ADHD Go-to-Guide Available

go-to-guide

I am very proud to present our newly launched book. Written for parents and teachers, the ADHD GO-TO-GUIDE is easy to read and easy to use. You can dip into any chapter and find the information you need on that day. We think it’s unique because it includes research and medical information in plain English as well as tons of strategies to help parents and teachers support, empower and advocate for children with ADHD. It also debunks myths. You can order a copy via my website.

The book is also available  at UWA Publishing in Australia, and Amazon US and Amazon UK.

Here are the links:

Australia:

ADHD Go-to Guide: Facts and strategies for parents and teachers

Amazon USA (which includes a Kindle edition):

www.amazon.com/ADHD-Go-Guide-strategies-teachers/dp/1742589480/ref=sr_1_1?ie=UTF8&qid=1501573873&sr=8-1&keywords=adhd+go+to+guide

Amazon UK:

www.amazon.co.uk/ADHD-Go-Guide-Strategies-Teachers/dp/1742589480/ref=sr_1_1?ie=UTF8&qid=1501574157&sr=8-1&keywords=adhd+go+to+guide

 

The ADHD March – it’s time to be heard

When it comes to ADHD everyone has an opinion, and it’s usually uninformed. But when journalists write an opinion piece we assume that they have been informed by research and by consulting those who have lived experience.  Not so with ADHD. Articles are written with little or no regard for the facts, creating a body of Alternative ADHD Facts.

And then there’s the unkindness, which is really stigma, and has no place in journalism.

One article in particular has caught my eye this week for its unkind and uninformed attack on a group parents who do it tough on a daily basis (ADHD: The cop-out diagnosis for lazy parents, by Kylie Lang, associate editor of the Courier Mail). You can find the link to this article at the end of this blog.

Parents, I hope this arms you with facts to address but a few of the Alternative ADHD Facts doing the rounds. Inspired by recent global events, I also encourage you to start an ADHD March. Not a physical march. Use your voices – add them to mine. At the end of this article I provide links where you can report stigmatising journalism. Be heard.

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Alternative ADHD Fact 1: ADHD is not a real condition (it is a “meaningless label” that is confused with normal, if annoying, childhood behaviour.)

The Facts: What do scientific researchers say? ADHD is described by The Australian Government’s National Health and Medical Research Council (NHMRC) as a serious condition that causes significant problems for children in all areas: educational, social, emotional and behavioural.  Without treatment, children are at risk of increased mental health problems, failure at school and university, employment difficulties, relationship issues and substance abuse. ADHD is recognised as a mental health condition in Australia.

Alternative ADHD Fact 2: ADHD is over-diagnosed in Australian children (the ‘ADHD Explosion’).

The Facts: In Western Australia, where these current Alternative ADHD Facts originated, we know that 1.9% of children are prescribed medication for ADHD. Let’s compare that figure to the prevalence rate of ADHD in children, which has been determined by scientific researchers. The NHMRC confirms that to be between 5% and 7%. When we examine the scientific facts, there is no evidence of over-diagnosis.

Alternative ADHD Fact 3: ADHD is diagnosed by uninformed adults. (‘Parents, often supported by teachers in their unqualified assessment, march in to a doctor’s room and demand a prescription’ and ‘some doctors are willing to treat with amphetamines what can be cured with tough love and patience while maturity kicks in’).

The Facts: ADHD can only be diagnosed and treated by a specialist paediatrician, psychiatrist or neurologist. In order for a diagnosis to be made there needs to be evidence of impairment across more than one setting. Input is required from parents, teachers, and other professionals. Doctors who prescribe ADHD medication require a licence to do so, and are highly accountable for their prescription practices.

Alternative ADHD Fact 4: ADHD is caused by bad parenting.

The Facts: What do scientific researchers say? According to the NHMRC ADHD is a biological condition. This fact has been established by extensive research in the fields of neuro-imaging, genetics and neuro-psychology. Research also tells us that parenting children with ADHD is exceptionally challenging. Parents are more likely to develop depression and marriages are more likely to end in separation or divorce as a result of the challenges associated with parenting a child with ADHD.

Alternative ADHD Fact 5: Lazy parents (and teachers) opt for pills as a quick fix.

The Facts: Medication for ADHD is only a part of the treatment. And some parents choose not to use it at all. But it’s all we hear about in the media. The truth is that parents are investing a lot of time and money to treat their children’s ADHD. Behaviour management, therapy, tutoring, coaching, social skills training, occupational therapy, speech therapy all have a place, and a price tag.

How can you join the ADHD March?

Report this article to SANE StigmaWatch https://www.sane.org/changing-attitudes/report-a-media-item-to-stigmawatch

ADHD is recognised in Australia as a mental health condition. According to SANE:

 

Media reports are stigmatising if they represent mental illness in ways that are inaccurate or offensive. A stigmatising report may encourage people to fear or be unsympathetic towards people with a mental illness, to mock or invite ridicule of them, or give inaccurate or misleading facts about mental illness.

 

According to SANE, stigma discourages people from seeking help, makes recovery harder, and causes isolation. See their guide to reducing stigma here: https://www.sane.org/images/PDFs/SANE-Guide-to-Reducing-Stigma.pdf

 

You will need the link to the article for  your report: http://www.couriermail.com.au/rendezview/adhd-the-copout-diagnosis-for-lazy-parents-and-teachers/news-story/fa54eb9a14b64b5f67682f5d5ecfc930

From A.D.D. to A.D.O.D – Janet’s Journey.

Have you ever experienced the situation where a colleague comes into work with a completely new, fabulous hairstyle and moments after the initial surprise, you find it difficult to recall a mental picture of how they looked before? The new look is quickly adjusted to, (after several favourable comments) and life simply moves on.

The process of transforming from regular, home-grown. A.D.D with all its challenges and fabulousness, to the improved A.D.O.D version, (Attention Deficit with Organisation, Disorder) has been much the same for me. Recently, when my colleagues were presented with the task of assisting me with my new system of organisation, there was a pause and THAT look as they tried to remember the past system (there wasn’t one.) The bright colours and the organisation of the new system beckoned. Things moved on quickly and I must say, smoothly.IMG_0404

With my newly-acquired A.D.O.D, I am dazzling during once-dreaded meetings: Last week, when I was asked:

“Will you have the current assessments ready by next meeting?”

I answered by producing said assessments, already completed, and filed in bright beautiful folders with superb A.D.D-style graphics. There was the pause, THAT look. And as I confidently answered: “Oh yes I have them here already”, things moved on quickly and calmly.

IMG_0405

I do love this new version of my A.D.D I have retained all of my wonderful A.D.D. style but now I am supported with organisational skills. What has surprised me, is how quickly those around have accepted the change. For years my children have checked to see if I had money, a purse and debit card before shopping or eating at a restaurant. They don’t do that now. It’s simply expected that I’m organised and we have what we need to be successful. The awkward and embarrassing events of the past are slowly fading and being replaced by flourishes of competence.

It’s difficult to understand A.D.D if you don’t have it. Higher order skills like analysing data and reporting the findings to a group – that’s no problem. Knowing where my keys are so I can get to the meeting …at times simply not possible! It was Michele Toner in WA my A.D.D coach who understood that the lower order tasks everyone just takes for granted were in fact, harder than rocket science for me. With coaching, over just a few months my ability to smoothly incorporate lower order tasks into my daily life improved (with a few setbacks to keep things challenging.)

Through the coaching process I have been able to write a manual or set of guidelines that I can refer to if I ever need reminding of how I stay on track. Life happens and there will be setbacks, but I believe I have the resources to recover much faster now.

A friend who knows me well suggested:

“Ah now you can just drop the A.D.D part and just be organised.”

But I will always have A.D.D, and I’m ok with that. The positive aspects of A.D.D., when combined with organisation are incredibly dynamic and productive. I am having my cake and eating it. I am also enjoying those “What the…?” looks from colleagues when they realise something has changed.

ADHD Coaching – Annette’s Story

Annette wrote this guest blog post in 2013. Although it says very kind things about my coaching, she and her husband are a great source of inspiration to me, as is their wonderful son. 

As parents, the backpack we carry when our journey starts with our child can place a heavy burden on the shoulders. Some days it seems light and almost feathery, though without warning, other days it becomes so weighty it feels almost unbearable. For me the weight of a backpack coupled with the ‘briefcase of a career’ seemed at times, to be the cause of the challenges that arose with what I thought was a wonderful, happy child.

The first occasion of my ‘talks’ arose at day care when the staff were keen to advise me daily that out of all the children my child would not take a nap. “Is he upset”? “No” was the answer. “Is he disrupting the other children?” “No”. “Is he trying to keep them awake or play with them?” “No”. I struggled to see the problem. Here was a lovely happy little 18 month old boy that seemed happy to be on the mat but just sit and play or look around at others. Not disturbing just happy to day dream but not sleep. This was mirrored at home and I was perplexed with the daily ‘tut tut’ I would receive, like it was something I was teaching him to do!

Though a pattern started to emerge.

At pre school and in Grade One the same ‘talks’ were regularly presented. Not naughty, not disruptive just won’t sit and if he does he daydreams, won’t concentrate on his work, is forgetful, won’t stay on task, doesn’t seem to listen and has difficulty understand instructions. I kept asking all along the way, “Do you think he has Autism, is he ADHD.” This was always met by a negative response and in the expert opinion of these care givers and teachers it was a behavioural problem (whatever that meant?)

By Grade Two after one to many ‘chats’ about the negatives and few positives of our lovely little boy I trotted him off to a Psychologist. After countless weekly visits and over a thousand dollars later it was declared that there was nothing wrong with the child, must be the teachers. Again I kept asking “Could he have Autism or ADHD?” “Definitely not”, was the response. His grandparents, through the magical unconditional love that they possess declared him perfect and just too clever; they also suggested it must be the teaching practices employed these days.

By now I had shifted the blame into the ‘growing heavier by the day backpack’ and declared a self prognosis of it being my fault as a full time working mother. By Grade Three a wonderful young teacher reached in and lifted a brick from the pack. “Annette do you think Hunter might have Passive ADD?” She was anxious at presenting this suggestion but the relief was immense for me.

Here was someone who had identified through research the inattentive form of the condition, not the Predominately Hyperactive/Impulsive Sub Type that most of us relate to ADHD. A stream I had never heard of. After taking her advice I also researched the subject matter and found quickly that kids with this condition do often fall under the radar during school years. Not drawing attention to themselves with hyperactivity and strong social behaviours, these quiet souls are often labeled as lazy school workers and day dreamers.

The journey continued to be a struggle as a series of testing had to be under taken to determine the condition. Visits by the Education Psychologist (who also deemed him not to be ADHD from observations), a local Doctor (reluctant to refer him to a Specialist because there was a belief he didn’t have ADHD), to the wonderful Specialist that said “I have spent three minutes with him and I think he is but let’s try fish oil and at the same time let’s get him clinically tested before we consider any medication.”

He did, he was, and he was then offered medication.

The backpack got lighter but the emotional backlash from family and friends was at times brutal. I have since realised that if you don’t live with ADHD you can’t possibly appreciate the challenges that are presented hour by hour. Not to mention the struggles experienced by those living with ADHD. I learnt to keep my mouth shut and lean on those that were supportive and encouraging at taking a proactive approach to help my son.

My son’s medication regime is designed to assist him ‘get through the school hours’. Kicking in soon after he arrives at school and wearing off at the end of the school day. Now a teenager the medication schedule is constantly being monitored and adjusted to assist with the all important after school study that is now part of our society’s educational expectations.

While the medication allows the brain connectors to ‘switch on’ and encourage focus during these blocks of hours there is a huge gap in the emotional and social needs of a fully functioning human being. Getting ready for the day, being organised enough at school and home to be able to focus on the tasks and instructions, personal hygiene and that all important social connection we all need in our lives. Building friendships and relationships and being able to read others and their emotional needs.

In our house the gap continued to grow with the body as it morphed into a teenager. While there seemed some relief in a new high school that accepted and worked with great vigour in assisting the transition from primary to high school, things were getting emotionally strained in our normally passive home environment. Then I noticed disturbing behaviours.

Fingers picked raw from stress and anxiety, scratching of the face when being confronted – it started to scream self harm and the backpack was suddenly leaden.

After a stressful morning and in a fretful state I made a call to our local support group, seeking advice for the name of a Psychiatrist that could help us. After calming me down and listening to my story this amazing woman was frank “I don’t think you need a Psychiatrist, I think your son might need a coach.” Coaching was not new to me, I had undertaken Professional Business Coaching at the height of the GFC and had gone on to learn from a couple of one on one Life Coaching sessions so the idea appealed.

We were given the contact, of whom in our own words is our ‘Family Angel’. In human form she is Dr Michele Toner, ADHD Coach.

The changes to my son and our family have been dramatic. He is now able, with strategies designed for him with Michele, to have some order and management of his personal routines, plan and manage his own study paths, and is now in the midst of learning the art of conversation and forming friendships.

The outcomes and results in a short six months? He can now get ready in the morning in a home that is ‘a screeching mother free zone’, his school grades have shot from Cs and Ds to As and Bs and his confidence in making new friends and forming stronger bonds with long time acquaintances  is going from strength to strength.

I would love to say pop a pill and go to a coach and this magic cloak will appear and all will be perfect, but it isn’t true. It needs a team, made up of family and friends, a supportive school environment and an angel of a coach. You will still need to push, then run ahead and pull – but you will get them over the life line.

Perhaps our proudest moment was just a few weeks ago when at a parent teacher night we moved from teacher to teacher to be told our son was in the top ten per cent of each subject. A first! A wonderful academic achievement and great result for all his hard work, but it didn’t seem to compare to the comments promoting what a great person he was.

“Willing to try everything, someone you can trust, always putting forward a great effort even when he might not be so good at something, and more importantly if he is good at something, helping others that might not be finding it so easy. The best sum up of the night ‘This is a wonderful young man’. What more could you ask for as a parent? The backpack was empty that night!

 

Bored with Colouring Books? Try a Jigsaw. Or a Wasgij!

Jigsaw

Every year, during the holiday break, my daughter and I build a jigsaw puzzle together. We’ve been doing this for about 10 years, and it has become a precious part of our annual downtime together. We started with jigsaws of beautiful paintings. Depictions of ballet dancers by Degas inspired us, as the works of art took form on our dining room table piece by piece. We moved on to very detailed cartoon pictures of snow skiers, beachgoers and shoppers, chuckling as we focused on each intricate piece of humour.

Looking back, we were engaging in mindfulness as we co-constructed our masterpieces. We were also experiencing positive emotions, including interest, amusement, serenity, awe and pride. There was one exception however – the year my son (the engineer) presented us with a 3D puzzle of Big Ben and challenged us to build it. There was very little evidence of serenity as I complained my way through the compilation of the Beast!  Eventually I had to admit defeat and enlist the help of many others. Thereafter 3D puzzles were banned, in the interest of mindfulness and positivity!

3DPuzzle1

One year we bought a Wasgij. I looked like an amusing puzzle with 1000 pieces. We diligently created the border and started building inwards. There was mindfulness, harmony and all those warm and fuzzy pre-3D feelings. Then we realised that the picture on the box was not the picture of the jigsaw we were building. Wasgij literally is Jigsaw backwards, and we were building what the characters on the box were seeing. We’ve been hooked since then and many Wasgij creations have ensued.

Wasgij2 Wasgig1

 

 

 

 

 

 

So here’s my challenge to you, as you contemplate passing the next few days. Practise mindfulness by building a Jigsaw. And if that sounds too boring for someone with ADHD – try a Wasgij. Or a 3D puzzle. I dare you.

See you in 2016!

7 Facts You Need to Know About ADHD


  1. ADHD is Real

    Australia’s National Health and Medical Research Council, along with organisations in other parts of the world recognises 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. [1,2,3,4,5,6,7]


  2. ADHD is a Common, Non-Discriminatory Disorder

    ADHD is a non-discriminatory disorder affecting people of every age, gender, IQ, religious and socio-economic 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%. [8] 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. [9]

    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 [10,11], he or she will be diagnosed with the disorder.


  4. Other Mental Health Conditions Often Occur Along With ADHD

    • Up to 30% of children and 25-40% of adults with ADHD have a co-existing anxiety disorder. [12]
    • Experts claim that up to 70% of those with ADHD will be treated for depression at some point in their lives. [13]
    • Sleep disorders affect people with ADHD two to three times as often as those without it. [14]

  5. ADHD is Not Benign

    ADHD is not benign.[15] Particularly when the ADHD is undiagnosed and untreated, ADHD contributes to:

    • Problems succeeding in school and successfully graduating. [16,17]
    • Problems at work, lost productivity, and reduced earning power.[18,19,20,21]
    • Problems with relationships. [22,23]
    • More driving citations and accidents. [24,25,26,27]
    • Problems with overeating and obesity. [28,29,30,31]
    • Problems with the law. [32,33]

    According to Dr. Joseph Biederman, professor of psychiatry at Harvard Medical School, ADHD may be one of the costliest medical conditions in the United States: “Evaluating, diagnosing and treating this condition may not only improve the quality of life, but may save billions of dollars every year.” [34]


  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). [35]

    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. [36]


  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. [37,38]

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Back to the top

  1. Mental Health: A Report of the Surgeon General, Chapter 3, Section 4: Attention-Deficit/Hyperactivity Disorder.www.surgeongeneral.gov/library/mentalhealth/chapter3/sec4.html
  2. National Institute of Mental Health: Attention Deficit Hyperactivity Disorder. www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/
  3. Center for Disease Control and Prevention: Attention-Deficit/Hyperactivity Disorder. www.cdc.gov/ncbddd/adhd/
  4. U.S Department of Education Research: Attention Deficit Hyperactivity Disorder. www2.ed.gov/rschstat/research/pubs/adhd/
  5. American Academy of Pediatrics Children’s Health Topics: ADHD.www.aap.org/healthtopics/adhd.cfm
  6. Phelan, K. (2002). World of Distraction: Adult Attention-Deficit/Hyperactivity Disorder. www.ama-assn.org/amednews/2002/03/18/hlsa0318.htm
  7. American Academy of Child & Adolescent Psychiatry: ADHD Resource Center. www.aacap.org/cs/ADHD.ResourceCenterBack to Fact 1
  8. Akinbami, L.J., Liu, X., Pastor, P.N., Reuben, C.A. (2011). Attention Deficit Hyperactivity Disorder Among Children Aged 5–17 Years in the United States, 1998–2009.www.cdc.gov/nchs/data/databriefs/db70.htm
  9. National Institute of Mental Health. (2006). Harvard Study Suggests Significant Prevalence of ADHD Symptoms Among Adults.www.nimh.nih.gov/science-news/2006/harvard-study-suggests-significant-prevalence-of-adhd-symptoms-among-adults.shtmlBack Fact 2
  10. Center for Disease Control and Prevention: Attention-Deficit/Hyperactivity Disorder Symptoms and Diagnosis.www.cdc.gov/ncbddd/adhd/diagnosis.html
  11. Searight, H.R., Burke, J.M., Rottnek, F. (2000). Adult ADHD: Evaluation and Treatment in Family Medicine.www.aafp.org/afp/20001101/2077.htmlBack to Fact 3
  12. National Resource Center on ADHD. (2008). What We Know: AD/HD and Coexisting Conditions.www.help4adhd.org/documents/WWK5.pdf
  13. National Resource Center on ADHD. (2008). What We Know: AD/HD and Coexisting Conditions: Depression.www.help4adhd.org/documents/WWK5c.pdf
  14. National Resource Center on ADHD. (2008). What We Know: AD/HD, Sleep, and Sleep Disorders.www.help4adhd.org/documents/WWK5d.pdfBack to Fact 4
  15. Barkley, R.A., et al. (2002). International Consensus Statement on ADHD. www.russellbarkley.org/images/Consensus 2002.pdf
  16. Adler, L.A and Cohen, J. (2002). ADHD: Recent Advances in Diagnosis and Treatment. www.medscape.org/viewarticle/443113
  17. Biederman, J., Faraone, S.V. (2006). The Effects of Attention-Deficit/Hyperactivity Disorder on Employment and Household Income.www.medscape.com/viewarticle/536264
  18. Adler, L.A and Cohen, J. (2002). ADHD: Recent Advances in Diagnosis and Treatment. www.medscape.org/viewarticle/443113
  19. Kessler, R. C., Lane, M., Stang, P. E., Van Brunt, D. L. (2009). The Prevalence and Workplace Costs of Adult Attention Deficit Hyperactivity Disorder in a Large Manufacturing Firm.www.ncbi.nlm.nih.gov/pubmed/18423074Back to Fact 5
  20. Gjervan, B., Torgersen, T., Nordahl, J M., Rasmussen, K. (2011). Functional Impairment and Occupational Outcome in Adults with ADHD.jad.sagepub.com/content/early/2011/06/29/1087054711413074.abstract
  21. Biederman, J., Faraone, S.V. (2006). The Effects of Attention-Deficit/Hyperactivity Disorder on Employment and Household Income.www.medscape.com/viewarticle/536264
  22. Barkley, R.A., Murphy, K., and Fischer, M. (2007). ADHD in Adults, What the Science Says. New York, NY: Gilford Press.
  23. Biederman, J., et al (2006). Functional Impairments in Adults with Self-reports of Diagnosed ADHD: A Controlled Study of 1001 Adults in the Community. www.ncbi.nlm.nih.gov/pubmed/16669717Back to Fact 5
  24. Barkley, R.A., Guevremont, D.C., Anastopoulos, A.D., DuPaul, G.J. & Shelton, T.L. (1993). Driving—Related Risks and Outcomes of Attention Deficit Hyperactivity Disorder in Adolescents and Young Adults: A 3- to 5-Year Follow-up Survey.pediatrics.aappublications.org/content/92/2/212.abstract
  25. Barkley, R.A., Murphy, K.R., Kwasnik, D. (1996). Motor Vehicle Driving Competencies and Risks in Teens and Young Adults with Attention Deficit Hyperactivity Disorder.pediatrics.aappublications.org/content/98/6/1089.abstract
  26. Snyder, J. (2001). ADHD & Driving: A Guide For Parents of Teens with AD/HD. Whitefish, MO: Whitefish Consultants.
  27. Murphy, K. (2006). Driving Risks in Adolescents and Young Adults with ADHD. preview.tinyurl.com/3nkpn7u
  28. Dukarm, C.P. (2006). Pieces of a Puzzle: The Link Between Eating Disorders and ADD. Washington, DC: Advantage Books.
  29. Waring, M.E., and LaPane, K.L. (2008). Overweight in Children and Adolescents in Relation to Attention-Deficit/Hyperactivity Disorder: Results From a National Sample.pediatrics.aappublications.org/content/122/1/e1.full.pdfBack to Fact 5
  30. Pagoto, S.L. et al. (2009). Association Between Adult Attention Deficit/Hyperactivity Disorder and Obesity in the US Population.www.nature.com/oby/journal/v17/n3/full/oby2008587a.html
  31. Dempsey, A., Dyhouse, J. and Schafer, J. (2011). The relationship between executive function, AD/HD, overeating, and obesity.wjn.sagepub.com/content/33/5/609.abstract
  32. Quily, P. (2011). Up To 45% 0f Prisoners Have ADHD Studies Show. Crime & Jail Are Costly, Treatment Is Cheap.adultaddstrengths.com/2011/01/12/adhd-and-crime-ignore-now-jail-later-15-clinical-studies/
  33. Biederman, J., et al (2006). Functional Impairments in Adults with Self-reports of Diagnosed ADHD: A Controlled Study of 1001 Adults in the Community. www.ncbi.nlm.nih.gov/pubmed/16669717
  34. Medical News Today. (2005). $77 billion in lost income is attributed to ADHD annually in USA.www.medicalnewstoday.com/releases/24988.phpBack to Fact 5
  35. Barkley, R.A., et al. (2002). International Consensus Statement on ADHD. www.russellbarkley.org/images/Consensus 2002.pdf
  36. American Academy of Child & Adolescent Psychiatry: ADHD Resource Center. www.aacap.org/cs/ADHD.ResourceCenter/adhd_faqsBack to Fact 6
  37. National Institute of Mental Health: Attention Deficit Hyperactivity Disorder. www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/how-is-adhd-treated.shtml
  38. Center for Disease Control and Prevention: Attention-Deficit/Hyperactivity Disorder.www.cdc.gov/ncbddd/adhd/treatment.html

Back Fact 7

All citations were retrieved from the Internet September 1, 2011.

Genes and ADHD in a Nutshell

No doubt you have heard several times that genes play an important part in ADHD. But what exactly does that mean? Well, it means that different types of genetics studies have identified links between ADHD and certain genes. There is also important research underway concerning the role of environmental factors and their interplay with genes, but more of that later.

Behaviour genetics investigates the contribution of genes and the environment to individual differences in behaviour. It examines familiality (Does ADHD run in families?) and heritability (Does ADHD get passed on?) And many 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 are also valuable. Adopted children share genes but not the environment with their biological parents. Any similarity between these adopted children and biological parents could therefore be attributed to their shared genes. In the same way, similarities between adopted children and their adoptive parents could 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. This supports 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. This 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 groups of 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.)

Embracing Diversity in the Workplace

A 2010 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.

The Focus Formula

Focus

The Focus Formula

“I have such trouble getting started on a task, and then I have trouble stopping. The only easy bit is the middle.” 
The frustration expressed by my client is something that I hear often. Perhaps you can relate? – The hardest part of doing something is actually getting started. There could be several reasons for this challenge. First, as a Big-Picture, Global thinker you may find it hard to break jobs down into chunks, and establish an entry point. Secondly, if the task is difficult or boring, you could find yourself engaging in all manner of procrastination. And the list goes on. This four-point plan has proved to be very useful with many of my clients. I call it the Focus Formula.
1. Plan
If the thought of planning makes you shudder, you’re not alone. Future blog post will deal with planning. For the purpose of the Focus Formula, you need to be specific about what you will be doing. Set aside some time and commit to using it for the task. Then, decide what part of the task you will work on. For example, instead of planning to “do your tax tomorrow”, identify what you need to start with and when you will do it: “I will get all of my receipts out of the shoebox and sort them into categories tomorrow at 11.”
2. Set Up
In order to make the assigned time productive, you need to set the task up independently from doing it. Get the shoebox of receipts out and put it on your desk. Ask yourself what else you will need to sort them. Will you need a pen and paper to make notes, for example? Have everything ready, and then walk away from the desk. Even a 10 minute break for a cup of tea will suffice. Keeping the Set Up separate prevents it from becoming a long-winded procrastination tool.
3. Sprint
ADHD brains are generally good sprinters. The thought of spending 5 hours on a tax return will fill them with dread. But they can blitz a 30 minute sprint. So make a deal with your brain – that you will give it a break in 30 minutes. Then get to work. After 30 minutes you have 2 options. You may find that you have hit the Focus Zone, and would like to keep working. If that it the case, keep at it. The Focus Formula has succeeded. However, if your brain demands the break as promised, you need to honour that. But before you walk away from the task, there is one more step:
4. Brain Dump
This is an valuable tool to use when you are stopping partway through a task. If you walk away from incomplete work, the chances are that it will feel like starting all over again when you return. And you could hit the same brick wall. So take the time to make a note of what you need to do next. In doing so, you are creating the next entry point. When you return to the task, it will be easier to get started on your next 30 minute sprint.
The Focus Formula can be used to get started on any task that is less that tantalising. Housework, paperwork, studying and many other activities can be conquered in 30 minute sprints – until you hit the Focus Zone.
Try it out, and let me know how you go.

Supporting students with ADHD in the classroom

 

Brain

Attention Deficit Hyperactivity Disorder (ADHD) is a common condition affecting 5-7% of school-aged children. Whilst much information about ADHD centres on the core symptoms of Inattention, Hyperactivity and Impulsivity, it is also helpful to focus on the Executive Function (EF) impairments typical of the disorder.  EF dysfunction has serious implications in the classroom for students with ADHD, as well as their teachers, who can find themselves frustrated by behaviours typical of these students.

EFs broadly refer to a set of cognitive processes, moderated by the prefrontal cortex that are responsible for goal-directed, problem-solving behaviours, and attention control. EFs enable us to do what we know we should do, much as the conductor of an orchestra enables the musicians to perform together and create harmonious sound. They exist in the gap between intentions and actions by organising what, when, where and how we do things.

 

What do EF Impairments Look Like?

EF theories vary, as the concept continues to evolve. Yale University’s Professor Thomas Brown offers a clear model with six separate clusters of functions that work together continually and unconsciously, to help each individual manage many tasks of daily life. As Dr Brown explains: while anyone can have occasional impairments in their executive functions, people with ADHD experience much more difficulty in the development and use of these functions than do most others of the same age and developmental level. Interestingly, even those with severe ADHD usually have some activities where their executive functions work very well. This makes it hard for people to accept their challenges in other domains.

  1. Activation: Students have difficulty getting started on tasks. Prioritising, time management and organising skills are lacking. Procrastination can be excessive, even on tasks they know to be important.
  2. Focus: Students have difficulty focusing attention on the task at hand, sustaining that attention, and shifting attention when required. They are easily distracted by things happening around them and also by their thoughts.
  3. Effort: Students with ADHD can be great ‘sprinters’ performing short-term tasks well, but they struggle to sustain effort over longer periods.
  4. Emotion: Students struggle to control their emotions. Frustration, worry and disappointment, among others, dominate their thoughts interfering with their ability to focus on tasks.
  5. Memory: Working Memory (WM) has been described as our ‘mental workbench’- a place to hold information in mind long enough to manipulate it in order to solve a problem or complete a task. Students with ADHD have significant WM impairments, forgetting where they put things, what they were doing, what they meant to say, or what was said to them.

Prospective Memory is the ability to ‘remember to remember’. It is our mental to-do list that reminds us to do things at a certain time. Impairment in this area causes students to remember important tasks before or after the fact, and forget to do them at the right time. They can also experience difficulty when trying to recall information from their long-term memory as required.

  1. Action: Students have difficulty controlling their actions, often reacting impulsively. They also experience difficulty reading social cues, resulting in behaviours that are inappropriate. Social isolation is not uncommon.

 

What can teachers do?

  1. Activation:

Chunk – and then dot-point. Most teachers are great at chunking work for students. However, they often do not realise the level of chunking that needs to occur for students with ADHD. Because of their inability to break work down, students become overwhelmed by what they perceive to be an enormous task. Giving students a short list of dot points creates an entry point for them, making it easier to get started.

Make Time Visible. For students with ADHD there are two deadlines: work that is due NOW and work that is due NOT NOW. They understand the timeframe of work that is due immediately, but not long-term projects. Have a planner on display with assignment due dates clearly marked. Cross off each day as it passes to give students a reference point. This creates a picture of the time available to them to complete a task. Encourage them to keep similar planners at home which include due dates of all assignments and out of school commitments.

Encourage ‘Free-Writing’. Sometimes the best ideas get lost as students struggle to articulate them in an appropriate format or style. Encourage students to get their ideas onto a page first and then arrange them into the appropriate format. This works best on a computer. For example, students might write the body of an essay first, and then go back to writing the introduction.

  1. Focus

Use white noise. Allow students to listen to music, ambient sounds or white noise through earphones while working independently. This will block external and internal distractions, and prevent students from distracting others.

Brain Dump.  When they find themselves focused, students are often reluctant to stop working, knowing how hard it will be to get started again. If at all possible, leave a focused student to complete a task. However, if work must stop, have students write down the next steps of the task. When they return, those notes will provide their next entry point.

  1. Effort

Sprint to get started. Because ADHD brains are great sprinters, they often leave work until the last minute. Once they can see the finish line, however, all things become possible. Help students create sprints by setting a 10/20/30 minute timer, and have them complete as much work as possible in that time.

Frequent breaks. Along with sprints, frequent short breaks can be extremely effective. Allow your student to create a cycle of timed sprints and timed breaks to get through a large task.

  1. Emotion

Expect inconsistency. One of the most frustrating aspects of ADHD for students, teachers and parents is inconsistency, even when students are medicated.  It is difficult to understand that they may be capable of a task one day, but not the next. Celebrate their good days, and encourage them to keep a Success Diary to remind themselves of their achievements.

  1. Memory

Take the load off working memory by making information available for students and their parents on the school portal, and keeping it up to date. Write all assigned homework on the board, and allow students to photograph the board at the end of class. Students with ADHD may be inconsistent with homework diaries and should be given accommodations in this area.

Provide regular check-ins by encouraging students to complete portions of assignments and discuss these with you before proceeding. Aside from the discussed benefits of chunking, this will keep them focused on the correct aspects, and prevent them from over-focusing on one aspect of the assignment to the detriment of others.

  1. Action

Allow Fidgeting to Focus. When students with ADHD are told to stop fidgeting they spend a huge amount of mental energy concentrating on sitting still. Consequently, they find it hard to focus on what is being taught. Teach your students discreet fidgets to overcome this problem. Doodling is a great fidgeting strategy, as is playing with a small piece of blutack, or rubbing a small pebble.

There is no doubt that students with ADHD can present challenges for teachers. However, with an improved understanding of the impairments they deal with on a daily basis, teachers can provide the scaffolding required in order for them to flourish.

Michele wrote this article for publication in ACEL e-teaching. A PDF of the article can be found here.