ADHD Stress- Mom, Husband & Kids

Having treated thousands of people with ADHD, I find one question that comes up over and over again. That question is “Doc, why is my ADHD life so damn hard?” Now there are variations of this question, such as “I thought the medication would take care of all of this ADHD stuff” or “Shouldn’t I have outgrown all this?” This is when I remind my patients that ADHD is a life long condition.  It requires a lifetime of learning and managing from many different angles in order to be successful.  Just because we get some relief from our medication, we still will always have to battle against those three primary traits of ADHD we have been dealing with all of our lives.

The good news is you’re probably familiar with the “Big 3” ADHD traits.  You have just probably forgotten how they look when you are older.   Remember those of us with ADHD tend to be: 1) Impulsive, 2) Inattentive and/or 3) Hyperactive

If you think you are going to outgrow these traits, or they are going to disappear now that you are taking medication, that just is not the case for most of us with ADHD.  I usually find that most of what is making ADHD life hard falls into three categories:

Being too impulsive:

“The Inability to Hold back, or think before making a decision…”

-We tend to make quick decisions.  Later those quick decisions only come back to “haunt” us.

-We make quick decisions without giving ourselves adequate time to carefully consider the possible effects or results of our actions.

-We sometimes don’t think about the possible alternatives which could serve us better.

Inattentiveness or Zoning out of life:

“Difficulty staying present and focused on what is right in front of us…”

-Inattentiveness can cause us to act on a quick decision without taking adequate time to look at possible negative results of our quick decisions.

-To some people it looks like we “just don’t learn from our mistakes.”

-We tend to operate on the principle:  Ready – Fire – Aim!

If, all your life, you have been told that you underachieve, sometimes it just feels better to shoot the gun now and aim later. This is akin to “acting without thinking”.  So, we miss our designated target and set in motion, a series of results that we did not foresee and do not want. This is where our impulsivity, not paying attention to what is around us or thinking about other positive possibilities or options becomes really clear. Often those of us with ADHD prefer to just spring into action without thinking.  This causes us to miss out on other aspects of the situation. Not taking a minute to think about those other possibilities means we miss out on many less obvious options.  That is the rub about ADHD. We may have wished we could have taken the time to think things through, but without some sort of assistance, like that which medication and proper nutrition provide, that option is simply not a possibility.

Battling our own inner Hyperactivity

“That feeling that we just need to keep moving, or are driven by our own motor that just won’t turn off. “

-As kids, we ADHD hyperactive kids got into heaps of trouble for being so hyper and impulsive. We did not see ourselves as others saw us. We felt excessively criticized and put down for just being who we were. Inside we felt happy and “normal’, and in a rush. The constant criticism took its toll on our self-esteem. We saw others as “too slow”. We felt very unique, loving and happy, but often our teachers and parents did not appreciate us for who we felt we were.

-We tend to grow out of the gross, physical, hyperactivity.   This obvious hyperactivity changes into more fine motor hyperactivity: i.e., jiggling our legs, swinging one leg over the other, tapping or drumming etc.  Adult hyperactivity can evolve and make an appearance in a more subtle way such as blinking, raising eyebrows, shrugging our shoulders, etc.  It’s as if the childlike hyperactivity moves more into a feeling of inner restlessness.

This is what I remind myself and my patients to be reminded of anytime they ask the question “Doc, why is my life so hard?”  These core traits are part of the hardwiring of the ADHD brain.  They require monitoring and management even when you just want to give in and let everything in your already overwhelmed brain just fall apart.  Resist that urge, as it usually just makes things worse. Instead, there are things that we can do to offset these “Big 3” ADHD traits.  Here are just a few suggestions to help get your ADHD life back in control:

1. Give yourself a break and expect to feel overwhelmed and plan for it. The question is not if you get overwhelmed, but when you get overwhelmed. If you know that it is just a natural part of a brain that is built like a Ferrari, then you can go easy on yourself.  Setbacks and misfires are just a part of what makes us human. Even people without ADHD feel overwhelmed sometimes. Give yourself a “get out of jail free card” every own and again. You might find it is just what the doctor ordered to help you stay on track.
2. Get enough rest. Sounds simple, but those of us with ADHD know just how difficult this can be.  Your ADHD brain just needs all the energy it can get. A sleepy ADHD brain is a useless ADHD brain.  Try to limit the amount of stimulation you have the 2 hours before you go to bed. This means no heavy talks, no super activating television shows, or thought provoking discussions two (2) hours before bedtime.
3. Eat enough protein!!  The same chemicals that your ADHD brain craves and gets in medication are made from the building blocks found in the protein you eat.  Without enough protein in your diet, all the medication in the world won’t help.
4. Drink enough water. Did you know that people who are dehydrated actually look a lot like those of us with ADHD? Dehydration can really cause you to not be able to think clearly.  If you find yourself heating up during the day, or have a dry mouth, reach for the H2O. As much as soda and coffee may taste good, soda leaches precious calcium from your body and coffee actually dehydrates you. So remember to drink two waters for every soda or coffee you drink.
5. Take your medication and your supplements. Many of us with ADHD think we are better or more free when we are off our medication. That may be how we “feel”, but that’s not usually the time when we make our best decisions and are in fact least effective.  If you are supposed to take medication or you are able to take supplements like Omega-3 fatty acids, do it! Omega -3 fatty acids really do impact the way in which our brains work. Anything that we can do to improve our ADHD brains is usually a good thing.

Next time you find yourself chasing after a life of what feels like out of control ADHD, remember that you can get control of your mind, and you can get control of your ADHD.  Take a minute and remember to keep an open mind. If something feels too extreme and out of balance—move on and look elsewhere. Find that place where your mind and your heart guide you to your best choices.

Take a moment to post a comment and tell me about how hard your ADHD life is and share any tips or strategies you found that have worked for you.

Till then—God bless.

Of particular interest to me, as an ADHD Doctor, is the similarity in symptoms that ADHD and Insomnia have in common.  Both cause problems with sleep; both cause impairments in daytime functioning.  In addition to fatigue and irritability,  there are  two other symptoms  sometimes mistakenly attributed to ADHD.  Those symptoms are difficulties with attention and concentration as well as decreased motivation. I have found it an invaluable asset to talk very specifically with my patients about the amount, as well as the quality of the sleep they are getting.  Sometimes my patients problems with inattention, motivation and the inability to focus are really the result of too little sleep. Increase the amount or the quality of sleep you get  and often these symptoms dramatically improve.

As a doctor who has seen thousands of cases of ADHD, it is very easy to look at an unmotivated teenager, one who is not motivated to go to class, to graduate, or even pay attention in school and think they have ADHD.  Fortunately, at our center, our comprehensive ADHD evaluation examines the quality, amount
and duration of sleep for every patient, at each visit.  Knowing this has often prevented me from giving a diagnosis of ADHD, when lack of sleep is really the problem.  I have seen this over and over again. As kids go into their teenage years, they stay up late, occupied with TV, video games, or being on the computer and lose sleep.   This is often the cause of their ADHD like symptoms.  Be aware that many things, including lack of sleep, can look like ADHD. Only a thorough and comprehensive evaluation of the whole person done by a qualified professional can really rule out any other causes before deciding that ADHD is the answer.

It has been my mission,   to discover what techniques for getting my essential life tasks finished actually seem to work for people with ADHD. I have found several antedotes for the poisen of overwhelm and lack of productivity.

First, change your self talk immediately! Few things are as damaging as the stories that we with ADHD tell ourselves.  Instead of  “I will never get the job done”, begin saying, “ I will get some of this done right now, no problem at all”.

Second, Get real with your abilites and pick a task tolerence time for yourself.    Ask yourself, “how many minutes would I for sure be able to handle doing this task?”   Most people with ADHD can do anything for a few minutes at a time – no problem.  Decide what your task tolerence limit is. For me, I can do anything for 10 minutes, even the hard things like laundry, or straightening up my stuff.  If it is really difficult, like opening the mail, I will break that down into 3 minute sessions.

Third, Use a timer or countdown clock online ( I like the online countdown clock atwww.online-stopwatch.com).  Set your timer for the number of minutes you decided on, start the timer and begin repeating your mantra “ I can do this, I can do this yes I can, yes I can”!  If you start to daydream or become distracted or discouraged, just look at the clock and remember you totally get to stop, after your timer goes off!  I am usually shocked how much I can do in ten minutes of uninterrupted task time. Today for example, I cleared off a pile of clothes and junk from a surface in my home office. It turns out that 10 minutes is all it took to organize and put away a weeks worth of piled clothes, papers and other miscalaneous stuff!

Fourth, Decide how much time you get off for doing a little on a task.  I am allowed 20 minutes off for every 10 minutes I spend doing my tasks. That might seem like a lot, but I would have easily burned right through a half an hour just procrastinating or doing something else. In fact as usual, I am writing this blog entry as a reward for doing a 10 minute office clean up.  I find that setting a reward-time timer is also essntial.  Without timers, I would be lost in internet space, or find myself three hours later writing a million word essay instead of a short and useful blog.

Getting tasks done around the house and at work used to really be overwhelming for me.  I found that for myself and for many of my clients with ADHD, setting a timer, using my mantra and giving myself reward time really works.

In fact, my reward time is almost done, so I will set it for another 10 minutes and see how much I can get straightened on my desk, then I will use my next reward time to finish and polish up this blog entry.  In any case, I have one very clear surface in my home office, and I got another blog entry done, not bad for about 30 minutes work.  My ADHD really works for me!

Let me know what you want to accomplish in 10 minute Power Bursts.

Tell us your dreams that are worth pressing on for…

Young men with early or heavy use of Marijuana appear to have a 70% greater risk of Testicular Cancer.  This risk is even higher the younger the age of first use.

Researchers at the Fred Hutchinson Cancer Research center in Seattle found an association with Nonseminoma, a fast growing and aggressive subtype of testicular cancer.  Of all testicular cancer, 40% is Nonseminoma and the rest are slower growing.

It appears that hormonal changes during puberty make young men more vulnerable.  The findings were independent of other known risk factors, such as family history, cigarette smoking and alcohol use.  It appears that the testes, like the brain, have receptors for tetrahydrocannabinol, or THC, the chemical component of marijuana.

I found this information very interesting.  In our center, we have seen so many young people with ADHD attempt to self-medicate with Marijuana.  It appears the dangers of Marijuana are greater than we initially understood.

Will:
“A friend of mine calls it “Eclectic Free-Ranging Focus”, not liking the pejorative sound of the words “deficit” and “disorder”. I kind of like that….”

Jennifer:
“Extra thinkers. Thinkers plus? Bonus thinkers.”

Ted:
“Thought-diffused”

Ann:
“I like Attention-Surplus…because nobody can focus like and ADHD’er (when we are interested!)

IF you have another name for ADHD or another analogy or metaphor for how you think of ADHD we would love to hear about it. So please take a minute and post your best ADHD analogy and share it with all of our blog readers.

ADHD Stress- Mom, Husband & Kids

There are two distinct conditions being discussed here. ADHD is one and stress is the other. Both are fairly easy to define and if you are a parent with a child who has ADHD it’s probably fair to say you know a bit about stress. The problem here though is that dealing with ADHD can be a tough task at the best of times, so if you throw stress into the mix, that task just got tougher.

Then, if all that is not hard enough, you add an extra ingredient of the holidays. Travel, visiting folks, having folks visit you, cooking, more cooking, the weather and all these things may make your stress levels soar to new heights. Stress has a way of upsetting the sufferer in many little and large ways. If you are stressed you will not sleep well, you may lose your appetite, you may feel like giving up and are likely to pick up colds and headaches more easily. It’s wise to get rid of stress.

So what else do we know? We know what usually happens during the holidays and even what may happen. So you are forewarned in that area. So we know about your ADHD child, you know about your spouse, you know about the holidays and you know that ball will suffer if you suffer from stress. But it is really possible to reduce or even remove your stress. And that simply has to happen because, let’s face it, a hyperactive child, or overzealous spouse plus the holidays do not need you suffering from stress. Simple. Get rid of the stress or the things which create the stress.

Here are some ways to do just that. Meditation. Now some people react to this idea with scorn and derision. It’s a waste of time, it doesn’t work and I’ll make a fool of myself. And those sorts of comments are usually from someone who has never tried meditation or never been serious in trying it. There are different philosophies and approaches to meditation but it all boils down to you stopping, being still in a quiet place and not doing anything other than relax. That in itself is a big help. For someone who is constantly on the go, constantly looking out for your ADHD child or spouse, putting on the brakes and doing nothing is good for your body, mind and soul. Make it for five minutes every day. Try it for ten minutes. It could mean the removal of your stress. Studies have shown that sitting doing nothing for 30 minutes a day, reduces cholesterol significantly and improves heart functioning. Imagine what a few minutes each day can do for you.

Then there’s logic. This involves you taking out a pad and pen and writing down, one topic at a time, the thing which is causing your stress. Don’t tackle more than one issue at a time or else you will become stressed. How ironical is that?

So let’s say you are behind in your study program. Your latest assignment is due and you haven’t found the time to do the necessary work. Just writing it down is helpful in itself. Then you need to list why this situation has arisen. Why are you behind? Well, obviously it’s because you are busy with other things, many of them essential. And once again, writing down the reasons is helpful in itself. And, now you must make a decision. List the way or ways you can find time to complete your work. Now that you have a plan, follow through, one step at a time. And presto, you feel better already.

Leave us a comment on how you handle Stress…

Pharmacy Technician

At first, the pharmacy tech was all smiles when she took my prescription and went to check if they had the medication on hand.  Then it started, “Oh really, it says here twice a day – I think that is too much.” “Oh yes, I will have to do some checking. Oh no, No- I don’t think that is o.k.” “This is for you?” she said surprisingly, with a scrunched face of disbelief on her forehead. “We will need to call and speak to the doctor, to make sure he knows about this dose for sure.”  ”We can not fill this for you, without first consulting the doctor. You will have to come back tomorrow.”   I told her that I had just been to my psychiatrist, a 30 year Specialist in ADHD, and Yes, he did prescribe 1-2 capsules per day, and yes I was a high metabolizer, and yes that dose was what my licensed psychiatrist believed was required to provide relief from my ADHD symptoms.

“Still no, no, I will have to speak with him.  After all  this ADHD is still so very new she proclaimed, there are some companies who have age cut offs for it or if they will treat your ADHD, and some will only pay for once a day.”  Was this really happening to me a licensed psychologist running one of the most esteemed ADHD centers in California? The answer was YES.  I was being given a giant dose of pharmacy shame. That feeling I get in my gut when I know someone just thinks ADHD is something for kids, and it is just a disorder de jour.  It was then that I realized that while I am surrounded by insightful and informed colleagues all day, there is still much of the world, including the insurance companies, and apparently pharmacy technicians who still believe that Adult ADHD is not a real disorder.

Then the punch line came, “after all, I think that the world today demands too much from our kids, they were meant to be in fields, that is what our kids need today.”  Now understand that I acknowledge that my fellow ADHDers may have been better hunters than they were farmers, as far as our ability to climb the evolutionary ladder.  Hartmann’s Hunter-Gatherer theory suggests that the hyperfocus and ability to take in many sources of stimuli were essential in our evolution as nomadic hunters. He suggest that as society has moved to a more farmer linear model, the previously helpful attributes are now considered a disorder. Yet, there I was after work on a Tuesday at CVS in Van Nuys, having to defend the validity of my psychiatric diagnosis to a pharmacy technician.

The take away point for me is that Adult ADHD has come a long way in being recognized as a legitimate disorder in the medical community, and still in the everyday world, there are those that are quick to discount this disorder as something that is less than valid, that I should have grown out of, or could be cured if I were not in a world as demanding as ours. Well, the reality is I do live a demanding world. I do have commitments and deadlines, and yes, I do lots of leisurely things to relax including exercise and eating well.  But I don’t have another 1000 years to evolve into a person with less ADHD. I have adult ADHD that deserves to be treated with the sufficient respect and dignity of other disorders that cause as much difficulty as does my ADHD.   Adult ADHD like most things in life, in that it looks unique for every person, and is measured along a spectrum from mild to severe. For many adults living with ADHD, medication is a lifeline to capability and thriving in the world. The stigma about adult ADHD is not gone, and so I say to my fellow ADHD’ers fight back and stand strong. My fellow ADHDers we have come a long way, and the battle for equity in treatment is still upon us. Adult ADHD is real, and life I guess is just hard enough without having to deal with an unwanted dose of “pharmacy shame”.

I would like to hear your thoughts and experiences with pharmacies and /or ADHD skeptics.  Leave your comments and we will post it on our blog.

You will probably just make it

Any adult who has ADHD will not be surprised when they hear someone say that their life is in turmoil. That is often a good description of someone with the condition, an ADDer or ADHDer. They find the following types of behavior or words to be commonplace in their life – procrastination, impulsive, poor time-management, easily distracted and inattention (actually-surplus attention). In fact those words are par for the course with many who have ADHD.

And of course if you do keep putting things off, if you tend to rush into things or find yourself running late or going overtime, your life can be pretty frustrating at those times. But there is a way through the difficulties.

The good thing about being an adult with ADHD is that you can understand the condition; you can have it explained and ask relevant questions. You can then consider strategies which are designed to help you make it through the day. And there are strategies which work. The first is quite simple. It’s in the heading of the article.

If you look at a task you have to perform and you calculate it will take an hour, double that time and thus give yourself the freedom to reach your goal without bumping up your stress meter. It sounds simple and it is but it works. If you have time-management problems and tend to get side-tracked or procrastinate, give yourself more time. Expand your time boundaries.

Another thing which is important to adults with ADHD is that they can consciously make decisions. An adult can look at the options and make a choice. And these choices, these strategies apply equally as well in your personal life as in your professional duties.

You don’t need to be an expert in human behavior, and you do need to follow some simple and tested rules. The first is to make a list of tasks you have to do. This of course is simple but then comes the tricky bit. You have to prioritize the tasks. You have to make a list of your tasks in order of importance

You see one of the characteristics of an ADHDer is they get to the end of the day and they haven’t done one or more of the things they needed to do. Now if the undone tasks are low in priority then that’s not such a bad thing. But if the unfinished task is important, your day could get even worse.

Once your list is done in order of priority – the most important tasks at the top – you make a plan. What do I need to do get those important tasks completed? That could mean setting an alarm clock, allowing plenty of time to finish the task and allowing for travel, meal breaks, tiredness, etc. Then you are armed for battle. You have a plan which is based on a list with tasks in order of importance. You’re ready to go. You’re ready to conquer your ADHD hiccups and make your day go exactly to plan.

When we face a task or a chore at home say like painting the fence, mowing the lawn or baking a cake, we should know approximately how long that chore will take. And this is especially so if we have baked that cake many times before or mown the lawn fifty times a year. But what if we were to get our timing wrong? What if we thought we could paint the fence in two hours and six hours later we were still not through?

Well as crazy as that sounds, guessing the time it takes to do something is a major problem for many people who suffer from ADHD. Their brain simply doesn’t compute the same way a non-ADHD brain computes.

People have what is called an internal clock. They are able to take a nap and set their internal clock to wake in two hours and they do. This skill is not as likely to occur in someone who has ADHD. In fact an ADHDer is more likely to have what is known as the impulsivity trait. A person with this characteristic is likely to underestimate time. They think an hour is ten minutes or thereabouts. They have poor time perception or an impaired time perception.

Poor time perception is demonstrated in other ways as well. A child with ADHD for instance does not always understand when the right time occurs. Their teacher or parent may ask a question and the child blurts out the answers too soon. They have not grasped the appropriate time in which to respond. The answers may need to be given one at a time in turn, and a child or adult with ADHD may answer too quickly or out of turn. This is due to their inability to sense time the ways non-ADHD people can. A short time may seem like a very long time to an ADHDer.

Studies of the brain and how it affects our moods and responses are being carried out at present. One discovery concerns the chemical in our brain called Dopamine which is a key to the way we behave. When there is a ‘malfunction’ of the chemical in our brain, the person can misjudge time. They may also become excitable and impulsive. It is not their fault. They are not being rude or naughty but rather, reacting to a chemical imbalance in their brain. The flow of Dopamine can be slowed or speeded up or even cut off altogether by outside influences. If a someone with ADHD becomes excited or is placed under stress, their Dopamine supply can be affected. This in turn shows up or manifests itself in the way the child or adult behaves.

Wouldn’t it be great if we all had an internal clock that never needed winding and always went off with its alarm reminding us to do something we planned to do?

There are devices available which can help ADHDers to tell the time or see how much time remains without having to be able to tell the time. There are ways to help all of us, and especially those with ADHD, to become better at judging time.