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Articles About Assessment, Treatment and Coping with ADHD
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This page features articles that have been authored by present and past staff at Clinical Psychology Associates of North Central Florida, P.A.
Many of the articles have appeared in North Florida Family Magazine formerly published as Gainesville Parent Magazine.
The articles are condensed and reprinted here solely for the use of our readers. These may not be printed or reprinted without permission, though feel free to link to our page. ADHD and Medications - Growing Choices (offsite).
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Ernest J. Bordini. Ph.D.
Executive Director
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We are proud to support CHADD of Alachua County. For information about meeting times and signing up for the CHADD of Alachua County newsletter, please visit the ADHDASSESSMENT.COM website.
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Attention-deficit Disorders and Teen Driving
by Ernest J. Bordini, Ph.D.
Clinical Psychology Associates of
North Central, Florida, P.A.
Gainesville Florida
Approaching teen driving in a well-considered manner is an important part of parental responsibility. While all parents must consider the risks involved in teen driving, the problem faced by those whose teenagers have problems with attention and impulsiveness is often more anxiety-provoking. This article seeks to offer some suggestions for this important adolescent milestone.
Attention-deficit Hyperactivity Disorder (ADHD) is a developmental disorder that is one of the most common childhood neurobehavioral disorders. It is characterized by difficulties in sitting still, paying attention, organizing, completing work, and impulsiveness.
While some of the motor restlessness sometimes resolves in adolescence or early adulthood, difficulties with attention, organizing and planning can persist. See ADHDASSESSMENT.COM, CPANCF.COM, and CHADD.ORG for more information about ADHD and it’s assessment. As adults, individuals with history of ADHD can have difficulties completing an education commensurate with their intelligence, change jobs more frequently, may experience marital difficulties, possible social skill difficulties and are more frequently involved in traffic accidents.
In general, the fatality rate for teen drivers is four times higher than for other drivers. This means that approximately 5500 teen drivers dies in motor vehicle accidents in the US each year. The vast majority were found to be due to driver mistakes. Some researchers have found ADHD teens have five times the number of traffic tickets than non ADHD teens. As a group they were more than seven times more likely to be involved in more than one accident.
Snyder (2001) has argued that these problems are less of a skill deficit, than the teens not doing what they know how to do. This may sound familiar to parents who have spent time frustrated at seeing their children fail tests on material that they have clearly mastered.
Snyder feels that applying early and consistent consequences for inappropriate driving is critical. Snyder cautions that expectations need to be reasonable. Not only ADHD children will make mistakes. However, it is important to hold teens responsible for their errors. A motor vehicle and insurance are for more costly to repair than the accidently broken glass that was knocked from the table. Snyder suggested having teens pay off fines and providing consequences for inappropriate behavior in the car when with family.
It is difficult to monitor activities such as driving which occurs when you are not there. It is possible, however to monitor curfew times. Returning the car home when expected is one verifiable aspect of responsible vehicle use. Keeping track of mileage can also alert the parent to use that may be in excess or inappropriate of what has been expected or allowed. In some cases, it may be helpful to check with the parents of other teens about times and dates of activities.
Snyder listed several tips for parents:
Start Early - talk to them about driving and driving safety before their teen years. Model the appropriate driving behaviors. Talk about driving errors and how to avoid them.
Communicate with your child about driving. In the car, talk to them why its important to use seat belts when in the care, importance of coming to a complete stop, the importance of being patient at intersections, and yielding and being aware of pedestrians.
Talk about newspaper accounts of collisions. Discuss how they may have been avoided and how the families must feel.
Don’t discourage their interests or questions. Encourage their questions. Listen to your child. Show that you are understanding how they feel, pay attention to appropriate and inappropriate statements they may make about driving.
Communicate your Values: Talk to them about the importance of safety, family/community responsibility, respect for driving rules and regulations.
Provide straightforward answers. Talk about it again. Repetition is important.
Set clear rules. With who? What activities are appropriate? Where they allowed to go? When can they go? When are they expected back?
Set limits about use of alcohol/drugs - clear consequences and restrictions.
Consistently enforce the rules.
Drinking and driving are a very serious concern. While ADHD children in general do not have a greatly increased risk of alcohol or drug abuse, those who have displayed conduct problems or excessive risk–taking behaviors are likely at higher risk. Snyder has developed teen driving contracts that help address these and other issues. More general information on teens and drinking can be found by visiting the links page on the CPANCF.COM website.
Overly aggressive driving may be a problem for children who are easily irritated or who have trouble with impulse and anger control. A useful exercise may be to check you or your teens level of hostility on the road http://www.aaafoundation.org/quizzes/index.cfm?button=aggressive
References: http://www.cpancf.com/links.html
Snyder, J. M. AD/HD & Driving. Whitefish Consultants, Montana, 2001
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UNDERSTANDING AND COPING WITH ADULT ADHD
by Janet Frank, Ph.D.
Clinical Psychology Associates
of North Central Florida, P.A.
Being a parent is enough to make any of us feel frazzled and unorganized at times. We have all experienced walking into a room, only to forget what we went there for. Having a busy, distracting life is tough enough, but for a parent with Attention Deficit Hyperactivity Disorder, some of the daily challenges take on even more significance. This article is intended to offer some information about ADHD in adults, and to provide some tips for parents and other adults who may have ADHD.
The full name of the disorder is Attention Deficit Hyperactivity Disorder. There are specifications for Hyperactive-Impulsive Type (ADHD) and Inattentive Type (ADD, without the H for hyperactivity). Ed Hallowell, M.D., says that ADHD is a misnomer, that it is really a disorder of attention inconsistency rather than deficit. Individuals with ADHD are capable of sustaining attention for long periods of time, but usually only to tasks that are of significant interest to them. This sometimes interferes in daily functioning, as well all have to do things at times that are not of great interest to us.
Adults with ADHD often exhibit many of the following behaviors: unfinished tasks, broken promises, unfulfilled potential, temper outbursts (emotional sensitivity), resistance to being touched (physical sensitivity), fidgety, tend toward drug/alcohol abuse, inability to cope with the stresses of life, procrastination (due to distractibility), seeming not to hear/being inattentive. ADHD adults also may overfocus (e.g., 12 hours on computer at expense of other important tasks), are impulsive, have difficulty with organization, are easily bored, can’t sit still, and often have learning disabilities.
These comments often characterize someone with ADHD: She doesn’t finish what she starts. He’s irresponsible. She’s smart but she doesn’t settle down. He never follows through. She won’t let me comfort her when she’s upset. He falls asleep watching TV the minute he comes home. She doesn’t realize I’m tired too. He’s so immature.
The severity of ADHD is on a continuum. Being diagnosed depends on how well one manages the symptoms. It’s this continuum that makes it hard to estimate how many people have it. Current estimates range between 1-22% of the general population. Some say more boys than girls have it. Dr. Lynn Weiss believes it’s the same proportionally, but the behavioral characteristics in women are not as easily observed, and may be diagnosed as emotional or unstable behavior instead. Dr. Barkley believes that the diagnostic criteria for children needs to be gender specific, and that currently, girls have to be more impaired than boys to receive the diagnosis.
The current thinking is that ADHD is that it is a genetic disorder. The brain is believed to be less active in the areas controlling attention/concentration. ADHD is also believed to be connected to low levels of a brain chemical called dopamine. Stimulant medications (such as Ritalin) are believed to work because they make that area more active and result in better focus.
It is a misconception that everyone with ADHD has emotional problems, though assessing for co-existing depression or anxiety disorders is important since this has important implications for treatment planning. Sometimes, the emotional difficulties a person experiences are just offshoots of living in a society that has non-ADHD standards. It is simply an issue of the ADHD person’s brain being wired a little differently from most individuals’. Contrary to popular myth, ADHD does not result from poor parenting or family dysfunction.
The diagnosis requires evaluation of childhood, parental, and sibling history and symptoms; school records/teacher comments; checklists used to assess inattention, impulsivity, hyperactivity, and emotionality. It is useful to hear several anecdotes to describe these symptoms, both from the patient and from significant others. Often psychological testing is used to look for patterns of consistent difficulties with attention or inhibition of behaviors, co-existing disorders such as learning disabilities, and rule out other disorders. Psychological testing allows for a more objective evaluation in comparison to others of like age and ability.
Treatment
Treatment of ADHD often involves a combination of education, medications, and learning skills. According to Dr. Weiss, there are stages of treatment through which an individual will need support:
1. Aha, I have it.
2. Grief–there’s a reason you could not live up to people’s standards!
3. Seek support, understanding, and companionship during grief
4. Seeking, exploration, and experimentation. Everything looks different—try new things.
5. Coming of age– enjoy a new identity, redefine values, honor talents/ gifts
Dr. Hallowell notes several common problems concerning treatment of ADHD:
1) someone key in life does not accept the diagnosis
2) after an initial burst in improvement, progress slows
3) a newly diagnosed person does not want to try meds (although this does not preclude success) 4) no meds seem to work (although Dr. Barkley says try them all in order to find the right one)
5) stigma about using meds, e.g., from pharmacists
6) lack of people who understand what it’s like to have ADHD
7) trouble deciding who to tell about ADHD, and how to tell them
8) hard to find a clinician qualified to diagnose and treat ADHD
9) attempts at structure keep falling apart
10) feelings of shame and embarrassment about having ADHD
Despite numerous possible obstacles and failures that have often occurred prior to diagnosis, adults with ADHD usually possess a number of wonderful qualities and traits. They are sensitive, creative, and often very intuitive. Treatment of adults often includes rebuilding one’s self-image, and learning to express and deal with pent-up anger and guilt. Individual or family therapy, as well as support groups can be helpful, as can learning to say no,
Useful Tips for ADHD Adults
Restructure your life.
- Encourage loved ones to assist by give you extra reminders, while taking the ultimate responsibility.
- Lists are your best friend.
- Pace yourself
- Your work space should be of sufficient space but free of excess distractions
- Experiment with background sound to cover other distractions
- Always have a specific plan. Budget in time for distraction. In other words, allow yourself to procrastinate.
- Try to master distractions. If you can’t see a reason to do something, don’t do it, unless it is a responsibility that cannot be shunned. Pay someone, trade off with a spouse–there has to be an inner willingness, or distraction will likely be a problem.
Learn to negotiate
- Get your temper under control. Never try to make a deal or compromise when your temper is active. Don’t blame others. Your reactions to what anyone does are still your responsibility. Identify the underlying anger and use words to express it.
- Learn not to blame. Remember that it doesn’t matter WHY something happened. But it does matter WHAT happened. Come up with a plan to solve the problem rather than worrying how the problem got there. Be specific. Set the plan in motion, and stick to it.
For couples
- Guard against co-dependent behaviors. In codependency, we focus attention on each other rather than taking responsibility for ourselves. A person with ADHD often blames others for problems, and significant others often end up taking responsibility.
- A partner can help break a task down, or facilitate communication with direct questions.
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The Challenge of Returning the ADHD Child to School
by
Ernest J. Bordini, Ph.D.
Clinical Psychology Associates
of North Central Florida, P.A.
ATTENTION-DEFICIT HYPERACTIVITY DISORDER (ADHD) is one of the most common childhood psychiatric disorders. Media attention and increased awareness among educators have helped to improve the identification of these children. This has also helped to increase the likelihood that they will receive appropriate accommodations, However, each school year presents the parents and the child with new challenges.
Some preparation needs to happen before the child has started the new year. This includes visiting the school if new, acquainting the child with rules and procedures, the schedule, and reviewing the school conduct code. Find out the school policy about medication. Make sure it is not embarrassing to the student.
Has the child's previous testing been for-warded to the school? Have the teachers read it? Beware of teachers who refuse to read the folders since it might prejudice them, A good evaluation provides a map for assistance, and the accommodations may be mandated by the Americans with Disabilities Act. Be assertive is setting the expectation that the teacher will have read this by a certain date, and set a meeting to discuss this with them. The evaluation is only as good as it is current. Young children change rapidly and the curriculum and schedules change every six months to a year. Children with borderline reading, writing, or math difficulties could actually be classified as learning disabled a year or even four years later.
For younger ADHD children, it may be helpful to plan ahead how you will monitor critical areas of conduct and how to track and turn in work. A quick and easy weekly if not a daily rating sheet can be tied into rewards, privilege and consequences at home. Review these with the child a week prior to the beginning of school and again the day before school starts. Follow-up and be consistent.
Do a self-appraisal to determine if you are expecting your child to be more consistent than you are. What do your schedule and demands look like? How will it interact with the child's schedule? Delegate if you fear becoming overwhelmed. Using school or community resources that provide homework assistance can go a long way to reduce parent burnout. Many parents try to do it all themselves with the consequence of great strain and frustration in the parent-child relationship. Ask yourself if your time with the child is balanced between providing instruction and assistance and with spending time recreating with the child. It need not be a one-to-one balance, but you want more than the aggravation of dealing with homework to be remembered by the child as they enter their teenage years.
Planning for return to school involves consulting with the school about seating, class schedules (put more demanding classes in the morning), and setting paths of communication between the teacher and parents. In middle school the teaching team leader or a designated teacher that can serve as a point-person to track progress with other teachers is often very critical.
Presenting new teachers with information as to previous assessments and what has worked in the past is important. Setting a follow-up meeting once the teachers have had the opportunity to interact with your child is even more critical. Setting priorities and monitoring progress on a regular basis will help identify successes, providing opportunities for much needed praise. This will also help identify problem areas early.
Elementary School children may show one of two patterns at the beginning of children. Some ADHD children become overstimulated by the novelty and chaos of a new classroom, teacher, or school, while for others the novelty raises their level or arousal and they do well until the novelty wears off. Reviewing your child's past patterns help you anticipate when you may need to devote more time in preparing the child or checking in with the teacher to see if the child if the child is sustaining the Honeymoon period. Letting teachers know what to expect based on previous experience will help teachers catch problems early.
Middle school children often face difficulties adapting to having multiple classes and multiple projects due at varying times of the week and semester, Attempts to make the child's schedule as predictable as possible can be done. Familiarize the student and yourself with the procedures and school resources that are available for help.
Organization is often the most difficult task facing middle school children. This is even more difficult for ADHD children. It is common for the child who has worked toward success in late elementary school to nosedive upon entering middle school. This is usually due to the increased organizational demands and complexity of multiple classes with different rules and assignments.
Investing energy into establishing structure and organization, and even more importantly reexamining whether the child is persisting with the method once is mastered will pay off in avoiding repeated crises and failure. Lists, reminders, notes, organizational planners, and periodic reorganization are survival basics. Many of the systems and techniques used for busy executives work wonderfully for ADHD children because both have the same problem: Too much to track without help. Organizers also help modulate executives and ADHD children's difficulties in setting
realistic expectations of themselves. Looking ahead in the organizer helps determine what what realistically can be added, or may pinpoint the need to set priorities. Organizers are available commercially and there is even one available through the local CHADD Organization.
Some ADHD'children have extreme difficulties in planning ahead and organizing what material they will need for school. A heavy-duty backpack is often the solution. Laptop computers are increasingly affordable, with older models often available for as much as a fancy calculator. Even an old word processing program and scheduler can go miles in helping your child with these tasks.
Dr. Halloway, author of Driven to Distraction, recommends arranging for a “study buddy" in each subject, with phone number. This will be a resource for study notes or the correct assignment if they were forgotten or mysteriously confiscated by aliens on your child's way home from school. Obviously, picking on someone who is well organized and takes good notes is important.
If your ADHD child is starting middle school ask to schedule a meeting among all the child's teachers, the counselors, the special education coordinator, the vice-principal, and the principal, etc. Changing schools is a significant change in placement that warrants a review of the child's acconunodations and educational plan. This may also create an opportunity to request further assessment if the past assessment was outdated and the last year was problematic.
An important recommendation conveyed to me by one of the frequent contributors to the CHADD website (www.chadd.org) is to try to understand your child's feelings. Walk in his shoes. Appreciate his struggle. Help her understand what her unique gifts and natural limits are. Help them see themselves as the special people they are. Find -Islands of Competence. These are areas your child has interests and aptitudes in. Feed and reinforce the Islands.
Don't neglect the importance of social acceptance and development of a sense of interpersonal competence for the middle school ADHD child. Research indicates that difficulties with social skills are among the most persistent of ADHD problems. Provide opportunities for positive interactions in setting which do not stress performance. Community and professional resources are available for more intense assistance in this critical area for self-esteem.
Attend school meetings, and school board meetings. Join CHADD, a national nonprofit organization devoted to assisting and educating ADHD Children and Adults. Attend local meetings and volunteer for your support group. There is strength in numbers. You are not alone, although it sometimes feels that way.
Clinical Psychology Associates
of North Central Florida, P.A.
Providing Quality Consultation, Assessment
and Psychotherapy to the North Central Florida Community
(352) 336-2888
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