What is ADHD and How is it Treated?


What is ADHD? ADHD is a problem with inattentiveness, over-activity, impulsivity, distractibility or a combination or some or all of these things. More recently we have begun to realize that "slow cognitive processing" or "slow cognitive tempo" is also part of this. You know, you ask someone a question and ....you wait a long time for an answer. Sometimes they forget to answer.

So ADHD might be noticed because your overactive and inattentive, disorganized and confused.  OR you might be very quiet, forgetful, and processing slow.  These can look like very different problems, but are actually part of the same disorder.

Most people think of ADHD as a childhood disorder. Until recently we didn't think teens or adults had ADHD, we thought they grew out of it. About 50% of children with ADHD continue to have the disorder as a teen and adult, although it's nature ....how it presents itself in behaviours and deficits, may change as you grow older and your environment changes and presents new problems for you to cope with. There are plenty of adults who suffer from ADHD as well. Almost 2/3rd of my ADHD patients are adults.

ADHD needs to be treated. Untreated children with ADHD are far more likely to have oppositional and defiant behavior, drug use, alcohol abuse and criminal activity. They are also far more susceptible to the stress, anxiety, depression, family issues, divorce, family conflict, and other external stressors. The first and foremost recommendation for young children is parent education or training (to teach you special techniques to support your child with ADHD) and only after that, if there is not significant improvement, medications. ADHD medications are about the most studied and understood medications we have. There are several different types, and your best source of information is from your medical doctor. A lot of what you read on line about ADHD treatment is nonsense, untrue, unproven and often proven not to work...but it's the internet and people can saw and write anything. Go to your medical doctor and see a psychologist for further support.

Adults with ADHD continue to have difficulties. Untreated adults may have trouble keeping up on important home responsibilities, such as record-keeping or bill-paying; may have difficulties following through with work responsibilities. They often experience relationship and other problems because of difficulties staying focused. Cognitive Behavioural Therapy can help, psycho-education for you and your partner ...or the entire family...can help. Behavioural therapy can help easy problems
What does ADHD look like in children?

The symptoms of ADHD fall into three groups: Lack of attention (inattentiveness), Hyperactivity and Impulsive behavior (impulsivity).
Again, more recently we have found that the "slow cognitive processing" type is also a major issue. Some children with ADHD primarily have the inattentive type. Others may have a combination of types. Those with the inattentive type are less disruptive and are more likely to not be diagnosed with ADHD.

Inattentive symptoms
1. Does not give close attention to details or makes careless mistakes in schoolwork
2. Has difficulty keeping attention during tasks or play
3. Does not seem to listen when spoken to directly
4. Does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace
5. Has trouble organizing tasks and activities
6. Avoids or dislikes tasks that require sustained mental effort (such as schoolwork)
7. Often loses toys, assignments, pencils, books, or tools needed for tasks or activities
8. Is easily distracted
9. Is often forgetful in daily activities

Hyperactivity symptoms:
1. Fidgets with hands or feet or squirms in seat
2. Leaves seat when remaining seated is expected
3. Runs around or climbs in inappropriate situations
4. Has difficulty playing quietly
5. Is often “on the go,” acts as if “driven by a motor,” talks excessively

Impulsivity symptoms:
1. Blurts out answers before questions have been completed
2. Has difficulty awaiting turn
3. Interrupts or intrudes on others (butts into conversations or games)

Although less likely than children to show the hyperactivity symptoms, adults with ADHD can show the same symptoms of impulsivity and inattention.  Often adults confuse "memory problems" with ADHD. They also get seen as having a "bad attitude" and "not caring." This is often far from the truth. A key component to treatment success is self education and educating your friends and family. Sometimes even your co-workers or boss.

What causes ADHD?
Research seems to clearly point to ADHD as being a genetic disorder. Something you inherit. If you look through a family tree, it is likely you will see it hop scotching its way across the generations. It is not unusual for one parent to have it and pass it along to one or more offspring. It is not unusual to have an entire family in treatment in one form or another.

Besides ADHD being a genetic disorder head trauma or brain injury (TBI) can often be a cause of ADHD. With both brain injury and ADHD we often see problems with "frontal lobe" functions in the brain. An area referred to as the "executive" area. But remember, many of these symptoms can be cause by something other than ADHD. People can have brain injuries, memory problems, brain tumours, depression, anxiety, movement disorders, OCD, tics ....any number of things can look just like ADHD. So remember, don't diagnose yourself. You may not have ADHD, and you may be missing what is really the problem! See a doctor - a psychologist or a medical doctor - who understands ADHD for a full assessment.

Treatments for ADHD
There are medical and non-medical ways to treat ADHD. Often it is best to use both. Behavioural therapy, parent education, Cognitive Behavioural Therapy, the learning of new specific skills to improve focus, planning and follow-through ...all of these can be done with or without medication. EEG and HEG Neurofeedback are often suggested, however, these are not as effective as those treatment already listed. Some research shows Neurofeedback to be fairly ineffective and it fails to generalize across symptoms.

Memory is also often a problem, specifically what we call "active memory," or "working memory." This is the processing of holding something in your head for a short period of time while you do something (like saying a group of numbers backwards). There are a number of computerized programs out there that claim to help with ADHD and memory. Right now there is only one intervention using computers that has been proven to improve "working memory," that is CogMed. CogMed has been show to improve working memory in the majority of patients. It is a five week program that can be extended, and is pretty costly (pricing ranges from $1,200-$2,200 for the program).  And it ONLY helps with "working memory."

Because working memory is so important to all other memory, focus, concentration and planning processes, I think improving your active and working memory is often a good idea. Talk to your doctor about testing for working memory problems before you invest in such a program.

Untreated ADHD

Anyone who suspects they or their child may be struggling with ADHD should get themselves or their child evaluated immediately. Oftentimes we will simply assume that it’s just “laziness.” ( Dr. Mel Levine has an excellent book for parents called "The Myth of Laziness."  It addresses this problem of perception, and also addresses the complexity of what is going on when a child fails to produce at a rate we would expect of them. An excellent read designed just for parents.  You can find this and other books on my website.) Not treating ADHD often results in in feeling humiliated, angry, and with children, a quick dislike of school -where they simple experience too many failures.

An adult with untreated ADHD will not be able to meet his/her full potential in education, work, or relationships. ADHD is a "developmental disorder" and often requires training in organizational and planning skills that you missed learning and practicing (successfully) as a child. ADHD can be treated, medication can quickly and effectually address problems of concentration and focus, and parent education can address skills that will help you support your child. Behavioural treatment teaches you skills to overcoming problems with planning, organizing, procrastination and emotional regulation. And Cognitive Behavioural Therapy (CBT) can help you with clear thinking and the emotional problems like anxiety and depression that often come with ADHD.

Finally, with both children and adults, a full assessment is often recommended as nearly 50% of individuals with ADHD have co-morbid learning disabilities.  Don't be fooled into thinking "my child has ADHD, so now he's taking medicine everything at school should be alright."  Make sure you or your child actually get all the support you need.


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For information on counselling and therapy services in Burnaby, Vancouver, Coquitlam and surrounding areas contact Dr. Roche at: (Office phone) 778.998.7975
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As usual, let me warn you that this blog, any of my other blogs, or my web pages are not designed to provide you with an assessment, diagnosis or treatment. If you are concerned you have a health issue such as ADHD, anxiety, depression or Asperger's | autism please see your health service provider, either a medical doctor or Registered Psychologist. What may appear to be symptoms of one disorder can often be caused by another unexpected disorder. Other disorders, such as ADHD, are very likely to exist at the same time as another disorder (called co-morbid disorder) such as anxiety, depressing or OCD. You need to see a professional to find this out. On-line symptom checklists will not provide this, and are often misleading.

Services provided in my offices include: (covered by most extended health care insurance)
ADHD (click here:http://www.relatedminds.com/adhd-attention-deficit-hyperactivity-disorder/)
Anxiety and Stress (click here: http://www.relatedminds.com/anxiety-stress/)
Autism and Asperger's Disorder (Click here: http://www.relatedminds.com/autism/)
Individual Counselling (click here: http://www.relatedminds.com/individual-therapy/)
Child Counselling / Therapy (click here: http://www.relatedminds.com/child-therapy/)
Couples Counselling / Therapy (click here: http://www.relatedminds.com/couples-therapy/)
The Angry Child (click here: http://www.relatedminds.com/dealing-with-angry-aggressive-and-explosive-children/)
Anger Management (Click here:http://www.relatedminds.com/anger-management/)
Pain Management and PTSD (Click here:http://www.relatedminds.com/pain )
Forensic Services (Independent Medical Examinations or IME)

About
My name is Dr. Jim Roche and I am a Registered Psychologist and a Registered Marriage and Family Therapist (RMFT) in British Columbia. In addition to my doctorate in clinical psychology, I hold a master's degree in family therapy, a certificate of advanced graduate studies (CAGS) in school and educational psychology from Norwich University, and have completed two years of post doctoral studies in neuro-psychology at The Fielding Institute in Santa Barbara, California. In addition to being a registered psychologist, I am a certified school psychologist, certified teacher of special education (New York and California), and a Clinical Member of the American Association of Marriage and Family Therapists (AAMFT). I also hold a doctoral degree in law with an emphasis in medical malpractice and education law. Beyond my academic credentials, I have completed two years of supervised clinical experience in both hospital and community based clinics and two years of post doctoral training in neuropsychology. I have served as director of behaviour programming for several school districts, as a consultant on autism for the province, and have held numerous academic positions including Clinical Instructor in Psychiatry at New York University and Bellevue Hospital in New York as well as being a faculty member at NYU, Brooklyn College, SUNY New Paltz, and Norwich University.

Key words
ADHD | Anxiety and Stress | Autism and Asperger's Disorder | Individual Counselling | Child Therapy | Testing and Assessments and Learning Disabilities | Couples Counselling | Depression | The Angry Child | Anger Management | Pain Management and PTSD | Forensic Services | Attention Deficit Hyperactivity Disorder | Vancouver | Burnaby | Coquitlam | New Westminster | Maple Ridge | Port Moody | Child Psychologist | Psychologist | Learning Disability | Assessment | Testing | Psycho-educational Assessment | Neuropsychological Assessment

http://www.relatedminds.com
http://Therapists.PsychologyToday.com/rms/70682
http://www.therapistlocator.net/member?183420
http://www.bcpsychologist.org/users/jimroche
http://www.actcommunity.net/jim-roche.html
Phone: 778.998-7975