Attention Deficit Hyperactivity Disorder (ADHD) Overview

http://health.nytimes.com/health/guides/disease/attention-deficit-hyperactivity-disorder-adhd/overview.html

Maternal Lifestyle Factors in Pregnancy Risk of Attention Deficit Hyperactivity Disorder and Associated Behaviors: Review of the Current Evidence

http://ajp.psychiatryonline.org/article.aspx?articleID=176255

Untangling the Myths About Attention Disorder

By PERRI KLASS, M.D.

Published: December 13, 2010

As recently as 2002, an international group of leading neuroscientists found it necessary to publish a statement arguing passionately that attention deficit hyperactivity disorder was a real condition.

In the face of “overwhelming” scientific evidence, they complained, A.D.H.D. was regularly portrayed in the media as “myth, fraud or benign condition” — an artifact of too-strict teachers, perhaps, or too much television.

In recent years, it has been rarer to hear serious doubt that the disorder really exists, and the evidence explaining its neurocircuitry and genetics has become more convincing and more complex.

Even so, I’ve lately read a number of articles and essays that use attention (or its lack) as a marker and a metaphor for something larger in society — for the multitasking, the electronic distractions, the sense that the nature of concentration may be changing, that people feel nibbled at, overscheduled, distracted, irritable.

But A.D.H.D. is not a metaphor. It is not the restlessness and rambunctiousness that happen when grade-schoolers are deprived of recess, or the distraction of socially minded teenagers in the smartphone era. Nor is it the reason your colleagues check their e-mail in meetings and even (spare me!) conversations.

“Attention is a really complex cognitive phenomenon that has a lot of pieces in it,” said Dr. David K. Urion of Harvard, who directs the learning disabilities and behavioral neurology program at Boston Children’s Hospital. “What we’re specifically talking about in kids with attention deficit is a problem compared to age- and gender-based peers in selective attention — what do you glom onto and what do you ignore?”

Moreover, the disorder occurs along a broad spectrum, from mild to extreme. Boys are more likely to be hyperactive and impulsive, girls to be inattentive. (One reason many girls don’t get an official diagnosis is that those with the inattentive form may be well behaved in school, but still unable to focus.) 

“There’s a lot we still don’t know,” said Bruce F. Pennington, a professor of psychology at the University of Denver and an expert on the genetics and neuropsychology of attention disorders. “But we know enough to say it is a brain-based disorder, and we have some idea about which circuits are involved and which genes.”

Imaging studies of people with attention deficits have shown a consistent pattern of below-normal activity in the brain’s frontal lobes, where so-called executive function resides. And scientists are focusing on the pathways for dopamine and similar neurotransmitters active in the circuits that pass information to and from the frontal lobes.

Low levels of activity in specific circuits may help explain the seeming paradox of using stimulants like Ritalin to treat children who already seem overstimulated. In many children with A.D.H.D., these drugs can help the circuits function more normally. 

“If you have a deficit in dopamine, it’s harder to concentrate on goal-oriented behavior,” Professor Pennington said. “The psychostimulants change the availability of dopamine in these same circuits.”

Although recent research has identified environmental factors that may increase the likelihood of developing the disorder, it is thought to have a stronger genetic component. Dr. Maximilian Muenke, chief of the medical genetics branch at the National Human Genome Research Institute, said that among identical twins, if one has A.D.H.D., the second has an 80 percent chance of having it as well. (Among fraternal twins, the comparable figure is 20 to 30 percent, the same as for any siblings.)

Dr. Muenke’s group published a paper last month identifying a gene, LPHN3, that is associated both with the disorder and with a favorable response to stimulants. But no one thinks that just one gene is responsible; just as attention is a complex phenomenon, so are the genetics of attention deficits.

When I asked Dr. Muenke whether genetic studies could someday play a role in treating the disorder, his reply was cautious. He spoke of eventually predicting which children will respond to specific medications, sparing families the frustration of switching from one medicine to another with no relief. He sounded more hopeful about the long-term prospects.

 

“I truly believe in the long run we will be able to develop personalized medicine for a child with A.D.H.D.,” he said, adding that when the specific underlying cause or causes are known, “this child will have a very specific treatment, whether this treatment is behavioral treatment alone or medication,” and the medication will be tailored to the child.

Perhaps eager to make clear that A.D.H.D. is far more than a metaphor for the distractions of modern life, scientists love to point out examples that date to well before the term was invented. 

Dr. Urion invoked Sir George Frederick Still, the first British professor of pediatric medicine, who in 1902 described the syndrome precisely, speaking of a boy who was “unable to keep his attention even to a game for more than a very short time,” and as a result was “backward in school attainments, although in manner and ordinary conversation he appeared as bright and intelligent as any child could be.”

Dr. Muenke brought up “Der Struwwelpeter“ (“Slovenly Peter”), the 1845 children’s book by Heinrich Hoffmann, which contains the story of “Zappel-Philipp,” or “Fidgety Philip.” (One English translation was done by Mark Twain, that great chronicler of boys.)

The circumstances of modern life can give rise to the false belief that a culture full of electronics and multitasking imperatives creates the disorder. “People have this idea that we live in a world that gives people A.D.H.D.,” Dr. Urion said. Of course one shouldn’t drive and text at the same time, he continued, but for “a harbor pilot bringing a huge four-masted sailing vessel into Boston Harbor, paying attention was a good idea then, too.”

(nytimes.com)

Why Money Matters Are So Challenging for You

 . . . and What You Can Do About It

by Russell A. Barkley, PhD, with Christine M. Benton

Adapted from Taking Charge of Adult ADHD by Russell A. Barkley, PhD. Copyright © 2010 by the Guilford Press. Reprinted with permission of Guilford Press, www.guilfordpress.com.

YOU DON'T PLAN TO END UP in financial trouble. You may, in fact, keep resolving not to go shopping today and not to buy anything advertised in an Internet pop-up. You might tell yourself today is the day to transfer some money from checking to savings. Maybe you tell yourself while you're at it you might as well see if you have any bills that are due.

So why don't you follow through on those convictions? Because ADHD won't let you. It's time to take charge - of your ADHD and your finances. Start by bringing into crisp focus how the deficits caused by ADHD steer you wrong - and how you can steer yourself back in the right direction. 

Adults with ADHD and Money

Our research has found that adults with ADHD:

	Made a lot of impulse purchases.
	Had high credit card balances.
	Exceeded their credit limits more than others.
	Made bill, loan, and rent payments late or not at all.
	Had their cars repossessed more often than others.
	Had lower credit ratings.
	Were more likely to have no savings.
	Were less likely to save for retirement.
	Bounced checks more often than others.
	Often failed to save receipts that could document money-saving tax deductions and other documents for their income tax returns.
	Lost friends after borrowing money and not repaying it.

The Four Executive Functions that Foster Self-Control

Scientists in the field of neuropsychology call the capacities behind self-control executive functions. They’re the actions directed at ourselves, the mental activities we engage in when we think about our future and what we should be doing to get there and to make it better. Many adults with ADHD exhibit delayed development of each of these four executive functions.

	nonverbal working memory (using the mind’s eye)
	verbal working memory (using the mind’s voice)
	self-regulation of emotion (using the mind’s heart)
	planning and problem-solving (using the mind’s playground)

Money and the mind's eye

Impulsive shopping can become compulsive shopping when your nonverbal working memory is weak. You can't picture what happened the last time you bought an expensive item you didn't need. You can't bring the future into sharp enough relief to put off the purchase till you've saved the cash. You haven't developed the self-awareness to realize that walking into an antique store for you is like opening the gates of hell. The mind's eye is particularly important in controlling the impulse to buy things you don't need or can't afford.

Try to resist spending money by keeping a photo of a long-term goal (a vacation spot, a home, a bike for one of your kids, etc.) in your pocket to pull out whenever you feel the urge to buy. You might train yourself to say out loud before you pull out your wallet, "Hmmmmmmm, do I really need this?" Then you could turn on your imaginary wide-screen TV and watch a film of yourself opening your credit card bill last time you overspent.

Your finances and the mind's voice

Remember, the mind's voice is your backup when the mind's eye is myopic. If you find yourself feeling the urge to pull out your credit card and you really can't call up a visual picture of what happened last time you overspent, interview yourself. If you're in a store, leave and do this on the sidewalk. You won't get hauled away for being delusional; people will just think you're on your cell phone when you talk to yourself about whether this purchase or withdrawal is wise.

If you tend to put off bill paying even when you've set an alarm to remind you to do it, this is another time you can talk to yourself about why you need to do it right now. The mind's voice is also the facility that allows you to formulate and use rules. Set certain rules about spending and saving and then repeat those rules to yourself quietly when under pressure from your ADHD to break them. Or write them down on a card you keep banded together with your credit card so you can't access the credit card without the rules card.

The mind's heart in the world of money

Are you an emotional spender? Are you the person who always buys a round of drinks at the pub when you're feeling great? The one who "needs" a new outfit when down? If you're mad at your landlord, do you "show him" by "forgetting" to pay the rent? Does not having cash to go out with friends make you feel so bad that you decide to put the charges on your credit card?

You're going to have to pull out your whole bag of mental imagery and self-talk tricks to recognize when your emotions are carrying you away and how to get control. Also, try to stick to a healthy lifestyle. Sleep deprivation, overconsumption of caffeine or alcohol, drug use, lack of exercise, and poor diet can all make you more vulnerable to daily stress and make it harder to control your emotions.

Don't forget that you can use your emotions for good, too. Hate bill paying? Feel the future: Do everything you can to feel the relief of getting it done. Can't motivate yourself to put money in savings when your paycheck is burning a hole in your pocket? Feel how great it will be to take it out when you pay for your Caribbean vacation.

Financial planning and problem-solving in the mind's playground

For many adults, ADHD or no ADHD, money matters are for "bean counters" and "number crunchers," which is usually a not-so-nice way of saying "I don't know how"—how to do financial planning, how to budget, how to oversee your investments, how to stop getting hit with late fees and hassled by collection agencies.

Make money management physical. Use tangible objects and graphic tools to manipulate the numbers whenever possible. The last section of this article and the “Curbing Your Spending” sidebar will give you some ideas. But remember the basics too: Make lists of steps to complete financial tasks you find daunting. Record your spending habits in your journal so you can take a look back at the patterns that are hurting you and any that are serving you well.

Fortunately, you've got a lot of resources at your fingertips for taking back control of your financial present and future. There are many strategies for discouraging spending. Tools and cues can help you meet your financial obligations on time. You can set up systems that enforce saving so you don't have to fight the urge to spend everything you earn over and over.

A new approach to money management

Here are a few ideas for getting started on a better path:

  Let your spouse, partner, or even parent manage your money. This option is something to consider if you feel overwhelmed by the problems you're having and find it impossible to control your spending or other financial habits. You can always agree to do this for a preset temporary time period or until a certain goal—such as paying off a debt or accumulating a certain amount of savings—is reached. Turn over your paycheck to this person, let the person allocate sufficient cash to you to meet daily expenses, then work together to see that monthly bills, loans, and credit cards are paid regularly.

  Budget! Make a monthly budget sheet that shows ALL your monthly expenses, including one-twelfth of your annual expenses (those that you may pay just once per year, such as taxes, car insurance, and home owner’s insurance). You need to have a monthly financial plan with all your bills listed in front of you so you can see what you owe. This budget needs to be less than what you make per month. Keep this budget out on your desk at home so you can refer to it often. Spending as you go each month is a recipe for disaster, not to mention having your utilities turned off and your car repossessed.

  Start living within your means today. Do not spend more each month than you earn and then try to use credit cards, loans, or other means of borrowing to see you through the month. You need to get your living expenses below ninety percent of your monthly earnings while saving that remaining ten percent. Enlist the help of a trusted relative, an accountant, or a bank employee in figuring out your expenses and what method is best for saving.

  Set up a system of accounts and deposits for enforced savings. Have your employer put ten percent of your pretax earnings into a retirement plan (tax deferred) such as a 401k, 403b, Keogh, or IRA. Then have your after-tax paycheck direct-deposited into your checking account. Once there, have your bank move ten percent of it into a savings account automatically each month. You also need an emergency savings account for those unexpected expenses such as car repairs and medical expenses not covered by insurance. The less you see of your cash, the less you can spend it impulsively.

  Try to get health and disability insurance through your employer. If they don’t have it, try to find a similar job that does. If you can’t, consider working for the local, state, or federal government, which nearly always provides these as fringe benefits. Unexpected medical bills can kill your chances of financial independence.

  Balance your bank statement monthly without fail. Don’t just wing it or guess. Having little idea of how much money you have at any one time in your account(s) is one of the biggest causes of bounced checks, credit card overuse, and debt accumulation. You keep getting caught with less money than you thought you would need and so borrow to make up the shortfall. And those forms of piracy known as high overdraft fees that banks now charge can mount up quickly, siphoning off cash you actually need and maybe even result in your exceeding what typical balances you have in your accounts.

  Keep all receipts as you get them. Put them in your wallet. Each night when you take your wallet out, take these receipts and put them in a file. You can use this file to help keep track of what you are spending and to store the receipts that will be very useful for preparing your taxes and getting the most of your available deductions.

Six Steps to Curbing Your Spending

Besides the ideas for controlling impulse buying described in the section on a new approach to money management, try these:

1.	Operate on a cash basis. Take out cash from your checking account only when you absolutely need it. Carry as little with you as possible so you're not tempted to spend it impulsively on stuff you don't need.
2.	Do NOT carry a credit or ATM card if at all possible. Get rid of all store credit cards, keep one general card like MasterCard or Visa, and put a sticker on it that reads FOR EMERGENCY USE ONLY. Transfer all unpaid balances on store cards to this single card and work to pay off the balance as soon as you possibly can.
3.	Do NOT go to a mall or department store if there is nothing that you need to buy. And I mean NEED, not want, to buy. The last place a person with ADHD needs to be is in a store or mall with all those attractive goodies crying out “Buy me!” So, the simplest solution is not to go.
4.	Don’t lend anyone other than your children any money. Period. And even your children are not a good bet to repay you, so keep those loans limited to educational expenses or necessities, not things like clothing or entertainment. Odds are you will not see that money again. If you give money to someone else, you’d better view it as the gift it most likely will be, not as a loan.
5.	Stay away from casinos. They always win. Don’t play cards for money and certainly no more than for pennies a hand. You are way too impulsive to be around gambling activities, so, like shopping, avoid such places, where impulsive spending can get the best of you.
6.	Take advantage of cognitive-behavioral treatments for impulse buying if no other measures help. If you find it hard to stop shopping and spending on things you don't need, get professional help from a psychologist or financial counselor.

Russell A. Barkley, PhD, is internationally known for his career-long research into ADHD and his efforts to educate professionals and the public. He is clinical professor of psychiatry at the Medical University of South Carolina and research professor of psychiatry at the State University of New York Upstate Medical University at Syracuse. The recipient of awards from the American Academy of Pediatrics and the American Psychological Association, among other honors, Barkley has published widely on ADHD and related disorders. His website is www.russellbarkley.org. Christine M. Benton is a Chicago-based writer and editor.

(chadd.org)

This week's ADHD Solution is: Alternate your "shoulds" and "wants".

ADHD is a world of extremes. Some days we can’t seem to do anything productive. Other days we only allow ourselves to work on the things we should, at the expense of everything else. Life becomes a drudgery.

There has to be a balance somewhere. But how to achieve it?

Try alternating your “shoulds” and “wants”. Whenever you accomplish a not-so-interesting task that needed to be done, reward yourself by working on something you want to do. Something more fun. Then choose another item from your “should” list and get that done. And so on. As long as you limit the duration of the fun stuff, you’ll probably get more done that way. Rewards are a great way to motivate yourself.

A variation on this theme works if you’re trying to eat more healthy foods. For example, I was dying for some apple pie today. So I ate some carrots. Then I ate the pie. No, not the whole pie! Just a small piece. I ate less of it because I was full from the carrots. And I ate the carrots because I knew they were the gateway to the pie. A "should", then a "want".

A balanced life is like lasagna. It’s all about layering. If all the pasta was on the bottom, and all the sauce was on the top, it wouldn’t be very tasty. 

www.adhdsolutions.net

CHADD Live | Attention Magazine

http://www.chadd.org/Content/CHADD/AttentionMagazine/default.htm

Overcoming Obstacles to Success When You Have ADHD How to Stop Procrastinating With ADHD

We're all guilty of putting things off once in a while, but waiting until the last minute to complete a task is just postponing the inevitable and makes life that much more stressful. Here, nine tips to keep you on track and on time.

If you have ADHD, it’s likely you’re a procrastinator. People with adult ADHD tend to put off paying bills, folding the laundry, and doing other chores at home and at work. You might procrastinate out of fear that you won’t succeed - perhaps you tried to tackle a similar task before and couldn’t complete it. Or maybe you procrastinate because you’re not interested in the task you were given - you find it boring. Whatever your reasons, these tips can help you overcome the tendency to stop putting off until tomorrow what you should do today.

Manage Stress to Stop Procrastinating

When you’re overwhelmed, you’ll find yourself procrastinating more, says Jennifer Koretsky Korey, a senior certified ADHD coach and author of Odd One Out: The Maverick's Guide to Adult ADD. You can manage stress by slowing down and taking excellent care of yourself. “I recommend that clients take half an hour a day — every day — to relax and recharge,” Korey says. Also, prioritize good sleep habits, good nutrition, and exercise. Even small changes in these areas will make a big difference.

Plan Your Road to Success

In order to finish something, you first need to know where to start, Korey says. "If you try to jump into a project without planning, it’s easy to become overwhelmed and shut down.” This is sound advice for anyone approaching a task, but it is particularly helpful if you have ADHD. Korey recommends taking 5 to 15 minutes to step back from the project and plan the steps that you need to take to complete it. “Then when you begin,” she says, “the hard work has been done, and you’re really just following a system.”

Break Tasks Into Small Parts

To best manage your ADHD symptoms, not only do you need to plan, but you also need to break down your plan into achievable steps. “I call them ‘doable tasks,’” says Alice Price, a professional organizer and time-management specialist based in West Islip, N.Y., and a member of the National Association of Professional Organizers. Small successes build on each other. Recounts David Rosenberg, MD, professor and chief of child psychiatry and psychology at the Children’s Hospital of Michigan and Wayne State University School of Medicine in Detroit: “My piano teacher used to tell me, rather than memorize the whole piece of music, to learn it in small sections. That’s great advice for learning to play the piano and critical for children with ADHD and people with adult ADHD.”

Create - and Stick to - an ADHD Schedule

You need to set a timeline for accomplishing each and every one of the smaller items on your to-do list. If you leave goals open-ended, you won’t be as motivated to get started. Just putting a date and time for completion next to each step will help you stay on track, says Dr. Rosenberg.

Find Motivation to Stop Procrastinating

When given a task, think about how completing it will improve your life. “Get in touch with why the task is actually worth doing and how it can help you,” Korey says. “You’ll definitely procrastinate if you’re just doing the task to please someone else, and you’ll add to your stress as a result.” For instance, if your mother-in-law comments on your messy house, but the clutter doesn’t bother you, you will resist the urge to clean before she comes over. So focus instead on how having a clean house will make achieving your own goals easier.

Delegate, Don't Procrastinate

Whenever possible, delegate any tasks you find boring. “There’s no shame in paying someone else for their skills,” says Korey. “This might mean hiring a house cleaner, a handyman, or even a personal assistant.” If money is an issue, cut out other luxuries so that you can afford the help you need to handle ADHD and stop procrastinating. “Ask yourself what costs more: the stress of procrastinating on this task or the cost of hiring someone else to do it?” Korey suggests.

Reward Yourself

Treat yourself to something fun when you complete half or even a third of an assigned task, and then again when it’s done. The reward can be just a break to watch a TV show, going out to lunch or dinner, or taking a soothing spa bath (great for relaxing when ADHD symptoms have you stressed). Rosenberg says the biggest reward should be contingent upon getting started, which is often the most difficult part for many with adult ADHD. On the flip side, resist punishing yourself for not completing a job. “Punishments rarely work for procrastination and can make things worse,” he cautions.

Do the Dreaded Deed First

Whatever it is, getting the task you dislike out of the way gives your self-esteem a boost, and that in turn stops procrastination. “You feel good because you did it, and it changes your attitude from a negative to a positive,” Price says. Here’s an example: If you work in sales and dislike the part of your job that requires making cold calls, do them first thing in the morning. “Then you have the rest of the day free from having to worry about them,” Price says.

Manage ADHD Symptoms With Set Routines

If you have adult ADHD, establish a routine that includes all tasks that must be accomplished each day, says Rosenberg. That way, doing them becomes almost automatic, because you don’t have time to sit around and think, “I won’t do this now; I’ll do it later.” Set up a routine for getting yourself and your family out the door in the morning. Have one for your workday and others for your evenings and weekends. And be sure to include the tasks you most often put off.

(everydayhealth.com)