Having raised three boys with a variety of ADHD presentations, I continue to find it fascinating how ADHD can be similar yet so different in girls and women. Unfortunately ADHD continues to be underdiagnosed in girls, resulting in many young women growing up with a significant dent in their self- esteem and wondering why things that seem simple for others can be such a struggle for them.
I just came across a wonderful article in the New York Times magazine, What It’s Like to have ADHD As a Grown Women, written by Rae Jacobson, a young woman with ADHD who grew up undiagnosed until the age of 21. The way other people treated her, their misperceptions and judgements are certainly disturbing, but the toll all of this took on her self- concept and confidence is the most heartbreaking. As she states:
“Repeated failure is destructive. It chips away at your self-confidence and eats at your resolve. It makes you hate yourself.”
Rae cites Dr. Patricia Quinn in her article. Dr. Quinn and Dr. Nadeau jointly host the ADDvance web site, http://www.addvance.com/, where they answer questions about ADHD with a focus on female ADHD. This is a wonderful resource for anyone interested in finding out more about ADHD in girls and women. Another great resource is a newly released up-dated version of Dr. Nadeau book, Understanding Girls with ADHD.
If you are a young woman, or know a young woman who has or thinks she may have ADHD, I strongly suggest that you read this article and access some of the numerous resources now available to assist girls and women with ADHD.
CADDAC presents ADHD PREP, a 2-day program on Saturday April 25 from 9AM - 4PM and Sunday April 26 9AM - 4PM
Visit the ADHD Prep Outline for an overview of the course content.
ADHD PREP is a comprehensive 12-hour program geared to parents of newly diagnosed children and adolescents with ADHD, and to parents wishing to upgrade their knowledge on the more complex aspects of ADHD including ADHD and learning, executive functioning and self and mood regulation.
Treatment options, parenting strategies and advocacy skills will also be covered. The program will occur over a weekend allowing parents from outside the local area to drive in for the weekend. Pricing includes workshop materials and light refreshments each morning and afternoon.
A post published by Mark Bertin M.D recently caught my eye for several reasons – one being the fact that Dr. Bertin will be one of our featured 2015 conference speakers, and another being his well-balanced multimodal approach to addressing ADHD, and his realization that the high levels of stress this disorder causes often drives the way families deal with ADHD.
Dr. Bertin begins with a genius analogy describing the fundamentals; the need for a strong foundation consisting of three pillars that has been proven to have significant impact on ADHD symptoms; school accommodations that recognize executive functioning impairments and; family supports and medical interventions.
Next steps would involve looking for ways to better things such as sleep, nutrition, exercise, communication, time management, safe driving and the excess time spent with electronic technology and media. Dr. Bertin concludes his analogy by talking the focus of his upcoming book, the use of mindfulness as a tool to help in “holding it all together”. If you have a child with ADHD who is struggling, or you are having difficulty functioning as a family with ADHD, this article may assist you in assessing where to start and how to build upon the successful management of ADHD as a family. Unfortunately while reading this article what came to my mind is the fact that in many parts of Canada it still remains difficult to access two of the supports that Dr. Bertin identifies as crucial: school accommodations and family support.
To view the Dr. Bertin’s entire post: https://www.psychologytoday.com/blog/child-development-central/201501/the-house-we-build-adhd
A new study researching how individuals with low birth weights were impacted found that they had decreased chances of developing alcohol and substance use disorders later in life but an increased chance of developing other psychiatric problems. Funded by the Canadian Institute of Health Research (CIHR), the study followed children into their 30s and found that they were 3 times less likely to develop alcohol or substance abuse issues, but 2.5 times more likely to develop psychiatric disorders such as anxiety, depression, and ADHD. Those born at an extremely low birth weight who received a full course of life saving steroids were nearly 4.5 times more likely to experience psychiatric problems.
Researchers feel that this information will increase awareness amongst parents and medical professionals and allow them to screen and assess for these disorders earlier. Of course it has been known for some time that premature babies have a higher incidence of ADHD, the new information about anxiety and depression is interesting. It would be interesting to find out how many of these adults who were diagnosed with ADHD also had comorbid anxiety and depression since these disorders frequently coexist in the adult ADHD population.
Because only 84 adults were followed all the way into their thirties, this is considered a small study; additionally, factors such as DNA and environment were not controlled and so a larger scale study would need to be completed before any definitive results could be reported.
For more information visit the original article at http://www.sciencedaily.com/releases/2015/02/150209083008.htm.
Don't forget to register for CADDAC's upcoming workshop on Adult ADHD, less than two weeks away!
Date: Saturday October 4th, 2014.
Location: Centennial College Culinary Arts Centre, 940 Progress Avenue, Toronto Ontario M1G 3T5.
Time: Registration and Breakfast from 8:00AM to 9:00AM. Presentations from 9:00AM to 3:30PM, followed by a Q & A Discussion session.
CADDAC is hosting a full day workshop on Understanding Adult ADHD. Presentations will be geared to adults and their families dealing with adult ADHD. This workshop will also be of interest to health professionals who wish to gain an understanding of adult ADHD and potential treatments.
The morning sessions will cover the medical science of adult ADHD, how it presents itself, how it differs from childhood ADHD, medication and psychosocial treatment options. These sessions will be followed by a unique presentation by adults with ADHD speaking about their own experiences and insights.
The afternoon will include a presentation on emotional dysregulation in adult ADHD and a presentation on ADHD in the workplace, discussing potential strategies and accommodations. An open question and answer and discussion period will follow where attendees can ask questions and share their insights.
Featured presenters include:
Dr. Flood, is a graduate of McGill University and the University of Manitoba. She is a family physician with a focused practice in Child and Adolescent Psychiatry at the Shoniker Clinic. She has considerable experience working in the field of ADHD, Learning Disorders and Autism. She is a member of CADDRA and on the Advisory Board of CADDAC.
Dr. David Teplin, is an adult clinical psychologist in private practice in Richmond Hill, Ontario. His primary focus is diagnostic assessment, clinical consultation, adult ADHD, and substance use disorders. Dr. Teplin is adjunct faculty in the Doctor of Clinical Psychology program at Medaille College in Buffalo, New York, and is on the editorial review boards of several clinical journals. He is also on the Advisory Board of CADDAC.
Heidi Bernhardt RN, is the mother of three young men with ADHD. She has a background in psychiatric nursing, was the Executive Director of the (CADDRA), a national not-for-profit organization of the leading clinicians and researchers in ADHD in Canada, and a founder of CADDAC and the ADRN. Heidi is presently the President and Executive Director of the Centre for ADHD Awareness Canada (CADDAC).
I strongly disagree with the recent article in Today’s parent magazine “What’s in a Label?” http://www.todaysparent.com/family/parenting/kids-health-labelling-behaviour/, which states that labeling a child with a disorder, be it ADHD, ODD, anxiety or OCD, imprisons a child and gives them the feeling of a life sentence. Liza Finlay, a psychotherapist, goes on to say that these labels allow a child to sidestep any effort to improve. My experiences are far different. From a personal family perspective as well as the perspective of someone who has spoken to thousands of families over the past twenty years, it is the lack of early diagnosis and therefore lack of treatment and access of resources that have imprisoned many children into a life of dealing with the consequences of these disorders. Left untreated, ADHD can lead to additional mental health disorders, increased rates of high school dropout, less years of education, self-medication leading to substance abuse, involvement with the justice system, as well as increased socioeconomic costs.
A psychologist who believes that the earlier mentioned disorders are nothing but behaviours, and that children can simply choose to adopt different behaviours, is an affront to decades of medical research. Does therapy combined with other treatments for these conditions prove helpful? Sometimes, but that does not mean that ADHD is simply a set of behaviours that can be unlearned.
The notion that "once a child is diagnosed with ADHD, parents stop expecting them to behave" is not only ludicrous, it is insulting. Once a diagnosis happens, parents are able to put the child’s behaviour into perspective. They are then able to focus on appropriate parenting strategies to assist that child with their behaviours and access other appropriate treatments.
I certainly agree that additionally focusing on a child’s strengths and working to increase their capacities is essential, but the best way to do this is within the understanding of a child’s overall profile. The lack of understanding of a child with ADHD can lead to all of the above mentioned consequences as well as increased childhood and family stress, family breakup, and, in extreme cases, abuse and children leaving home.
Do we need increased tolerance for those who do not fit into society’s definition of normal? Do we need to expand society’s definition of normal? The answer to both of these questions, of course, is yes. But we need to make sure that while we work on this goal, we don’t neglect the children who are labeling themselves as stupid, lazy and bad because no one has let them know why they might be finding it more difficult to succeed than their peers.
*** You can comment on the original article or click here to leave a letter for the editor. ***
I was notified about an incident that occurred during a Vancouver City Park Board meeting which highlighted the continued misunderstanding and stigma which still remains about adult ADHD. Vancouver Park Board Commissioner Melissa DeGenova shamed and stigmatized Vancouver Park Board Commissioner Sarah Blyth, who is the first politician in Canada to go public with ADHD.
Asking a question about Vancouver paying for the cost of business coaching is of course acceptable, making someone with a medical condition feel ashamed for asking for assistance is not.
About a year ago Sarah Blyth asked park board staff for help as she would be chairing some upcoming contentious meetings. She was offered business coaching. At this park board meeting questions were asked with regard to expenses surrounding the ADHD coaching she received. Commissioner Jasper asked staff to bring to the board any related information; and added that chairing the park board is at times a difficult job, and that if a commissioner needed help that he thought the request was reasonable. He also stated that Sarah Blyth was open about being diagnosed with ADHD.
Following this discussion, Melissa DeGenova asked why the governing party would not elect someone capable of doing the job, and further stated that she had disabilities, too. Melissa has two diagnosed Learning Disabilities: dyslexia and written output disorder, and is on the City of Vancouver Disability Advisory Committee. Ms. Blyth and others reported that, as she was leaving the meeting, Commissioner DeGenova proceeded to follow her out the door asking why she was playing the, "Poor me, I have a disability card."
To access Sarah Blyth’s description of the stigma she felt, please click on the following link or copy and paste it into your browser: https://www.facebook.com/notes/sarah-blyth/stigma/10152386409495210
To access Jamie Lee Hamilton’s account of the incident and request for an apology, please click on the following link or copy and paste it into your browser: https://www.facebook.com/jamie.hamilton.9480/posts/461977273945834
I recently came across an article that nicely summed up things parents should consider when deciding on ADHD medication treatment: linked here.
The article listed five things to parents should consider when making the decision, the first being a thorough medical evaluation by a trusted expert in the field of ADHD. For a description of what is involved in a thorough ADHD assessment access Diagnosing ADHD on the CADDAC Website. For further reading, access Assessment and Diagnosis for Children and Adolescents.
Once you are assured that your child has ADHD, your next step would be to ask yourself what is your desired outcome. How will it benefit your child? I would add that your expectations of medication treatment should be realistic. The symptoms that you would like to target should actually be something that medication will assist.
You will then need to consider all side effects; not just those of medication treatment, but also symptoms of untreated ADHD. Also consider that the decision to try medication as a treatment is not a permanent decision. Most ADHD medication may be started and stopped quickly or used only when required.
Finally, remember that this is not a decision that must be made quickly or under pressure. Other treatments, such as school accommodations and parenting strategies, should be tried initially. Medication treatment can always be added at a later date if necessary.
On the other hand, it may become evident very quickly that many things have been tried unsuccessfully in the past and the child is in significant distress. In this case, a medication trial may be initiated immediately. Also you should be aware that it may actually take some time to find the right medication and the right dose.
Medical professionals make a treatment decision by assessing benefit /risk ratio and so should you. What are the potential benefits to your child and what are the potential risks? While assessing these, make sure that you are relying on proper medical research that has been peer-reviewed and duplicated on a large scale, not anecdotal stories on the Internet.
I just finished listening to a great presentation by Dr. David Goodman about this topic. If you are interested in this topic I would highly recommend you access this presentation sponsored by the National Resource Centre on AD/HD at https://www.youtube.com/watch?v=L7lYicr3s5A.
In his opening Dr. Goodman reviews the actual accuracy of newspaper articles on ADHD research.
He goes on to explain how journalists construct articles with victims, villains and heroes in order to catch a reader’s interest. He suggests that readers try and identify these roles in the storey and also question whether the author is trying to express extreme attitudes to sensationalize the story to increase interest. He points out that many journalists, especially national journalists, have agendas, or have been given agendas by their publishers, so ask yourself “What is the agenda of this article?” as you are reading it. He closes by stating, “The credibility of the information is dependent on the intent of the provider.”
Two parts of the presentation confirmed my fears that these type of articles increase fear and shame in parents and impact patient diagnoses and treatment. Furthermore, he indicated that the public is easily seduced by articles that sound scientific, but are actually lacking in up-to-date or comprehensive research on a topic, and may sensationalize new unproven research in order to interest more readers.
In the presentation and Q&A period Dr. Goodman offers concrete suggestions on:
An interesting article called "The Smart Pill Oversell" was just published in the latest issue of the online publication Nature International Weekly Journal of Science. Unlike much of what has come out in lately in the media, this article is more balanced; offering a variety of opinions and some interesting points of discussion.
The majority of current studies indicate that medication treatment alone does not improve long term academic performance. ADHD and how it impacts learning is very complex, so why would we expect that medication alone would solve these complex impairments, especially those of executive functioning? This is why multimodal treatment for ADHD: including learning strategies, behaviour strategies, therapy, coaching, and so forth is recommended.
Unfortunately, many forms of treatment are often difficult to access due to the lack of availability, cost, and the continuous demand by schools that students with ADHD prove their learning is actually impaired. This requirement still exists in in many school boards and some universities; although current testing does not accurately assess executive functioning impairment in those with ADHD. At the same time, medication has proven beneficial for many children, and parents should not be made to feel guilty for or fearful of choosing to add this treatment to a child’s regime. They should, however, be fully informed, as some researchers in the article point out, medication is not magic, and will not automatically make their child academically successful.
Recently, many of the researchers involved in the original MTA study and the follow-up of the study are evaluating why long term gains for those in the study were not what they originally expected. This article presents a variety of different viewpoints, including the fact that after three years, these children went back to accessing community treatment, which was most often of a lower quality of care than they received in the study. Peter Jensen’s statement that only one in four children in the U.S. is getting adequate treatment for ADHD is very concerning, because I would assume it is no different here in Canada. Further research is really the only option that would provide us with a definitive answer. Unfortunately, these long term studies are very expensive; and often unethical because they necessitate a control group of children that you inadequately treated for a long period of time.
The article also points out that, while we know that medications for ADHD are misused by those without ADHD as study aids or cognitive enhancers, there is no evidence that these medications actually enhance cognition. Interestingly though, a paper that is cited here states that students who do not have ADHD, report feeling a boost motivation after taking the medication and perhaps that is why they feel their learning has been enhanced. This theory is yet unproven. We should be improving our efforts to educate young adult students that ADHD mediations do not really make them smarter or improve their academic abilities.
In closing, I would recommend this article for anyone interested in the current discussions on ADHD medication.