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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.
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). Are ADHD Medications Overprescribed? (offsite).
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Ernest J. Bordini. Ph.D.
Lic. Psychologist, 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.
Attention-deficit Disorders and Teen Driving
by Ernest J. Bordini, Ph.D.
Clinical Psychology Associates of
North Central, Florida, 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, PediatricNeuropsychology.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://cpancf.com/Community_Health_Links.asp
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
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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Clinical Psychology Associates of North Central Florida
Providing Quality Consultation, Assessment
and Psychotherapy to the North Central Florida Community
(352) 336-2888
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