This manual integrates information on Attention-Deficit/Hyperactivity Disorder (AD/HD) from prominent researchers and writers in the field. These individuals appear in the References section. It is not meant to be an academic treatise; specific sources for information and ideas are not specifically documented.
A. Everyone has occasional difficulty sustaining attention, controlling impulses and being still. For some, these behaviors are so pronounced that they interfere with work, friendships, and family. It is likely that a portion of these individuals have an Attention-Deficit/Hyperactivity Disorder (AD/HD).
B. AD/HD is the most recent diagnostic label for individuals presenting persistent and severe problems with attention, impulse control and over-activity.
C. AD/HD is the most commonly diagnosed psychiatric condition in children.
1. 3 to 5% of school age children are thought to have AD/HD.
2. Boys are more likely to be diagnosed.
a. More likely to exhibit hyperactivity.
b. Actual sex ratio (boys:girls) thought to be from 2:1 to 10:2,
depending on the study.
c. Sex ratio is closer in adults.
D. AD/HD in adults.
1. Until recently AD/HD was viewed as a childhood disorder that was outgrown by adolescence.
a. Longitudinal research has found that AD/HD is often a chronic
condition affecting individuals into adulthood.
b. While actual prevalence is unknown, it’s estimated that 20 to 60%
of those with childhood AD/HD continue to have symptoms in adulthood
(1 to 3% of population).
2. AD/HD in children has been extensively researched; studies on adult
AD/HD are on-going; information on adult AD/HD is tentative and
ever-growing.
3. It is likely that AD/HD in adults is under diagnosed.
a. Therapists may overlook AD/HD symptoms and focus on the anxiety, depression, or relationship conflict that often accompany them.
E. AD/HD is a powerful diagnosis; powerfully destructive when missed; powerfully constructive when correctly identified.
A. There is no single presentation of AD/HD.
1. Each person with AD/HD will have a unique combination of traits and
behaviors resulting from the interplay of biological make-up and
environmental experience.
2. AD/HD is not an all or none condition - symptoms exist in degrees.
3. It is likely that AD/HD represents a group or family of related
conditions rather than a specific disorder.
B. Most people can identify with AD/HD-like symptoms.
1. They occur from time to time in virtually everyone.
+ Attention and focus may be effected by fatigue.
2. Cultural norms may be growing closer to criteria for AD/HD.
C. What differentiates the person with AD/HD is the severity, duration and extent symptoms interfere with everyday life.
1. Those with AD/HD experience symptoms most of the time.
2. Experience them more intensely than non-AD/HD.
3. AD/HD represents individuals on the extreme end of the severity
continuum or normal curve.
D. Diagnosis of AD/HD made on how deviant an individual is from average on the primary symptoms of AD/HD.
1. Inattention/distractibility.
2. Impulsivity.
3. Hyperactivity/restlessness.
A. Inattention/Distractibility.
1. Short attention span unless very interested.
a. Difficulty sustaining attention in conversations, lectures, instructions.
+ Will tune out or drift away.
b. May appear as if mind is elsewhere.
+ Preoccupied.
+ In a fog.
+ A dreamer.
c. Sustaining attention requires much more effort for those with AD/HD.
+ Fatigue quickly when trying to pay attention.
+ Act of attending becomes painful.
2. Easily distracted.
a. Attention to on-going task is interrupted in order to attend to
irrelevant stimuli ignored by others.
b. Non-essential stimuli are difficult to resist.
+ Dropped pencil
+ Ticking clock
+ Wind whistling through window
c. May pay attention to everything at once.
+ Constant scanning of environment.
3. Frequently off task engaging in activity unrelated to what previously started.
a. Has difficulty with a consistent task-focus over sustained period
of time.
b. Easily bored - especially if activity is perceived as tedious,
routine, or no longer challenging.
c. Many projects initiated but few finished. Enthusiastic beginnings
but disappointing endings.
d. May avoid tasks requiring sustained mental effort.
+ Often read less than would expect for educational level.
4. Disorganized.
a. Doesn’t maintain organized work/living area.
+ Messy desk -what non-AD/HD files, AD/HD piles.
+ Essential materials are scattered, lost, carelessly damaged.
+ Unkept home/cluttered dorm room.
+ Several home improvement projects going at same time.
b. May experience difficulty with organizing and expressing
thoughts.
c. Poor financial management - unpaid bills, checkbook a mess.
d. Late papers, incomplete assignments.
e. Chronically late/in a hurry.
5. Frequent forgetfulness/problems with memory.
a. Retain little even when forcing self to concentrate.
+ May carefully listen to directions but still doesn’t remember what to do.
b. What appears to be forgetfulness may be not attending in the first place.
+ Inattentiveness and impulsitivity may result in a diminished ability to fix a memory trace.
c. Lose/misplace things.
+ Keys.
+ Wallet/purse.
d. Careless mistakes.
e. Memory difficulties most often:
+ Prospective - remembering to do things in future (eg. errands,
appointments).
+ Procedural - remembering sequence of tasks; can’t follow
directions because lose track of successive steps.
+ Working memory - holding units of information in mind while
problem solving (eg. solving sequential math problem, forget
what want to say if don’t say it immediately).
+ Under pressure - difficulty retrieving previously learned
information when feel anxious or “on the spot” (i.e. mind goes
blank, brain turns to straw).
f. Memory of past events is less problematic.
6. Excessive Procrastination.
a. Some procrastinate due to feeling scattered, anxious and disorganized.
+ Can’t decide which of many stimuli should be responded too.
+ Experience difficulty with sorting out and prioritizing.
b. Others may put tasks off because they anticipate a tedious or
frustrating experience.
c. Still others need the pressure of a deadline to enlist sufficient
motivation to undertake a task.
+ All-night cramming session before a test. + Writing a paper an hour before its due.
7. Behavior often variable.
a. Most consistent thing about those with AD/HD is their
inconsistency.
b. Do well one day and poorly the next.
c. Focused and on track in the morning but bored and distractible in
the afternoon.
8. Low tolerance of stress.
a. Often overwhelmed by daily living tasks.
b. Prone to over-arousal and over-reaction.
+ React too quickly, too strongly and for too long a time.
+ Manifested in temper tantrums, mini-panics, anxiety and worry.
c. Easily discouraged - lack persistence.
d. Often perform worse under pressure.
9. May have ability to intensely focus (hyperfocus).
a. Can focus to an extraordinary degree and for a considerable
length of time on an activity to which he/she is drawn.
b. May accomplish a lot quickly - best work often done in moments of
hyperfocus.
c. May find it difficult to shift attention - often hate to be
interrupted once in a “zone” - may exhibit temper outbursts.
B. Impulsivity.
1. Tendency to do or say whatever comes to mind.
a. React without thinking.
+ A prisoner of immediate emotions.
+ May say things others only think.
b. Makes quick decisions, often without reflection and on basis of insufficient information.
+ May result in hasty opinions and ill-founded conclusions.
+ May guess at the answer to an exam question half-way through
reading the question.
c. Doesn’t anticipate or weigh consequences of behavior.
+ Engages in minimal self-talk/reflection.
d. May result in:
2. Delaying action causes discomfort.
a. The attempt to inhibit action is painful.
+ “Feel like I’m fighting myself.”
+ “Want to scream.”
b. Has difficulty with standing in line and taking turns.
+ Traffic lights/grocery check-outs.
c. May resist going through proper channels or following procedure.
+ Reads directions when all else fails.
d. Becomes frustrated with details.
+ Loves the bottom line.
+ ”Get to the point!”
3. Emotionally impulsive.
a. May experience mood shifts lasting from minutes to hours.
+ Sadness to excitement and back again.
+ An emotional roller coaster.
b. Impatient, easily frustrated.
+ Explosive temper.
+ Low boiling point/short fuse.
+ Often high strung and intense to be with.
+ Relationships may be volatile.
c. Quick to anger - quick to cool off.
+ Can’t understand why others remain angry when he/she recovers composure so quickly.
4. Has difficulty putting aside what is immediately captivating to work on tasks providing longer term reward.
a. Like a company motivated to maximize immediate profits and less
concerned with planning for future development.
b. Influenced by immediate context - don’t think in terms of the
future.
c. Do what is appealing and put off the rest.
C. Hyperactivity/Restlessness.
1. Nervous/Jittery.
a. Can’t relax unless fatigued.
b. Feel edgy when not active.
+ May relax best while doing something.
c. Subjective feeling of restlessness can be painful.
d. Nervousness is more an inability to “settle down” than anxiety
about what may happen in the future.
+ More physiological than psychological.
e. May experience sleep problems, especially getting to sleep - can’t stop thinking, mind always working.
2. High need for movement and activity.
a. Compulsive need to be doing something - would rather stand than
sit.
b. May perform best doing multiple things at once.
c. Most productive thinking often done while
driving/pacing/exercising.
d. Ideal fantasy to one AD/HD adult:
“Being in a room with three TV’s going, PC running, fax operating, CD playing, portable phone in one ear, newspaper spread out in front of me, and three deals about to go down.”
3. Difficulty persisting in sedentary activities.
a. Can’t sit through entire TV program/movie/book chapter.
b. Leaves table immediately after eating.
c. If forced to remain still may:
+ Fidget, squirm.
+ Tap fingers, change posture.
+ Hum or make odd noises.
+ May end up fatigued by effort needed to restrain movement.
4. May have higher energy level than most.
+ Diminished need for sleep.
5. May think and talk fast.
a. Often very verbal
+ Quick retorts/come-backs.
b. Stand-up comedy tendencies.
+ Class clown in high school.
c. Friends complain that you talk too much.
d. May experience difficulty expressing thoughts - unable to talk as
fast as think.
6. High need for stimulation.
a. Simple pleasures of life are too mild.
+ Crave more intense experience.
+ Thrill seeker - bungee jumping, hang gliding, rock climbing,
gambling, race track, high stress jobs, alcohol/drugs,
promiscuity.
+ Love fast cars and big cities.
b. Exhibit risk taking, dare-devil behavior.
+ Reckless.
+ Will find out how deep the water is by jumping in.
+ Accident prone.
c. Enjoy gadgets providing immediate and varied stimulation.
+ PC, fax, answering machine, video games, portable phone.
d. May seek high intensity situations:
e. High stimulus activities:
+ Decrease boredom.
+ Increase ability to concentrate.
+ May feel most focused and calm in high pressure situations
demanding maximum attention.
7. Physical hyperactivity tends to subside with age.
+ May also change in form:
* As child, run and climb incessantly.
* As adult, feels restless, dislikes inactivity, can’t relax.
8. AD/HD may exist with hyperactivity (ADD+H), or without hyperactivity (ADD-H).
a. Early diagnostic descriptions of AD/HD focused on those with hyperactivity.
+ But perhaps only 50% of individuals with AD/HD are hyperactive.
b. Those with ADD+H and ADD-H both have difficulties with attention
and concentration, but other behavior traits may differ.
c. Possible descriptors of ADD+H:
d. Possible descriptors of ADD-H:
e. ADD-H often identified later in life.
+ Don’t cause the behavior problems that individuals with
hyperactivity do.
+ Sit in back of class looking out window, lost in thoughts.
+ Often function adequately until faced with the multiple
responsibilities of adulthood - spouse, parent, career,
finances.
f. ADD-H is likely to have a somewhat different set of causes and to create a different set of problems, than ADD+H.
D. AD/HD Symptoms are:
1. Most evident when situation requires:
a. Sustained attention.
b. A reasoned response.
c. Quiet sitting.
2. Less evident:
a. Novel settings.
b. Interesting tasks, or challenging tasks.
c. One-on-one situations.
d. Situations offering immediate rewards, (e.g. Nintendo game).
+ Psychological symptoms may develop as a result of the primary syndrome not
being recognized.
+ Often most difficult to treat; the longer AD/HD is unrecognized, the
greater secondary problems become.
A. Low self-esteem/depression.
1. May feel ineffectual, demoralized, and overwhelmed.
2. Often have experienced significant frustrations and failures in life.
3. Steady diet of negative feedback.
a. Labeled lazy, odd, stupid, a loser.
b. Teased by peers - feel like an outcast.
c. Frequent criticism - viewed as under-achiever.
+ “You could do better if you tried.”
+ ”You’re not living up to your potential.”
4. Tend to develop strong sense of feeling misunderstood.
5. Depression may also develop from:
a. Sense of exhaustion with constant struggle to pass for normal.
b. Tendency to get into realistic life difficulties.
+ Academic, career, legal, financial, personal.
B. Relationship Difficulties.
1. May have trouble sustaining friendships and romantic relationships.
2. May exhibit attributes that alienate others:
3. Poor observer of self and others.
a. Lack awareness of how other people feel.
+ Don’t study people any better than books.
b. Don’t accurately gauge the effect they have on others.
+ Often underestimate their impact.
c. May not pick up on social cues.
+ Raised eyebrows, changes in voice/posture.
C. Chronic Under-Achievement/Boredom and Frustration With School.
1. Education history variable and erratic.
a. Lower grades and less education than siblings/peers.
b. Up to 30% may not complete high school.
c. As college student may:
+ Switch majors.
+ Accumulate many incompletes.
+ Drop in and out of school.
d. Good school record does not rule out AD/HD.
2. May appear bright but doesn’t excel.
a. Academic performance may decrease as grade-level increases.
b. Innate intelligence can’t carry them as easily.
c. With more material, must study/organize/plan/persist.
d. Can no longer get by with cramming the night before.
3. A typical early school pattern:
a. Child appears bright, talkative, active [ADD+H].
b. Performance tapers off as work becomes more frustrating/boring.
c. Teacher concern with inattention, underachievement, misconduct.
+ “Fails to live up to potential” a common complaint.
d. Parents become increasingly critical of effort and behavior.
e. Those with ADD-H often go unnoticed in early grades. Shy and
quiet, they don’t cause classroom disruption; often eager to please,
they may put much effort into their schoolwork.
+ Average to above average grades achieved through long hours of study and extra credit.
4. Common characteristics of student with AD/HD:
a. Disorganized - desk, locker, bedroom.
b. Poor handwriting/messy work.
c. Assignments forgotten/written down incorrectly.
d. Homework unfinished/inordinate amount of time spent doing it.
e. “Negative attitude” regarding school.
5. Learning Disabilities (LD).
a. AD/HD more likely than non-AD/HD to have LD.
b. LD more likely than non-LD to have AD/HD.
c. Can have one without the other.
6. Employment history often variable and erratic.
a. Lack consistent pattern of productivity.
+ Sometimes excel, sometimes blow assignment.
+ Always on brink of being fired or promoted.
b. May quit job once mastered and becomes boring.
c. Employed less often in higher level professions.
d. May gravitate towards stimulating, high energy and high pressure
occupations such as sales or marketing.
+ Most evident in those with ADD+H.
e. Often self-employed.
f. Problems at work may include:
D. Substance Abuse/Legal Difficulties.
1. Substance Abuse.
a. Increased risk of alcohol and drug abuse compared to non-AD/HD.
b. Up to 5% of those using alcohol/drugs will drift into excessive
use.
c. Tobacco is drug most highly correlated with AD/HD.
2. Legal difficulties.
a. Greater likelihood of contact with police/courts.
b. More likely to have traffic violations/accidents.
A. Biological Component.
1. Actual mechanism causing AD/HD not entirely understood.
2. Thought to be related to Central Nervous System (CNS) functioning.
3. Current hypotheses include:
a. Underactive frontal lobe region of the brain.
+ Frontal lobe thought to regulate attention and impulse control.
b. Faulty regulation of certain neurotransmitters, perhaps dopamine and norepinephrine.
+ Neurotransmitters effect functioning of brain pathways and structures.
4. Unlikely that a single CNS mechanism/function will explain all AD/HD symptoms.
B. Genetic component.
1. Research suggests strong genetic predisposition to AD/HD -
underactivity of certain regions of the brain appears to be genetically
transmitted.
2. Higher rates of AD/HD found in identical vs. fraternal twins.
3. Increased risk of AD/HD in biological relatives.
4. Higher rate of depression, alcoholism, conduct problems found among
biological relatives of AD/HD’s.
C. Environmental component.
1. AD/HD may be exacerbated by exposure to toxin in uterus, pregnancy
complications, and social factors in family.
2. Family dysfunction may make AD/HD symptoms worse but cannot cause it.
3. Psychosocial and educational factors help determine how one’s genetic
script is expressed.
+ Do not self diagnose . . . consult a professional experienced with AD/HD to establish the diagnosis and rule-out others.
A. There is no universally agreed
upon assessment format for AD/HD.
B. There is no single test that can
determine presence of AD/HD.
1. Can’t examine blood, tissue or x-rays to determine if presenting
symptoms are result of AD/HD.
2. AD/HD is diagnosed by evaluating one’s symptoms with a variety of
measures and from different perspectives to determine how well the
symptom pattern fits an AD/HD profile.
C. Possible Assessment Format.
1. Behavior checklists/rating scales.
a. Self/parent/significant other.
2. Semi-structured interview to include:
a. History of symptoms (SX).
(1) Must have had SX before age seven years.
(2) Adult AD/HD can’t exist without child AD/HD, but necessary
evidence often unavailable.
+ Memories often spotty.
+ Helpful to get information from parent/significant other.
b. Treatment history.
(1) Psychological/educational evaluations.
(2) Previous psychotherapy/counseling.
(3) Medication trials.
c. Developmental history.
(1) Pre-natal conditions/pregnancy complications.
(2) Age walked/talked.
(3) Often associated with AD/HD in children:
d. Social/School history.
(1) Peer relationships.
(2) School adjustment.
+ Academic success.
+ Teacher concerns:
* Disruptive behavior.
* Inattention.
* Not working to potential.
e. Post High School Education/Occupational history.
D. Examination of history extremely important.
1. AD/HD adults usually report problems dating back to childhood.
+ Academic.
+ Conduct.
+ Relationships.
2. AD/HD SX may be evident to parent when child is three to four years old.
+ Overactive.
+ Difficult to care for.
+ Doesn’t listen.
+ Temperamental/stubborn.
3. Often identified in early school years when required to:
+ Sustain attention over long periods of time.
+ Follow rules and directions.
+ Interact and cooperate with peers.
4. Still others may not be identified until high school, college or beyond.
+ Individuals with ADD-H may not be disruptive or cause problems in
home/class.
+ Bright individuals may compensate for difficulties and not draw
attention.
+ Students from stable, supportive environments may do well until
entering college when structure decreases and demands to organize
and concentrate increase.
+ Some with AD/HD, especially if highly motivated and overachieving,
may function adequately until forced to juggle adult roles of
parent, spouse, household and career.
E. Common presenting complaints of AD/HD adults:
1. Depression/demoralization.
2. Intense frustration and chronic sense of underachievement - unable to
translate ability into results.
3. Inability to cope with everyday life stresses.
4. Relationship strife and instability.
5. Wish to “get one’s life together”.
+ Often seek help after son/daughter diagnosed with AD/HD.
6. Inattention or distractibility may not be volunteered as a problem. Adults have greater control over their environment than a child - may have selected a lifestyle/career that fits their pattern of strengths and weaknesses.
F. Common presenting complaints of college students with AD/HD:
1. Can’t decide upon a major/drop in and out of school.
2. Lack of motivation; problems with procrastination and time
management.
+ Undisciplined study and living habits.
+ Studies put off until last minute - all night cramming sessions.
+ Late assignments/many incompletes/erratic grades.
3. Need to read and re-read passage to retain information.
+ Studying takes longer than for typical student.
+ Disorganized, distractible, slow to comprehend.
4. Memory problems.
+ Lack of concentration makes it difficult to encode information.
+ Often unable to recall, or produce on demand previously learned
material.
5. Inability to:
+ Express self verbally or on paper due to racing thoughts and
difficulty organizing ideas.
+ Complete exams within time limits.
+ Complete math and foreign language requirements.
G. Differential diagnosis may be difficult.
1. AD/HD often co-exists and may be masked by other conditions.
2. AD/HD may be overlooked because evaluator may be more familiar with
the co-existing disorder.
3. AD/HD will exacerbate other conditions.
4. Various medical and psychiatric conditions may cause AD/HD-like
symptoms.
5. A physical examination may be helpful to rule out medical disorders.
H. Testing.
a. Neuropsychological/personality/intelligence/achievement tests may be
used to help confirm a diagnosis, and to identify/rule-out co-existing
conditions.
b. Cannot diagnose AD/HD solely on basis of tests.
|
KEY to diagnosis of AD/HD is
obtaining the person’s life story - - one’s own recollection of current and
past experiences, confirmed and amplified by significant others.
Ascertain presence of AD/HD from:
|
|
+ In general, treat primary symptoms (distractibility/inattention,
hyperactivity, impulsivity) with medication and increased
structure/organization of one’s daily life. + Treat secondary symptoms (low self-esteem, depression, frustration, impaired relations, drug/alcohol abuse) with psychotherapy. |
A. MEDICATION.
1. Often the most effective and immediate treatment for AD/HD.
a. Primary symptoms respond better to medication than to counseling.
(1) Thought to be effective in about 60-80% of those with AD/HD.
b. When effective, medications:
(1) Improve ability to focus and sustain attention.
(2) Improve impulse control; restlessness, need to fidget.
(3) Decrease mini-panics, startle responses, over-reactions.
(4) Decrease moodiness and tendency to become easily frustrated.
c. Ameliorates, does not cure.
(1) Suppresses symptoms.
(2) Doesn’t eliminate underlying cause.
2. Decision to try medication should be the result of a mutual exploration of:
a. Benefit: risk ratio of trying medication.
b. Benefit: risk ratio of not trying medication.
3. Do not conclude too quickly that medication does not work.
a. Cannot determine beforehand which medication will be most
effective - one’s biochemistry is as unique as one’s personality.
b. May take number of trials to find the best medication, dosage
level, and dosage schedule.
4. Types of medication’s for AD/HD.
a. Psychostimulants.
(1) Ritalin, Dexedrine, Adderall.
(2) Thought to stimulate region of brain (frontal lobe)
considered to be underaroused/underactive in person with AD/HD.
(3) Most common side effects:
(4) Often very effective but may be sparingly prescribed.
+ A controlled substance - potential for abuse exists.
+ Exercise caution with individuals susceptible to abusing
drugs.
(5) Ritalin and Dexidrine have been used for many years without notable long-term detrimental effects, but there is no definitive research proving stimulants have no adverse effects.
b. Anti-depressants.
(1) Thought to have a similar effect on neurotransmitters as
stimulants.
(2) Includes:
+ Tri-cyclic antidepressants (e.g. Desipramine).
+ Wellbutrin.
+ Effexor.
c. Stimulants tend to improve attention and concentration more than
anti-depressants.
d. Anti-depressants tend to improve mood, anxiety and sleep problems
more than stimulants - both tend to improve impulsiveness and
restlessness.
e. Medication should not be regarded as the whole treatment.
(1) Helps control symptoms, but still must learn coping skills.
+ Reduces the amount of traffic on the highway but you still must learn how to drive.
(2) Individuals tend to do better when medications are combined with educational and psychological assistance.
B. PSYCHOTHERAPY.
Areas to be addressed:
|
1. Education.
a. Learning one has AD/HD is often a relief.
(1) Puts a name, and set of solutions, to a problem.
(2) Allows you to look at the past through a new and more accurate
lens.
(3) Helps decrease guilt and shame.
b. Education may be the single most powerful RX for AD/HD.
(1) Knowledge is power!
(a) The more you know, the better you will be able to understand
your life and the turns it has taken.
(b) The more you know, the better you will be able to manage
your difficulties.
(c) Use your knowledge proactively to prevent problems before
they occur.
(d) To learn about AD/HD:
(2) “Educate significant others” - parents, teachers, siblings, friends, lover, spouse.
(a) Share information with those close to you.
(b) Bring your spouse or significant other to a counseling
session.
(c) Talk about your experience.
+ Many with AD/HD try to hide their mistakes and
idiosyncrasies to avoid embarrassment and shame.
+ Often have history of keeping their true selves hidden
from others.
(d) Educating significant others helps them to tolerate your shortcomings and to work towards solutions to problems.
(e) Understanding what is going on for you often helps others retain a sense of humor and perspective.
2. Organization and Structure.
a. Disorganization and inability to structure is a major problem.
(1) Have often spent a lifetime dodging necessity of organizing
yourself.
(2) Need to figure out how to manage your life to stay in sync with
the rest of the world.
b. Benefits of structure:
(1) External control compensates for unreliable internal controls.
(2) Structure makes possible the expression of talent - - without
it, no matter how talented, chaos reigns.
(a) Helps shape and direct creative energies.
(b) Like the walls of a bobsled run, it keeps the sled on path.
c. To improve structure:
(1) Develop routines and rituals doing the same tasks, in the same order, on the same schedule.
(a) Habitual behavior doesn’t tax memory.
(b) Adds consistency and order to life.
(c) Regular bed, waking and meal times.
(d) 10 minute planning session in the evening to map out
tomorrow.
(e) Keep your morning routine as simple as possible.
(f) Make it a habit to be at class, meetings and appointments on
time.
(g) Do not underestimate the shock to your system that occurs
due to the lack of structure and external control that is
typical of the college environment.
(2) Utilize schedules, lists and reminders.
(a) Buy a daily planner and keep it with you.
+ Make sure it’s a sophisticated planner.
+ Live by the rule “do it now or write it down.”
(b) Weekly study schedule.
(c) Semester calendar.
(d) Implement to-do lists, reminders, visual prompts.
+ “Post-it’s” on bathroom mirror.
+ Key hook by door.
+ Have back-ups for essential items (eg. spare car keys at
office).
(e) Note pads in strategic places.
+ Bathroom, bedroom, study desk.
+ You never know when an idea might hit.
(f) Utilize filing systems, rolodexes and bulletin boards.
(3) Organize your living space.
(a) It’s difficult to be organized and efficient when surrounded by clutter.
+ Those with AD/HD are very sensitive to environmental cues, if your environment is disorganized so will your thinking.
(b) File vs. pile.
(c) Once your space is organized, train yourself to keep it this
way.
(4) You may initially feel overwhelmed when trying to develop form from chaos.
(a) Need to start somewhere.
+ Become clear on problems.
+ Prioritize.
(b) Break projects down into smaller parts and complete each part.
+ Large tasks overwhelm.
(c) Don’t be afraid to ask for help.
+ Instructor.
+ Classmate.
+ Spouse.
+ Friend.
(d) Some projects will fail - - the cost of doing business.
(5) Effective organization strategies must be practiced until they
become habit.
(6) Those with AD/HD are often more dependent on external sources
for the drive and motivation to persist on tasks not providing
immediate reinforcement.
+ Try to ensure that you have a network friends/family/advisors who can support you in your efforts.
3. Treatment of Secondary Symptoms.
Improving self esteem
a. Will often suffer from low self-esteem.
(1) Damaged by experiences of frustration, failure and negative
reactions from others.
(2) Have often spent years feeling inadequate, out-of-step, and
misunderstood.
(3) Have often grown up with such labels as lazy, oddball,
underachiever, klutz.
(4) May have forgotten what is good about yourself.
b. Identify and develop your gifts and areas of competency.
(1) Often unusually creative.
+ Able to view things in novel manner.
+ Comfortable with the chaos and disorganization needed to
create something new and different.
+ Visionary imagination.
+ Complex sense of humor.
+ Inventors and innovators.
+ Mozart, Edison, Einstein thought to have had AD/HD.
(2) High energy - movers and doers.
(3) Enthusiastic/spontaneous.
(4) Trusting nature, warm-hearted.
(5) Sensitive.
(6) Intuitive.
(7) Strong willed and independent.
(8) Ability to hyperfocus when captivated by task.
+ Can accomplish large amounts in short period of time.
(9) Learn to use your strengths to full advantage.
c. Explore alternate means of bolstering sense of self worth.
(1) Sports/hobbies/crafts.
(2) Clubs/groups/organizations.
(3) Become a tutor, volunteer your time.
d. Practice forgiveness.
(1) At the end of each day reflect on your accomplishments.
(2) Forgive yourself for making mistakes.
+ Not a license to repeat them.
+ Learn how to cope with mistakes so you can learn from them,
instead of being traumatized by them.
+ Avoid the tendency to deny, rationalize or externalize
responsibility for self-defeating behavior.
(3) Forgive those you’ve had conflicts with.
+ Does not mean transgressions should be overlooked.
Managing your mood
a. Those with AD/HD are prone to periods of blues, moodiness and
depression.
b. Tend to engage in excessive negative self-talk.
(1) May have long ago resigned self to attitudes of:
+ “It’s hopeless”.
+ “I’m a loser”.
+ “I can’t do anything right”.
+ “Here it goes again”.
(2) Negative self-talk goes on endlessly, relentlessly,
unforgivably.
(3) Must be identified and replaced with more positive messages.
+ “I’m OK”.
+ “I’ll give it another try”.
+ “There’s nothing wrong with being different”.
+ “So I made a mistake, I’ll learn from it and do better next
time.”
(4) Will often revert back to old thinking habits - especially negativity.
+ Don’t give up!
c. Strive to remember and hold onto past successes.
(1) Tend to forget successes and brood about shortcomings.
d. Learn to anticipate and manage your moods.
(1) Identify and acknowledge your feelings.
(2) Learn to tolerate those that are painful.
+ I Trust that they will pass.
+ I Practice strategies to help them pass sooner.
* Compile list of 10 things to do when feeling down.
* Use it!
(3) Some with AD/HD attempt to short-circuit painful feelings through impulsive action.
e. Avoid setting yourself up.
(1) Seek balance in your life - - emotionally, professionally, and socially.
+ Find a healthy equilibrium between the structure you need and
the spontaneity you enjoy.
+ This can be a high wire act.
(2) A person with AD/HD is like an expensive sports car - - you need to be well cared for to get top performance.
+ Attend to physical and emotional needs.
+ Don’t get strung out.
+ Build in “chill out” time.
+ AD/HD symptoms are worse under stress - don’t procrastinate!
(3) Analyze your personal schedule - - responsibilities, duties, free time.
+ Often overbook and overcommit - can’t say “no”.
+ For some, it helps to keep life simple - overextending oneself
may result in feeling overwhelmed.
+ Others are most effective when very active and involved - if
have spare time, will waste it.
(4) Analyze your strengths and weaknesses.
+ What do I do well?
+ What do I do adequately?
+ What shouldn’t I do?
(5) Give careful thought to the choice of romantic partners - love
somebody who will love you back.
(6) Exercise regularly.
+ Soothes and calms body.
+ Helps relax, clear and focus mind.
+ Works off excess aggression/energy.
+ Often do best thinking during or immediately after exercise.
+ It may help to exercise with a friend.
(7) Practice relaxation techniques.
+ Progressive relaxation
+ Deep breathing
+ Visual imagery
(8) Learn how to find and ask for help effectively.
+ Don’t wait for a crisis to seek assistance.
+ Deal with stressors before they compound.
(9) Seek encouragement and support of others.
+ Thrive with it/whither without it.
+ Will often do for others things wouldn’t do for self.
+ Cultivate friendships, join groups where you are appreciated.
+ Seek out mentors and role models.
+ Learn about available resources and how to access help.
+ Join an AD/HD support group.
Improving interpersonal effectiveness.
a. Some with AD/HD (especially ADD+H) while outgoing and gregarious, feel lonely and disconnected from others.
+ Often socially awkward.
+ Impulsive - may speak before thinking.
+ May be aggressive and intrusive - appear rude.
+ Tend to elicit strong reactions from others - charismatic or
scorned.
+ Tend to be poor self-observers.
+ Don’t accurately gauge their impact on others.
b. Others with AD/HD (especially ADD-H) tend to be shy, quiet and seek to avoid drawing attention to themselves.
+ More likely to be overlooked by peers than rejected.
+ Not disliked as much as not remembered.
+ Often over-sensitive and easily hurt.
+ Susceptible to being taken advantage of in relationships.
c. Both may shun close relationships to avoid being rejected or
disregarded.
d. To improve:
+ Seek feedback from others.
* How do you come across?
* How does your behavior effect how others respond?
+ Examine self-defeating behavior.
* What led up to your reaction?
* What could have been done differently?
+ Learn what to do in social situations.
* Making “small talk”.
* The importance of listening.
+ Learn how to present yourself.
* Eye contact.
* An effective handshake.
e. Some issues between people may never be resolved.
+ Too many hurtful interactions and damaged feelings.
+ Life is full of compromises and half solutions.
Improving learning ability/academic performances
a. College students with AD/HD often inadequately prepared for learning.
+ May have skipped many classes in high/grade school.
+ Early school difficulties may have resulted in being guided to
less demanding courses.
+ Effective study habits and critical thinking skills often
underdeveloped.
+ Attitudes towards academics may be non-conducive for success.
b. Learn and practice productive study strategies.
+ Reading/note-taking/paper-writing skills.
+ Manage your time effectively - follow a study schedule.
+ Develop clear short and long-term goals - monitor them regularly.
+ Accept the fact that you may have to study longer and harder than
some students.
+ Test-taking skills.
+ Read questions carefully.
+ Practice writing essays.
c. Recognize learning strengths and weaknesses.
+ There are many ways to study - what works best for you?
+ When do you study best?
+ Are you more effective during the day or at night?
+ Fatigue and time of day often effect those with AD/HD more.
+ Often perform better in AM vs. PM classes.
+ What is your best learning style?
+ Are you an auditory learner?
+ Visual learner?
+ Hands-on learner?
d. What classes/subjects come easier?
+ Typically better when instructors are active and novel.
+ Better in discussion vs. lecture classes.
+ Better in smaller classes.
HINT: Check out instructors before
registering for classes.
|
e. To improve concentration in class:
+ Review assigned reading prior to lecture.
+ Sit in front row.
+ Maintain eye contact with instructors.
+ Actively participate in class discussions to increase your
concentration.
+ Avoid proximity to high traffic areas (e.g. doors, windows).
+ Form a working relationship with each instructor.
- Make sure they know who you are.
f. Notice where you study best.
+ May thrive under unusual conditions.
- Noisy room.
+ Background music may help if distractible.
+ Modify your environment to create atmosphere where you can study
most effectively.
+ Consider ear phones or utilize a “white noise” machine.
+ It may help to walk around and talk to yourself as you study -
movement may improve processing of information.
+ May need to tap foot/hum to recruit enough attention to
concentrate and focus.
+ Make sure your study area is organized and you have your study
materials near.
g. What keeps you energized and motivated?
+ If distractible:
* Modify your study area.
* Move to a different area.
+ If bored:
* Take a break.
* Mix low-interest activities with higher interest activities.
* Do something physical.
* Challenge yourself to complete a fixed amount of work.
+ If overwhelmed:
* Take a short break, get your thoughts together and return to
your project.
* Break work down into smaller units.
* Ask for some help to get started.
+ Learn to identify “crunch” times to avoid overload.
* Utilize a semester calendar.
+ Utilize study breaks.
* 40 - 45 minutes of study, 10 - 15 minutes of break.
- Get back to work promptly.
* Take more frequent breaks (e.g. every 30 minutes) if they help you study.
+ Form a study group.
* Test your comprehension of reading material through discussion
with other students.
* Stimulation of interacting with others may increase your
interest.
+ If you need “deadline pressure” to perform, procrastinate “planfully”.
* Make sure you have the materials and time to complete your project.
+ Use activities you want to do as rewards for doing those activities you ought to do.
* Dinner with a friend.
* New CD.
* A movie.
h. Take advantage of university resources.
+ Tutoring and Learning Center.
+ Counseling Center.
+ Health Services.
+ Disability Services.
+ Career Services.
i. Know your rights - become your own advocate.
+ 1973 Rehabilitation Act, Section 504.
+ 1975 Individuals with Disabilities Education Act.
Improving work performance.
a. Job selection important.
+ Those with AD/HD vary in what type of atmosphere they work best
in.
+ Some need structure with clear goals and readily available
supervision.
+ Others thrive in atmosphere of independence and challenge.
+ Most need an outlet for their creativity.
b. Don’t feel chained to conventional careers.
+ Don’t try to force self into a mold you may never fit.
+ Don’t be bound by other people’s expectations.
+ Delegate tasks you aren’t good at.
+ Consider alternate means of working (eg. job sharing, independent
contractor, consultant).
c. To assist an employee with AD/HD.
+ Utilize clear instructions and time limits - provide needed
structure and focus.
+ Directions should be short, easily understood or written down.
+ Rearrange nature of work to make it more interesting.
+ Provide immediate and salient consequences and rewards.
+ Those with AD/HD often experience greatest difficulty when
responsibilities aren’t clearly defined; regulations seem arbitrary;
rules are not consistently enforced.
Chronicity of AD/HD.
a. AD/HD is an on-going, persistent medical condition in the same manner
as diabetes.
b. No existing treatment permanently corrects underlying problem.
+ This does not mean it’s unmanageable.
+ Most helpful interventions involve life style changes and
medications.
c. Coping strategies need to become part of your life.
+ A life style, not a life sentence.
d. Manage your living environment to compensate for AD/HD behavior.
+ Develop compensatory strategies that can be used everyday.
+ Learn to cope with AD/HD symptoms in on-going manner.
+ Take one day at a time and keep it simple.
+ Progress is often uneven - - - two steps forward, one step back.
+ You may find it difficult to “stay with the program,” even if it
is working.
+ Don’t give up on yourself.
|
Long-term follow-up study on AD/HD
children: Looking back as adults, the most important assistance they received was the feeling that...
|
A. ADDendum (for adults with ADD)
c/o C.P.S.
5041-A Backlick Road
Annadale, VA 22003
This quarterly publication for adults with AD/HD includes reviews of recent research, interviews and articles by leading researchers and clinicians specializing in adult AD/HD, question and answer columns; and articles/poetry written by adults with AD/HD. ADDendum has available a nationwide listing of adult AD/HD support groups.
B. ADDult News
C/O Mary Jane Johnson
ADDult Support Network
2620 Ivy Place
Toledo, OH 43613
This newsletter includes articles about issues relevant to adults with AD/HD, as well as a listing of resources/support group announcements.
C. Attention Deficit Disorder
Association (ADDA)
P.O. Box 972
Mentor, OH 44061
(800) 487-2282
ADDA provides educational resources on AD/HD to individuals and support organizations.
D. C.H.A.D.D.E.R. and C.H.A.D.D.E.R.
BOX
C.H.A.D.D. National Headquarters
499 NW 70th Avenue, Suite 308
Plantation, FL
C.H.A.D.D.E.R.: A bi-annual, twenty-five page plus newsletter that frequently contains articles written by leading researchers and clinicians for adults with AD/HD.
C.H.A.D.D.E.R. BOX: A monthly newsletter with several issues per year devoted solely to adult AD/HD concerns.
E. Self-Help Clearing House
St. Claire’s Riverside Medical Center
Pocono Road
Denville, NJ 07834
(201) 625-9565
Provides local/national referral services and carries support group listings.
F. Disability Services...UW-Stevens
Point
Student Services Center, Room 103
1100 Fremont Street
Stevens Point, WI 54481
(715) 346-3362
Provides information on assessment and services to students.
1. Bramer, J. (1996). Succeeding In College With Attention Deficit Disorders. Florida: Specialty Press.
2. Hallowell, E. & Ratey, J. (1994). Answers to Distraction. New York: Bantam Books. (Read after Driven to Distraction).*
3. Hallowell, E. & Ratey, J. (1994). Driven to Distraction. New York: Pantheon Books.*
4. Hartmann, T. (1995). ADD Success Stories. California:Underwood Books.*
5. Kelly, K. & Ramundo, P. (1993). You Mean I’m not Lazy, Stupid or Crazy? A self help book for Adults with Attention Deficit Disorder. Cincinnati: Tyrell & Jerem.
6. Murphy, K. (1995). Out of the Fog. New York:Skylight Press.*
7. Nadeau, K. (1994). Survival Guide For College Students With ADD or LD. New York: Magination Press.
8. Nadeau, K. (Ed.) (1995). A Comprehensive Guide to Attention Deficit Disorder in Adults. New York: Brunner/Mazel.*
9. Solden, S. (1995). Women with Attention Deficit Disorder. California: Underwood Books.*
10. Weiss, L. (1992). Attention Deficit Disorder in Adults: Practical Help for Sufferers and their Spouses. Dallas: Taylor.
11. Wender, P. (1995). Attention Deficit Hyperactivity Disorder in Adults. New York: Oxford Press.
* highly recommended.
AD/HD Report (1994). V2#1.
AD/HD Report (1994). V2#3.
AD/HD Report (1994). V2#6.
AD/HD Report (1996). V4#1.
AD/HD Report (1997). V5#3
American Psychiatric Association (1994): Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, D.C. American Psychiatric Association/1994.
Barkley, R. (1990). Attention Deficit Hyperactivity Disorder. New York: Guilford Press.
Barkley, R. (1992). ADHD: What Can We Do? Program Manual. New York: Guilford Press.
Barkley, R. (1994). ADHD in Adults: Program Manual. New York: Guilford Press.
Barkley, R. (1997). Behavioral Inhibition, Sustained Attention, and Executive Functions: Constructing A Unifying Therapy of AD/HD. Psychological Bulletin, 121: 65-94
Barkley, R. (1998). Attention - Deficit Hyperactivity Disorder (2nd Ed.) New York: Guilford Press.
Christie, L. (1996). AD/HD Workshop. Madison, WI.
Copeland, E. & Copps, S. (1995). Medications For Attention Disorders and Related Medical Problems. Florida: Specialty Press.
Friedman, R. (1994). AD/HD Workshop. Stevens Point, WI
Halowell, E. & Ratey, J. (1994). Answers to Distraction. New York: Bantam.
Halowell, E. & Rately, J. (1994). Driven to Distraction. New York: Pantheon Books.
Halowell, E. (1997). What I’ve Learned from A.D.D. Psychology Today. May/June, p. 40.
Hartman, T. (1995). ADD Success Stories. California: Underwood Books.
Hughes, J. (1997). American Journal of Psychiatry. 154(1): 132.
Javorsky, J. & Gussin, B. (1994). College Students with Attention Deficit Disorder: Overview and Description of Services. Journal of College Student Development, 35: 70-177.
Journal of Postsecondary Education and Disability (1995). V11 #2 & 3.
Kelly, K. & Ramundo, P. (1993). You Mean I’m Not Lazy, Stupid, or Crazy? A Self Help Book for Adults with Attention Deficit Disorder. Cincinnati: Tyrell & Jerem.
Latham, P.S. & Latham, P. (1992). Attention Deficit Disorder And The Law. Washington: JRL Communications.
Murphy, K. (1995). Out of the Fog. New York: Skylight Press.
Murphy, K. & Barkley, R. (1996). Parents of Children with Attention Deficit/Hyperactivity Disorder. American Journal of Orthopsychiatry. 66(1): 93-102.
Nadeau, K. (1994). Survival Guide for College Students With ADD or LD. New York: Magination Press.
Nadeau, K. (Ed.) (1995). A Comprehensive Guide to Attention Deficit Disorder in Adults. New York: Brunner/Mazel.
Roberts, M.S. & Jansen, G. (1997). Living With ADD. Oakland: New Harbinger Productions
Weiss, L. (1992). Attention Deficit Disorder in Adults. Dallas: Taylor.
Wender, P. (1995). Attention Deficit Hyperactivity Disorder in Adults. New York: Oxford Press.