One group of self-referred individuals actually have Post-Traumatic Stress Disorder. PTSD is a condition which develops in some people in response to a traumatic event - either directly experienced or witnessed by the person. Most typically they are from severely abusive homes, have been sexually assaulted, participated in wars, or have witnessed events outside the realm of normal human experience. These clients complain of difficulty sleeping, irritability or outbursts of anger, difficulty concentrating, hypervigilance, exaggerated startle response, and difficulty remembering things. Many alternate between an emotional numbness and overreactivity in relationships. Some have nightmares or flashbacks of the traumatic event, and avoid situations which remind them of the incident. Some of the symptoms are identical to those found in adults with ADD.
Traumatic events are usually not part of the presentation of ADHD, although some have a history of fairly severe discipline. With ADHD, there is no avoidance although emotional sensitivity, low frustration tolerance, and overreactivity can be present. In a few cases, however, some clients, due to embarrassment over their childhood learning disabilities and attentional problems, did experience school as traumatic and actually have nightmares about it. Some have a history of physical abuse; however, this is not common. One study examined parents' treatment of ADHD children and their siblings by retrospective report. Whitmore (1993) and her colleagues found no difference in the ADHD subjects' and their siblings' reports of physical punishment, discipline, or parental rejection. Furthermore, the amount of physical punishment reported was unrelated to the degree of hyperactive and aggressive symptoms in the children.
In an examination of comorbidity of these two disorders, Cuffe and his colleagues (1994) suggest that children with ADHD may be at higher risk for trauma due to their difficulties with impulse control, dangerous behaviors, and parents who may also respond impulsively. These researchers also acknowledge that the hyperarousal, hypervigilance, and poor concentration associated with PTSD may produce ADHD-like symptoms. Sufficient research has not been done to determine whether ADHD individuals are actually at greater risk for trauma. However, individuals with PTSD do seem more likely to be traumatized again, and one author suggests that this is possibly due to their inaccurate perception of environmental cues. If this is the case - that individuals with PTSD are at risk because they are not correctly attending to cues of possible danger, then it would seem that ADHD individuals may be at risk as well.
References:
Cuffe, S. P., McCullough, E. L., and Pumariega, A. J. (1994). Comorbidity of attention deficit hyperactivity disorder and post-traumatic stress disorder. Journal of Child and Family Studies, 3(3), 327-336.
Matsakis, A. (1994). Post-Traumatic Stress Disorder: A Complete Treatment Guide Oakland, CA: New Harbinger Publications, Inc.
One of the most troubling aspects of ADHD is the sense of being out of control. Because attention is skewed...one's life is skewed. Bills aren't paid on time (unless one's spouse is paying them!); appointments are missed or arrived at late; work or school deadlines create an overlay of stress that makes life miserable, while being the very agents that adrenaline-driven performance depends upon...that last minute stress-driven adrenaline surge being necessary for one to access brain chemistry to finish the task. And what about relationships? Whether inattentive or hyperactive...the impact on relationships is much the same...one is not present with the other person. Whether impatience is conveyed by finger tapping, jiggling leg or foot, or impulsive interruption; or whether lack of interest is conveyed by not paying attention, doing other things at the same time someone is talking, or not fully looking at the other person...the end result can be the same...discounted, dissatisfied, disconnected relationships.
Folks, attention deficit disorder can be effectively treated. It's a whole new ball game once you've been diagnosed and medicated for ADHD. For many individuals medication must be in place in order to make changes; however, medication alone will not change the above mentioned behaviors. With the educational/therapy part of treatment in place you get to make life changes. You get to build a new history of being responsible, of getting to appointments on time, of taking care of responsibilities responsibly, of being an attentive partner and good listener. You can get there from here!
Two factors that seem to be significant elements in effecting behavior change are "personal responsibility" and "predecision." Personal responsibility is crucial to being in control of one's ADHD symptoms. A lifetime of untreated ADHD can lead to a sense of there being no "adult on board"...a sense of inadequacy and "I can't help it if I forget things." Or, "I can't help being late", or "I can't sit here and listen to you talk...you talk too slowly!"...a sense of "I can't." Personal responsibility means taking prescribed medication properly and then rolling up one's sleeves figuratively and saying "All right. What can I do about getting those bills paid on time? What can I do to get my work done effectively and not have to wait until the last minute so that I'm so stressed I make everyone miserable until the deadline is reached? What can I do to be a better friend, communicator, partner? How can I value and treat my partner with love and respect? How can we have a fulfilling relationship? What can I do about these areas that have been so out of control?" With personal responsibility activated, the next significant element to change can be employed.
Predecision, vital element number two, can be described in this way. In this moment...right now...I'm thinking of an issue that is troubling me in some way. Right now is the time I'm going to look at this issue and find some way to get a handle on it. For instance, if paying bills on time is a problem, now is the time I can look at that issue and spend time coming up with a way to pay them on time. The truth is...that can happen, even though in the past I've not paid them on time. I am not one of the "flawed, doomed to failure." I can actively make new decisions that serve me well.
It may be that I need to get some new information about how to do things differently in ways that serve me better. One excellent example of predecision is Dr. Edward Hallowell's concept of "pattern planning". This is a process of getting down on a schedule when one chooses to do certain repetitive tasks, such as picking up dry cleaning, going to the bank, etc. (Hallowell & Ratey, 1995). A benefit of this predecision is that one doesn't have to mentally keep track of so many details, and over time, one comes to automatically do things on the days set apart for those tasks. Predeciding can have a big payoff in effectiveness and in lowered hyperarousal from fear of forgetting something important.
So, back to bill paying. What can I predecide to make paying bills easier and to make it actually happen? Are there some bills that I can pay on certain dates? Okay. I can pay "X" bills on the first and "Y" bills on the fifteenth. What about the other bills that happen at odd times? I can go ahead and write the check as a bill is received, and address, seal, stamp and put a date-to-be-mailed notation. I can designate a certain spot-basket-place for bills-to-be-mailed. I can then predecide to check the designated spot in the morning at a specified point during my morning routine. Okay. All right! Things are shaping up here! But how does it actually get mailed? Most ADDers could step over a fallen body and not pay attention. Looking at a to-be-mailed notation is slightly less entertaining than watching grass grow. How can I make the task novel enough or important enough to actually follow through and pay attention to it?
Hmmm. You know, it may not be novel or exciting to take this action; however, there's a lot in it for me to follow through with this. If I actually get this system set up for me, I then have the potential to be what I could not be before coming up with a plan...I can be responsible. I can feel a sense of safety with myself that I can count on me, and with that piece in place...other people can count on me as well. I don't have to be in hyperarousal that I'm inadequate or "flaky" or that I can't be depended on to do things in a timely manner. Yes! I get to BE the adult on board. I get to have a new standard of behavior that serves me very well...that actually allows me to be the me I always knew I could be if I weren't trapped in the fog of inattention and unreality that some experience as ADHD.
Is this the only plan for one to be able to pay bills successfully? Hey! We're talking about the most creative, unique group of people in the world! Of course this is just one method that might help. I'm sure each reader can generalize this process, however, and come up with your own solution that will work best for you. The basic premise is that there IS a way for you to be in control of that task, whatever it may be, and come up with a plan that will serve you better; and whether anyone else would do it that way is irrelevant. You get to be successful at the task, using whatever memory techniques you need to use to increase your attention to attend to the task as needed. Personal responsibility and Predecision. Powerful agents to bring about life changes that can give one a sense of safety with self and personal power over the difficulties that each person with ADHD faces. Is it easy? No. Is it worth the effort and thought and time to develop new patterns of behavior? Hmmm. Why don't you be the judge of that!
Adults who have been diagnosed with ADHD, and who want to take action to develop strategies for dealing successfully with their symptoms, are invited to contact , M.S., LPC for individual therapy, coaching, and strategy development. As you probably are aware, suggested treatment which provides the greatest potential for getting in control of your ADHD symptoms is comprised of three components: medication, psychotherapy, and education. With these factors in place you have the opportunity to make life changes that can allow you to live a more fulfilling and successful life. What are your particular needs? Do you need to explore options before taking the step to seek medication? Are you ready now to look at aspects of your life that may be causing stress or pain and explore options to gain control in those areas? Some of those areas might include communication skills, relationship building, more effective organization and time management skills, problem-solving skills, and learning how to deal with the hyperarousal of living with ADHD.
Students who are wanting to succeed in their college efforts, and who are ready to take action to develop strategies for that success are invited to contact us for individualized coaching and strategy development. Our focus will be on what your particular needs are -- some of which might include how to problem-solve, how to tackle and accomplish those long-term projects, how to organize and stay on task, how to cope with all the pressures involved in being a student, and how to build on your particular strengths.
ADD ADULTS: Getting Tested
This audio cassette provides you with the diagnostic criteria for ADHD, and
tells you what to look for in an evaluation, and what to expect from
psychological testing. This informative tape explains the "why" behind
certain tests and procedures and turns you into an informed consumer. Also
included is a written transcript and list of references. To order, call
972-980-7488 or write to ADDTRC at 4230 LBJ Freeway, Suite 525, Dallas, TX 75244
and enclose $14.95 + tax (1.65) per cassette plus shipping and handling. Tax is
for TEXAS purchasers only.
Differential Diagnosis of ADHD in Adults
This tape covers the thought disorders, affective disorders, personality
disorders, anxiety disorders, and even some nonpsychiatric disorders and helps
you differentiate them from ADHD. This tape is geared toward professionals
learning to diagnose ADHD in adults, and who are interested in the current
research on psychometric testing of attentional problems. The cost is 34.95 +
tax (2.88) per package; and this package includes a written transcript along
with an extensive reference list. Tax is for TEXAS purchasers only.
Beginning in February and running through May1997, Dennis Hines, MS, a supervising LPC and Charles Wadley, a counseling intern, will be holding a series of six week seminars which will meet on Monday nights. The sessions are expected to last an hour and a half, and the fee will be 150$ per person. These sessions run consecutively and will repeat every six weeks - so if you have to miss one you can make it up the next time around. Here's more info:
LIFE SKILLS
A Group Therapy Series
This group is designed to be fun, motivational, and developmental.
To participate, call 972-980-7488.
Here are some interesting research findings on the stress of parenting an ADD child.
There are currently over a thousand references for ADD in the psychological literature. Each issue we will pick a topic and provide you with a list of references. The topic for this issue is parenting and includes those references used in the parenting stress review above.
Anastopoulos, A. D., Guevremont, D. C., Shelton, T. L., & DuPaul, G. J. (1992). Parenting stress among families of children with attention deficit hyperactivity disorder. Journal of Abnormal Child Psychology, 20, 503-520.
Baker, D. B. (1994). Parenting stress and ADHD: A comparison of mothers and fathers. Journal of Emotional and Behavioral Disorders, 2(1), 46-50.
Barkley, R. A. (1985). The social behavior of hyperactive children: Developmental changes, drug effects, and situational variation. In R. McMahon & R. Peters (Eds.), Childhood disorders: Behavioral-developmental approaches (pp. 218-243). New York: Brunner/Mazel
Barkley, R. A. (1988). Attention deficit disorder with hyperactivity. In E. J. Mash & L. G. Terdal (Eds.), Behavioral assessment of childhood disorders. (2nd ed., pp. 69-104). New York: Guilford.
Barkley, R. A. (1988). The effects of methylphenidate on the interactions of preschool ADHD children with their mothers. Journal of the American Academy of Child and Adolescent Psychiatry. 27, 336-341.
Barkley, R. A.. (1989). Hyperactive girls and boys: Stimulant drug effects on mother-child interactions. Journal of Child Psychology and Psychiatry, 30, 379-390.
Barkley, R. A., & Cunningham, C. E. (1980). The parent-child interactions of hyperactive children and their modification by stimulant drugs. In R. Knights & D. Bakker (Eds.), Treatment of hyperactive and learning disabled children (pp. 219-236). Baltimore: University Park Press.
Barkley, R. A., Karlsson, J., Pollard, S., & Murphy, J. V. (1985). Developmental changes in the mother-child interactions of hyperactive boys: Effects of two dose levels of Ritalin. Journal of Child Psychology and Psychiatry, 26, 705-715.
Barkley, R. A., Karlsson, J., Strzelecki, E. & Murphy, J. (1984). Effects of age and Ritalin dosage on the mother-child interactions of hyperactive children. Journal of Consulting and Clinical Psychology, 52, 750-758.
Befera, M. S. & Barkley, R. A. (1985). Hyperactive and normal girls and boys: Mother-child interaction, parent psychiatric status and child psychopathology. Journal of Child Psychology and Psychiatry, 26, 439-452.
Breen, M. J. & Barkley, R. A. (1988). Child psychopathology and parenting stress in girls and boys having attention deficit disorder with hyperactivity. Journal of Pediatric Psychology. 13, 265-280.
Campbell, S. B. (1975). Mother-child interaction: A comparison of hyperactive, learning disabled, and normal boys. American Journal of Orthopsychiatry, 45, 835-845.
Cunningham, C. E. & Barkley, R. A. (1978). The effects of methylphenidate on the mother-child interactions of hyperactive twin boys. Developmental Medicine and Child Neurology, 20, 634-642.
Cunningham, C., E., Siegel, L. S., & Offord, D. R. (1985). A developmental dose-response analysis of the effects of methylphenidate on the peer interactions of attention deficit disordered boys. Journal of Child Psychology and Psychiatry, 26, 955-971.
Fisher, M. (1990). Parenting stress and the child with attention deficit hyperactivity disorder. Journal of Clinical Child Psychology, 19(4), 337-346.
Forehand, R. L. & McMahon, R. J. (1981). Helping the noncompliant child: A clinician's guide to parent training. New York: Guilford.
Gillberg, C., Carlstrom, G., & Rasmussen, P. (1983). Hyperkinetic disorders in seven-year-old children with perceptual, motor and attentional deficits. Journal of Child Psychology and Psychiatry, 24, 233-246.
Humphries, T., Kinsbourne, M., & Swanson, J. (1978). Stimulant effects on cooperation and social interaction between hyperactive children and their mothers. Journal of Child Psychology and Psychiatry, 19, 13-22.
Mash, E. J. & Johnston, C. (1982). A comparison of mother-child interactions of younger and older hyperactive and normal children. Child Development, 53, 1371-1381.
Mash, E. J. & Johnston, C. (1983). Parental perceptions of child behavior problems, parenting self-esteem, and mothers' reported stress in younger and older hyperactive and normal children. Journal of Consulting and Clinical Psychology, 51, 86-99.
Mash, E. J. & Johnston, C. (1983). Sibling interactions of hyperactive and normal children and their relationship to reports of maternal stress and self-esteem. Journal of Clinical Child Psychology. 12, 91-99.
Sandberg, S. T., Wieselberg, M. & Shaffer, D. (1980). Hyperkinetic and conduct problem children in a primary school population: Some epidemiological considerations. Journal of Child Psychology and Psychiatry, 21, 293-311.
Schachar, R., Taylor, E., Wieselberg, M., Thorley, G. & Rutter, M. (1987). Changes in family function and relationships in children who respond to methylphenidate. Journal of the American Academy of Child and Adolescent Psychiatry, 26, 728-732.
Tallmadge, J. M. & Barkley, R. A. (1983). The interactions of hyperactive and normal boys with their fathers and mothers. Journal of Abnormal Child Psychology, 11, 565-580.
Tarver-Behring, S. Barkley, R. A., & Karlsson, J. (1985). The mother-child interactions of hyperactive boys and their normal siblings. American Journal of Orthopsychiatry, 55, 202-209.
Whalen, C. K., Henker, B., & Dotemoto, S. (1981). Teacher response to the methylphenidate (Ritalin) versus placebo status of hyperactive boys in the classroom. Child Development, 52, 1005-1014.
This issue's pick is for those of you considering returning to school. If you are seeking financial aid for college, here's a site where you can obtain booklets from the Department of Education at:
http://www.ed.gov/offices/OPE/
"The 1997-1998 Student Guide: Financial Aid from the U. S. Department of Education" provides information about student financial assistance for the 1997-1998 award year.
"Funding Your Education 1997-1998" is designed for high school students and others considering entering a postsecondary school for the first time.
"Looking for Student Aid" helps find sources of free information about student aid and scholarship search services.
"Instructions for Completing the 1996-1997 Free Application for Federal Student Aid (FAFSA)" & "FAFSA Express" make the paperless financial aid application a reality. FAFSA Express is software you can download and transmit electronic forms to the Department of Education.
ADDTRC researcher, Cindy Taylor, with the statistical assistance of Dr. Dan Miller from Texas Woman's University, has been analyzing data collected from over 400 adult evaluations. We first analyzed the test results according to the number of diagnoses received. For this first analysis, it didn't matter what the subjects had, just how many diagnoses. Results indicated that the more psychiatric disorders one had, the more overall attentional impairment was present.
The second analysis examined three groups: those diagnosed with ADD; those diagnosed with other psychiatric disorders; and those who did not receive a psychiatric diagnosis. Analyzing the differences between these groups revealed a pattern of tests results specific to each group. Overall, the ADD group experienced the most overall impairment in attention across several attentional measures. The group with other psychiatric disorders was closely behind and those with no diagnosis were significantly less impaired than either of the other two groups.
This initial analysis indicates that the group with other psychiatric disorders scored significantly worse on one particular neuropsychological screening measure, while the ADD group had most difficulty sustaining their attention. The groups were not significantly different on tests believed to measure cognitive flexibility, or the ability to shift attention. What about IQ? Glad you asked.....the normals had the highest average IQ, the ADDers next, and the other psychiatric problems group had the lowest average intellectual functioning.
Interestingly, only around 11% of 400 subjects received a diagnosis of ADD alone. This is similar to other studies which find an extremely high rate of comorbidity in adults with ADD. Overall, close to 40% actually did have ADD, but most met the criteria for another disorder as well.
There are a couple of other studies in progress. One examines the differences between ADD, Normal, and Other Psychiatric disordered individuals on various tests of personality, while validating a new instrument for the differential diagnosis of attentional problems. Another examines the data from the assessments of individuals who received our more comprehensive "full battery" which tests for ADD, Learning disabilities, and emotional difficulties.
These research results are exciting and will lead to greater certainty in differentiating ADD from other psychiatric disorders which cause attentional impairment.
I want to take a moment to thank those of you who have visited our home page and particularly those who have left E-mail at our site. We have tried to respond to all of you, and appreciate your taking the time to ask questions and share your stories with us. Some of your letters are so sincere and touching that I have often wished they could be shared with others in similar situations. And many of you are natural born writers!!! Our intent is to keep your personal stories confidential unless otherwise stated. However, if you are interested in sharing your experiences with others who could benefit, please let us know that you wouldn't mind having your story printed in the newsletter. In addition to personal stories, we are seeking scholarly articles from students or others including original research, literature reviews, or any other information appropriate to the content of the ADDTRC News. We're doing this for all of you who either have, or know someone who has ADD. So, please let us know what interests you and we can do this together!
We'd like to hear from you. Please send us an email message.