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Dr. Hallowell's Blog

Archive for March, 2014

Thursday, March 13th, 2014

MY ADHD CHILD

©TRACY NICOLAUS

He’s bouncin’ off the wall, a superball gone insane,
He runs through your world like an off-rail freight train.

Interruptions are constant, tantrums galore.
When it’s time to do homework,
he’s gone, out the door

The drama is constant, oh his foot fell asleep,
He moans and he wails, the theatrics run deep.

School is a nightmare, the teachers are lost
If they only could see, he is worth the cost

He is brighter than most, as most these kids are
And with patience and love,
I know he’ll go far

But the crap I must take from “well meaning friends”
“Don’t let him do that!” “Oh, these rules that he bends!”
“You’re not a good parent”. “Your child’s really rude”
“His temper’s outrageous.” “He has hands in his food”.

He hears this and wonders, just what’s wrong with me?
I tell him, “You’re special, you have A.D.H.D.”.

“Now A.D.H.D. is a gift from above.
It teaches us grownups how to strengthen our love.

It helps teach your teachers, no two kids are the same.
You have awesome energy that could bring you great fame.

You don’t need much sleep, you never wear down,
You’re silly and funny, when you act like a clown,

You’ve felt lots of pain from what people have said.
but you pray for those people when you go to bed.

So just try every day to make a fresh start,
for God gifted you with an extra big heart.”

As I look at my child, he sees through my soul.
My heart feels like bursting, as I realize my goal.

I know this young boy like no one else could,
He’s a blessing to me, he’s strong, and he’s good.

So I’ll love him and guide him through the worst of the worst,
And he’ll make a great man (if I don’t kill him first).

I’m kidding, of course, ’cause I know what’s to be,
When I look in his eyes, It’s a reflection of me.

Tuesday, March 11th, 2014

As Time’s Winged Chariot Hurries Near, How do we Make the Most of Every Moment?

“But at my back I always hear time’s winged chariot hurrying near.”  That line from Andrew Marvell’s poem, “To His Coy Mistress,” has stuck in my mind ever since I first read it in the 12th. grade in 1968.

Time’s winged chariot has gained some 46 years on me since then, and I still haven’t figured out what to do about it.

We all know it’s best to make the most of every moment, every day, every week, every year.  We all know time’s winged chariot bears down upon us, and will ultimately overtake us.  But the question that’s gnawed at me ever since I first read that line, the question that’s made the line stick with me and recur in my mind like the sometime tolling of a tower bell, is How?  How do we make the most of every moment?

Given that we have so many, many mundane tasks that we simply must perform, from brushing teeth to making bed to filling out forms to get car inspected to going to dry cleaner to paying bills to gassing up car to grocery shopping to clearing the table to shopping for shoes to looking for lost keys to applying for a mortgage to, well you get it, so very, very much, how in the world are we supposed to make the most of those moments?

How do I take into account time’s winged chariot hurrying near while I’m brushing my teeth?  Do I brush all the harder?  Do I say to myself, Be grateful, Ned, that you are alive enough to brush your teeth, the day will come when you can’t?  Or do I vary my tooth-brushing technique to remind me that each moment is unique and irreplaceable?  Or do I try to meditate while brushing, to make more of the experience of the moment?

What I am getting at is how difficult on a practical level it can be to relish every precious moment of life, even though we know every moment is precious.  The plain fact is that much of life is, perforce, humdrum.

But perhaps the hum of that drum, the hum of the ordinary, sets off the rest, the special moments, and makes them special.  Otherwise they would be humdrum, too.

What I tell myself, what I suggest to you all, is not that time’s winged chariot is hurrying near, even though I know it is, but rather life’s eternal wonder is always at hand, ready to be apprehended at any time, even when brushing teeth.

It is a wonder, this mysterious gift called life.  We can best let it enchant us, when and how it will.

Ned Hallowell 3/11/14

Monday, March 10th, 2014

Treatment of Anxiety and Coexisting Conditions with ADHD in Young Adults

by Terri Bacow, PhD

Treatment for ADHD with therapy may take a variety of forms.  But what if you have ADHD and you also have anxiety? First of all, know that this is incredibly common. The norm is for ADHD to be accompanied by at least one other psychiatric condition (but do not worry if you do not have one!) Approximately 25% of children with ADHD will meet criteria for an anxiety disorder. The rate of overlap between ADHD and anxiety for people of all ages is about 28%. So what to do? First, it may help to clarify that we all experience a normal amount of anxiety in our daily lives because life can be inherently stressful.  Anxiety only becomes a “problem” if it begins interfering with things that you would like to do or creates considerable distress.  For example, you could be less than thrilled to use airplanes as a form of travel, but it is not until you begin to avoid flying altogether or panic every time that you have to get on a plane, that it is time to seek treatment.

Anxiety is by nature, actually very adaptive.  If a wild boar is running towards you (or a fast city bus) it is best to get out of the way! Some of us have alarm systems that are more sensitive than others such that things that do not give other people pause, make us highly anxious or worried.  The goal of therapy is to help reduce these alarm systems to a place where we react to things that most people would react to under the same circumstances and the anxiety is no longer interfering with our ability to function.

What if ADHD is present or added to the mix? For some people, the experience of ADHD is inherently one of chronic anxiety.  It is stressful, arguably extremely so, to have difficulties attending, focusing, organizing time, completing one’s work, planning ahead, curtailing impulses, sitting still, when these “executive functions” are part of our daily lives and present in almost every task. Many of the patients I see report this type of stress and have difficulty managing it, which makes it very common in clinical practice. Some questions that folks with ADHD commonly report include:

  • What have I forgotten?
  • What will go wrong next?
  • How can I keep track of the balls I have in the air?

Not surprisingly, individuals with ADHD are also highly resilient and have developed a variety of excellent strategies to cope with these challenges.  Dr. Hallowell, in his book, “Worry” describes the very natural anxiety that people with ADHD experience as a “startle response.”  Dr. Hallowell describes the following sequence:

  1. Something “startles” the brain (i.e. a transition)
  2. A “mini-panic” ensues; the mind does not know where to focus
  3. Anxious rumination replaces panic; the focus is on worry (“Will I get my taxes paid on time?”)

In this sequence, the ADD mind uses worry to get organized (or stuck) and avoid chaos. The worry serves as something concrete to focus on. This very normal process is what I would consider “secondary” anxiety in that the anxiety is secondary to ADHD.  In other cases, anxiety is the primary problem.  The anxiety difficulty is a disorder that is truly separate from the ADHD and co-occurs with it. Some examples include OCD (obsessive-compulsive disorder), panic disorder, post-traumatic stress disorder, generalized anxiety disorder and social phobia.

Whether you have ADHD and also feel a little bit anxious, or you have ADHD and feel VERY anxious, do not fear – help is available! The most effective type of therapy for both ADHD and anxiety disorders is cognitive-behavioral therapy, or CBT.

CBT is similar to all other types of therapy in that it involves a one-on-one conversation with your therapist, and in this way it is extremely similar to traditional talk therapies.  The CBT therapist, however, is more active and directive, and the goal of CBT is to teach patients specific coping skills to manage his or her symptoms.  In this manner, CBT tends to be a more structured and didactic.  It is also quite effective, with the aim to reduce symptoms within six months. CBT is based on a specific model that emphasizes the way we think and how we react, and teaches that any given emotion, whether it be anxiety, frustration, anger or sadness, can be broken down into three components: a thought, a feeling and a behavior.  This core CBT model theorizes that if you change the way you think or the way you behave, you can improve the way that you feel.  CBT is comprised of a wide variety of short-term interventions aimed at teaching the patient skills to change thinking and behaviors and improve emotion regulation.  These may include simple skills such as problem solving and more complex ones such as identifying and reframing our beliefs in a variety of situations that trigger negative emotions.

Having ADHD can be a confusing experience, as strengths are often mixed with real challenges. There is an enormous benefit of receiving therapy and/or coaching and sometimes combining the two interventions can achieve ideal results.  This is good news for all of us who feel anxious and are seeking a bit of calmness and relief in our lives!

 

Monday, March 10th, 2014

ADHD – A Blessing or a Curse? Educators and Parents can Help Students with ADHD Succeed in School

Cynthia Nagrath 508 790-1990  The International Educator (TIE)

National Best-Selling Author, Dr. Edward Hallowell spoke recently at the Cape Cod Institute on his unique strength-based approach to ADHD.

Speaking before a room full of educators, psychologist and counselors at the Cape Cod Institute, located at the Cape Cod National Seashore, Dr. Edward Hallowell one of the nation’s leading experts on ADHD, shared his unique approach on how to view the condition that is the most commonly diagnosed neurobehavioral disorder of childhood. According to the Center for Disease Control and Prevention, ADHD affects nearly one out of ten children between the ages of 4-17, or approximately 5.4 million children nationwide.

Attention-deficit/hyperactivity disorder (ADHD) is a neurobehavioral disorder that typically begins in childhood and often persists into adulthood, and is characterized by developmentally inappropriate levels of inattention and hyperactivity resulting in functional impairment in academic, family, and social settings.

A New Definition of ADHD
That’s the official definition, but Dr. Hallowell prefers to look at it as a collection of traits instead. What’s the difference? According to Dr. Hallowell, a trained MD, “It’s very debasing to be told you have a disorder. Because medical school is all about pathology, we’re trained to look for the defects and the emphasis is always on what’s missing. It’s all about misery and mental disease; we don’t learn about joy and mental health.” As a result, Dr. Hallowell says, “People in my profession create the notion that someone has a disease and by that definition, they attach low expectations to the patient.” Dr. Hallowell is on a mission to change that and it starts with how the diagnosis of ADHD is communicated to patients and positioned to the world at large.

The Good News about ADHD
When Dr. Hallowell tells his patients about their diagnosis, he tells them he has good news, “You have a Ferrari brain, with bicycle brakes.” When hearing the “diagnosis” presented in such an upbeat way, patients are often, for the first time, able to focus on their positive attributes versus their deficiencies. He also tells them about the all the successful entrepreneurs, artists, actors, writers, and doctors (including himself) who have ADHD. “When people leave my office they walk away with the feeling, ‘We’re champions in the making!’” exclaimed Dr. Hallowell. “I urge you to embrace a model that celebrates the strengths,” he advised the rapt audience of educators and mental health professionals, attending the Cape Cod Institute’s summer-long series of courses. “Who wants a deficit disorder?” he asks, “when they can have hope, optimism and cheerfulness.”

Dr. Hallowell simply tells his younger patients that they will need to work on their brakes and he gives them strategies, or “brake fluid,” to help them slow down their racing car. “You want your kid to know he has extra work to do, but if he does the work, the sky’s the limit,” says Dr. Hallowell full of enthusiasm. If managed properly, the traits can be turned into strengths.

Deficits are Strengths in Disguise
Dr. Hallowell calls for a different way of looking at some of the typical ADHD traits. Instead of deficiencies, they can be viewed as strengths or blessings in disguise. For example, “Distractibility is really an indicator of curiosity. Impulsivity is the flip-side of creativity, or put another way, creativity is impulsivity gone good,” according to Dr. Hallowell. “The trait of hyperactivity is actually energy,” Dr. Hallowell points out, “Which is not such a bad thing and comes in pretty handy at my age,” he said with a broad smile.

The strength based approach to viewing and dealing with conditions like ADHD is starting to gain ground with educators. Forrest Broman, Publisher of The International Educator (TIE), a newspaper specializing in educational news and developments at international schools worldwide, feels strongly that Dr. Hallowell’s approach needs to be embraced by parents, teachers and their ADHD children. “There are just too many examples of ADHD traits being put to creative use and professional success for Dr. Hallowell’s message and program to be ignored,” said Mr. Broman. “He is on to an approach that should revolutionize the treatment of children diagnosed with ADHD.”

Prognosis Good
“Highly creative people pay a major price for their gift,” Dr. Hallowell cautions. “It’s an odd fact about talent that it’s inextricably linked to challenges.” Students find enormous challenges in school because most teachers still regard ADHD as a discipline problem and they are told that they need to work harder. This is what Dr. Hallowell refers to as the “moral diagnosis” because often students are told that they’re lazy or simply not putting in enough effort. Once teachers begin to look at the deficits as actual strengths turned inside-out, kids will begin to thrive. Dr. Hallowell advises that “Children with ADHD need their parents’ and teachers’ help, but the good news is, they’re remarkably good at bouncing back.”

“International schools still have some work to do in this department,” admits Mr. Broman, “but our role at TIE is to educate educators, and we want to help spread the word about Dr. Hallowell’s positive approach.”

For parents of kids with ADHD, there are plenty of reasons to feel optimistic about the future.    Parents should encourage their children to think big, because as Hallowell says, for these high-energy kids, “The sky’s the limit!”

The Cape Cod Institute is a summer-long learning program attended by health, education, and management professionals from all over the world who are seeking to enhance their practice and stay current in their fields. The Cape Cod Institute, now in its 33rd year, features internationally recognized leaders in the fields of psychology, education, and therapeutic practice who share with participants their expertise by offering world-class professional development opportunities in a relaxing casual atmosphere near the Cape Cod National Seashore.

Saturday, March 8th, 2014

Dr. Hallowell: 5 Tips for Raising Good Kids

The greatest gift parents and teachers can give children is happiness.

It’s what all parents want for their children, but how to achieve it? Dr. Hallowell outlines 5 Steps here.

Friday, March 7th, 2014

The Deep Anxiety Differential

Matthew J. Kaplowitz, PhD

When the impulsive self goes against the responsible self, life gets complicated.

A lot of ADHD people try to compensate for this, and are determined to stay on track and work hard to overcome the deficit. As Dr. Hallowell advocates in his strength-based approach, many of the underlying attributes of ADHD can ultimately be leveraged as strengths rather than deficits.

Unfortunately, the same cannot be said of anxiety.

When the anxious self goes against the responsible self, it usually wins.

That’s because anxiety creates a distortion of reality.  Anxiety is not the same as fear. Fear is realistic, and keeps us safe. Anxiety is paranoid, and drives us nuts.

Fear responds to a realistic situation that is threatening, for example the sound of gunshots. Anxiety is more complicated, driven by an internal not external disturbance (e.g., I’m scared my boss must think awful things about me).

While fear alerts us to realistic dangers, anxiety raises the premonition of danger, keeping us on edge indefinitely with an internal, diffuse signal of an imagined threat. Sometimes these premonitions come true, sometimes they do not—sometimes we make them come true, as in worrying so much about a project for work that we can barely focus on the project, and little gets done.

Therefore, central to dealing with ADHD is also dealing with anxiety.

If you have a nervous system at risk you will get anxious. It’s impossible to have a neurological-based issue without anxiety as an accompaniment, given the impact on normal functioning. As a child, issues like ADHD will at minimum get the adults in the environment stirred up. The stirred-up adults will then give anxious feedback to the child, so immediately they’re being labeled with a problem, which in turn makes the child anxious. How do you then differentiate which parts of the problem are caused by neurology, and which by anxiety?

To make matters more complicated, anxiety can cause the same symptoms of distractibility and restlessness as in ADHD.

In fact, if you get anxious with an intact nervous system, that can still have a distracting effect.  Meaning, in certain cases, what appears to be ADHD is not that at all, but really deep anxiety.

Since there is no one-size-fits-all approach in treating either ADHD or anxiety, each person must figure out exactly what work they need to do to move from deficit to strength. Doing the wrong work, despite the level of effort you put in, will not change anything.  Part of discovering the right work involves understanding anxiety, meaning: 1) how anxiety interacts with your ADHD, and 2), to what extent (if any) anxiety is at the root of some or all of your ADHD symptoms.  These are critical discernments for you to make along the path from deficit to strength.

Matthew J. Kaplowitz, PhD
Dr. Kaplowitz is a licensed psychologist. At the Hallowell Center, he provides psychotherapy and career counseling for adults and adolescents. He also offers an array of career development services, including comprehensive professional assessments that may include differential diagnosis. Dr. Kaplowitz worked for many years as Expert Therapist and Clinical Researcher at the Anxiety Disorders Clinic at Columbia University Medical Center/New York State Psychiatric Institute, where he received special training in a variety of empirically validated treatments that have proven efficacious for anxiety disorders and ADHD.

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