20 Jul 2014

Tips for Managing ADHD

Your Guide to Diagnosing and Managing ADHD

If you think you or your child may have ADD or ADHD, the therapist at the Center for Behavioral Medicine can help. 

The symptoms of ADD / ADHD, such as concentration problems and hyperactivity, can be

confused with other disorders and medical problems. Just because it looks like ADHD doesn’t mean it is, so

getting a thorough assessment and diagnosis is important.

At present, no laboratory or imaging test exists to determine if your child or yourself has ADD / ADHD.

Clinicians base their diagnosis on the behavioral symptoms they observe and by ruling out other disorders.

The American Academy of Pediatrics recommends that an evaluation for childhood ADD / ADHD include:

• A thorough medical and family history.

• A general physical and neurological exam.

• A comprehensive interview with the parents, the child, and the child’s teacher(s).

• Standardized screening tools for ADD / ADHD.

• Observation of the child.

• A variety of psychological tests to measure IQ and social and emotional adjustment.

Many people only learn that they have ADD / ADHD when they become adults. Some find out after their

children receive the diagnosis; as they become educated about the condition, they realize that they also

have it. For others, the symptoms finally outpace their coping skills, causing significant enough problems

in their daily life that they seek help. If you recognize the signs and symptoms of ADD / ADHD in yourself,

schedule a visit with us today.

Because ADD / ADHD often co-occurs with other conditions such as anxiety and depression, it is best to see

a therapist who has experience diagnosing and treating the disorder.

To determine if you have ADD / ADHD, we will:

• Ask you about your symptoms, including how long they’ve been bothering you.

• Administer ADD / ADHD tests, such as symptom checklists and attention-span tests.

• Ask you about problems the symptoms are causing or have caused in the past.

• Talk to family members or someone close to you about the symptoms.

• Help you to rule out other physical causes for the symptoms.

Diagnosing ADD / ADHD in adults

Most adults who need to be evaluated for AD/HD have serious problems with concentration or paying

attention, or are overactive in one or more areas of living.

Some of the most common problems include:

• Problems with jobs or careers; losing or quitting jobs frequently

• Problems doing as well as you should at work or in school

• Problems with day-to-day tasks such as doing household chores, paying bills, organizing things

• Problems with relationships because you forget important things, can’t finish tasks, or get upset over little

things

• Ongoing stress and worry because you don’t meet goals and responsibilities

• Ongoing, strong feelings of frustration, guilt, or blame

To be diagnosed with ADD / ADHD, both children and adults must exhibit multiple symptoms of hyperactivity,

impulsivity, or inattention. In addition, while assessing the problem we will also look at:

The severity of the symptoms – To be diagnosed with ADD / ADHD, the symptoms must have a

negative impact on the person’s education, career, relationships, or social life.

When the symptoms started – Since ADD / ADHD starts in childhood, we will look at how early

the symptoms appeared. To receive a diagnosis, the symptoms must have been present before age seven.

How long the symptoms have been present – The symptoms must have been going on for at

least 6 months before ADD / ADHD can be diagnosed.

When and where the symptoms appear – The symptoms of ADD / ADHD must be present in

multiple settings, such as at home and school. If the problem only appears in one environment, it is unlikely

to be caused by ADD / ADHD.

According to the DSM the following is a description of the criteria needed to meet a diagnosis of ADD/

ADHD.

A. Either (1) or (2)

(1). 6 (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that

is maladaptive and inconsistent with developmental level:

Inattention

(a) often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other

activities (b) often has difficulty sustaining attention in tasks or play activities (c) often does not seem to

listen when spoken to directly (d) often does not follow through on instructions and fails to finish schoolwork,

chores, or duties in the workplace (not due to oppositional behaviour or failure to understand instructions) (e)

often has difficulty organising tasks and activities (f) often avoids, dislikes, or is reluctant to engage in tasks

that require sustained mental effort (such as schoolwork or homework). (g) often loses things necessary for

tasks or activities (e.g. toys, school assignments, pencils, books, or tools) (h) is often easily distracted by

extraneous stimuli (i) is often forgetful in daily activities

(2) 6 (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to

a degree that is maladaptive and inconsistent with developmental level

How do I know if I need an evaluation for adult ADD / ADHD?

ADD / ADHD Diagnostic Criteria

(a) often fidgets with hands or feet or squirms in seat (b) often leaves seat in classroom or in other situations

in which remaining seated is expected (c) often runs about or climbs excessively in situations in which it is

inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness) (d) often has

difficulty playing or engaging in leisure activities quietly (e) is often “on the go” or often acts as if “driven by

a motor” (f) often talks excessively

(g) often blurts out answers before questions have been completed (h) often has difficulty awaiting turn (i)

often interrupts or intrudes on others (e.g. butts into conversations or games)

B. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7

years.

C. Some impairment from the symptoms is present in two or more settings (e.g. at school [or work] and at

home).

D. There must be clear evidence of clinically significant impairment in social, academic, or occupational

functioning.

E. The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder,

Schizophrenia, or other Psychotic Disorder and are not better accounted for by another mental disorder

Major stressful life events can result in temporary symptoms that look like ADD / ADHD. These events

include divorce, child abuse, death of a loved one, a move, or a sudden traumatic experience. Under these

circumstances, symptoms of inattention and hyperactivity may arise suddenly and, therefore, would have

no long-term history. Remember, ADD / ADHD symptoms must exist for at least six months and cause some

difficulty before the age of seven. Of course, a child can have ADD / ADHD and experience a stressful event,

so such events do not automatically rule out the existence of ADD / ADHD.

Other mental health conditions and disorders also commonly co-occur with ADD / ADHD. They may also be

mistaken for ADD / ADHD, and making the distinction can be difficult. That is why evaluations need to be

conducted by a therapist who is trained in a wide variety of child and adolescent disorders.

Oppositional Defiant Disorder - A pattern of negative, hostile, and defiant behavior. Symptoms

include frequent loss of temper, arguing (especially with adults), refusal to obey rules, intentionally annoying

others, blaming others. The person is angry, resentful, possibly spiteful, and touchy.

Conduct Disorder - A pattern of behavior that persistently violates the basic rights of others or

society’s rules. Behaviors may include aggression toward people and animals, destruction of property,

deceitfulness or theft, or serious rule violations.

Anxiety - Excessive worry that occurs frequently and is difficult to control. Symptoms include

feeling restless or on edge, easily fatigued, difficulty concentrating, irritability, muscle tension, and sleep

disturbances.

Hyperactivity

Impulsivity


Co-existing conditions and ADD / ADHD

Once you or your child has received an ADD / ADHD diagnosis, it’s time to explore the treatment options.

There are many effective treatments that can help, including behavior therapy, support groups, social skills

training, medication, and ADD coaching.

Medication–when used as part of a comprehensive treatment plan–can improve symptoms of hyperactivity,

impulsivity, and inattention. However, all drugs should be approached with caution, as they have side

effects that may prove to be more difficult than the problem they are supposed to be treating. Furthermore,

medication for ADD / ADHD is not a cure and should not be used by everyone.

For adults with ADD / ADHD, life can be a frustrating merry-go-round of running late, not getting things

done, sleeping at odd hours, and feeling like things are out of control. Due to the nature of the disorder, even

routine chores and work activities can seem overwhelming. However, there are many skills you can learn

to help get your life under control. It’s a challenge, but you can recognize your strengths and use them to

develop skills to work better, increase organization, and interact with people more effectively. With the right

skills and support, you can counteract the effects of ADD / ADHD.

Adult ADD / ADHD is a newly understood disorder, so if you have it, you might feel that family and friends

might not understand it too well. The more you learn about adult ADD/ADHD and treatment options, the

better you’ll be at assisting your own recovery. Sharing information with friends and family can help them

understand as well. The first step is ensuring you have an accurate diagnosis. Make sure that you get a

diagnosis from a qualified professional with experience in diagnosing ADD/ADHD. Adult ADD/ADHD can

be a challenge to diagnose, as there is no simple test for it. Many symptoms of ADD/ADHD overlap with

other conditions, such as depression, emotional trauma, or anxiety disorders such as obsessive compulsive

disorder. What’s more, it’s not uncommon for someone with ADD/ADHD to have another condition such as

depression or anxiety as well. If this is the case for you, those conditions need to be treated concurrently

with your ADD / ADHD.

Medication for ADD / ADHD

Living with adult ADD / ADHD

Get the education and support you need

Treatment options for ADD / ADHD

Depression - A condition marked by trouble concentrating, sleeping, and feelings of dejection and

guilt. There are many types of depression. With ADD / ADHD you might commonly see dysthymia, which

consists of a depressed mood for many days, over or under eating, sleeping too much or too little, low

energy, low self-esteem, poor concentration, and feeling hopeless. Other forms of depression may also be

present.

Learning Disabilities - Problems with reading, writing, or mathematics. When given standardized

tests, the student’s ability or intelligence is substantially higher than his or her achievement. While children

with ADD / ADHD frequently have problems with reading fluency and math, these problems have to do with

attention and memory, rather than a learning disability.

While most people feel they could probably benefit from self care activities such as eating well and exercising

regularly, with adult ADD / ADHD, it is especially critical. Due to the impulsivity and disorganization that often

comes along with the disorder, you may struggle with erratic sleep, compulsive eating or extra stress due to

missed deadlines and appointments.

Minimize stress. With ADD / ADHD, where mood swings and trouble with organization is already

a challenge, decreasing stress will increase your productivity and minimize symptoms.

Improve your sleep. Simple changes to daytime habits, such as avoiding caffeine late in the day,

having a predictable, quiet bedtime routine and going to bed at the same time every night goes a long way

towards a good night’s sleep.

Healthy eating. Eating a wide variety of healthy foods and using caution with sugary foods can

help stabilize mood swings from unhealthy eating.

Exercising. Exercise is easier to fit into your routine than you think, and several 10 minute bursts

each day can be just as effective.

If you have ADD / ADHD, you might not understand how some people seem to be so efficient at organization

and managing time. It’s true some people seem to be naturally better at it than others, but organization and

time management are skills that can be learned by everyone. Here are two tips to keep in mind as you begin

to learn these skills:

Start with simple steps and habits. With the impulsivity typical of ADD / ADHD, you might want

to throw yourself headfirst into an organizing frenzy- a sure recipe for frustration and burnout. Good habits

take time to develop. Just pick one or two key habits to start, and stick with only those for a few weeks. Then

slowly build upon those steps to take back control of your daily schedule, household, and finances.

Organization doesn’t happen overnight. If you expect your life to suddenly become organized

and mess to disappear, you will be disappointed. You might have quite a backlog of paperwork or clutter to

work through. Don’t try to tackle it all at once, or you might get so overwhelmed you give up before you even

start. Organization is ongoing. As you learn new skills and build upon them, gradually your organization will

improve. Daily good habits help stop clutter and disorganization from building again.

A simple, daily schedule can be an enormous help in organizing your life. Start by finding the best planner

or electronic organizer for you and commit to using it for all of your appointments, scheduling and contact

information. Scraps of paper easily get buried or lost, and phone messages can be mistakenly deleted or

hard to find.

Make a daily to-do list. Prioritize the items so you do the most important ones first. Keep the list

with you and refer to it often.

Review your schedule each morning. Before you start your day, take a look at your planner. Take

an inventory of your appointments and the things you need to get done.

Update your schedule every night. Establish a time every evening for reviewing what you got

done and transferring new tasks and appointments into your day planner.

Getting organized

Starting a daily schedule and planner.


Developing healthy daily habits

If you have ADD / ADHD, paperwork to you might mean piles of paper strewn everywhere. You might

not want to throw anything away, because it is too important—but when you actually need a document

it is impossible to find! If you take some time to set up a paperwork system that works for you, you can

tremendously streamline handling paperwork in your life.

Set up a filing system that works for you. Use dividers or separate file folders for different types

of documents (such as medical records, receipts, and income statements). Label and categorize your files

so that you can find what you need quickly.

Deal with mail on a daily basis. Set aside a few minutes each day to deal with the mail. Either

trash it, file it, or put it in an “action” folder.

Have a dedicated time to deal with your “action” items. It might be just an hour every week to

start, but as you have a set amount of time, you will find that dealing with action items takes less time than

you think.

Time can take on a fluid quality for those with Adult ADD / ADHD. Boring tasks might feel like they take

forever, or you might get so absorbed in a diversion that suddenly you lose track of time and are late for an

appointment.

Give yourself more time than you think you need. For each 30 minutes of time you think it will

take you to get someplace or complete a task, add 10 minutes. Don’t take on more than you can handle.

Adults with ADD / ADHD tend to underestimate how long it will take to get things done. Check your schedule

first before committing to something new.

Plan to be early and set up reminders to leave. Try writing down appointments for 15 minutes

earlier than they’re really going to be, or setting clocks and your watch several minutes ahead. Don’t let

yourself lose track of time or get distracted. Use alarm clocks, online reminders or timers to tell you when it’s

time to go.

Because people with ADD / ADHD often are impulsive and jump from one subject to another, completing

tasks is often difficult. Big projects also might seem tough to tackle because of all the small steps needed to

get to the end result. The following ideas can help you manage tasks.

Build breathing space into your schedule. Give yourself space in between meetings and other

appointments so you can gather your thoughts. If you find your attention wandering during a task, especially

from something boring or repetitive, switch to something else for a few minutes. Or work with frequent builtin

breaks, such as 30 minutes on, 5 minutes off.

Slow and steady wins the race. Large projects are really made up of smaller tasks to get to

the end result. Break big tasks into a series of smaller ones. For example, the project of cleaning out and

organizing the garage can be broken down into flattening cartons, putting up a shelf, organizing your tools,

and so forth. Keep the big picture in mind. If you get stuck or fixated on a step, ask yourself if extra time on

that step really matters for the end result.

Managing paperwork

Managing your time

Task management tips

Money management requires budgeting, planning, and organization. So for many adults with ADD / ADHD,

it is a particular point of weakness. Organizing skills, such as setting up a paperwork system and time for

paying bills as described above, can help get bills in on time and avoid penalties for missed deadlines.

Assessing your financial situation is the next step to getting budgeting under control.

Start by keeping track of every expense, no matter how small, for a month. Then analyze where your money

is going. You may be surprised how much you’re spending on unnecessary items and impulse purchases.

Using this “spending snapshot” to create a monthly budget based on your income and needs. Figure out

what you can do to avoid straying from your budget. For example, if you’re spending too much at restaurants,

make an eating-in plan and factor in time for grocery shopping and meal preparation.

• Shop with cash. Leave your checkbook and credit cards at home.

• Cut up all but one credit card, and put it somewhere you can’t easily get to it.

• When you shop, make a list of what you need and stick to it.

• Use a calculator to keep a running total when shopping.

• Stay away from places where you’re likely to spend too much money.

• Throw away catalogs as they arrive.

As you learn how ADD / ADHD affects you, you can bring that self-knowledge to the workplace or classroom.

To start, determine what your best working conditions are. Are you most comfortable working or studying

where it’s quiet, or can you concentrate better with background music or in an office buzzing with people

and activity? Do you need to focus on one thing at a time, or are you at your best when multitasking? Figure

out how you work best and arrange your environment accordingly.

Eat your dessert first. The things you do best should be the things you do first. Rearrange your

schedule so the things you enjoy the most – which are usually the things we do best – are the first things you

do when you start your day. Rather than feeling drained before 10:00, you’ll be more productive and you’ll

have more energy to face the rest of your day.

Focus your energy on your strengths, not your weaknesses. Start keeping a work log. Writing

down how you spend your time, whether it was spent doing something you do well that contributes to your

business or whether it was spent doing things that may be necessary but aren’t necessarily things you do

well. Chances are good that you’ll be surprised to learn how little of your day using your strengths.

Remember: What you pay attention to grows. The things we neglect tend to die. If you’re

paying attention to your weaknesses, then your weaknesses are going to grow. That’s why it’s so important

to pay attention to what you do well. You “grow” your strengths and talents by focusing on the things you do

well.

Sip, don’t gulp your decisions. It’s easy to get caught up in the excitement of a new project and

move ahead before you or your business is ready. These impulsive decisions can create more problems than

they solve. Learn to sip your decisions slowly and not gulp down choices that you might later regret. Savor

the decision making process, “sipping” each choice you face like a fine wine, rather than gulping it down too

quickly. Once you make a decision, see how it tastes before making another.

Track your finances

Putting a Stop to Impulse Shopping

Improving job performance

Tips for Career Success

Taking control of your finances and job performance

People with ADD / ADHD often misinterpret the verbal and nonverbal social cues that most people take

for granted. They might interrupt conversations, often with irrelevant comments or questions. They let their

attention wander, making it look as if they don’t consider what others are saying as important. Or they may

talk on and on, not noticing that others are becoming bored or exasperated. As a result, people with ADD /

ADHD are sometimes seen as rude, insensitive, and socially inept—qualities that take their toll on friendships

and relationships, not to mention self-esteem. However, you can work on “retraining” your brain to better

understand other people are communicating with their words, facial expressions, and body language.

Be mindful. Focus on the speaker and on what is being said as the most important information you

need to hear right now. If necessary, check with the speaker to make sure you got the information right.

Pace your conversation. Pause after expressing each point in a conversation, and wait for a

response before continuing to talk. Engage the listener, then listen carefully to the other person’s response.

Practice, practice, practice. Rehearse skills with a friend or family member, such as focusing on

other people’s words and waiting for a response. Choose role models at work and in your personal life and

watch how they communicate.

Show your strengths. Becoming a good listener doesn’t mean you have to hide your knowledge,

cleverness, or sense of humor. The idea is to be the smart, fun person you are without monopolizing the

conversation.

ADD / ADHD is a very treatable condition. Unfortunately most people stop at medications. If you work with

your therapist and learn some new skills and learn to manage your condition you will find that the destructive

patterns can be minimized or stopped completely.

At the Counseling Center of New Smyrna Beach we have several therapist that specialize in diagnosing

and treating ADD / ADHD. Please call us today to get on your way to a life with less impulsions and

distractions.

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