Dr G's ADHD Chat

Last episode we spent a lot of time on 504 plans because that’s one of the first things to consider when getting ready for back to school. Now I want to discuss the actual nuts and bolts, mechanical part of improving your ADHDer’s ability to learn. Your ADHDer has the ability to learn like anybody else but his/her brain needs some extras like interest, urgency, novelty and challenge. Over the next few episodes I’’l be covering all these topics. Trust me, there are things you can do to increase your ADHDer’s learning and enjoyment in school.

!Back to School time is upon us and for ADHD parents this can be a time of anxiety and concern. It is also time to prepare for the school year. One of the biggest issues is re-establishing the essential routines and reviewing the child study group recommendations, the 504 plan and the effectiveness of these for your child. Barring the occasional teacher who has ADHD him or herself, you may well be the expert on ADHD in your 504 plan Child Study meeting so you need to come to those meetings prepared and knowing what you want and need for your child. I remember the first Child Study meeting I ever attended (not for my child), the vice principal, who was chairing the meeting, looked at me and said “Okay Doc, What are you going to make us do?” Not exactly the colllegial atmosphere I was hopping for. You find a wide range of levels of support in these meetings, so be prepared. I’ll present some of the things that I think you have to do to prepare yourself,

We are seeing a trend in this moment in time in which older people are asking for evaluation of posssible ADHD. There is increasing recognition of ADHD and its prevalence in our society. It used to be that my most frequent adult patients came to me because I had just evaluated their child and recognized themselves in his/her diagnosis of ADHD. Nowadays more and more adults are recognizing themselves as possible ADHDers. In this episode I’ll discuss some of the issues related to late daiagnosis of ADHD. It’s not all relief. Sometimes there’s a lot of regret.

In most of the family structures I’ve worked with, one of the parents also has ADHD (along with the child they brought in for evaluation) and the other parent is a slightly (or strongly) compulsive individual who is constantly making sure that all the time-critical things get done, more or less on time. Probably the most well-known ADHD family with this pattern is the Holderness family. They got almost instant fame with the publication of their book, ADHD is Awesome. Penn is the father and identified ADHDer. He makes a living in advertising, I think writing a lot of jingles and producing them. Kim is the wife and identified compulsive organizer of the family. They have multiple children but I’m not sure how many are ADHD. So, in addition to their book they do a lot of social media usually with Penn doing something typically ADHD and Kim rolling her eyes with just a little frustration. So can you imagine my surprise when Kim recently indicated that she had been diagnosed with ADHD herself!1 So much for the typical stereotypes. It’s also making me wonder about myself especially every time I don’t get around to doing something I was supposed to do. I’ll be discussing this situation in more detail in this episode.

Not everyone will geek out about this episode but ithis is important to all of us members of the ADHD world- Researchers have discovered 3 distinct biotypes in the ADHD world. They are hugely different from what we have in the Diagnostic and Statistical Manual, it they have identified specific biological characteristics of each type. This will have an impact on treatments in the future.

In my experience, the most usual family structure is some number of children with ADHD and one parent with ADHD and one neurotypical parent. In my practice, most of the time the neurotypical parent was the Wife and the husband was the ADHDer. Obviously there are no rules. In my own case, I’m the husband and my wife has the ADHD. It’s easy when you’re the neurotypical parent to get a little overwhelmed from time to time. All the energy, all the emotions and all the noise and the argufrments can all be occasionally overwhelming. I’ll talk about some things you can do to be more comfortable and last longer, some from my clinical experience and some from my personal experience.

Your ADHD child faces a world that wasn’t designed for him/her. Your ADHDer will find increasing difficulties as the pressure to perform increases as he/she gets older. The key to getting through all the criticism and negative feedback is having a support system he/she can trust and count on. You, as the parent have a difficult tightrope to walk to set limits but also to keep your child’s trust. I’ll be discussing this balancing act in some detail.

ADHD children frequently have difficulties completing tasks when told to do so. With their difficulties with working memory and executive functioning they frequently forget steps in tasks like getting ready for bed, getting up in the morning, and getting ready for school. Routines are important in all our lives. Once established, we follow them without having to make a conscious effort. A routine practiced consistently becomes a habit which doesn’t require thought or planning. The trick is it takes a little longer for and ADHDer to develop a habit so we have to add another procedure I call “externalizing the executive. “ For example for getting ready for bed have a checklist that is in a strategic location where it can be easily seen. The ADHDer has to mark the checklist list as every step is completed. This can be done in a variety of ways such using a grease pencil to mark the checklist that is in a document protector or you can buy the fun checklist from Easy Daysies that has magnets you move when the task is completed. Eventually the routines become habits and become ingrained so your child doesn’t have to think about or remember the routine. It’s automatic.

While treatment for ADHD, especially medication is seen as one of the most effective treatments in all of psychiatry, a surprising 80% of all patients quit within a year. If it’s such a wonderful and successful treatment, why do so many discontinue treatment. I’ll discuss this situation in some detail. In case you’re wondering, my own son discontinued medication. His mother and I loved it when he was taking his meds. He was so much calmer and easier to be around. He was distressed and disturbed by the side effects of the medication. We had a severe shortage of psychiatrists in our area and our G>P. Was in over his head and didn’t know of other options.

The thing that ADHD parents in my private practice were most concerned about was their child’s temper tantrums. I agree that these displays of anger were sometimes scary and some parents were thinking their child’s temper tantrums might have a major diagnosis like Bipolar disorder or even Schizophrenia. Temper tantrums are upsetting but they are more complicated than just anger. I’m going to discuss the more complicated explanation which involves something called Rejection Sensaitive Dysphoria. This is a recent way of looking at anger in ADHDers. It suggests that the anger is a result of the feeling of being constantly criticized and feeling inadequate. It’s a display of frustration and fear but not really anger.