Jamie’s Story

When I was originally diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) in fourth grade, my parents weren’t sure of how accurate the doctor’s and teacher’s assessment was. I didn’t have a history of behavioral problems in school, my grades were average, I did well on tests and learned quickly in most subjects. The only real detriment to my grades was my difficulty remembering to complete or turn in my homework. The biggest problem I had that all my family members and teacher could agree on was my inability to regulate my emotions. I was always very excited, very angry, very upset with little in between, and usually I had a hard time engaging with others when I was struggling to manage those emotions.

The test results didn’t lie though: across the board, all the adults in my life observing my learning and organizational skills saw the trouble I had staying engaged. I could learn quickly, but repeating that information until I’d memorized it was boring so I’d usually wander off to find something else to do or end up daydreaming. When I was really interested in something, I had the opposite problem in that I would want to continue with it long after everyone else had moved on, and struggled to transition to other tasks.

Fortunately for me, my parents were open to the doctor’s suggestion that I try a new medication, and the second attempt to find me a prescription without major side effects worked. Within three weeks, I’d gone from low B’s and C’s to straight A’s in school. I was arguing less with my parents, learning systems to organize my room and my school things, and working with a counselor to learn to pause before responding to intense emotions.

The medication didn’t fix everything, but I was lucky in getting my diagnosis early in life. Diagnosis of girls with ADHD is still less common than it is with boys, and the inattentive type of ADHD can be more difficult to identify than the hyperactive type. I worked a lot with my family and different school counselors over the years on self-reflection to see where I could improve, and learned as much as I could about the diagnosis to try to ensure I reached the potential that every teacher for the first four years of my schooling said I could reach if I “just focused a little more.” The interest I’d had in learning about and managing my ADHD for myself grew into an interest about other mental health conditions too, and eventually became a way that I could help others by becoming a therapist myself.

As an adult, a lot of managing my ADHD comes down to systems I’ve implemented. Examples of these systems are identifying places to put the things I don’t want to lose, creating habits through routine, and participating in therapy to ensure I can moderate the intense emotions and impulse control. I’m grateful now for the understanding of myself that my diagnosis allowed me, and the tools that others have helped me to develop over the years to manage my ADHD symptoms. If you believe that you or someone you care about is struggling with ADHD, I strongly encourage you to reach out for more information and a better understanding of this mental health condition.

Options for Treating ADHD

Like with most other mental health conditions, treating ADHD is usually best achieved through a combination of treatment modalities. Many parents, myself included, are reluctant to place their child(ren) on medication. Some of this reluctance is based on notions that ADHD medications can stunt growth. CHADD, a resource for children, adolescents, adults, and families suffering from ADHD, shared the results of a meta-analysis that demonstrated that there are no remarkable differences in the height of children who took stimulant medication versus children who did not. Below we will review evidence based options for treatment that is applicable to individuals of all ages. Much of the following information was obtained from CHADD’s website.

1. Medication management. Medication management is highly recommended for the treatment of ADHD. Dr. Caroline Buzanko reported that the ADHD brain is smaller than the non-ADHD brain and has fewer connections between different brain regions. ADHD brains do not have the neural organization to self-regulate and to stop automatic responses. Medication is instrumental in helping the brain to function differently and more efficiently. Often times, other treatment modalities are ineffective until the brain is calm enough to receive and process information. While the primary medication class for treating ADHD is stimulants (i.e. Adderall, Vyvanse, and Ritalin) there are non-stimulant options that are also used such as Wellbutrin, Intuniv and Strattera.

2. Individual therapy. Cognitive-Behavioral Therapy (CBT) is a recommended treatment modality for working with individuals struggling with ADHD. Programs that address executive dysfunction fall into the category of cognitive-behavioral therapy because they impart more adaptive cognitions about how to go about planning, organizing, etc. and also impart more effective behavioral skills. An example of an adaptive cognition is the self-instruction to “break down complex or unpleasant tasks into manageable parts.” Examples of behavioral skills are using a planner regularly and implementing a filing system. Positive thoughts and positive behaviors reinforce each other; as the person becomes more effective in managing time, s/he comes to have more positive beliefs and cognitions about the self, and these in turn help to generate and maintain more adaptive behaviors.

3. Family therapy/parent training. Parents have the greatest influence on their young child’s behavior. Only therapy that focuses on training parents is recommended for young children with ADHD because young children are not mature enough to change their own behavior without their parents’ help. Parents can use behavior management skills to support children with ADHD. The children can also use these skills to cope with ADHD symptoms throughout their lives. Parent training specifically helps by developing a positive relationship with the child, teaching parents about child develop, and helping parents manage negative behavior and increase positive behavior.

4. Nutrition. Eating a healthy, balanced diet made up of whole foods and minimally processed foods is key to a healthy mind and body for everyone. Some studies suggest that artificial food dyes and preservatives could make ADHD symptoms worse in some children. Eliminating all food dyes and preservatives can be challenging, but if you think your child is sensitive to them, talk with your doctor about changing their diet. There have been some encouraging studies on

   micronutrient supplements (including zinc, iron, magnesium, vitamin B, vitamin D and omega-3 fatty acids) for improving ADHD symptoms. More studies are needed before they can be considered evidence-based treatment. Talk with your or your child’s doctor to find out about micronutrient deficiency that can be addressed through diet.

5. Exercise. Physical exercise has long been known to help decrease ADHD symptoms for some people. The researchers who conducted the new study looked at how team sports as part of exercise could improve executive functioning. “Although physical exercise, such as team or racket sports, appears most effective when it directly challenges executive functions, it may also improve cognition, albeit to a lower degree, when it simply provides aerobic stimulation,” they write. “Acute bouts of intense aerobic exercise have been shown to improve executive functions due to neurotransmitter modifications which relate to central executive tasks.” This means exercise that moves your body enough to break a light sweat can also stimulate your brain to create more neurotransmitters, which can have an effect similar to taking medications to decrease ADHD symptoms.

6. Behavioral strategies. Behavioral strategies refer to external aids or prompts that assist an individual in managing their life around their ADHD symptoms. Examples of this include, but are not limited to, to do lists, chore charts, day planners, and alarms. Visual aids can also be helpful to act as subtle reminders. Many of my clients with ADHD prefer to keep frequently used items in eyesight as they will easily forget them if put away.

7. Sleep. A lack of sleep can look like ADHD symptoms or worsen ADHD symptoms. Researchers have also noted the benefits of a consistent bedtime routine for children. Getting enough sleep and rest can improve attention and executive functioning. It is important for all children, but particularly for those who struggle with ADHD symptoms. ADHD medication can interfere with sleep, so talk with your doctor.

8. Brain training. Neurofeedback aims to decrease ADHD symptoms by teaching people to change their brain wave patterns. It is labor-intensive and expensive. Research studies that are not blinded—where study participants know which intervention they are receiving—report neurofeedback to be helpful for ADHD symptoms, but no well-blinded randomized trial has shown significant benefit for ADHD.

9. Mindfulness. Some research studies indicate that mindfulness, yoga, and meditation can improve symptoms, executive functioning, and parent-child relationships. More research needs to be done on

   these practices. A few studies show limited evidence for acupuncture’s effectiveness for ADHD symptoms.

Recap of Topic: Options for Treating ADHD

ADHD is a debilitating mental health condition that impairs an individuals ability to perform executive functioning tasks. Executive functioning governs the part of the brain that is responsible for memory, attention span, decision making and impulse control. In individuals with ADHD, brain imaging has shown that their brains are smaller in these areas in comparison to their non-ADHD counterparts. If left untreated, ADHD has a strong comorbidity with depression and anxiety in adults. While the reasons for this can be varied, the internalized beliefs about the self (i.e. I am lazy, I cannot succeed, I am stupid, and I can’t learn) that are developed over time invariably contribute to the development of these conditions. Luckily treatment options are well researched and include medication management, individual therapy, family therapy/parent training, nutrition, exercise, behavioral strategies, sleep, brain training and mindfulness.

Supporting a Loved One with ADHD

Living with someone who has ADHD can be a challenge. Not only are they genuinely incapable of seeing things that a non-ADHD brain can see (i.e. towels on the floor, lack of household supplies, or a stack of mail on the counter) they frequently do not finish tasks, forget things they are supposed to do, talk excessively, lack emotional control and do not clean up after themselves. Unless well understood, this can be a common area of tension in most households and can lead to feelings of frustration, resentment, hurt and burn out. If you are living with someone who has ADHD, the following actions can be used to support yourself and your loved one. I will share how I use some of these with my husband to support him and our relationship.

1. Be a body double. ADHD can also be thought of as a disorder of motivation or an inability to tolerate boredom. Assuming your loved one enjoys your company, being present with him or her while doing a boring task is one way to help someone with ADHD remain engaged through to completion. This is pretty much essential in my household for doing things like weeding and cleaning.

2. Co-regulate. Mindfulness, exercise and sensory based coping strategies can be used with your loved one to create a calm state of mind. Examples of sensory based coping skills include going for a walk, giving a massage or taking a bath or shower together. Parents and partners can use this technique to attune to their loved ones dysregulation.

3. Understand that their process is not your process. My husband keeps his deodorant and daily medication next to the coffee pot. Do I like this? Hell, no. Do I accept this as what he needs in order to function in his daily life? Yes, I do. While you can assist with scaffolding activities, i.e. (Let’s first start by sweeping the floor or let’s spend the next hour studying for biology), you will also have to accept that they will create a path for themselves that helps them through the world. Learning not to take this personally or interfere, is necessary when living with someone who has ADHD. A perfect example of this is procrastination. Many individuals with ADHD have learned that they can use this as a technique to motivate behavior and productivity. While procrastination may not be desirable to you, allowing for its use for your loved one is a way to accept their process.

4. Advocate and encourage. Someone suffering from ADHD, will receive messages both internally and externally that they are deficient and inadequate. You cannot prevent this. Advocating for your child by talking to their doctors and teachers may be necessary as their parent to ensure that the child receives the support he or she needs. Recognizing when your loved one is in need of encouragement is also critical as they will be down on themselves when their symptoms are hard to manage.

5. Know and communicate your limits. ADHD individuals can overwhelm others with their stories, interest in novel concepts or ideas and overall energy about life. This overwhelm in others can lead to irritability and distancing. If you live with someone with ADHD, it is critical that you communicate when you are overwhelmed and what you need in that moment. Without effective communication, distancing behaviors will be perceived as rejection.

6. Don’t assume their motives or intent. I cannot tell you the number of times this has bit me in the ass. Failing to complete a task or failing to complete a task in a reasonable time frame is part and parcel for ADHD. Learning to ask about the motive or intention behind this is necessary. It is not uncommon for my husband to have reasoned through a very logical explanation for his failure to complete something. It is also not uncommon that he forgot to share this information with me as he decided this for himself and moved on. This coincides with respecting that their process will not be your process.

7. Don’t over-function. It will be tempting to fall into this behavioral pattern when living with someone with ADHD. This is true for parents and spouses. You see that your loved one struggles to accomplish tasks that require next to no energy from you. You can compensate for them by doing the task for them. While this may occasionally be an effective solution, if overdone it cripples the individual with ADHD who has learned to depend on you for basic functioning. For example, I manage our family’s online lives. I pay the bills, fill out online applications, and navigate websites to accomplish tasks. While I accept this responsibility for our home, it is important that I identify ways that my partner can contribute to the relationship in ways that are unique to him. If you are in doubt if you are over-functioning, feelings of resentment and exhaustion will present as warning indicators.

8. Understand their communication nuances. Many individuals with ADHD do not make eye contact, interrupt others while speaking and share stories to communicate their understanding in lieu of validating emotions. None of this is done to hurt or dismiss another. It is simply their way of participating in a conversation with you. You can support your loved one by not shaming their response or demanding an alternative response. You can also support your loved one by letting him or her known in advance what you need from them in the conversation. You may need to offer a gentle reminder or redirection when your loved one gets off task. You can also ask to slow the conversation down and request that they repeat what you last stated to ensure that understanding took place. My husband likes to interrupt my statements and assume the ending to many of my sentences or questions. Sometimes he assumes correctly but I have learned that it is important to bring the conversation back to the point of interruption and complete my statement for communication to be effective.

9. Giving space for their ideas. Individuals with ADHD have ideas. Lots and lots of ideas. They will want to share these ideas with you especially if they like you. While they know that you will likely not find the idea as fascinating as they do, their ideas are how they see the world and they will need time and space to share them. For those of us without ADHD, this can be challenging. For starters, I’ve learned to take my husband’s ideas with a grain of salt. Just because he talks about doing something, does not mean he is actually going to do the thing. I listen to the idea and ask questions but do not become emotionally invested until I hear the idea a few times. After the third iteration of the idea, I know that this idea is more than a frequent flyer and something that has meaning and potential. Timing is also another issue with holding space for their ideas. Individuals with ADHD as excitable and will want to share their exciting news right now. You can’t ask them not to do that as this is literally how their brain is wired. You can ask for time to respond to the ideas or schedule time to discuss the idea. In my experience, this is one of the harder relational dynamics to manage as it can quickly lead to feelings of rejection, frustration and overwhelm.

Recap of Topic: Supporting a Loved One with ADHD

Living with someone who has ADHD can be a challenge. Assuming you do not have ADHD, your loved one’s executive functioning will likely never mirror your own. This is true even if your loved one is on medication. Like with many other mental health conditions, the primary goal of ADHD is management. The reason for this is simply because ADHD is lifelong and chronic. As a loved one of someone with ADHD, you can support them through being a body double, co-regulating, understanding their process, advocating and encouraging, knowing and communicating your limits, not assuming their motives, not over-functioning, understanding their communication nuances, and giving space for their ideas.

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