Saturday, October 8, 2011

Seven Facts you need to know about ADHD

CHADD (Children and Adults with Attention Deficit/Hyperactivity Disorder), the American nonprofit organization serving individuals and their families, has developed a list of “Seven Facts You Need To Know About ADHD” to promote awareness, identification and treatment for those affected by this disorder: 1. ADHD is real. Nearly every mainstream medical, psychological and educational organization in the United States long ago concluded that Attention-Deficit/Hyperactivity Disorder (ADHD) is a real, brain-based medical disorder. These organizations also concluded that children and adults with ADHD benefit from appropriate treatment.
2. ADHD is a common, nondiscriminatory disorder. ADHD is a nondiscriminatory disorder affecting people of every age, gender, IQ and religious and socioeconomic background. In 2011, the Centers for Disease Control and Prevention reported that the percentage of children in the United States who have ever been diagnosed with ADHD is now 9.5 percent. Boys are diagnosed two to three times as often as girls. Among adults, the Harvard/NIMH National Comorbidity Survey Replication found 4.4 percent of adults, ages 18-44 in the United States, experience symptoms and some disability. ADHD, AD/HD and ADD all refer to the same disorder. The only difference is that some people have hyperactivity and some people don’t.
3. Diagnosing ADHD is a complex process. In order for a diagnosis of ADHD to be considered, the person must exhibit a large number of symptoms, demonstrate significant problems with daily life in several major life areas (work, school or friends) and have had the symptoms for a minimum of six months. To complicate the diagnostic process, many of the symptoms look like extreme forms of normal behavior. Additionally, a number of other conditions resemble ADHD. Therefore, other possible causes of the symptoms must be taken into consideration before reaching a diagnosis of ADHD. What makes ADHD different from other conditions is that the symptoms are excessive, pervasive and persistent. That is, behaviors are more extreme, show up in multiple settings and continue showing up throughout life. No single test will confirm that a person has ADHD. Instead, diagnosticians rely on a variety of tools, the most important of which is information about the person and his or her behavior and environment. If the person meets all of the criteria for ADHD, he or she will be diagnosed with the disorder.
4. Other mental health conditions frequently co-occur With ADHD.
• Up to 30 percent of children and 25-40 percent of adults with ADHD have a co-existing anxiety disorder.
• Experts claim that up to 70 percent of those with ADHD will be treated for depression at some point in their lives.
• Sleep disorders affect people with ADHD two to three times as often as those without it.
5. ADHD is not benign. Particularly when it is undiagnosed and untreated, ADHD contributes to:
• Problems succeeding in school and successfully graduating.
• Problems at work, lost productivity and reduced earning power.
• Problems with relationships.
• More driving citations and accidents.
• Problems with overeating and obesity.
• Problems with the law.
6. ADHD is nobody’s fault. ADHD is not caused by moral failure, poor parenting, family problems, poor teachers or schools, too much TV, food allergies or excess sugar. Instead, research shows that ADHD is both highly genetic (with the majority of ADHD cases having a genetic component) and a brain-based disorder (with the symptoms of ADHD linked to many specific brain areas). The factors that appear to increase a child’s likelihood of having the disorder include gender, family history, prenatal risks, environmental toxins and physical differences in the brain.
7. ADHD treatment is multi-faceted. Currently, available treatments focus on reducing the symptoms of ADHD and improving functioning. Treatments include medication, various types of psychotherapy, behavioral interventions, education or training and educational support. Usually a person with ADHD receives a combination of treatments.

Friday, September 30, 2011

My Request to the West Australian Newspaper

I wrote a letter to the newspaper today. Will they print it? Time will tell. I thought I'd share my thoughts here as well, because I feel so strongly about this issue.

The front page of today's West Australian tells the story of a courageous man who has gone public with his struggle to deal with Bipolar Disorder, and his very close call with suicide. The issue is treated with the respect it deserves. Bipolar Disorder is described as a chemical imbalance, and the reader is left in no doubt that it is a serious condition, requiring specialised treatment. There is respectful mention of the treating psychiatrist and the use of medication. As a result of this article, the general public has a better understanding of Bipolar Disorder. People with Bipolar Disorder will find it easier to request help, and those experiencing worrying symptoms will be more inclined  to make a doctor's appointment, or to contact Lifeline, whose telephone number was supplied.

Page 13 of the same newspaper carries an article about ADHD in Western Australia - specifically, what it deems to be the over-use of stimulant medication to treat it. People with ADHD are vilified, and so are the doctors who treat them. A politician in western Australia, who has no medical qualifications whatsoever is permitted to dominate the discourse in this serious matter. He points out that adults diagnosed with ADHD are predominantly from wealthier suburbs in WA, but neglects to say that adults with ADHD are denied treatment in the public health system. Only those who can afford a private psychiatrist receive treatment. He then accuses people diagnosed with ADHD of abusing their medications. There is no mention of the people who have had their lives turned around by their diagnosis and by the use of this medication. Finally, he attacks the doctors - in particular one psychiatrist in WA who treats 1253 patients a year for ADHD. He fails to mention that people with ADHD only see their specialist once every six months, or perhaps even once a year. Would an orthopaedic surgeon who specialises in knee replacements be criticised for seeing 1253 patients with knee problems?

Finally, the voice of reason - and it is only offered the final 2 sentences of the article in which to make itself heard. Margaret Vikingur, president of the evidence-based support group LADS (Learning & Attentional DIsorders Society of WA Inc), rightly points out that there is much scientific evidence to support the diagnosis and treatment of ADHD in adults. So why is this evidence consistently ignored?

Let's look at the evidence, and put this hysterical nonsense about ADHD to bed. We know from epidemiologocal studies that ADHD occurs in 4.4% of the adult population. We also know frorm the latest avalable WA report that the number of adults taking medication for ADHD is lower than 0.5%. So why are we constantly fed misinformation about over-prescription when the condition is clearly under-diagnosed and under-treated? We also know from the substantial research available that people with ADHD have a greater risk of developing other mental illnesses, including Depression, Anxiety, Obsessive Compulsive Disorder and Bipolar Disorder. Untreated, people with ADHD find themselves with significant difficulties in the workplace, at university and in personal relationships.

One thing we do know, is that people whose ADHD is properly managed can be extremely successful members of society. In fact, the world needs people with ADHD - big picture thinkers with mountains of energy and an endless supply of wonderful ideas. Sadly, as a result of today's article on pg 13, people diagnosed with ADHD will find it even harder to disclose their conditions to friends and colleagues and ask for their support. They will feel less inclined to see their doctors about troubling symptoms. Many will try to soldier on alone. They were not even given the telephone number of the only evidence-based support group in the state. So here it is: (08) 9346-7544. Call LADS if you need to speak to someone who knows what you're going through, and how upsetting articles like today's pg 13 can be. I have made a request of the West Australian - that future articles on ADHD focus on the research and not the opinions of a politician.

Tuesday, August 23, 2011

ADHD Coach Perth: Tips for improving emotional wellbeing at school

In my last blog I spoke about a recent link established between children's mental health & wellbeing and academic results. In this blog I'll share some tips for enabling the school to support your child's emotional as well as academic progress.

Teach them about your child - Make a list of your child's strengths and challenges, and ensure that all of your children's teachers receive the list. If your child is at high school, don't rely on the year co-ordinator to inform everybody - do it yourself, and follow through to check that they have all received the information. If your child is at primary school, remember to include art, music or physical education teachers. Tell teachers that your child has ADHD, but also let them know if there are any co-existing conditions such as anxiety or a learning difficulty.

Let the teachers know what they can do to help your child be successful Share information about your child's strengths (e.g. 'My child is an expert on birds - or WWII fighter planes, and would love an opportunity to share some of this knowledge with the class). Ask the teacher to 'prep' your child in private about questions that will come up in the class (e.g. 'Tomorrow when I talk about volcanos, I'll be asking you about ..... What will your response be?) A few successful responses will enable your child to answer future questions more confidently in the future.

Don't assume that the teacher knows about ADHD. Teachers sometimes base their ADHD  strategies on experiences they have had with a particular student. Let your child's teacher know that ADHD affects each child differently. For example, some children with ADHD have very slow processing speeds, and need a lot more time to complete their work. Others need to work really quickly in order to get all of the information out of their heads and onto paper. Be sure to inform the teacher that inconsistency is one of the most frustrating aspects of ADHD.  Teachers often assume that students aren't trying hard enough because they are successful one day and unsuccessful the next.

Request a mentor or a go-to person for your child. Children with ADHD can feel very isolated and overwhelmed at school. This can result in frequent toilet breaks or sick bay visits. Find out who your child trusts at the school, and have an arrangement for your child to see that person when he or she feels the need. When children feel supported they are far less likely to get anxious - which means they are better able to learn.

Ask the teacher to treat your child with respect. Teachers often become frustrated with challenging children, and they sometimes let that frustration show. As Rick Lavoie explains, each time a teacher is short or disrespectful towards a child, they are giving the rest of the class permission to behave in the same way. By way of contrast, if teachers go out of their way to show the class that they value your child, they will be encouraging other students to do the same.

Contact me if you have more specific concerns about your child:
Mobile 0411 067 541
Email: micheletoner@hotmail.com



Friday, July 22, 2011

ADHD Coach Perth: Children's Mental Wellbeing Produces Academic Success

A recent PhD study conducted at the Flinders University in Australia examined  a programme to promote mental health in primary school children and its effect on academic performance. (Dix et al, Implementation Quality of Whole-School Mental Health Promotion and Students' Academic Performance. Child & Adolescent Mental Health, 2011). The study found that schools which implemented the KidsMatter mental health programme well achieved better academic outcomes in students, equal to 6 months or more of schooling by year 7.

 KidsMatter is an Australian mental health early intervention initiative. It was designed to involve all members of the school community, including  students, parents, teachers & principals. The programme had 3 aims: (1) to improve the mental health & wellbeing of students; (2) to reduce mental health problems among students, and: (3) to achieve greater support for students experiencing mental health problems.  In order to achieve these aims it provided: (1) a positive school community; (2) social & emotional training for students; (3) parenting support & education, and: (4) early intervention for students with mental health difficulties.

NAPLAN (National Assessment Program - Literacy and Numeracy) results were cross-referenced with results from the KidsMatter Primary Evaluation data. Socio-economic factors and family circumstances were controlled so as not to influence the results. The study has limitations. But as an initial exploration of this issue it highlights what other researchers have previously noted, namely, that there are strong links between student behaviour, academic achievement, and social & emotional development. In the words of one principal: 'We found that happy kids and contented kids, and kids who know how to interact better with one another are much better learners'

Is your child's school looking after their social & emotional wellbeing as well as their learning needs? In my experience there is often a willingness on the part of teachers to support children in every way, but they don't always know how to do it. Schools are always open to suggestions. In my next blog I'll suggest some strategies you might want to pass on to your child's school.

Wednesday, July 6, 2011

Embracing Difference in the Workplace

A recent article published in the Melbourne University Law Review addresses the issue of ADHD in the workplace. I was particularly pleased and proud to read it because it quotes my Masters research.
For those who wish to read the article in its entirety, here is the reference:
IT JUST DOESN'T ADD UP: ADD/ADHD, THE WORKPLACE AND DISCRIMINATION. Melbourne University Law Review 34 No. 2, 2010. Authors : Bruce Arnold, Patricia Easteal, Simon Easteal & Simon Rice,

The authors start by making the valuable point that workplace conditions which appear  fair can often discriminate against people who find conforming to them difficult or even impossible, due to neurological or cognitive differences. Furthermore, people who experience discrimination are required to prove this by using the Australian Disability Discrimination Act (DDA). This can be problematic for those with so-called 'invisible' difficulties such as ADHD, because of the attached stigma, and the way the DDA is interpreted.  An alternative approach, as advocated by the authors of this article, is to treat ADHD within a framework that recognises different abilities (in the same way that gender and race differences are treated), rather than classing it as a disability.

Infrastructure and employment practices in our current society were designed at a time when there was little acknowledgement of genetic diversity. Conditions that suit the majority are considered to be fair. As a result, people who do not fit in, and require special arrangements appear, and are labelled disabled. However, the acknowledgement that women, for example, are disadvantaged in the workplace does not label them as disabled, rather as having different needs. Is it possible that neurodiversity could receive the same treatment as women, when attempting to provide fair working conditions? Workplaces that accommodate women  using flexible working conditions benefit greatly from the contributions made by these women. In the same way, workplaces that provide flexible working conditions for people with ADHD will be enriched by the many positive attributes they display.

We know from the research that ADHD can reduce employment opportunities for some. People with ADHD can find it difficult to complete tasks without digressing to another activity; time management can be problematic; they may hyper-focus on one task to the detriment of other equally important work; they appear to procrastinate, particularly with tedious tasks; they may fidget and pace. In addition, they may experience difficulty with social interactions - talking excessively and appearing over-emotional.On a positive note, there are many characteristics of people with ADHD, and these should provide incentive for changes in the workplace. As this article argues, the flipside of what is described in the literature as an 'impairment'of executive functioning may be a creative genius with a richness of wandering thoughts that could greatly benefit an organisation. Tapping into diversity can improve organisational performance.

Anti-discrimination law in Australia places ADHD in a disability framework, based on the idea that ADHD is a deficit relative to a norm. This approach compares a person who has a disability with a person who does not, or against a standard that is 'objectively' reasonable.  The law anticipates that people with a characteristic that differs from the 'norm' will suffer for it. Therefore disability discrimination laws operate to protect, not to promote. They endorse a positive view of a difference indirectly - by reprimanding those who take a negative view of that difference.


As this article points out, however, legislation that prohibits discrimination on the ground of race or sex is designed to negate the concept of a 'normal' sex or race and to promote equal, non-differential treatment. Therefore, when a person complains of sex discrimination, they identify as having a particular sex, and claim they have been treated differently because of this. Disability discrimination, on the other hand, establishes a deficit, which does not measure up to the accepted 'ability'. Instead of protecting people who are deemed less able, the article proposes that they be accepted for a different ability. If there is unfair treatment in the workplace, it should be addressed within a framework of neurodiversity, that recognises people as differently abled, rather than as disabled - in the same way that people are recognised for being differently gendered or having different cultural backgrounds.

Using this approach, a person with ADHD would not be labelled as an employee with a 'problem', but as an employee with abilities. If performance problems arose, the adjustments made would be designed to accommodate diversity, rather than to compensate for disability.

In conclusion, the article points out that modern workplaces are more diverse than ever before, and a simple 'one-size-fits-all' approach to management is no longer appropriate. Workplaces could and should be adjusted to accommodate neuro-cognitive diversity.

Saturday, June 4, 2011

The Genetics of ADHD

A substantial number of behaviour genetics and molecular genetics studies have confirmed the strong genetic component associated with AD/HD. Behaviour genetics investigates the contribution of genes and the environment to individual differences in behaviour. Such research traditionally examines familiality (Does ADHD run in families?) and heritability (Does ADHD get passed on ?) . Numerous family studies confirm the highly familial nature of ADHD, with first-degree relatives displaying a four to five fold risk of ADHD compared to the general population.


Twin studies and adoption studies, in addition, are necessary to ascertain whether the familial nature of ADHD is due to genes or the environment. Adopted children share genes but not the environment with their biological parents. Any similarity between these adopted children and biological parents can therefore be attributed to their shared genes. In the same way, similarities between adopted children and their adoptive parents can be attributed to the environment they share. Adoption studies have found that adoptive parents of children with ADHD display less behaviours of hyperactivity, and do better on standardized tests of attention than the biological parents, supporting the belief that ADHD has a genetic component. Twin studies have also investigated the genetic components of ADHD. When conducting twin studies, researchers consider behaviours which are highly common to identical twins to be influenced by genetics, with those common to non-identical twins to be caused by environmental factors. In reviewing the numerous twin studies on the heritability of ADHD, researchers have concluded that up to 90% of the aetiology of ADHD can be attributed to genetic factors.

Molecular genetics research of ADHD includes linkage and association studies. Linkage studies aim to pinpoint the location of individual genes responsible for a particular disease, an approach which has not been successful with ADHD, due to the multiple genes involved. However association studies in ADHD have followed a candidate gene approach, which has been very successful in identifying risk genes for ADHD. Focusing on the genes of neurotransmitter systems such as dopamine, serotonin and noradrenalin, it has identified DRD4, DRD5 and DAT1 as risk genes for ADHD. Researchers in the field of genetics are presently developing methods of combining behaviour genetics with molecular genetics research. These combined studies could, in the future, assist in the identification of specific genes implicated in ADHD, assisting the processes of diagnosis and treatment.

A substantial number of behaviour genetics and molecular genetics studies have confirmed the strong genetic component associated with ADHD. Behaviour genetics investigates the contribution of genes and the environment to individual differences in behaviour. Such research traditionally examines familiality (Does ADHD run in families?) and heritability (Does ADHD get passed on ?) . Numerous family studies confirm the highly familial nature of ADHD, with first-degree relatives displaying a four to five fold risk of ADHD compared to the general population.


Twin studies and adoption studies, in addition, are necessary to ascertain whether the familial nature of ADHD is due to genes or the environment. Adopted children share genes but not the environment with their biological parents. Any similarity between these adopted children and biological parents can therefore be attributed to their shared genes. In the same way, similarities between adopted children and their adoptive parents can be attributed to the environment they share. Adoption studies have found that adoptive parents of children with ADHD display less behaviours of hyperactivity, and do better on standardized tests of attention than the biological parents, supporting the belief that ADHD has a genetic component. Twin studies have also investigated the genetic components of ADHD. When conducting twin studies, researchers consider behaviours which are highly common to identical twins to be influenced by genetics, with those common to non-identical twins to be caused by environmental factors. In reviewing the numerous twin studies on the heritability of ADHD, researchers have concluded that up to 90% of the cause of ADHD can be attributed to genetic factors.

Molecular genetics research of ADHD includes linkage and association studies. Linkage studies aim to pinpoint the location of individual genes responsible for a particular disease, an approach which has not been successful with ADHD, due to the multiple genes involved. However association studies in ADHD have followed a candidate gene approach, which has been very successful in identifying risk genes for ADHD. Focusing on the genes of neurotransmitter systems such as dopamine, serotonin and noradrenalin, it has identified DRD4, DRD5 and DAT1 as risk genes for ADHD. Researchers in the field of genetics are presently developing methods of combining behaviour genetics with molecular genetics research. These combined studies could, in the future, assist in the identification of specific genes implicated in ADHD, assisting the processes of diagnosis and treatment.

(Ref: Hawi, Z., & Lowe, N. (2007). Molecular genetic aspects of attention deficit hyperactivity disorder. In M. Fitzgerald, M. Bellgrove & M. Gill (Eds.), Handbook of attention deficit hyperactivity disorder (pp. 129-149). West Sussex: John Wiley and Sons.)

Saturday, May 28, 2011

Do ADHD Medications Cause Heart Problems in Children?

In recent years there has been concern expressed by some researchers that children on ADHD medications may be at increased risk of developing heart problems. A new American study (Schelleman et al, Pediatrics, May 16 2011) examined this proposed link. The researchers used extensive medical databases to compare the frequency of cardiac events in children using ADHD medications with children who have never taken ADHD medication. They identified a large group (241 417) of children taking medication (Dexamphetamine / Ritalin / Concerta / Strattera) and matched each child with non-users of medication on the basis of data source, gender, state and age. Cardiovascular events were verified using medical records. Data analysis showed no significant differences in the rate of sudden death, stroke or irregular heart rhythms between medication users and non-users. Furthermore, no heart attacks were identified in medication users.

The researchers concluded that the rate of cardiovascular events in children taking ADHD medications was very low in general, and no higher than the rate in children who were not using ADHD medications.

Sunday, May 22, 2011

Make the Most of your Time

As many people know, Randy Pausch was the author of an inspiring book called The Last Lecture. A professor at Carnegie Mellon University in the US, Randy was scheduled to deliver a lecture in a series which featured academics speaking on a topic they might choose if they were to present their last ever lecture. Sadly, Randy was diagnosed with pancreatic cancer shortly before he spoke. His resulting lecture, entitled How to Achieve your Childhood Dreams became a Youtube sensation, and led to the publication of the bestselling book. Also on Youtube is a video where Randy shares his timesaving tips. I first summarised his talk for the LADS newsletter, and thought it was worth repeating here. It is still on Youtube, along with his now-famous last lecture.

According to Randy, the average office worker wastes 2 hours per day through losing things and poor planning (sound familiar?). He believed, therefore, that managing time better makes people more successful. He encouraged people to think about their time in terms of monetary value - decide how much your time is worth and you'll be less likely to waste it.

Goals, Priorities & Planning
Randy recommended drawing up a to-do list, then examining each item on your list and asking the following questions:
Why is it on my list? - cross it off if it's not important
Why will I succeed at doing it?
What will happen if I don't?
His motto - Doing the right things is better than doing things right!

According to Randy, planning should be done at multiple levels: Plan for 1) today, 2) this week, 3) this month. Reassess your plan each day & modify it as necessary. (ADHD coaches often recommend a Master to-do list, where you can note down all the things you ever need to do. Each day you can choose something off your master list.)

Paperwork
Randy had interesting advice for controlling paper - a problem often experienced by people with ADHD. He recommended buying a filing cabinet, and filing every piece of paper in alphabetical order. This system, for him, was a simple, quick & efficient way of finding a place for every sheet of paper he needed to keep - at home or at work. It enabled him to keep his desk free of paper at all times.

Emails
Randy recommended keeping your inbox clear at all times. In his opinion, many people tend to use their inbox as a to-do list. He believed that once an email has been read it should be filed in the relevant email folder, and said that a cluttered inbox is as unproductive as a cluttered desk. He also recommended checking emailas no more that once or twice a day.

Appointments
According to Randy, even if you can remember your appointments without a diary, that activity is taking up too much valuable brain space. Therefore, he was a great advocate of an appointment diary - either paper or electronic. In fact, he recommended that you have a second computer monitor at work, with one monitor displaying your appointments at all times.

Telephone calls
Telephone calls should be grouped, wherever possible, and returned together - right before lunch or before the end of the day. In order to keep telephone conversations short, stand while you're talking. Have an excuse ready if you need to get off a phone call, e.g. 'Please excuse me, but I have an appointment with somebody and need to end this call'.

Interruptions
Randy quoted research that the average interruption takes up to six minutes of your time, and then a further 4-5 minute recovery to get your head back into your work (even more if you have ADHD). His tips for limiting interruptions:
Turn phone calls into emails. For example, your voicemail could ask callers to send an email rather than a phone number.
If people wish to interrupt you, say 'I'm in the middle of somethhing right now', or 'I have 5 minutes'.

How to say 'No'
Many people struggle to say 'no'. Randy had some advice for saying 'no' in a gentle way: Tell the person making the request that you are very busy, but you will do it if nobody else agrees to do it. Also, check to see if there will be enough people to do the job. Ask how many people are required. If the answer is 3, agree to do the job when 2 other people have agreed.

Time Journal
Because our time is so valuable, Randy recommended keeping a time journal to see where it goes. Analyse the tasks in your time journal and see what can be delegated. Identify your productive time and protect it fiercely. You might even want to schedule a fake appointment to give yourself this time. Also, find your unproductive time and schedule meetings, phone calls and mundane things.

Randy's Final Tips
Get an organiser - and use it.
Make a to-do list in priority order
Keep a time journal
Read this article, or watch his film again in one month and see what you have changed about your behaviour.

Wednesday, April 27, 2011

Easing Transitions

Ever noticed that you have difficulty leaving work at work?

Do you struggle to settle into an indoors activity after you've been outdoors?
Is it difficult to switch the TV off and go to bed at night - even if the show you're watching isn't a favourite?
Problems getting your children to settle down and do their homework after playing with friends?


Making a transition from one activity to another is not always easy for the ADHD brain. To understand this better, let's look at one aspect of our brains. The Executive Functions (EF) are the central control processes of the brain. They connect, prioritise and integrate cognitive functions of the brain, rather like the conductor of a symphony orchestra. Individuals develop their executive functioning skills throughout childhood, adolescence, and even into adulthood. There are many EF models proposed by various researchers. According to Professor Thomas Brown they include the ability to:




  • organise, prioritise & activate

  • regulate alertness, effort & processing speed

  • manage frustration, control emotions

  • monitor & self-regulate actions

  • utilise working memory

  • FOCUS, SHIFT & SUSTAIN ATTENTION

Dr Russell Barkley describes Executive Functions as self-regulation. They enable us to:



  • visualise your past to yourself (so you can plan the future)

  • talk to yourself in your mind (as opposed to talking out loud to yourself)

  • modify emotional reactions to events

  • restrain yourself (self-discipline)

  • play with information in your mind - manipulate it into new forms (working memory)

  • SELF-DIRECT ATTENTION

Anyone with ADHD will recognise that all of the above functions can be challenging at times. The most relevant EF to the act of making a transition is the ability to focus, shift & sustain attention, or self-direct attention. People who do not have difficulties in this area are able to switch attention between tasks with minimal disruption. For people with ADHD it's infinitely more challenging. At school, teachers complain that students with ADHD take longer to settle after recess, and often wander around the classroom long after their classmates are seated and working. Then they complain that these same students, who took so long to get started, insist on working at the task after the other students have moved onto the next one. In the workplace adults complain that it takes then a while to get started in the mornings, and that the constant distraction of incoming emails makes it hard to complete any tasks. Each time they stop what they're doing to check their email, they are unable to immediately return to the task at hand. This results in unproductive time, which causes them to work overtime unnecessarily and sometime to miss deadlines.


Tips for easing transitions:

Be aware of this difficulty, and build in transition times wherever possible

Create bridges between tasks by setting a warning to sound ten minutes before you are meant to transition.

Rehearse - on your way to work visualise yourself sitting down at your desk and working. Tune your brain into the next task before you begin. Likewise, on your way home, consciously 'close the door' on work thoughts. Then visualise walking into your home and engaging with your family. Explain to your family that you may need some transition time when you get home.

Reward yourself with high-stimulus activities at the end of a difficult task. For example, don't try playing a computer game or checking your facebook page "briefly" before doing something boring (like a tax return). The would be a very difficult transition indeed.

Remember - there is a positive side to this difficulty with transitions - ADHD hyperfocus. The reason transitions are difficult in the first place. Go for the hyperfocus when you're at work and get as much done as possible when you're 'in the zone'!

Monday, April 11, 2011

Change Your Thoughts

People with ADHD tend to ruminate. Something unpleasant happens and they focus on it, imagining the worst. These negative thought can take over our minds, keeping us awake at night and preventing us from getting on with our lives. Martin Seligman has a process for Disputing Negative Thoughts, and it's as easy as A B C D E. I'd like to share it with you. The steps are:

A - Adversity
B - Beliefs
C - Consequences
D - Disputing
E- Energizing

Do this exercise with a pen and paper, and make detailed notes for each step. Let's use a job application as an example.

A - Write down a recent Adversity that has occurred in your life, causing to ruminate. Be objective when you describe it. Resist the urge to become emotional about it.
For example - I've just heard that I didn't get a job I recently applied for. I managed to get through two rounds of interviews, but they have just informed me that the job has been awarded to someone with more experience in this particular field.

B - Record your beliefs about this situation. What are you saying to yourself in connection with the Adversity.
For example - I'll never get a decent job. Nobody wants to employ me. I must have said something stupid in the interview. I guess I just don't have what it takes.

C- Now record the consequences of your beliefs about this Adversity. Be specific, listing everything you said and did. Be aware of the emotions you are feeling and list them as well.
For example - Well I felt really low when I thought about it. I decided that there was no point applying for jobs, so I haven't been putting my resume in for other positions. I just keep looking through the available jobs and convincing myself that I won't get them.

D - Ok, now it's time to dispute those beliefs. Challenge yourself to find one truth to prove your beliefs wrong. Write it down
For example - Actually, I did get through the first round of interviews, so I must have had some qualities they need. In fact, I received some very positive feedback from their HR department. Also, the person they employed has been working in this field for 5 years, as opposed to my 2 years. Another take on this could be that it wasn't the job for me. Which means the job for me is still out there.
E- Now that you have disputed your negative beliefs, what has happened to your energy? How else could you approach this situation and turn it into a positive experience? List your new thoughts.
For example - Well I feel more hopeful now. My energy has lifted and I feel capable of getting a good job that is suited to my strengths. I reckon I can spend the afternoon applying for more jobs.

Try the ABCDE model for yourself. Remember that your thoughts are not necessarily truths. Dispute them. Turn them around.
As Mike Dooley says in his inspiring Notes from the Universe:
Thoughts become things. Choose the good ones.

Monday, March 28, 2011

Promises, promises

Many of my clients beat themselves up because they 'break their promises'. They tell me that co-workers call them unreliable, while friends & family consider them to be uncaring. How can this be, they wonder, knowing that they are comitted to performing well at work and being there for loved ones? When they pause to consider some scenarios, they realise that is their eagerness to please, they often commit to more than is humanly possible. There may be many reasons for that. Time management is certainly problematic for many. I think it was Ed Hallowell who once said that while time was designed to divide the day into manageable bits, it becomes a black hole that swallows people with ADHD. I have one client who refers to 'the vortex' - which she enters with the intention of staying 30 minutes, only to emerge an hour later. There are many strategies to combat this. Nancy Ratey, for example suggests that we add a third to any time we estimate the time a task will take. Impulsivity poses another challenge. How can our brain stop and think about adding a third to our time when our mouth is alreday saying: 'No worries. Of course I can do that by the end of the day'? I teach my clients a mantra: 'I'll get back to you with a time'. This creates the valuable PAUSE that coaches work towards with their clients. Our aim is always to under-promise and over-deliver. There are many ways of achieving this state of bliss - when we succeed at keeping our promises and exceeding the expectations of those around us. Practical strategies go part of the way. But we also need to examine our beliefs around promises broken and kept. Everyone's solution will be different, but one thing's certain - beating yourself up achieves nothing except a damaged sense of self. Coaching is a "no beat-up zone". Consider using it to achieve your goals.

Thursday, February 17, 2011

The Body Double Concept

Sometimes, all you need to get a boring or troublesome job done is the presence of someone else. That's where the Body Double comes in.

I was first introduced to this well-used coaching strategy in A wonderful book by Judith Kolberg & Kathleen Nadeau (ADD-Friendly Ways to Organise Your Life). They describe a Body Double as 'a support person who doesn't need to do anything except be there while you work.' Their role is one of support, and they serve as a reminder that you are there to focus on a particular task.

The Body Double works in many ways. For example, Kolberg & Nadeau suggest that if you have lots of bills to pay, and letters to send off, the Body Double can sit at a table with you while you do that. They could be reading a book, or writing letters of their own, and could then help by sealing envelopes and sticking stamps, leaving all the other administration to you.

In a recent training programme I was required to do a module review each month - a task I found unappealing and decidedly boring. Enter Body-Double-Bobby, who is based in California. We were doing the training together via teleconference and he was also finding the Module Reviews a chore. We set up a weekly Skype session where we both worked independently on our reviews, and had the occasional chat between answers. Our work was done before we knew it. Each time I was given a new review to complete, I resolved to do it before the call, just to prove I could. But I always ended up waiting because it was so much more appealing to do it with somebody else.

My clients often use me as a remote Body Double. For example, if they have a long to-do list to complete, they will ask if they can SMS me after each item has been completed. The fact that I am waiting for their SMS messages motivates them to get on with the job. Sometimes they even use my spare office space to do chores - and then I'm a real-life Body Double for them, even though I'm in a different room.

How could you use a Body Double to get jobs done?

Tuesday, January 11, 2011

What do people say about attention difficulties?

A recent Dutch survey investigated the effects of attention difficulties in the general population. 1500 people with no diagnosis of ADHD completed checklists to ascertain their level of attention difficulties, and what impact these difficulties were having on their Quality of Life (QoL). The results will come as no surprise to people with ADHD, who have been dealing with this issue for all of their lives.

Results of the survey analysis found that attention problems are common in the general population, and that they are related to depressed mood, anxiety and sleep problems. Their effects on individuals' Quality of Life include problems with social functioning, emotional problems, and lack of vitality. These problems occurred in a third of the people surveyed. No reasons for these attention difficulties were explored, and it is possible that the participants, who were described as 'healthy' had some undiagnosed conditions causing their attentional difficulties. We know, for example, that ADHD is under-diagnosed. In addition, a group of participants were classified as 'elderly', which could account for their particular attention problems.

Another possibility exists - that participants could have symptoms at a sub-clinical level. In other words, they could have some attentional difficulties, but not enough to warrant any clinical diagnosis. Clearly, their symptoms were still troublesome. Dr John Ratey wrote a wonderful book some years ago, entitled Shadow Syndromes. It provided a compelling account of the impairments experienced by people who had mild versions of serious disorders.

The message is clear - people with attention difficulties, with or without a diagnosis - have symptoms interfering with their quality of life. They need to learn more about how those symptoms are affecting them, and devise strategies to deal with them.

Scholtissen-In de Braek et al, (2011)The identification of attention complaints in the general population and their effect on quality of life. Journal of Attention Disorders, 15 (1).

Sunday, January 2, 2011

i-Phone Malfunction more serious if you have ADHD

As soon as I awoke this morning I knew that something was wrong. You see, each weekday I go for a walk at 5am with my friend Lorraine. Often, I don't fel like going, but the knowledge that she will be standing at my gate waiting for me to appear is enough to get me moving. And I always feel SO good afterwards. But this morning, as soon as I opened my eyes, I realised that it didn't feel like 5am - too light and too hot. My trusty i-phone alarm had failed. 'How could this happen?', I asked my husband, and saw immediately by the look on his face that he didn't believe me. He patted my hand kindly and got me the paper from the porch. Shortly thereafter, our daughter, who was scheduled to go kayaking in the ocean with her Dad, had to be woken - most unusual for our disciplined dancer. She too was protesting that her i-phone had let her down. How curious? And then I spotted the article on pg 5 of the newspaper. It seems that a software glitch prevented the i-phone alarm function from working after January 1st. Pretty much nobody noticed until this morning.

My first thought when I awoke had been one of embarrassment and disappointment, because I had let my friend down. But I knew that she would understand, because I am (normally) always so reliable. Then I started to worry about all of my clients and friends with ADHD who rely so much on technology like the i-phone. It struck me that an incident such as this has farther-reaching consequences for those whose brains function in a different manner.

People with ADHD are often thought of as being unreliable. This is because time management skills do not come naturally to these lateral-thinking, big picture people who love to live in the moment. Society can be very judgemental of such wondrous beings, and so I spared a thought for those who would be accused of 'not caring', enough to be on time this morning. How would they explain their way out of this situation, knowing full well that many people have heard many excuses from them in the past? And what would it do for their confidence? Having found a reminder system that works for them, would this software glitch make them feel despondent about 'ever getting it right'?

Well here's what I think: people with ADHD should take comfort from the fact that Apple Software got it wrong. Everybody should give themself permission to get it wrong sometimes. It's what makes it so wonderful when we get it right. The i-phone is a great invention. It has changed the way we communicate, and has made the world a lot more accessible to people with disabilities. Such big-picture, lateral thinking can come at a price. Ask anyone with ADHD. Sometimes the mundane details are overlooked. And that's not the end of the world.

Fortunately, today is a public holiday in Australia. Although I'm aware that many people do indeed go to work today, I take comfort that the number of people (with or without ADHD) who might have been late for work was reduced considerably. I'm confident that any dates, who thought they had been stood up, will understand when they hear about the Apple software bug, so the disruption in people's lives should be kept to a minimum.

One last thing - I can't help wondering how many chance encounters will occur today, as a result of the i-phone glitch. How many people will meet their life partner as they take the later train, change their route to save time, or change their plans totally? Something to think about as you mutter under your breath about your "@$/%! i-phone. Don't forget to pay attention to the possibilities this situation might present. In the words of Charles Darwin:

It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change.