If You Think Fear-Based Management Works for You—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. What sometimes seems to help us cope in the short term can, in the long-term be our undoing. And, for many adults with late-diagnosis ADHD, it's hard to distinguish between helpful and counterproductive coping skills.;

As regards my husband's long top go-to strategy, FBM, he swears it got him through graduate school. The way it worked then: He nurtured thoughts of disastrous consequences if he didn't finish that paper on time and complete that research project. 

FBM may have helped him to earn a tough advanced degree in the hard sciences. But, looking back, with the advantage of diagnosis and better treatment, he sees now that "self-medicating with fear" did little for his nervous system or, ultimately, 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. 

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.

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.

Adult ADHD and 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?

Fortunately, living here also means we have a rich variety of hiking trails in every direction. Getting out for a trek together at the coast, in the redwoods, through the inland valleys has been a great unifying thread throughout our married life. 

No matter what else was going on when either of us suggested a hike, the other one always said, "Yes, let's go." These outings have been our salvation in more ways than one.

Living with ADHD, in oneself or a partner, the threat always lurks of being distracted from self-care and relationship-care by the easy stimulation. 

So it was that on a beautifully foggy and cool day, as we started up the trail, I nixed the idea of talking about the blog post in favor of savoring the sights, smells, and sensations.  And my husband gratefully agreed. 

Wildflowers still bloomed in abundance. Fog rolled over the hills. Birds chirped and swooped. The chaparral smelled fresh and sparkled from the light mist. We found a funnel-web spider's hole (see photo below). 

 My husband, a great forager, picked so many wild blackberries for me (the only time he does the "cooking") I had my fill. The heavy fog had kept most hikers away and we felt like we had the entire mountain to ourselves.

In hopes of inspiring you, too, to heal any lingering "nature deficit disorder" in your life or relationship, I share below some photos of our hikes over the last year or two.

I also invite you to share with other blog readers how you recharge your batteries in the great outdoors -- perhaps with a sport, a bicycle, regular walks in the neighborhood, or lazing in the hammock and listening to the wind or the birds.

Communicating ... Mindfully

This month's guest post comes to you from Mark Bertin, MD, a developmental pediatrician and author of The Family ADHD Solution: A Scientific Approach to Maximizing Your Child’s Attention and Minimizing Parental Stress. – G.P.

 

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. 

"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?

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.  –Marco 

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.

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.

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.”

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.

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 ADHD 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
• An overview of ADHD medications, including dosage availability and common side effects, presented by ADHD specialist Ted Mandelkorn, M.D.

I welcome your comments and advice on finding effective medical treatment for Adult ADHD!—Gina Pera

Q & A on Adult ADHD: What Is Personality, What Are Symptoms?

Continuing with last month's theme of sharing questions and my answers from CHADD's Ask the Expert chat, here is a two-part question from a reader named Matt. 


I welcome your responses to both Matt's questions and my answers.

—Gina Pera

1. How do you separate ADHD from the person? Because it is neurological, it just doesn't seem possible. It would be like separating sexual orientation from a person.

Hi Matt,

Boy, that’s a question for the philosophers! But I’ll give it a try. It’s true that, especially with late-diagnosis adult ADHD, you often hear comments such as “I don’t know if I have ADHD or if I am ADHD.”

A 30-something man with ADHD recently told me that his personality is the Life of the Party. But, I asked him, is that really his personality? Or, could it be a behavior developed many years ago because he was unable to follow the many conversational threads at a party? 

Adult ADHD Question-and-Answer: on ADHD and "Denial"

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!

      

Reprinted courtesy of "Kev" 
http://www.kevscartoons.com

The Internet is chockablock with information on ADHD, but some of it is unreliable. You can count on these Ask the Expert chats to be solid. (The latest one was with Dr. Russell Barkley.) Moreover,  back issues of CHADD's excellent Attention magazine are stored in the archives for members' access. So, if you're not a CHADD member, I encourage you to sign up now (it's tax-deductible, too!).

During my Ask the Expert chat, the questions came in massive quantities!  So many that I didn't have time to answer them in the chat itself. Fortunately, I saved the file. In the coming months, I will be sharing the most topical questions and answers with you.  This month: What do you do when an adult in your life is "in denial" about what seem obvious ADHD-related challenges?

Adult ADHD and "Time Blindness": Dr. Russell Barkley's Tactics for Taming That Trickster, Time

Time.  That's one word that always makes the top of the list when I ask adults in our local CHADD discussion group to name their top ADHD-related challenges.

• Keeping track of time.
• Estimating the time it will take to complete a project.
• Planning for future time instead of getting totally wrapped up in present time.

Managing time is a constant challenge for most humans, especially in our speeded-up age. Yet, for people with ADHD, time can be a particularly shape-shifting trickster. 


No one knows this better than psychologist Russell Barkley, a preeminent researcher, lecturer, expert, and author in the field of ADHD. And no one better explains to the layperson why this is and what to do about it than does Dr. Barkley in his new book, Taking Charge of Adult ADHD. 

The following excerpt, from Chapter 10, offers tips for taking charge of your time. Earlier chapters build a strong foundation for understanding ADHD neurobiology and guidelines for medical treatment; remaining chapters offer straightforward but in-depth strategies for tackling your particular issues in various areas of life. 

The "Invisible Ropes" of Adult ADHD, And How A Special Type of Therapy Can Help Set You Free

Introduction:  When I'm asked about the best kind of therapy for Adult ADHD, I explain that the research thus far points to cognitive-behavioral therapy (CBT), in combination with medication.  Then I emphasize a critical point: not just any CBT but that with a special focus on ADHD. 

      Standard CBT that does not acknowledge the neurobiological role of ADHD can be counter-productive, at best.  How do I know this?  Because I listen to the top experts who make this study and practice their life's work. 

      I'm pleased to offer a guest essay this month from one of these top experts: J. Russell Ramsay, psychologist and co-director at the Adult ADHD Clinic at the University of Pennsylvania. (Please see bio at the end of this post).  In preparing my talk for the upcoming CHADD 22nd International Conference on ADHD ("Adult ADHD Symptoms or Poor Coping Skills?"), I relied heavily on the book he co-authored with Dr. Anthony Rostain (see below).  

      The conference will be held in Atlanta this year, Nov. 11-13.  I cannot overemphasize the wealth of knowledge, validation, and support to be gained at this conference. If there's a possibility that you can attend, try your hardest to get there!  Sign up by September 15, and receive the early-bird discount!   --Gina Pera

By J. Russell Ramsay, Ph.D.

Circus elephants are trained while secured with ropes until they are subdued. Trainers then teach them to perform tricks for audiences without the use of restraints. No less powerful than when they were in the wild, these elephants are held back by the invisible ropes of their training.

      Growing up with ADHD, particularly when it has gone undiagnosed until adulthood, makes it very likely that adults with ADHD have encountered their own “ropes” in life, such as academic trauma, ongoing troubles handling the demands of daily life, or hurtful criticisms made by others. Although their circumstances may change in their adult lives, these experiences may have trained them to hold negative attitudes about themselves and their future.