreted - something. The best way to do this is to restate, in your own words, what you think your partner said - and how your partner feels. Then ask your partner if you've gotten it right.
Don't continue the discussion until you're certain that you understand your partner's position.
Look for anger cues
In many instances, it's possible to sidestep disagreements altogether if each partner watches for signs that the other is becoming annoyed.
Consider my client Bob and his wife, who always seemed to get angry at him "out of the blue." Once the three of us talked things over, Bob had an important realization: Long before she blew up at him, his wife showed many signs of anger - clenched fists, crossed arms, facial flushing, and changes in her tone of voice. Things got better between them once he started paying closer attention to these non-verbal cues - and once she agreed to try to express herself more directly.
Keep things in perspective
Arguments take a heavy physical and mental toll. Is it really worth the time and emotional stress? Often it's better to be like Teflon - and let things slide - than to be like Velcro, quickly grabbing on to every annoyance or perceived slight.
(additudemag.com)
Timers for ADD Adults and ADHD Children
These gadgets will help you get organized and get things done on time.
by Sandy Maynard
Most adults and children with attention deficit hyperactivity disorder (ADD/ADHD) do well using a simple kitchen timer. Decide how much time you need to do something -- five minutes, an hour, and so on -- and set it. When the buzzer sounds, it’s time to move on.
If you have trouble remembering to perform specific, recurring tasks (taking ADD/ADHD drugs, picking up the kids, and so on), you might do well with a WatchMinder (watchminder.com). This wristwatch-like device displays any of 60 preprogrammed messages and up to three customized messages. You can set as many as 30 alarms to vibrate or beep.
If you’re the sort of person who simply loses track of time, you might prefer a Time Timer (timetimer.com). This gadget, available in clock or watch form, as well as a computer program, shows remaining time with a shrinking red disc.
(additudemag.com)
Study shows spanking boosts odds of mental illness
People who were hit or spanked as children face higher odds of mental ailments as adults, including mood and anxiety disorders and problems with alcohol and drug abuse, researchers said Monday.
The study, led by Canadian researchers, is the first to examine the link between psychological problems and spanking, while excluding more severe physical or sexual abuse in order to better gauge the effect of corporal punishment alone.
Those who were spanked or hit as kids were between two and seven percent more likely to encounter mental issues later, said the research in the US journal Pediatrics, based on a retrospective survey of more than 600 US adults.
That figure may seem low, particularly since about half of the US population recalls being spanked in childhood, but nevertheless shows that physical punishment can raise the risk of problems later on, experts said.
"The study is valuable because it opens the conversation about parenting," said Victor Fornari, director of the division of child and adolescent psychiatry at North Shore-Long Island Jewish Health System in New York.
The rate "is not dramatically higher, but it is higher, just to suggest that physical punishment is a risk factor for developing more mental disturbances as an adult," said Fornari, who was not involved in the study.
Previous research has repeatedly shown that children who were physically abused as youngsters suffer from more mental disturbances as adults, and are more likely to engage in aggressive behavior than kids who were not hit.
But these studies have typically included more serious abuse.
The current study excludes both sexual abuse and physical abuse that left bruises, marks or caused injury.
Instead it focuses on "harsh physical punishment," defined as pushing, grabbing, shoving, slapping or hitting as a form of punishment from elders.
While 32 nations around the world have banned corporal punishment of kids, the United States and Canada are not among them.
Using a nationally representative survey sample of 653 Americans, they found that those who recalled experiencing harsh punishment as children faced higher odds of a range of mental problems.
Between two and five percent of disorders like depression, anxiety, bipolar, anorexia or bulimia were attributable to physical punishment as a child, the study said.
From four to seven percent of more serious problems including personality disorders, obsessive-compulsive disorder and intellectual disabilities were associated with such punishments in childhood.
Researchers stressed that the study could not establish that spanking had actually caused these disorders in certain adults, only that there was a link between memories of such punishment and a higher incidence of mental problems.
The survey data came from the National Epidemiologic Survey on Alcohol and Related Conditions collected between 2004 and 2005, and included adults over age 20.
Participants were asked: "As a child how often were you ever pushed, grabbed, shoved, slapped or hit by your parents or any adult living in your house?" Those who answered "sometimes" or greater were included in the analysis.
Roya Samuels, a pediatrician at Cohen Children's Medical Center in New York, said the parents' genes may influence both their response to raising an unruly child as well as their likelihood of passing down certain ailments.
"Parents who are resorting to mechanisms of corporal punishment might themselves be at risk for depression and mental disorders; therefore, there might be a hereditary factor going on in these families," she told AFP.
Future research could shed more light on the issue. In the meantime, the study offers a reminder that other disciplinary options such as positive reinforcement and removing rewards are viewed more favorably by doctors.
"The reality is, if 50 percent of the population has experienced being spanked in the past year, most kids are resilient. It is just that there are better ways for parents to discipline kids than spanking," Fornari said.
"And for some vulnerable kids, the spanking may increase their risk for the development of mental disturbances. So for those reasons it is important to really minimize or extinguish physical punishment."
The American Academy of Pediatrics opposes striking children for any cause and the Canadian Pediatric Society recommends that doctors strongly discourage the use of physical punishment.
Source: AFP
(Islamweb.net)
Taming the Temper-Prone ADDer
If you overreact or get defensive for no reason, these anger-management tips can help.
by Sandy Maynard
Do you lash out when your spouse reminds you — nicely — to take out the dog or pick up a gallon of milk? Do you fly off the handle when the boss asks you to turn in the next assignment on time?
I know many people who do, including myself. In fact, many of us adults with attention deficit disorder (ADD/ADHD) lack restraint when we think that someone is dissing us. The question is: Are they? Because many of us have low self-esteem — after years of negative interactions — we are hypersensitive to criticism, real or imagined.
Bursts of anger have repercussions that last much longer than the few seconds it takes to vent. Having an argument in the workplace can get you fired. Blowing up at a loved one can strain the relationship. And it all takes a toll on your self-esteem — bringing remorse or shame for days afterward.
Get the Anger Out?
My client, Mike, came to me to learn some anger-management strategies after he realized his ADD tantrums had damaged his relationship with his teenage son, who, like Mike, has attention deficit. Mike had long believed that “getting the anger out of [his] system” was healthy.
Until now. “My outbursts are creating a rift between me and my son that doubling his allowance won’t repair,” he told me. “I need to figure out how to keep anger in check — or I may make front-page news for strangling my son!”
I explained that most teens know which buttons to press, because they installed them. After a good laugh, we identified the times when Mike was most likely to lose his temper — after a tough day at work when he had screwed up an assignment. When he came home to find that his son hadn’t taken out the garbage — again — Mike got upset. If his son had a fender bender, received a parking ticket, or cut out of school early, Mike blew his lid.
Help, Don’t Yell
I reminded Mike that he must maintain realistic expectations about his son, who was easily distracted. Mike came to see that neither he nor his son was perfect, and that he should adjust his own imperfect behavior. Instead of yelling at his teen for forgetting to do a chore, Mike worked on helping him remember to do it by posting a list on a bulletin board in the kitchen and reinforcing it with text messages during the day.
If Mike’s son still forgot — or got into trouble at school — Mike learned to observe his rising anger, and figured out ways to short-circuit it. He took a relaxing walk with his dog and deferred discussions with his son until Saturday or Sunday morning, when he felt refreshed and less pressured by his job. He and his son were able to talk calmly — and productively — during those chats.
Finally, Mike found comfort in a local ADD support group for parents contending with similar problems. It is a great comfort to him to know that he isn’t alone with his anger problems.
Hit the Pause Button
Another client, Karin, who was sweet and personable during her visits, surprised me when she told me she had problems managing her anger at work. Karin was furious with a coworker who frequently blamed her for something that wasn’t her fault.
Instead of talking with the coworker or her immediate supervisor, she acted impulsively and went to the boss to defend herself. “Knowing that everyone thought it was my fault that the company lost the contract made me so angry,” says Karin. “I felt I had to let Mr. James know that it wasn’t.” Karin’s supervisor was livid about
We talked about a strategy that would let her indulge her anger without acting rashly. I suggested that she set a timer and let herself be angry for five minutes. After the time was up, she had to move on. I also had her place a visual cue next to her phone that would remind her to pause before taking rash action — like calling the boss. She rummaged through her photos and found a snapshot of herself and her kids making sand castles on the beach.
“Looking at the photo does two things for me when I get angry,” says Karin. “It reminds me that my job is not as important as it seems. What counts most is my relationship with my family. It also reminds me that my happiness doesn’t come from my job but from within—and that no coworker or boss can take it away from me.”
Karin still gets angry at work, so she has expanded her cuing strategy: She keeps a draft folder for e-mails labeled “Wait On.” If she thinks she is sending e-mail out of anger, she lets her message sit for 24 hours and re-reads it before hitting the send button. “Many of these e-mails never leave that folder. If I decide to send one, I edit out rude or inappropriate remarks before doing so.”
And when she does slip up and says something that she regrets later? “I own up to my mistake and apologize.” Not all of her apologies are accepted graciously, but saying she’s sorry makes her feel better about herself. As a result, her relationship with her coworkers has improved dramatically.
(additudemag.com)
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