•  Your coach needs to help you continually return your focus to the work throughout a coaching session. Perhaps you will also need shorter sessions. If this feels  inconvenient  to a coach, they shouldn’t be working with clients with ADHD.

•  Chances are that you may fidget and squirm if you try to sit still for an hour. It’s not very helpful to fight it; save your mental energy for better things. Look for a coach  who isn’t distracted by it. Taking a walk during your session may help – are they ok with that?

• You will need and want to work towards getting to your appointments on time. If your coach feels upset by your lateness or takes it personally, understand that that’s their  issue.

• Trying to do tasks alone at home or work may not be a tactic that works well for you. Be sure your coach is flexible and will adjust their “normal” process to make things  work for you. If projects take longer than is usual with their other clients, that’s a fact of life that they must be comfortable with.

• I’d be surprised if you haven’t gotten into a life-long habit of “adjusting the truth” to sidestep criticism. This is very common for individuals with ADHD. A coach has to  understand this, help you take the time to give the most truthful answer and never take it personally.

• It is typical to forget, get distracted, go off on tangents, to get caught by an interesting idea or get bored. When your neurobiology is a certain way, you need to have  coaching that doesn’t ignore the facts.

It may not be obvious whether a coach has the experience and understanding you want until you’ve worked with them for a while. But these “issues” are an everyday part of life for many people with ADHD and your coach must not only accept these behaviors as a typical starting point, but must patiently address them as fundamental aspects of your work together.

Jay Livingston can be reached at LivingstonServices.com. Just use Jay@

You’re ready to head for bed, emotionally and physically wound down. Just a few simple routines to complete and you can drift into the mysterious state called sleep – check the doors, turn off the lights, brush, floss and settle into the embrace of your bed and sleep.

As you shuffle through the kitchen one last time, the image of a bowl of ice cream snaps into your mind. Wouldn’t the creamy, sweet, cold taste of a small bowl of chocolate be delightful? If
you slow your steps, you’ll likely open the drawer for the ice cream scoop.

It is possible to learn to resist at will. Try picturing something else. Focus on images of your bed or an experience you had of stepping on a scale that stopped short of where it previously was. Too hard? Picture a great play from the last game you watched or some other really good experience. Just know that if you stare at the freezer, you are more likely to indulge.

Have you had the experience of walking away from temptation and having the image weaken and lose its urgency? Try it as an experiment; walk away and see what happens over the next few minutes. Focus on paying attention to your reactions and the process of learning instead of the treat.

Controlling your impulses can be learned, whether it’s to stop putting junk food in your mouth or quieting your frustration with yourself, employees, colleagues or clients. Maybe you’ll never find it easy, always have to push to keep your focus, even fall off track sometimes when you’re
tired, but you can develop improved strength and technique with desire and practice.

Eight Quick Hints:

• Use distractions to pull your attention away from temptations
• Don’t re-evaluate previous decisions when you’re under the influence of temptations
• Develop an unbending pattern of behavior until you’re past thinking about a temptation
• Understand that developing will power (self-control) is a process of learning and practice
• Dump the old notion that your abilities or attitudes are set – they aren’t, you can learn new ways
• Notice, celebrate and savor small bits of progress
• Have a support person or group who you feel accountable to – who bolsters your self-control
• Live for the changes that you’re working on and practice them into being

Multiple past failures to grow your self-control simply mean you haven’t yet found the right approach. It’s discouraging, but learning is often a process of gaining knowledge from failures until you start getting a hint of which directions are successful. Try getting a new perspective (a coach’s
point of view) and more emotional support. Remind yourself, “With practice I can learn this.”

Want a more complete primer on how to improve self-control and self-discipline? I help people develop new habits and behaviors; it’s what I’ve been doing for over 30 years. Change takes practice and support, but the actual process is simple.

Jay Livingston

Jay@LivingstonServices.com

The study period was from 1986-2005 and included data from over 1.2 million children and young adults. No increased risk was found for those patients taking ADHD medications. In fact the heart risks for current users of ADHD medications were slightly lower than the risk for non-medication users or for those who had taken medication previously.

Bottom line is that the risk of cardiovascular problems exists at the same rate whether you take ADHD medications or not. If you or your child are considering treatment, this large government funded ADHD medication study can hopefully put your mind at ease that the risks, at least for heart side effects or stroke, are minimal.
See NEJM.ORG for the online article (10.1056/NEJMoa1110212) published Nov 1st, 2011.

The Virtual AD/HD Conference is a unique event that brings together the top experts in AD/HD. Join an international community of people affected by AD/HD, including adults, parents, spouses/partners, doctors, therapists, advocates, coaches, counselors, and many more. Rather than the time and expense of attending a physical conference, the Virtual AD/HD Conference brings the experts to you!
You can learn more about the conference, review the full conference agenda, and read testimonials from people who have attended here: http://addmanagement.com/affiliate.html?w=vac&p=cerulli
5 reasons why I recommend the Virtual AD/HD Conference:
1. You’ll access the top AD/HD experts from the comfort of your own home or office.
2. You’ll get the latest information and strategies on the most important topics in AD/HD. The conference topics cover everything from children to adults, from parenting to marriage, and from alternative treatments to medication management.
3. You’ll connect with a supportive group of your peers. The conference is attended by hundreds of people who understand the challenges of AD/HD.
4. You’ll participate at your own pace. You can choose to attend the sessions live via phone or Internet, or you can download the presentations later. The presentations and materials are available online for 3 months after the close of the conference.
5. You’ll skip the costs and hassles of traveling to a conference. The Virtual AD/HD Conference is cost efficient because it removes the need for hotels, airports, babysitters, and expensive restaurants.
The Virtual AD/HD Conference takes place October 3-6. I think the conference is a great opportunity to connect with your peers and get all the tools you need to succeed from the top experts in the world of AD/HD. I hope you’ll consider joining us!
Once again, you can learn more about the conference, review the full agenda, and read testimonials from people who have attended here: http://addmanagement.com/affiliate.html?w=vac&p=cerulli
The Virtual AD/HD Conference promises to be a value packed 4-day event. Hope to “see” you there!
Warm Regards,
Theresa Cerulli, M.D.

http://www.youtube.com/watch?v=wF1YRE8ff1g

Szifra

If your ADHD child does develop tics, don’t panic. Most of the time tics are benign and kids grow out of them even with no medical intervention. The peak age for symptoms of tics is approximately age 10 or 11 and then by adolescence usually the tics will begin to fade. Knowing that tics will generally improve on their own, how do you decide when to treat them? My simple answer – treat the tic if it’s bothersome to the individual and/or interfering with daily functioning. The decision should be a collaborative one among the patient, the patient’s family, and the treating physician.

Some of the medications we use to treat tics are actually blood pressure medications called clonidine and guanfacine. They work well to decrease the frequency and severity of tics. If you do decide to try these medicines, be patient. They take time to work and initially can cause some sedation, particularly in the first few weeks.

In children with combined ADHD and tics, prior studies have shown stimulant medications can exacerbate tics so the treatment may simply be to stop the stimulant. This is not to say that stimulant medications cause tics, in fact they don’t. Many patients with ADHD and co-existing tics are able to successfully take the stimulants. If however the stimulant medications do cause problematic side effects for your child, remember there are also non-stimluant medications for treating ADHD such as Strattera or Intuniv.

In summary, tics are fairly common with ADHD, are usually benign, and tend to improve by late adolescence even without treatment. Be able to recognize symptoms of motor and vocal tics in your ADHD child so you can talk to your doctor about treatment options.

Theresa Cerulli, M.D.

Traditionally when medication is first approved by the FDA there is a patent placed on the newly “branded” drug. After a certain number of years the patent expires and any other company is welcome to make a copy-cat “generic” of the drug. Is there any difference between the original and the copy? Yes. Does it matter? That depends on who you ask. My opinion -ultimately it depends on the person taking the drug – the patient!

When generics are manufactured, the FDA allows a slight deviation from the amount of active ingredient compared with the original branded version of the medication. Maybe Brand X has 32% of the active ingredient and Generic X has 30%. Probably not a noticeable difference clinically for most people. But, where brands and generics differ the most are in the filler components – the stuff that literally holds the tablet together. These filler components can be completely different, resulting in the pill looking nothing like the original one. The size, shape, and color may be may be unrecognizable when you go to pick it up at the pharmacy. The name – the generic name – may be unrecognizable as well. This is a source of many frustrated phone calls to our office from patients worried that the pharmacy gave them the wrong bottle.

Rule of thumb is that most generics will work fine for most people. However, there are some exceptions so certainly let your doctor know if you are experiencing any change in symptoms or side effects when going to a generic. For example, you could be allergic to the red dye coating of generic Y that wasn’t in brand Y. Or your child may have trouble swallowing generic Z because it’s twice the size of brand Z.

Cost cutting is generally driving the substitution of generic medications in place of the brand. That’s good news if both drugs are equally effective for you. But if you have noticed differences in effectiveness or side effects, ask your doctor to contact your insurance company to do a “Prior Authorization” requesting coverage for the brand. It will usually take 3-5 business days for your insurance company to respond to the doctor’s request so patience and planning are helpful in these situations.

ADHD is known to be highly genetic. Approximately 77% of the time someone diagnosed with ADHD has the condition because of the genes they carry. However, genes are not the only factor. Researchers are finding other issues can “correlate” with ADHD. In this recent study published in January’s Journal of Pediatrics researchers show that neonatal health is an important risk factor for ADHD.

An astounding 980,902 children born in Denmark between 1988-2001 were monitored. The baby’s health immediately after birth was measured by commonly used Apgar scores. Then all children were followed from age 3 until a diagnosis of hyperkinetic disorder, a first medication for ADHD, migration, death, or the end of 2006, whichever came first.

The results – The lower the Apgar score the greater the risk for the child developing ADHD. Compared with children with Apgar scores of 9 or 10 at 5 minutes, the risk for ADHD was 75% higher in children than with Apgar scores of 1 to 4 and 63% higher for those with Apgar scores of 5 to 6.

Doctors concluded from this study that a low Apgar score is associated with risk of ADHD in childhood. Perhaps low Apgar scores and ADHD share common causes, or a low Apgar score reflects at least one possible pathway leading to ADHD.

So, when I read a recent Boston Globe article on Billy Starr, the founder of the Pan Mass Challenge, I instantly thought of many of my compellingly interesting, non-cookie cutter clients and their strengths.

 You might also find it interesting, so I’ve attached it. (For those of you want to scan, I bolded the parts that made me wonder about ADHD, and took a few sentences out for brevity.)

 Pedalers of Hope  Boston Globe, November 12, 2010

The older I get, the more I realize how little I know, which is exactly what I was thinking as a guy named Billy Starr described the annual event he founded and runs known as the Pan-Massachusetts Challenge.

I had heard of it. Everyone’s heard of it. It’s a bike ride, a big one, in which cyclists in Spandex solicit money from friends to pedal unimaginable distances over a couple of days.

And then these maddeningly cheerful people give the proceeds to a worthy cause.

For the record, he looks like his name, with a mop of sandy hair parted Pete Rose-style in the middle and an athlete’s build that makes him look a decade younger than his 58 years. He is in constant motion, arms flailing, head bobbing, even when he thinks he’s sitting still. The guy rides his bike up Mount Washington on a Sunday with less effort than another man might lug a bowl of Brigham’s ice cream to the couch to watch the Patriots on TV.

His Pan-Mass Challenge headquarters is located in an utterly charmless single-story building in a generic Needham office park.

Things get worse inside. There were cords everywhere. The staff apparently collects trash for a hobby. There’s neither reason nor rhythm to how desks are scattered. The place makes the Globe newsroom seem like the Four Seasons Dorchester.

Billy Starr is proud of this, too. In his separate cinderblock office, I ask him how the Pan-Mass Challenge (PMC, in the lingo of those around it) compares to, say, the Avon Walk for Breast Cancer, or the Walk for Hunger.

He looks stunned.

“We raise more money in Massachusetts than all of them combined,’’ he said.

Where do you rank in terms of the biggest events like this in the country?

Now he looks hurt. “We’re the biggest in the world.’’

… tonight, at Fenway Park, he will present a check for $33 million to the Jimmy Fund and the Dana-Farber Cancer Institute, the entire proceeds from the August ride.

… the PMC’s total contribution to Dana-Farber to a mind-boggling $303 million in cold, hard, lovable cash over 31 years. Dana-Farber is the exclusive recipient of PMC money.

To put this in perspective, you would basically need a charity with $650 million in assets — nearly the size of the Boston Foundation — to reliably spin off $33 million a year in grants. And that charity is going to have a lot more than the half-dozen staffers that the PMC does — and a more expensive office.

Dana-Farber’s chief executive, Edward J. Benz Jr., is unequivocal in the importance of the PMC to his institution. “We couldn’t give the care we want to give, or have the cutting-edge research we want to conduct, if it wasn’t for the PMC,’’ he told me.

What began in 1980 with a group of 36 friends raising $10,000 has turned into 5,000 cyclists raising money from 230,000 contributors to ride as many as 190 miles over two days, all of it staffed by 3,100 volunteers. Starr founded the ride after his mother, cousin, and uncle died of cancer in the 1970s.…

Brian McGrory is a Globe columnist. He can be reached at mcgrory@globe.com

 P.S. If you have ADHD, I hope this story helps you recognize and appreciate the gifts of your biology.  And, for spouses and partners, please take a moment to recall what attracted you to the high-intensity, creative, different-minded man or woman you are with. Wouldn’t it be great if Billy Starr’s partner (if he has one, I didn’t research that!) was able to recognize how much his temperament (maybe ADHD, I don’t know) fueled the success of this amazing project.

Szifra@BirkeConsulting.com

www.BirkeConsulting.com

www.SzifraBirke.com

978-446-9600