Category: ADHD Parenthood

Understanding ADHD

Per Russell Barkley (RB), ADHD guru (i.e., scholar and scientist):

ADHD is a disorder of self-regulation that can also be described as a “disorder of age-inappropriate behavior” that looks like inattention and lack of inhibition.

Though I want to clarify that the inattention depends on what you are doing; another guru of ADHD, Thomas Brown, says the “central mystery” of ADHD is that those with it can pay attention to some things and seem incapable of paying attention to other things.white-matter-fibers-hcp-dataset-red-corpus-callosum

But back to RB and ADHD as a disorder of self-regulation.

RB defines self-regulation as “self-directed action intended to alter subsequent behavior so as to change the probability of a future event or consequence” (to improve your longer-term welfare).

For example, say you have a problem with money and keep getting into debt by living off credit.  You want to pay off your debt (self-directed action) to be able to cancel your credit card and limit spending (subsequent behavior) to reduce the chance you’ll get into debt again (change the probability of a future event).

Where does ADHD fit? With ADHD one has the intention to alter behavior (e.g, limit spending) to change the future (e.g., live debt-free) but struggles with the self-directed action (e.g., paying off debt) required for this.

Barkley says it’s a disorder where knowledge fails to guide performance.  You know what to do but struggle to do it.

WHY?

RB highlights that ADHD brains show prefrontal cortical network differences (these networks are responsible for Executive Functioning and self-regulation is the core of Executive Functioning).  Here is where the differences exist and what comes into play:

  • Frontal-striatal circuit, the “what” network (what we think influences what we do) Here lives…
    • Freedom from distraction
    • Working memory
    • Organization and planning
  • Frontal-cerebellar circuit, the “when” network (timing of thought, behavior)
    • With ADHD, there’s “time blindness,” and
    • A “myopia to the future”
  • Frontal-limbic circuit, the “why” network.  Here lives…
    • The decision-maker of the brain (if you have multiple goals, which do you pursue? this circuit, as RB puts it, “makes the final call”)
    • Motivation
    • Emotional control or dyscontrol

These network differences show up as self-regulation differences that encompass

Self-directed action, Self-awareness, Self-motivation, Self-directed attention, Self-restraint, Self-directed sensing, Self-directed emotions, and Self-directed play.

WHAT TO DO?

Outsource these brain functions.

RB calls this externalizing the brain functions where there are deficits.  For example, he says, use “artificial prosthetic cues to substitute for working memory deficits.”

Ideally, this is what ADHD coaches will help you do (for more on this, see Does ADHD Coaching Work?)

Here are some pointers for externalization:

  1. Per RB, the externalization of brain functions is needed at the point of performance and within your natural setting (e.g., if you struggle to write a report at work, you need external factors to guide your attention at work at the time you need to write); and
  2. To externalize, change your environment (think planners, alarms, points, signs).

Replenish your self-regulation (think self-control) resource pool.  It’s depleted by simple use as well as stress, drug abuse, illness.  Replenish through

  • Rewards, positive emotions
  • Positive self-talk
  • 10 minute breaks between tasks requiring self-control
  • 3 minutes of relaxation or meditation
  • Glucose ingestion (Gatorade, lemonade, sugar water) while working on tasks requiring self-control
  • Daily physical exercise

Also, break lengthy or complicated tasks down.  One of my favorite reminders of this, though I really like elephants, is, “How do you eat an elephant?”

Answer:  one bite at a time.

RB adds that accommodations or scaffolding and the compassion and willingness of others to make accommodations are “vital” to your self-regulation effectiveness.

Sources:  Two talks by Russell Barkley on ADHD, one from 2013 entitled, “The Importance of Emotion in Understanding and Managing ADHD (here) and one from 2012 entitled, “ADHD, Self-Regulation, and Executive Functioning:  Theory and Implications for Management” (the part of it I used is here).

3

Does ADHD Coaching Work?

There are three things to know about coaching.

First, if you read Russell Barkley, scholar and researcher on ADHD, the idea of coaching makes sense.  Barkley argues that what you need with ADHD is something external to guide your behavior right at the moment that the behavior’s needed.

Imagine you need to study for a job interview you have the next day and you are about to surf online.  Right at that moment, with your fingers poised to tap the keyboard, you need something external to stop you (or to guide you toward stopping).  This something will then need to remind you of your interview and reinforce studying over surfing.  This is ideally what a coach does…guides your behavior at the moment it most matters, which is when you play the game…of job-seeking or whatever it is.

A coach guides your action as it is happening.

baseball-1536097_1920Second thing to know is that the reality of ADHD coaching appears to approximate this at best.

You can get a coach working with you multiple times a week and the work can center around where you most struggle.  But, at best, it’s like having a coach available by phone some of the times you play the game.  It’s just unrealistic to have the ideal kind of coaching…unless you’re wealthy and want to pay someone to be with you, guiding your behavior at various points of the day, as needed.  Perhaps one day, we’ll have robots do this for us, should we choose…hmm.

The third thing to know is that the research on what makes for an effective ADHD coach is sorely lacking.  Only a few exploratory kind of studies, primarily focused on college students, seem to look at this, with the recommendation for future larger scale, more rigorous research.  So while you can find folks credentialed to be an ADHD coach, there’s no real research showing coaching clearly works and under what circumstances.

This leaves us all figuring out for ourselves, if we pursue coaching, whether it’s working. Actually, even if research clearly said it’s likely to be effective for most, we’d still have to figure out whether it was effective for us.

1

Fidgeting: Spin vs. Science

My local Memorial weekend festival had fidget spinners for sale, ranging from $12 to over $20, advertised to help with ADHD, anxiety and more.  It left me wondering what we know about their effectiveness.  It turns out very little.  On my go-to research source, pubmed, I could find no single study on fidget spinners or their kin (cubes, etc.).  But NPR published two articles exactly two years apart, one on fidget spinners and one on fidgeting.  ball-1023984_1920

On May 14, 2017, NPR published an article on fidget spinners.

Essentially, the article quotes a Duke professor suggesting to stick with what’s known to work.

The professor points out that there’s no evidence that fidget spinners work.  Though it’s said, what seems perhaps buried or likely to be easily overlooked is that the reason there’s no evidence is that there’s actually no trustworthy research on them.  See here.

Meanwhile, two years earlier, on May 14, 2015, NPR published an article describing a small study that shows that children with ADHD performed better on tasks requiring concentration when they fidgeted.  (The children worked while on a swivel chair that they, of course, spun and moved.)

Overall, more movement meant better performance for these kids (kids without ADHD, on the other hand, did worse with movement).  The lead author, however, cautioned against both too little and too much movement.  See here.

Perhaps fidget spinners would fall into too much movement or the wrong kind (attracting eyes as well as fingers), but it’d be interesting to see some real research on them.

1

Medication Metaphor: Tunnels

Imagine yourself inside a room full of tunnels.

You can look down any of them.  Maybe you like this sense of freedom.  Maybe you also find it distracting.led-lighting-1846929_1920

But now you have your ADHD medication.

Walls go up over all the tunnels except the one you’re facing.

When you turn your head, the wall for the last tunnel you faced slides up.  The wall for the tunnel you now face slides down.

You can switch which tunnel you look down, but you can see only one tunnel at a time.

You can also see the tunnels with obstacles.

On medication, you find it’s easier to enter these previously-avoided tunnels (maybe because the more appealing tunnels have their walls up, keeping their temptations out of sight).

And once you enter one of these “harder” tunnels, the medication helps you stay there.

This is part of the experience of ADHD medication for many of those with ADHD, on the one that’s working for them.

0

Something Fishy

ADHD comes with omega-3 and omega-6 fatty acid deficiencies.

But upping your omega-3 and omega-6 fatty acids may have little effect on your ADHD symptoms.  What gives? Recent research reveals that it’s all about the ratio.

ADHD means low levels of both but overall higher levels of omega-6 to omega-3.

So now you may say, well, I just need to increase my omega-3 levels, right? Oh, how I wish it were so simple.  Researchers have tried this with only some succesfish-2207845_1920s.  A supplement heavier on the omega-3 than omega-6 side may be better, as indicated by a study that found benefit from giving participants an omega-3/6 supplement containing mostly EPA and DHA (omega-3), with only 60mg of LA (omega-6).

Still, it seems you’re best off knowing your ratio.  And then knowing how much omega-3 (EPA and DHA, specifically) and omega-6 (LA or AA, specifically) you need to optimize it.

See here.

1

Medicating Children

As the mother of a teenager with ADHD soon entering high school, I want to know the pros and cons of medication.  If you are a parenpill-1254786t reading this, you likely do, too.  And I will admit, I’m torn.

The research seems too unfinished for me to rely on it as much as I might like.

Consider that over 40 scholars from the UK, USA, Denmark, Italy, Germany, Switzerland and Australia will be reviewing  various “pharmacological interventions” to rank how well they work and their “tolerability profiles,” looking at these things for children, teens and adults.  The scholars note that “there is a lack of up-to-date and comprehensive evidence on how available ADHD drugs compare and rank” with regard to their ability to deliver desired results and to do so with tolerable side effects.  See more here.

But do we keep waiting for what seem to be more definitive answers? At what cost?

Consider this…recent research suggests that school could be a more rewarding experience for children and teens with ADHD who use medication for their symptoms.

Examining about 10, 0000 12-year-old twins, some who’d been followed since 7 years of age, researchers found that medication-free children with ADHD showed lower educational achievement than children with ADHD using methylphenidate (Ritalin, Concerta).  And the medicated children showed lower educational achievement than children without ADHD.  That is, ADHD appeared to lead to lower educational achievement but especially when unmedicated.  Plus ADHD symptoms predicted a negative educational trajectory from 14 to 16 years of age.  See study here.

Where does this leave us parents wanting our children to have the best chance at achieving what deep down really matters to them?

It leaves me leaning toward the test of experience.  I am willing to let my teen, when wishing to do so, swallow a pill as I (figuratively) swallow mine.

Meanwhile, I will keep combing the research….

0

Show & Tell or Hide & Seek?

When one has a psychiatric diagnosis, questions about revelation come up.  A search for answers around revealing ADHD brings up onhide-seeke:  It depends.

What’s the context (work, school, home)? What’s the situation? Who are the parties involved (believers, non-believers, agnostics)? What are the stakes? Ultimately, what are the real pros and cons, short- and long-term? For ADHD, the only time I’ve seen the answer clearly lean toward “yes, tell” is at school for the purpose of working out accommodations.

At work, the answer may largely depend on the work culture.  How much and what kind of diversity surrounds you?

How I wish we had more research examining the reality of telling vs. staying quiet.

1

Go, Go, Go and Slow, Slow, Slow?

A few years ago, researchers at MIT showed that adults with ADHD have two brain networks that compete for their attention instead of “playing nice,” as they do for adults without ADHD.  These networks are essentially a go, go, go one that lights up when we have a task to do (“task-positive network”) and a slow, slow, slow one that activates when we have nothing to do and can daydream or let our minds wander (“defccv-jp-ngault mode network”).  Without ADHD, when one network has its turn to be active, the other one turns down…they cooperate.  With ADHD, they appear to often be active at the same time.  Imagine what that’s like.  If you have ADHD, you already know.  If only others could experience your brain to know what it’s like….

See for yourself.

1

To get things started, add sugar…a spoonful or more

Just the other day, my husband played this song to our daughter, and I said, “Hey, Mary Poppins had it right.”  As a mental health therapist running groups for adults diagnosed with ADHD, I encourage members to have fun with their tasks as much as possirestaurant-coffee-cup-cappuccinoble.  Turn up the pleasure, excitement, interest.  Some will work outside or somewhere they find pleasant, some pair a reward with tasks and some work with others, even just as company.  Some do all of these.

If you struggle to start something, remember Mary Poppins.  And that some of us need a little more sugar than a spoonful.

 

0

Blog at WordPress.com.

Up ↑