Monday, October 31, 2011

Beyond Medications

Today’s guest blog is by J. Russell Ramsay, PhD.

If adults with ADHD could only have one treatment for their symptoms, research indicates that pharmacotherapy, particularly the use of stimulant medications, is the single most effective option for reducing the core symptoms of ADHD. However, medications alone may represent insufficient treatment for the many difficulties experienced by adults with ADHD, such as disorganization, procrastination, poor time management, mood and anxiety issues, and low self-esteem, to name a few.

During CHADD’s Annual International Conference on ADHD, my session on adjunctive treatments for adult ADHD will be held on Thursday, November 10. The session will cover the current status of various non-medication treatments for adult ADHD that are often used in combination with medications in order to help individuals achieve improved overall well-being and functioning in addition to symptom relief. Here is a brief overview of those treatments.

Psychosocial treatments. Many standard psychotherapy approaches have been modified in order to more effectively address the typical coping difficulties faced by adults with ADHD. In general, cognitive-behavioral therapy (CBT) approaches for adult ADHD, which focus on modifying self-defeating thought and behavioral patterns, have been found to be a useful adjunct to medications in several published studies, including recent randomized controlled designs comparing CBT with other active treatments. Sessions focus on the development and consistent implementation of coping skills in daily life. Psychosocial treatment, namely CBT for adult ADHD, stands out as the adjunctive treatment with the strongest research support.

Coaching. Although not the same as CBT, ADHD coaching shares the goal of helping adults with ADHD to employ more effective coping strategies to fulfill their personal goals. ADHD coaches target specific coping difficulties, such as disorganization and poor time management, and help clients develop and follow through on action plans. While the benefit of coaching support makes logical sense and it is an increasingly available option, to date there has been only one published study of its effectiveness for adults with ADHD adults.

Academic support and accommodations. Similar to ADHD coaching, while academic accommodations targeting specific areas of impairment make logical sense, such as extended time to complete an exam, these adjustments do not have research support. There are many informal steps that students can take to manage the effects of ADHD on their academic performance. However, there are preliminary studies of learning support and coaching approaches for college students with ADHD that have yielded positive results, making it a promising option.

Workplace support and accommodations. Workers with ADHD whose impairments fulfill the legal definition for a disability may be entitled to reasonable workplace accommodations, though most adults with ADHD do not pursue official accommodations. As with students, there are many informal adjustments in the work setting, assistive technologies, and other coping tools that may be helpful for adults with ADHD. As with academic accommodations, the effectiveness of these coping efforts has not been systematically studied.

Relationship treatment. Research on the effects of ADHD throughout the lifespan has increasingly identified its negative impact on family and social life for both children and adults with ADHD. The parents and caregivers usually participate in treatment programs for their children with ADHD, though they are rarely screened for ADHD despite high heritability rates. In fact, parental ADHD (even in sub-clinical form) is likely a common reason for dropout in family treatment programs for child ADHD and/or oppositional behavior.

Similarly, there may be unique difficulties faced in marriages and committed relationships in which one or both partners has ADHD. No studies have yet been published on either marital or family therapy involving adults with ADHD.

Neurofeedback and working memory training. Proponents of neurofeedback training cite numerous studies of its effectiveness, though there have been few studies using samples of adults with ADHD. Critics of neurofeedback, on the other hand, point out that many of the studies are case reports or have serious methodological flaws that cast doubts on their findings. A review of the few studies involving adults with ADHD suggests a middle-ground conclusion that neurofeedback has tentative support. There have been some recent studies of neurofeedback for children with ADHD that used improved research designs.

Computerized working memory training has yielded some positive results in samples of children with ADHD and such training would seem to be helpful for adults, though there have not yet been published reports involving adults with ADHD. However, as with neurofeedback, even if the therapeutic effects are reliable it remains unclear precisely how these interventions work and whether the positive effects generalize to improved functioning in day-to-day life.

Complementary and alternative treatments. There is a wide array of what are deemed “alternative” treatments for ADHD, such as nutritional supplements, specialized exercise programs targeting certain brain regions, dietary approaches, etc. There is preliminary evidence that omega-3 fatty acid supplementation may result in mild improvements in some ADHD symptoms, though these are based on studies of children. Likewise, pilot research of mindfulness meditation suggests it is associated with some improvements for adults with ADHD. There are obvious health benefits of mineral supplementation in cases of identified deficiencies; likewise, exercise, healthy diet, and other good health practices should be part of an overall wellness plan rather than being considered “treatments” for adult ADHD.

There are a number of treatment options for adult ADHD that can be used in combination with medications to target specific areas of impairment. A few of the treatment options have relatively strong support and some others have promising but preliminary evidence for their use while still others have not been found to be helpful. It is important to personalize the combination of treatments to meet the needs of the adult with ADHD in order to optimize functioning and well-being.

J. Russell Ramsay, PhD, is associate professor of clinical psychology in psychiatry and co-director of the Adult ADHD Treatment and Research Program at the University of Pennsylvania Perelman School of Medicine.

Thursday, October 27, 2011

Making Homework Simple

Today's guest blog is by Ann Dolin, MEd.

Helping with homework can be a humbling experience, and this is especially true when you are the parent of a child with ADHD. All too often, parents find themselves cast in the role of the nightly homework police, and the divide this role creates can be one of the most painful aspects of parenting.

My presentation during CHADD’s Annual International Conference on ADHD in Orlando this November will bring you proven solutions for even the most challenging homework issues.

In this workshop, parents and professionals will learn specific strategies for each of the common, yet challenging homework profiles that students present when pressured by homework. They are:

o The Disorganized
o The Rusher
o The Procrastinator
o The Avoider
o The Inattentive
o The Easy Frustrated

Novel strategies to address each issue will be shared. These include:

• Easy solutions for setting up the Simple Solution binder system, including an accordion file and one dedicated homework folder.
• Identifying optimal homework spaces (there should be more than one!) and organizing portable materials.
• Simple tips for encouraging students to record their assignments accurately whether it be a paper assignment notebook or one of the cutting-edge electronic calendars.
• Prioritizing, planning, and managing long-term assignments. Quite often, students with ADHD have great difficulty breaking down large tasks into smaller increments.
• Ways to reduce procrastination and eliminate last-minute stress by using a timer, study groups, and other self-regulation strategies.
• Novel study skills for academic success such as easy note-taking ideas, using color for comprehension, creating study guides, and proofreading strategies.
• Strategies to encourage on-task behavior such as the use of the Tangle Jr., Wikki Stix, timers, and software.
• Solutions for finding the balance between helping too much and not enough.
• And for educators, best practices for assigning homework to ADHD students.

Above all, participants will learn how to help children do the most important things when it comes to homework – focusing and finishing!

I look forward to seeing you on Saturday, November 12th from 3:30 to 5:00. This workshop is DEFINITELY worth staying for until the end of the day!

Most sincerely,

Ann Dolin, MEd

A recognized expert in education and learning disability issues, Ann Dolin, MEd, sits on the board of CHADD of Northern Virginia and the International Dyslexia Association. She is the author of Homework Made Simple — Tips, Tools and Solutions for Stress-Free Homework.

Monday, October 24, 2011

“Hey, I Need Help Too!"


Today's guest blog is by Terry Dickson, MD, ACG.

The profound impact ADHD can have on marriage is well known. Less emphasis has been directed toward what a non-ADHD spouse married to an ADHD spouse truly experiences and what competencies, skills, and techniques are most effective for strengthening the relationship with a partner who has ADHD. A few of the questions a non-ADHD spouse may have are:
1. How can I understand the hard-wiring of my ADHD spouse? What are the traits of ADHD that tend to get in the way of the relationship?
2. How can I effectively communicate with my ADHD spouse when he/she has challenging communication skills?
3. How can I effectively cope with the frustrations of daily life with my ADHD spouse?
4. How can I work with my ADHD spouse to reach his/her full potential in the context of a healthy marriage?
5. Am I to blame for my ADHD spouse’s behavior?

Who are non-ADHD spouses? What do they experience that brings them to their wits end, that makes them want to divorce, or yell, feel unloved, tense up in a ball of frustration, or scream in anger?

Come join me as we explore these questions and more on Thursday, November 10, 2011 for a pre-conference institute from 9 am until noon at CHADD's 23rd Annual International Conference in Orlando, Florida.

During the presentation, my wife (who is a non-ADHD spouse) will talk about her experience being married to a person with ADHD (me). We will discuss how we have been able to work together effectively to strengthen our relationship. You will also hear the experiences of other non-ADHD spouses I have videotaped. You will gain a better understanding of the impact the behaviors of a person with ADHD has on a non-ADHD spouse and tips for strengthening your relationship for a lifetime.

To your success,

Terry M. Dickson, MD, ACG

Terry M. Dickson, MD, ACG, is an ADD Relationship Coach. He is also the founder and director of the Behavioral Medicine Clinic of NW Michigan, and has been principal study investigator for several clinical ADHD medication trials.

Thursday, October 20, 2011

Understanding Cyberbullying


Today’s guest blog is by Meghan K. McCoy, MEd.

Bullying—the repetitive, targeted and intentional, peer-on-peer abuse inflicted among two people in an unequal power relationship—has been in existence for as long many of us can remember. High-profile cases, tragic consequences, and increasing legal sanctions have aided in bringing this important topic to the forefront of our consciousness. Now that we all recognize the problem, it’s imperative that we begin to understand it from an evidence-based perspective!

This peer-on-peer abuse is not restricted, or even most rampant, in the hallways and classrooms of our schools. It has also invaded the online world of children and teens. We call this online abuse cyberbullying. In a world where youth are spending increasing amounts of time online, educators and professionals working with these digital natives will inevitably be faced with the fallout of this online abuse. A better understanding of digital natives, those who have “grown up online,” as well as the trends, frequencies, methods, and motivations of cyberbullying behaviors is crucial in helping to keep youth safe and responsible in their online use.

Join me at CHADD’s Annual International Conference on ADHD in Orlando to learn best-practice tools and techniques for preventing and responding to bullying and cyberbullying.
• What advice can we offer to victims and bystanders?
• What specific principles do the kids need to know about their online behavior?
• How can understanding the common characteristics of digital natives help us in combatting these issues?

Come to CHADD’s conference and let me share the some of the newest research with you!

Meghan K. McCoy, MEd, is the program coordinator of the Massachusetts Aggression Reduction Center at Bridgewater State University.

Thursday, October 13, 2011

Friends Are Important

This week's guest blog is by Ari Tuckman, PsyD, MBA.

I always look forward to the CHADD conference. As a psychologist and presenter, there's no better place to learn about ADHD from the biggest names in the business. But honestly, my biggest reason to look forward to it is that I have so much fun with my friends there (my wife calls them my "CHADD buddies"). Unfortunately, since most of these friends aren't local, I only see them at the conference. Sure, phone and email are good but they're not as good as the real thing of being together in person.

So it's fitting that this year I'll be presenting Everyone Needs Friends: Even (Especially) Adults with ADHD. It's hard to find the time to stay in touch with friends, whether they're local or far away. I know this very well from personal experience, as I juggle work obligations, giving time to my family, and staying in contact with friends. Far too often, work and family get most of my time and my friends get a quick email. I know I need to keep a better balance, but it's a real challenge. It also seems like I have more and more clients talking about similar struggles. Like me, some don't feel like they have enough time for friends. Others have the time but don't know how to make those friendships happen. In both cases, we feel like we're missing out. And we are.

So that's why I wanted to present on this important but often overlooked topic this year. It's a universal struggle, but folks with ADHD often have some additional challenges because of the way that typical ADHD behaviors tend to be interpreted. This then influences how others see the person with ADHD which feeds into how that person sees himself. Self-esteem and self-image interact with relationship dynamics. My goal for this presentation is to help attendees better understand themselves and others, so that they can create friendships where everybody feels better.

Hopefully I'll see you at my presentation on Saturday morning at 10:30. But you can look for me and my friends each night at the hotel bar. We'll be the ones laughing and making a bunch of noise.

Ari Tuckman, PsyD, MBA, is a psychologist in private practice who specializes in the diagnosis and treatment of children, teens, and adults with ADHD, anxiety, and depression. He is the author of More Attention, Less Deficit: Success Strategies for Adults with ADHD (Specialty Press, 2009).