Friday, September 26, 2014

ADHD and the Automatic No—or Yes

Have you heard of the "Automatic No"? It's one of those phrases that describes a phenomenon among some people with ADHD that is so obvious, so clear, that no doubt a multitude of people have come up with the term, assuming they were the first. I count myself in that group.

My husband used to be the Master of the Automatic No. Once he was diagnosed with ADHD (in 1999), I started understanding how he developed this habit.  When I interviewed him, a few years ago, for an article on his best tips for slowing his own ADHD roller coaster, I asked him about the Automatic No. Here is his response:

“What’s the Automatic No? I would routinely say no when my wife would propose an outing or a different way of doing things at home. I didn’t know why. I wasn’t opposed to most of her suggestions.

“Looking back, I suspect I didn’t want to think about and remember something else, possibly resulting in another failure. Most of you know what I mean by this: You grow so accustomed to falling flat when attempting new things that you avoid trying them. I found it easier to say no and go watch Star Trek instead!

“I’ve learned to listen with an open mind before rejecting an idea. Now we have this shtick, in which my wife will suggest something and I’ll say ‘no.’ She’ll repeat it, and I’ll say ‘no.’ She tries one more time, and I often say ‘OK.’ It helps to get the no’s out of my system, and it allows me to assess how I feel about the idea.”

Sort of like this guy, from the BBC show The Vicar of Dibley.

It made such a difference when my husband started saying "yes" or "let me think about it" or "I'd say yes, but" instead of the Automatic No.

The other day, I was talking to a friend who has ADHD and wrestles with the opposite problem: The Automatic Yes. Whether it's concerning events at her children's school or her sister always asking her to babysit, she has trouble saying no.  Trouble is, she over-commits, thus disappointing others and herself.

For all of us, but especially for people with ADHD, it can be hard finding the middle ground in life. Between the Automatic No and the Automatic Yes.  Have you grappled with this issue? Have you made peace with it? What was your strategy?  We'd love to know.

   —Gina Pera

Sunday, August 17, 2014

Stop—And Smell the Gardenia

“Ohhhh, smell this gardenia,” I said to my husband, lifting a freshly picked specimen to his face. Sniff. Sniff. Sniff. SniffSniffSniff. His quick succession of inhalations over the ivory-petaled flower produced no reaction. Continuing at that pace, however, he'd soon be hyperventilating.

What a shame, that he couldn’t partake in the pleasure of the rich fragrance, a fond remembrance of my growing up in the South. In the summers, the scent of gardenias—along with their larger cousins, the magnolia tree flowers—would hang in the warmly humid air. It was practically the only good thing to come from that oppressive heat; our house had only spotty air-conditioning back then.

That little gardenia bush had produced nothing but leafy growth for the past eight years. They are notoriously finicky bloomers in the Bay Area, I've been told. And, this summer marked the first success: a constant profusion of velvety blossoms against shiny, deep-green foliage. The bush is pictured here, along with a metal goat stuck in the rose pot behind it. It is fitting for this post, because my husband’s nickname is Dr. Goat. Here, the goat looks like he might eat the gardenias, fine-smelling or not.

This wasn’t the first time when my husband could not share my appreciation of scented flowers. “I must have blown out my olfactory receptors in the lab,” he always says, speaking of his time spent studying to become a biologist and dealing with various chemicals during experiments in the lab.

For years, I left it at that, though sometimes wondering if a zinc deficiency also might explain his poor sense of smell.  Yet, he doesn’t seem to have any of the other signs of a zinc deficiency, and we eat a fairly zinc-rich diet. Plus, he is always quick to pick up any annoying scent, including scented laundry detergent and fabric softener, chemical deodorizers, colognes, and the like.

Finally, as I continued to extend that gardenia blossom before him, I noticed the manner in which he attempted to take in its scent: SniffSniffSniff. That’s when I realized: He’s not focusing on smelling!  I shared this stroke of insight with him: “Okay, now close your eyes, take a deep breath…”  My husband always erupts into chortles when I make that particular suggestion, so I change tactics.  “Okay, just try to relax and leisurely take in the scent of the gardenia.”  He did.

“Oh, that’s lovely.” he said. Eureka!

After 16 years of studying ADHD, I still learn something new every day. Reading a book, listening to a lecture or a member of our CHADD Silicon Valley Adult ADHD group, or reading posts from the online discussion group that I moderate for the partners of adults with ADHD, I hit upon some small understanding that adds to the larger picture of comprehension. Who knew that we had to “focus” on smelling a flower? Even if a micro-focus, it’s still focus. For me, it gives entirely new meaning to the phrase “Stop—and smell the roses.”

Speaking of roses, I hope you are having a lovely summer.  My summer (and, in fact, most of the last two years) has been spent finishing a professional guide for couple therapists treating ADHD-challenged couples (Routledge, 2015) and writing the chapter on couple therapy for Dr. Russell Barkley’s “gold standard” clinical guide, ADHD: A Diagnosis and Treatment Handbook (Guildford, 2014). So, I hope you will forgive my absence over the past few months, as I’ve been digging even deeper to understand and synthesize for professionals and the reading public the vast range of issues presented by ADHD for adults and their loved ones. I look forward to more regular posting in the coming months.

—Gina Pera

Monday, February 10, 2014

Cooling "Heat of the Moment" Despair

Back in the “bad old days,” when my husband and I were getting whipped around on the ADHD roller coaster, we desperately needed better strategies—fast! Both of us learning about ADHD and my husband taking medication helped immensely. But that went only so far to counter entrenched patterns developed not knowing that ADHD was in the picture, especially the pattern I call the "downspiral of despair," the feeling of futility each time the roller coaster dropped again.  In the early days especially, when progress sometimes means two steps forward and one step (or even three steps!) backward, it's tough to keep believing that things will progressive get better. 

In honor of Valentine's Day, I offer to YouMeADD blog readers a few tools that I wish we'd had then and which we will use now. I hope they help to ease the drops and dips in your relationships (not just the romantic ones, either), including your relationship with yourself.   

At the end of this post you'll find a musical dance-number my husband and I created just for you!

A Treasure Chest of Memories

When I spied this box at a local store, I knew I'd found the perfect gift for my husband Valentine's Day: A Treasure Chest to store the hand-made cards and funny notes we have made for each other over the years, along with little mementos of good times together. Why such an idea?  I'll tell you.

It is all too easy, when caught up in the heat of an argument or disappointment,  to forget all that's good in the relationship—and the other person.  Of course, this is true for humans in general but it seems especially true in ADHD-challenged relationships, especially in the early days after diagnosis.  Reacting "in the moment" sometimes means forgetting the Big Picture. If a trove of positive remembrances sits prominently displayed, you needn't go digging into drawers, folders, and envelopes to spark your memory. It's right there.

Even single adults with ADHD often find themselves losing sight of the Big Picture in their lives. That old adage about there being two kinds of time for folks with ADHD, Now and Not Now, can leave them stuck in Now, with no conception that things might look different in Not Now. When their string of successes is interrupted with one slip, they "hyperfocus" on the slip, giving it undue weight and forgetting all they achieved before it and will go on to achieve after—if they don't let themselves become preoccupied with the one slip. They can benefit from an active strategy for offsetting this negative pattern, to avoid sinking their mood and self-esteem and paving the way to an attitude of "why try?"

The same can be said for the partners of adults with ADHD, who after years of frustration can become sensitized to yet another another dip on the ADHD roller coaster. Even after steady progress has been made, the dip can too much remind them of all the past disappointments. The tendency is to think the worst.

One way to avoid falling into either of these extreme negative positions is to build "environmental supports" for remembering the many good qualities about one's relationship or oneself. That's why I brought home this little Treasure Chest. But you can substitute a simpler method, such as a Memory Jar like this one:

Couples can write a little note to thank the other for a kind word or note a kind deed—or simply express an appreciation or brief memory of a lovely time together. Individuals can jot down successes  large or small ("A student thanked me for understanding her" or "I completed a report in record time!").  And there the notes remain— colorfully visible, just waiting to be dipped into  when the need arises.

Scaffolding for Important Communications

What I wouldn't have given, years ago, to hear my husband offer a heartfelt apology. It would have dramatically cut short long-simmering hurts and resentments. Instead, I had to drag apologies out of him, which hardly served the purpose.  As I discovered years into our relationship, he harbored a pragmatic bias against apologies, born of years living without benefit of ADHD diagnosis: "Why apologize for a behavior that I know full well I'll probably do again?  An apology implies that I would correct the behavior. My offering an apology would be a false promise."

Okay, sometimes he does sound a bit like Commander Data on Star Trek. And, you could call his defense either a pragmatic attitude or run-for-cover rationale. Call me gullible, but I took him at his word. Recently, I ran across a brilliant solution that I wish I'd discovered years ago:  Formal Notices, from the Bureau of Communications. They work sort of like the old children's game Mad Libs, that game where you fill in the missing words of a story, read to uproarious laughter.

My husband would have loved these fill-in-the-blank templates because they're both practical and clever. And because an undercurrent of humor runs through them, it makes it less intimidating to convey the sentiments expressed therein. For my many friends with ADHD who have voiced their struggles with composing letters of this sort, it seems the perfect solution. Of course, some recipients might be put off by a "form letter" that offers an apology or pays a compliment. So you want to choose the recipients wisely. Personally, I see no reason why heartfelt cannot sometimes also be hilarious. Then again, a huge coping skill for my husband and I has been a keen appreciation of the absurd and an ability to laugh at our sometimes over-the-top behaviors.

Below are my favorites: the written scaffolding for expressing an apology, offering forgiveness, and expressing gratitude—all of which are important for both adults with ADHD and their partners.  All  "formal notices" are printed on glossy stock; just pull out of the book, fold, and deliver. You can even send through the mail.

A personal note from Gina to You Me ADD blog readers:  

Speaking of couple strategies, I apologize for the lack of posts recently. I have been immersed for the past year in writing and editing a professional guide for couple therapists treating ADHD-affected couples. Routledge Press asked me to produce the book, and I declined several times, knowing it would be an immense project. Finally, though, I relented. The idea of helping thousands of  therapists to help couples who desperately need ADHD-related strategies proved too tempting. Look for the book in 2015.

At the same time, Dr. Russell Barkley asked me to write the chapter on couple therapy to his upcoming revision of ADHD Diagnosis and Treatment Handbook (in press). I look forward to reading all the other contributors' chapters in this "gold standard" professional guide. Between these two efforts, I hope to have significantly advanced the goalposts of clinically treating ADHD-affected couples. Thank you for your patient and continued support. And now a musical number especially for you from my husband and I.  Gina Pera

Saturday, June 15, 2013

Fear-Based Management? Think Again.

Prior to being diagnosed with ADHD at age 37, my husband says his best coping tool was "Fear-Based Management"—fondly referred to as FBM. Especially in graduate school, he nurtured thoughts of disastrous consequences if he didn't finish that paper on time and complete that research project. FBM helped him earn a tough advanced degree, but he sees now it did little for his nervous system or his ability to relax and enjoy life.

Anyone following the online headlines and heated commentary these days, on any topic, gets the feeling we're all relying a little too heavily on FBM and the rest of the limbic system. Being a little too quick to react, without fully taking in details, and often in anger. A little too willing to let our "primitive" and fear-based brains overcome higher-order, more rational thinking. I was pondering about this very topic when I ran a piece by writer Susan Schorn, author of Smile at Strangers and Other Lessons In the Art of Living Fearlessly. I found her essay "Tigers, Tigers" wise and thought-provoking. She has graciously allowed me to reprint below. Enjoy—and check out the video sharing Susan's fascinating journey from a "small child with a small personality" into a powerful writer and martial-arts instructor who teaches violence prevention. 

Tuesday, October 23, 2012

Fired Up and Ready for CHADD 2012!

In less than two weeks, Nov. 8-10, 2012, CHADD's 24th Annual International Conference takes place right in my backyard! The Hyatt Regency near San Francisco International airport.

I've been so busy helping to plan events (and dealing with medical challenges) that I'm far behind in my posting here. My apologies! It's been for a good cause.

If you're already registered for the conference, great! Please say hello if you see me. If you're still pondering, I encourage you to register today.  This is a tremendous opportunity to cost-effectively learn a lot about ADHD in a short amount of time from top experts.

Sunday, August 12, 2012

The Couple That Gets Fit Together...

This month, YouMeADD blog kicks it up a notch, following last month's Nature Sufficient Syndrome and the hikes my husband and I enjoy.  Now get ready for "Adventure Hikes" for couples and a companion strategy for boosting brain function called Intermittent Fasting.

Your guide: psychiatrist Michael Lara, who will be speaking about The Exercise Prescription for ADHD at the upcoming CHADD International Conference on ADHD in San Francisco. He also wrote a piece for the June issue of CHADD's Attention magazine.

First the back story: I'd heard about Intermittent Fasting and learned more through this BBC documentary. Still, I wondered: Was it another fad or could there be something to it?  I turned to Dr. Lara, a local Silicon Valley psychiatrist and athlete with a long interest in supporting brain function through exercise and dietary strategies.

Not only was he familiar with Intermittent Fasting, he reported some success in his practice from patients using the technique to better manage anxiety and depression. He'd also noticed a "side effect" in these patients: improved physical composition.

Most notable to me and anyone else who needs to lose a few pounds: He said that Intermittent Fasting was in part responsible for his wife's dramatic weight loss (80 pounds!). Each time I've seen May Lara in recent months, she's looked dramatically fitter and younger. See for yourself.

August 2012
December 2010

When it comes to exercise, Dr. Lara follows his own advice, and so does May. They hit the trail by their home each morning for what they call an "adventure hikes." It sounds more fun than the gym; plus you get Vitamin D!  You're exercising together but adapting the routine for your individual skill and strength levels. I asked for details, and here they are. As soon as my broken toe heals, I might meet them at a local park soon!  Enjoy!                                 –Gina Pera   

Adventure Hiking 101

by Michael Lara, MD

May struggled with obesity almost all of her life. A busy mother of three daughters with a full-time job, she barely had time for herself. Finding time to go to the gym had always been a challenge. But earlier this year, after more than 30 years of struggling, May finally attained her ideal body weight...without ever stepping foot in the gym.

Tuesday, July 3, 2012

Nature-Sufficient Syndrome

My husband (pictured above, with San Francisco in the background; more photos below) and I had just parked the car last Sunday and were headed for the trail on San Bruno Mountain when I remembered, "Oh! My first-Tuesday blog post is due this week. What shall I write about?"

"Well," he said, following close behind, "you could write about how most of us are too attached to our electronic screens and devices. And how the industry is exploiting human vulnerabilities." This came as welcome news, especially since it wasn't that long ago that between the two of us, it was only me issuing frequent warnings about "cyber addiction" in our house and in society. A great uncontrolled experiment is being conducted our collective brain, and aside from a few researchers raising the alarm, few seem to care.

My husband was an early adapter of personal digital devices, being one of the first Apple Newton users and buying each successive iteration. When we finally purchased a flat-screen HD TV, the effect on him of watching even mediocre commercials was impressive: lounging on the sofa almost slack-jawed and reminding me of a listless opium-den habitué. The rapture lasted only a few weeks, though. Then one night I noticed him looking at my iPad while watching TV. Did I mention that we live smack-dab in Silicon Valley, where the ante is constantly being upped in the digital-distraction game?

Tuesday, June 5, 2012

Communicating ... Mindfully

If you know you have ADHD, you’re probably aware of how distractibility, impulsiveness or difficulty “keeping track” of everyday life affects you.  But are you aware of how it affects your communication style with loved ones?

To address this aspect of ADHD’s potential effect on interpersonal relationships, let’s consider a few examples:  
  • Distractibility may cause you to miss what's being said or being asked of you – or to even appear disinterested.
  • Impulsiveness and reactivity may change your tone in ways you don’t intend  –snapped responses or flares of anger  – leaving your loved one feeling hurt or confused. 
  • A busy mind drowns out the details of the conversation for a few minutes, or plans rebuttals for what it anticipates coming next, or doesn’t fully wait to hear out another person’s perspective.  
None of this is intentional, of course, but all of it influences how you come across and engage with others. 

Whether speaking or listening, we can hone our ability to communicate as we would any other skill. One proven method is through the practice of mindfulness. Think of mindfulness simply as getting out of “autopilot” – that habit of automatically acting and reacting while mentally we are somewhere else entirely.  On the outside, we’re smiling and nodding to someone but inside we’re lost in thoughts of the future, past, or anywhere our mind travels. 

Thursday, May 3, 2012

"Our Weekend Without Meds"

The most common question I am asked about Adult ADHD (other than "Is it real?") is this: "Does the medication really make a difference?"

I used to recite the facts and figures. After all, double-blind research should provide rock-solid persuasion that yes, for some people with ADHD, the medication is positively life-changing.

Wrong. After only a few times of watching eyes glaze over during my recitations, I got wise: I started answering the question by sharing before-and-after stories of real-life adults with ADHD.

As one of my college journalism professors used to repeat: "Show, Don't Tell." In other words, don't tell your readers what to think by laying out tedious facts and arguments; instead, provide richly detailed stories and let the readers decide for themselves.

With that in mind, I offer you this "as told to" tragicomedy from a friend named Jason about the weekend that Robert, his partner, ran out of medication. (It's not a typo; Jason and Robert are both men, a reminder that ADHD's effect on relationships is not a "Mars-Venus Thing" and that ADHD does not discriminate on the basis of gender, age, or sexual orientation.)

It's important to note that Jason did not know Robert before he was diagnosed with ADHD and started taking medication. In fact, he had assumed Robert was making "too big of a deal" of his ADHD by taking medication. This "lost weekend" made him a believer.

It seemed like no big deal when my partner, Robert, said he’d forgotten to call his doctor and would run out of medicine over the weekend. "I'll just pick it up on Monday, no problem," he’d said. With hindsight, I should have packed a bag and gone to Vegas. He missed only three days’ medication but the downhill effect was dramatic.

I first noticed the difference on Saturday when it took him three hours to pick up cleaning supplies. On Friday, he’d planned to clean out his home office on Sunday. Unfortunately, he made the plans while on his medication and the event took place while he was off.

Sunday I sat down to enjoy some basketball games on TV in peace while Robert cleaned the office. Eight hours later, he asked me to come see how it looked. I didn’t know what to say. Yes, the office was cleaner. But the hallway was lined with junk and massive quantities of cleaning supplies.

Then he checks his e-mail. Two hours later, at midnight, I wander in to tell him goodnight. He is staring at the computer. I asked him what’s the matter. "I don't know." He is a born geek. Turns out, his PC was fine. He couldn't remember what he was trying to do! It wasn’t easy, but I finally got him to recognize it was because he had not had his medication in nearly two days.

On Monday, he found out that he couldn't get the prescription until Tuesday. He spent the evening on EBay shopping for things we didn’t need. Tuesday morning, he asked me to pick up his prescription; he didn’t have time during lunch hour. But he’d transposed two numbers in the address, and without the doctor’s name, I couldn’t find the office.

Luckily, he went by after work, got it, and had it filled. But he’d gotten lost trying to find his own doctor! He called me for directions, extremely frustrated and blaming me because I couldn’t find the doctor’s office earlier. Huh? He slammed down the phone, saying he would call back.

Two hours later, he arrives. When I asked why he hadn’t called back—I was worried— he didn't remember saying he would call. Where had he been for two hours? “Shopping.” But all he had in his hands was the prescription. "Oh, I forgot the things in the car.” He brings in groceries and more of the same cleaning supplies he purchased Saturday! Now, we have two of everything, including the world’s largest bottles of Simple Green!

When we finally got the air cleared over who was responsible for him being lost, we sat down to relax by watching TV. He picked a show about terrorist training. After all the bad news on this topic, not to mention the last three days' tension, I didn’t consider that relaxing. “But it’s really good!” he insisted.

After 20 minutes of watching him “self-medicate” by seeing torture victims suffer atrocities, I said, "No, I don't want to watch this," but he stubbornly left it on. I left the room. He said, "If you don't like it change the channel!" He had forgotten that he was holding the damn thing in a death grip. Argh!!!

He took a dose of the medication this morning. Hopefully, we will be headed back to a more even keel shortly. Hopefully, he will remember to fill his prescription next time before he runs completely out. In fact, I think I’ll put it on the calendar.

How about you? Can relate to these examples? Do you have others to share? What's the biggest difference medication has made in your or your partner's life?

Tuesday, April 3, 2012

ADHD and "Cyber Junkies"

Once my boyfriend starts on the Internet, there's no turning back. It seems the perfect trap for people with ADHD: He can drift aimlessly from topic to topic with just the click of a mouse. I just wish he could use all that internet time for something useful.   –Beth

My wife was supposed to turn in her masters-thesis outline by Tuesday. After doing nothing for six months, she worked at the computer all night in a last-minute attempt and still spent half the time playing games on Facebook. I think a typewriter would have presented fewer distractions.

My husband seems very addicted to the computer.  Ours is downstairs, and if I ask him to get something from down there it takes him 20 minutes because he stops to play a game or do some "social-networking." When I finally call down to see what is taking so long he yells back in anger. He was addicted to porn at one point. Who knows. Maybe he still is.   –Kim

It's not only the partners of adults with ADHD who report concerns about computer addiction. The adults themselves  curse electronic gadgets' mesmerizing hold over them. In this previous post, for example, Glen says he staves off sleep by scanning every news headline worldwide on the Internet. And he is not alone.

Clearly, many of us recognize this potential problem. But what to do about it? Below, national cyber-addiction expert, author, and support-group leader Kevin Roberts offers pro-active strategies.
                                                                                     –Gina Pera                                    

Are you a Cyber Junkie? 

Five Steps to Take Back Your Life


By Kevin Roberts

Author and cyber-addiction expert Kevin Roberts
Do you, like many adults with ADHD struggle to regulate the amount of time you spend online?  Has “social networking” on Facebook turned into real-time isolation?  Is the cyber world sabotaging your chances for success and happiness? If these questions hit home, you’re not alone.

I am an ADHD adult who also suffers from anxiety.  In addition to these challenges, I spent 14,000 hours over ten years wasting my life on computer games, endless Facebook sessions, and random Internet surfing.  The problem is now under control, but it is a daily effort to keep it that way.

We know that somewhere around 50 percent of untreated ADHD adults will, at some point in their lives, turn to substance abuse.  Data has started to mount that an even greater percentage of people with ADHD struggle with excessive, or even addictive, use of the cyber world.  In both cases, people who do not get treatment usually attempt to self-medicate, meaning that they engage in substances, or behaviors, that temporarily ease the discomfort or the disorder.

Tuesday, March 6, 2012

Reaching Out to Your Community

How can we best reach adults with ADHD who have no idea they have it? Based on my 12 years of advocacy, I'd say it is through people with ADHD talking about it openly and honestly with others in their day-to-day communities. In this way, others hear the facts about ADHD from people they already know instead of thinly drawn profiles in the media.

I jokingly refer to our Adult ADHD CHADD group in Palo Alto as  "ADHD without Borders," because the meeting routinely draws transplants from many countries, including China, India, Vietnam, Israel, Germany, and Brazil.

These people often express great relief to finally find a group who understands them, because their friends and family back home typically do not. Realizing the genetic connection, they cannot accept that ADHD is an "American invention." They clearly see that extended family members also have ADHD and they need to be educated. They vow to take the message back home and put ADHD in a context their friends and family can understand.

Tuesday, February 7, 2012

Q & A: When to Disclose – And More

Dear readers - I hope you like this blog's new, cleaner design!

A few years ago, I participated in an Ask the Expert Chat on "ADHD and Relationships", sponsored by the National Resource Center on ADHD. In this free forum, the public is invited to ask questions of a top ADHD expert in a live online chat. This text-based Q&A is later stored in the CHADD Ask the Expert archive (you can view the topics at that link but access is limited to CHADD members). Participants had so many questions, we had no room for the overflow, so I am sharing them here.

Question: When beginning a new relationship, at what point do you suggest disclosing that you have ADHD and what is a good way to do it?

Hi Rebeca,

Well, I wouldn’t mention it on the first date!  Or perhaps even the third or fifth.

I’d give the person time to get to know you first, so you can avoid the risk of letting that person’s possible misconceptions about ADHD filter perceptions of you. 

Then again, if despite your best efforts, you still have a tendency to “blurt” or “mishear” or some other common ADHD-related trait, it might be good to provide a little education first, so the person won’t misinterpret your behavior as, for example, rude or uncaring. Even then, though, you don’t have to say “I do this because I have ADHD.” Because, again, you don’t know the person’s level of understanding of ADHD. Instead, you can say something like this: “Sometimes I have trouble arriving places on time. I just want you to know that if I’m ever late to meet you, it’s not because I don’t care. I’m working on strategies, but sometimes I slip.”

Thursday, January 19, 2012

Wearing “ADHD Eyeglasses” with Care

Maybe this has happened to you. As soon as you started learning about ADHD, you suddenly saw it all around you. No, it's not that new people with ADHD suddenly started popping up in your midst; rather, you started seeing oh-so-familiar behaviors in a new light, through the lens of ADHD knowledge.

Thanks to 21st century brain-science breakthroughs, we’re developing enlightened attitudes about the organ linked to everything we do, feel, or think: the brain. Yet resistance remains, so we can't expect everyone to openly embrace what, after careful study, we've come to accept: ADHD is real, it is more common than anyone knew, and, when left unacknowledged, ADHD symptoms can limit the options and self-realization of those who have it—and their loved ones, too.

Is there a parallel in history, when knowledge that promised to vastly expanded human potential somehow gained acceptance only slowly and amid great opposition? Yes indeed, and now we can’t imagine how our ancestors didn’t immediately “see” the benefits of one such invention: eyeglasses.

Eyeglasses debuted in the 13th century, though crude attempts date back to ancient Rome. It took a few hundred years to perfect the design but much longer to erase the stigma. That’s right, the stigma from wearing eyeglasses. To avoid making “spectacles” of themselves, many people preferred stumbling around.

These days we call eyeglasses “eyewear”—chic accessories for those who need them and vanity items for some who don’t. Eye exams take place routinely, and nobody questions the necessity of "vision correction." More relevant to our analogy, no one suggests that if you can’t see well enough to read then you’re probably not smart enough to understand what you’d be reading. Three cheers for progress.

Vision: A Function of the Brain as well as the Eye

The example of eyeglasses offers a practical application in explaining ADHD. Consider this fact: Vision is only partly a function of the eye. Yes, the eye receives sensory input in the form of light hitting the retina.  But those light patterns are then converted into electrical signals, which travel along brain pathways to a visual processing center. That’s where your brain tells you what you’ve seen and makes sense of it. Or doesn’t.

Saturday, August 13, 2011

Q: How to Deal with "Meds Roulette"?

A few years ago, I participated in an Ask the Expert Chat on "ADHD and Relationships", sponsored by the National Resource Center on ADHD. In this free forum, the public is invited to ask questions of a top ADHD expert in a live online chat. This text-based Q&A is later stored in the CHADD Ask the Expert archive (you can view the topics at that link but access is limited to CHADD members). Among CHADD membership's many benefits, I consider this one of the best!

Question from Nina:  How do you deal with a significant other who just got diagnosed with Adult AD/HD and is trying out new medications with all different types of side effects?

Hi Nina,

Okay, so you’re at the stage that we sometimes call “Meds Roulette.” By the time some adults with ADHD are diagnosed, there can be intense pressure to "get better FAST."  Unfortunately, tweaking medications is not a fast process. So, it's important that you both show some patience and use a thoughtful approach. Most of all, it's important that both of you be educated.
We are extremely lucky to have many medication options today. Just a few years ago, choices were few and side effects much more problematic. Today’s wide range of options increases the odds that each person can find one that works with their unique biochemistry. We hope that some day, genetic research will help indicate which medication will be most effective for an individual. But we’re not there yet. In the meantime, that means lots of trial and error.

That said, a careful prescribing physician and a pro-active patient can take steps to avoid/minimize potential side effects or cut them short when they do occur. Noting side effects can be an important part of the process; side effects can provide clues as to the underlying neurophysiology and the next direction to consider. Unfortunately, many physicians aren’t so careful in their monitoring or don’t know how to read such clues.
The fact is, 75 percent of late-diagnosis adults have a co-existing condition, such as depression or anxiety. A stimulant alone can intensify the depression or anxiety in some people, who might need an antidepressant or anti-anxiety medication in addition to a stimulant. There are many possible concerns and options.

Overall, though, the problems I hear most often involve physicians following no logical plan or method. Instead, they use a more haphazard “pin the meds on the ADHD” approach. For example, some prescribe a medication at too high a dosage, when they should be “starting low and titrating slow.” (This means beginning with a low dosage and increasing it by small increments over time, noticing the effect at each stage.) A most regrettable result is the person deciding that "the cure is worse than the disease" and gives up. That’s a sad waste of opportunity.

Dr. Margaret Weiss is a top ADHD researcher and clinician. She was kind enough to share with me,  so I could share with my book’s readers, the recommended protocol for achieving optimal results with ADHD medication treatment. I am hoping that readers will share it with their doctors, so we can all work together to raise treatment standards.
Based on the best experts' advice, I also recommend that the partners of adults with ADHD get involved with the process, taking a team approach, unless it is clear that your ADHD partner can handle it well on his or her own. Throughout treatment, the physician should be asking for your feedback. This is recommended for several reasons:
  • Some ADHD adults don’t always notice the changes (positive or negative) or remember to share the details with the physician.
  • Some might half-hear or half-forget instructions from the physician. (It’s amazing to me how many ADHD-treating physicians, knowing ADHD challenges, don’t write down instructions for their patients.)
  • Some might not notice that the physician is not acting in a methodical or thoughtful manner.
Some people bristle at the idea of a "team approach" when pursuing ADHD treatment. They might say, "My partner is an adult; why should I be involved?" I wrote about the reasons for it in this post, Partners in Life, Partners in ADHD Treatment.

Of course medication is only part of the physical treatment process.  It’s also important to pay attention to diet, sleep, food sensitivities, and exercise.  No medication can offset poor health and lifestyle habits.

When the medication is right, however, it can make life so much easier for everyone. I’m constantly astounded by the positive reports from the adults in our Silicon Valley Adult ADHD discussion group  and the online “partners of adult with ADHD” group as well. It’s an awe-inspiring transformation to witness.  So, if you want best results from medication, know that it takes an educated, pro-active approach!  Here are more resources to help you do just that:
  • Adult ADHD Treatment guidelines from the National Resource Center on ADHD
  • A video interview with me, Gina Pera, on "the side effects of poor medical treatment for Adult ADHD"
  • An overview of ADHD medications, including dosage availability and common side effects, presented by ADHD specialist Ted Mandelkorn, M.D.
  • ADHD Practice Guidelines, including rating scales (recommended for gauging medication efficacy) and medication guidelines, compiled by Dr. Margaret Weiss and colleagues at the Canadian ADHD Resource Alliance (CADDRA)
We welcome your comments and advice on finding effective medical treatment for Adult ADHD!

Tuesday, May 31, 2011

Love Means Saying You're Sorry

This month's insights on Adult ADHD and relationships come from psychologist Ari Tuckman, with two excerpts from his book More Attention, Less Deficit: Success Strategies for Adults with ADHD. Enjoy, and please join in with your comments on these topics!  -- Gina Pera

By Ari  Tuckman, Ph.D.
It's been said that if one person in a relationship has ADHD, then the other person kind of has it, too. The one person’s ADHD affects not only how he interacts with his romantic partner, but also his ability to meet his practical obligations in the relationship, like getting to dinner on time and picking up after himself. This can lead to some predictable and interesting dynamics between the two people as they work to find a better way. Every couple faces their own challenges, but a relationship where one person has ADHD will tend to face certain kinds of challenges—and benefit from certain kinds of strategies.
          It’s important to remember that when it comes to improving your relationships and friendships or reducing the effect that your ADHD has on them, you don’t need to strive for perfection. Often, some partial improvements are enough to make things much better and create a situation where your positive qualities outweigh the negative feelings the other person has about your ADHD-based behaviors. Of course, you may also decide that you’re tired of trying to be something you aren’t and make some choices about who you interact with. Some other people may be much more appreciative of your good qualities and much more tolerant of your negative ones.
          I use the word relationship broadly to refer to interactions of all kinds: family member, friend, coworker, boss, for example, so it doesn’t apply just to romantic relationships. Besides, a lot of the same rules apply to all of these. Usually romantic relationships intensify feelings and thoughts that we can keep simpler in other relationships.
         Below are two excerpts from my book
More Attention, Less Deficit: Success Strategies for Adults with ADHD:, drawn from Chapter 15: Relationships and Friendships: Strive for Balance