ADDitude

A Dad’s Role in Modeling Social Skills

Carly Broadway — Wed, 10 May 2023 09:15:02 +0000

I cringed when I heard my nine-year-old son saying to a group of his peers at wrestling practice, “Excuse me. Excuse me.” The boys look perplexed. Why would a kid their age say “excuse me” to them? This was certainly not something I taught him; rather, he learned this in his social skills group at school.

When I realized my son needed help cultivating and sustaining friendships, I looked for a social skills program but found nothing specifically for boys with ADHD. There were plenty of these groups in our area, but most featured well-meaning female clinicians or guidance counselors teaching formal etiquette and scripted communication that did not resemble the way boys talk to each other. “How are you doing today?” “What are your hobbies?” When boys speak in that way, as my son had done at wrestling practice, it comes across as inauthentic. I know this because I was a boy, and I’ve worked with hundreds throughout my career as a school social worker, therapist, and camp director who runs programs for boys with ADHD.

When kids with ADHD struggle socially, their inability to read social cues isn’t the problem. Instead, they more likely have lagging and inconsistent use of social executive function (SEF) skills, which we use to understand others’ thoughts and feelings. These SEF skills help us know how we’re coming across to others, how to read a room (or situational awareness), how to initiate and end conversations, and how to use humor appropriately.

Building Boys’ Social Savvy

When fathers call me about their son’s social difficulties, they tend to talk much more than mothers do, perhaps because this is the first time they’re speaking to another man about this challenge. During these conversations, I find that most parents don’t see the connection between ADHD and lagging social skills. (In fact, I’ve heard a lot lately about kids who were misdiagnosed with autism because of their difficulty with SEF.) I explain the important role that male role models play in helping boys improve SEF skills; and the differentiated and valuable perspective they bring to their sons because they understand how boys’ friendships evolve and how boys communicate when adults aren’t around.

I want each father to understand that his son’s emotional awkwardness, and difficulty understanding how he’s coming across to others, is neither a choice nor apathy. These are skills he is still developing, and he is most likely several years behind his peers’ emotional maturity because ADHD is an executive function developmental delay.

[Download: Solving Behavior Problems Rooted in Executive Function Deficits]

When boys with ADHD struggle socially, their fathers often resort to lecturing, telling their sons what they’re doing wrong. In turn, their sons typically become argumentative or defensive because they truly don’t understand how they’re coming across to their peers. The defensiveness is often a result of their shame, knowing that they have a harder time connecting with their peers but not knowing why.

Tips for Dads

Here are a few tactics for dads, and other male role models, to help boys improve socially:

Cite successes. ADHD brains live in the present. Kids do not think about how to cultivate and sustain friendships when they’re not around their peers. Point out situations when your child showed another boy that he wanted to be friends and kept that friendship going.

Describe healthy friendships. Say what it means to be a good friend as well as when to end friendships that have become hurtful. Many of the boys I’ve worked with were quick to latch on to other boys who showed interest in them. I’ve seen boys cling to friendships when they’re not being treated well out of desperation for friends, or for inclusion in a peer group. In my school-year programs and in summer camp, I share stories about when I was growing up to give the boys examples of good friends I’ve had, and times I’ve had to cut off a friendship.

[Read: Help Your Child Forge Lasting Friendships]

Raise awareness of patterns. Teach boys to understand how they come across to others. In Socially Smarter, my parent training program to build SEF, I depict a sequence of events: your child’s words, another person’s response to those words, and your child’s thoughts and feelings about their peer’s response. Parents can discuss why the interaction worked, or didn’t work, and how future communications can be improved.

Teach tolerance. Being part of a peer group means being flexible. If your child is invited to go bowling, he should go, even if he doesn’t like bowling. He was invited because someone wants to spend time with him. If he says “no” whenever he doesn’t like the activity, he may stop getting invited to outings because the other kids might assume he’s not interested in spending time with them.

Give praise. Kids can’t learn what they should be doing if we don’t praise them for what they’re doing well. That’s why it’s important to offer recognition of and praise for behaviors we do want, such as thinking about others, being flexible, and putting effort into social relationships.

The ADHD executive function liabilities are not gender-specific. Girls with ADHD struggle too. But I don’t teach girls because I did not have the experience of growing up female.

Just as girls need friendships with girls, boys need friendships with boys. They do not need social skills groups or role playing; research shows that clinic-based social skills groups offer no benefit to kids with ADHD. Boys need male role models to help them understand social communication and how friendships evolve between males.

Social Skills & ADHD: Next Steps

Download: Questions to Get Your Child Talking
Watch: The Social Lives of Boys with ADHD
Read: What Parents Misunderstand About Executive Function
Read: 10 Hard (But Essential) Truths for Dads of Boys with ADHD

Ryan Wexelblatt, LCSW, is a licensed clinical social worker, former school social worker, and father to a son with ADHD. He creates content at the ADHD Dude YouTube channel. Learn more at www.adhddude.com.

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Solve My Problem: I Can’t Make Myself Exercise!

Nicole Kear — Tue, 09 May 2023 09:14:43 +0000

ADHD brains benefit from exercise — but they also struggle with follow-through and lack of motivation. Which is why, for most of us, having the best intentions to exercise doesn’t always translate into actually breaking a sweat.

We asked ADDitude’s innovative readers what tricks they have up their sleeve to avoid the powerful pull of the couch and embrace exercise. Here’s what they said:

“I purchased a treadmill and put it in front of the TV. If I want to watch TV, I have to walk on the treadmill for at least 15 minutes.”

“I signed up for a workout class with a friend.”

“Finding someone local to go on a walk with can be a game changer, especially if you explain that you need support getting out of the house). Having the other person to help me “task initiate” is brilliant.”

[Read:Take It Outside! How to Treat ADHD with Exercise]

“When I put a load of laundry in, I do a yoga or walking video until the washing machine buzzer goes off. I get in exercise and feel productive.”

“I just got a VR (virtual reality) headset and am super into one of the fitness games in it. I don’t even realize I’m working out.”

“I tricked myself into liking the gym by getting a “black card” which gets me access to a hydro massage chair! I work out, I get a massage.”

“My creative solution: accountability and competition. I don’t want to exercise, but I do want to keep my promise to play tennis with my friend (and I also want to destroy him).”

[Watch: “How to Leverage Sports Psychology to Benefit ADHD Brains”]

“Committing to just the warm-up portion of a video exercise helps. I usually feel like doing the rest once I’ve warmed up.”

“I have finally, after years of wanting to, got into doing yoga regularly —every single weekday morning. I’ve identified the barriers, and tried to address them. Number one is: I have to work out straight away, as if I do anything else, my meds kick in and I’ll get focused on it too much.”

“Sign up for an intramural sports team. That way, you have people counting on you to show up to practice and for games.”

Workout Motivation with ADHD: Next Steps

Read: 6 ADD-Friendly Tips for Starting and Maintaining an Exercise Program
Download: Free Guide to Health & Fitness — Lifestyle Changes for Adults with ADHD
Read: Exercise and the ADHD Brain -— The Neuroscience of Movement

How Parental Alienation Harms ADHD Families

Melanie Wachsman — Mon, 08 May 2023 09:01:30 +0000

When Nadine Vogel* got divorced, she rented a four-bedroom house so each of her children, ages 14, 16, and 18, could have their own room when they came to visit as her custody agreement dictated — one night a week and on alternating weekends. Except her children rarely came. And when they did, they were often angry and suspicious, repeating their father’s accusations about Vogel. That she was crazy. That her efforts to seek treatment for their ADHD — all three kids had been diagnosed with the condition — proved she over-medicated them. That she was trying to cut off the kids from their dad. That she was not to be trusted.

“In his senior year, my son started drinking, doing drugs, and not going to school,” says Vogel, who lives near Washington, D.C. “They didn’t let him graduate. My kids were all suffering.”

What Is Parental Alienation?

What Vogel and her kids experienced is called parental alienation, a form of emotional abuse so profound its effects on children can last a lifetime. Parental alienation happens when a child aligns with one parent and rejects the other, without justification, due to manipulation by the favored parent. This typically occurs during high-conflict divorces. Methods of manipulation include badmouthing the targeted parent, limiting contact, and interfering with communication.

”We Don’t Talk About It”

A study, published recently in The Children and Youth Services Review found that more than 3.8 million children were affected by parental alienation.¹ These numbers, as devastating as they are, may not reflect the full scope of the problem because “it’s shameful and heartbreaking, so we don’t talk about it,” says Danielle Silverman,* a New York City mother who has been alienated from her three kids, ages 22, 23, and 28, for several years. “It reflects on you, even if you know you did nothing to deserve it.”

Amy J.L. Baker, Ph.D., co-author of Surviving Parental Alienation: A Journey of Hope and Healing (#CommissionsEarned), emphasizes that catching alienating behaviors early, when it’s easier to treat children effectively, is critical. “A mildly alienated child comes back after spending time with the other parent; they may be a little suspicious, cold, wary, but that distrust only lasts an hour. It might take a full week for a moderately alienated child to warm up. Severely alienated children are shut down the whole time they’re with the targeted parent — or they don’t come [to see them] at all,” she says.

[Click to Download: 13-Step Guide to Raising a Child with ADHD]

It’s important to note that, to establish whether a child is being alienated, experts must determine that the targeted parent has not committed abuse or neglect, as the other parent may have alleged.

“Your Dad’s in a Cult”

Crystal Shivers was five when her mother told her that her father was in a cult that killed people. She said it wasn’t safe for Crystal to talk to him or any of his family. This story wasn’t true. “I remember being so sad,” says Shivers, who reunited with her father as an adult. “I missed out on relationships with my cousins, aunts, uncles, extended family, grandparents. It was a huge and heavy burden to carry.”

Joshua Coleman, Ph.D., author of The Rules of Estrangement: Why Adult Children Cut Ties and How to Heal the Conflict (#CommissionsEarned), and senior fellow with the Council on Contemporary Families, says children in alienation situations often suffer from depression and anxiety and have difficulty trusting themselves and others. They also suffer from guilt, low self-esteem, impulse control, and academic challenges. The emotional abuse is usually invisible to teachers, social workers, and even family court judges involved in custody hearings, according to a report by the National Center for State Courts.²

“Your child is out to sea. They’re being pushed underwater,” Coleman says. “You have to be the lighthouse on the shore that’s always on.”

[Self-Test: Does My Child Have Generalized Anxiety Disorder?]

Parental Alienation: Warning Signs

Examples of parental alienation behaviors include:

telling a child that their targeted parent does not love them
saying, or implying, that the targeted parent is dangerous
asking a child to spy on the targeted parent or keep secrets from them
withholding medical, academic, and other important information about the child from the targeted parent

When You’re the Target of Parental Alienation

Look at your own behavior: Is there anything you can change about how you’re relating to the co-parent to avoid triggering them?
Don’t argue with your child about the lies being leveled against you. Do everything you can to make your time together pleasant.
Document every instance of alienating behavior in the event you need to hire a family lawyer, preferably one knowledgeable about parental alienation.
Learn about coping strategies from organizations such as the Parental Alienation Study Group and the National Coalition Against Parental Alienation.

Parental Alienation: Next Steps

Read: When Parents Disagree About ADHD Medications
Q&A: “How Do I Manage Inconsistent Routines and Discipline in a Shared Custody Situation?”
Free Download: Take Charge of Your Child’s Medication

*Vogel and Silverman asked that their names be changed.

Nicole Kear is Consumer Health Editor at ADDitude.

Sources

¹Harman, J. J., Leder-Elder, S., & Biringen, Z. (2019). Prevalence of Adults who are the Targets of Parental Alienating Behaviors and Their Impact: Results from Three National Polls. Child & Youth Services Review. 106, 1-13. https://doi.org/10.1016/j.childyouth.2019.104471

² Lewis, Ken. (2020) Parental Alienation Can Be Emotional Child Abuse. NCSC Trends in State Courts https:www.ncsc.org/__data/assets/pdf_file/0014/42152/parental_alienation_Lewis.pdf

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication

“My Self-Esteem Was Garbage:” How ADHD Impacts Relationships

Anni Layne Rodgers — Sun, 07 May 2023 09:22:32 +0000

As a teen, Taylor* struggled to develop intimate social relationships with her peers. She felt compelled to drink in nearly any social setting — including on dates and around boys. In high school and college, she never ‘hooked up’ with a man without being under the influence. At age 29 — after years of low self-esteem and criticism — Beth finally had her first healthy romantic relationship.

“I dated loser after loser, unavailable men, dangerous men,” Taylor, a woman with ADHD, told ADDitude. “I never had a ‘real’ relationship until I met my future husband at age 29. We didn’t marry until I was 33.”

Taylor was the last of her siblings, and of her small friend group, to get married.

“People always told me that I wouldn’t find a husband, that no man would ever love me, etc. My self-esteem was garbage, and it was reflected in all of my dating decisions.”

Low self-esteem and lagging social skills are common for children with ADHD. With the proper treatment plan, teens can go on to have healthy and successful relationships. But for women and girls — who often go undiagnosed or misdiagnosed ^1,² — the impact of untreated ADHD cannot be understated.

[Download: Hormones & Symptoms of ADHD in Women]

We asked ADDitude readers: “How has ADHD influenced your decisions about dating, marriage, and other relationships?” Answer this questions yourself in the Comments section, above.

How Does ADHD Affect Relationship Decisions?

“Before I was diagnosed, I was easily manipulated by a narcissist who didn’t need to try hard to make me fall into patterns of masking. By the time we divorced, I had masked so much and for so long that I didn’t even know who I was anymore. My ADHD influenced me by thinking I could publicly prove my worth if I married again. That was an even bigger disaster… I have remarried — yes, for a third time — but since being diagnosed, I understand myself, my needs, and my worth to a level that allowed me the confidence to talk with my current husband calmly and openly about my struggles. It’s not paradise all the time, but it is healthy and supportive.” — Brianna, Iowa

“I have been impulsive with all of my relationships prior to being medicated. I either move in quickly, get married quickly, or have children quickly without paying attention to the red flags.” — Courtney, New York

“Absolutely; [there was] lots of risk-taking in [my] late teens and early 20s. Lots of impulsive sex, forgotten contraception, zoning out, and not interpreting male behavior correctly. I put undeserving men on pedestals because of my own lack of self-worth, a lifetime of negative self-talk, and what I didn’t know were ADHD symptoms.” — An ADDitude reader

[Read: Why ADHD in Women is Routinely Dismissed, Misdiagnosed, & Treated Inadequately]

“Though I did not realize it when I was younger, I see now that my ADHD had a huge influence on my relationships — both romantic and platonic. If I was around someone frequently in school or work, I found it much easier to keep up with those relationships. Once a situation changed and required any level of effort on my part to keep up with the relationship, it would begin to fade. I still find it extremely difficult to initiate phone calls, texts, and get-togethers. With my spouse, I forget to call or text during the day. It’s like out of sight, out of mind.” — Gina, Florida

“It makes my marriage much harder because my spouse doesn’t understand (he says he tries) why my ADHD brain works the way it does. I have realized that maybe being married isn’t for me, but I am not confident enough to do anything about it.” — An ADDitude reader

“Over the years, I’ve learned that the level of stress and shame in my life is directly proportional to the efforts I make to have relationships of any kind. So, I don’t. Isolation isn’t ideal, but it’s easier and less stressful than trying to maintain friendships or romantic relationships.” — An ADDitude reader

“Since I got my diagnosis, my relationships with many people have changed — mostly because of their prejudices against ADHD. But my relationship with my fiancé and our daughter has greatly improved because we now know why I am the way I am. It helps to avoid lots of conflicts that would have evolved to arguments before my diagnosis.” — An ADDitude reader

“My ADHD played a significant part in my decision to stop dating and spend more time alone. I like and understand myself! I don’t have to apologize for my clutter. And I’m fortunate, after one marriage, to have produced a wonderful young adult son with whom I share this complex and creative brain condition.” — Kathy, California

“Unknowingly, yes. Neither one of us was diagnosed at the time, but I remember breaking off an engagement with a very smart, nice young man because we both seemed to have difficulties with follow-through on household (and other) tasks. I knew our budget would be very tight, and I had trouble with maintaining a strict budget. I knew just these two issues were more than enough to cause us serious problems.” — Victoria

[ADDitude Directory: Find an ADHD Coach]

“My daughter is always educating others on the limitations and difficulties of living with ADHD. She works hard every day to keep her coping skills at above-normal levels. She does not want to date or marry another person with ADHD as she feels daily life would be difficult, especially when she becomes a parent.” — Barbara, Georgia

“I was diagnosed when I was already in a relationship with my current partner. My partner also has ADHD and is part of the reason why I was finally diagnosed. I think if anything happens in the future and we are no longer together, I would look for a partner who is supportive of my ADHD.” — An ADDitude reader

“My relationship is just ending after 19 years largely because of ADHD, I believe. She is never able to just laugh over things that go wrong, whether because of my ADHD or our sons. I grew up in a family that always said, ‘Don’t sweat the small stuff,’ and some of our funniest memories are of things that went awry. I am in no hurry to look for another serious relationship in my lifetime. I’ll stick with my friends who love me as I am.” — Janice, California

“Marriage has become a struggle; we believe all four of us have ADHD. No one is good at follow-ups on low-interest items. We have sought outside advice on how to distribute tasks, partner better, and learn coping skills.” — An ADDitude reader

“It is difficult to form relationships when you are always talking. Learning to listen has been difficult.” — Lisa, North Carolina

“Sometimes I have to limit my time with friends or family members who try to change my bad habits. It’s overwhelming.” — Donna, Georgia

“My spouse and my daughter have ADHD. I realized that I need to preserve energy and have to say ‘no’ to things I would like to say ‘yes’ to in order to preserve my well-being.” — An ADDitude reader

*Name has been changed to protect anonymity.

Women with ADHD & Dating: Next Steps

Download: Manage ADHD’s Impact on Your Relationship
Read: From Love Bombing to Boredom
Read: The Rules of Dating (and Breaking Up) with ADHD

Sources

¹ 1 Kessler R.C., Adler L., Barkley R., et al. (2006). The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry, 163(4):716-723. https://doi.org/10.1176/ajp.2006.163.4.716

² Slobodin, O., & Davidovitch, M. (2019). Gender differences in objective and subjective measures of ADHD among clinic-referred children. Frontiers in Human Neuroscience, 13, 441. https://doi.org/10.3389/fnhum.2019.00441

Decision 7: How should I follow up with patients with ADHD, and what should we discuss during these checkups?

Hope @ ADDitude — Fri, 05 May 2023 17:29:47 +0000

FOLLOW-UP: How should a clinician follow up with a patient being treated for ADHD?

A: Like diabetes or hypertension, ADHD is not an illness for which one can hand the patient a prescription for pills and assume recovery is automatic… | Keep reading on Medscape »

COLLABORATIVE CARE: How can collaborative care models improve care for patients with ADHD?

A: This model – wherein primary care providers, case managers, and psychiatrists work as a team to care for and monitor patients – effectively resolves many common barriers to quality… | Keep reading on ADDitude »

DIVERSION: How can clinicians educate patients about the danger of drug diversion?

A: Doctors can provide printed or video material explaining the legal and health risks associated with sharing or selling stimulants… | Keep reading on ADDitude »

TREATMENT RELUCTANCE: Why might a child resist ADHD treatment, and how can clinicians address medication aversion?

A: When someone refuses to even consider change, your best strategy is to show him empathy and normalize the situation. Instead of driving him into an even more defensive posture… | Keep reading on ADDitude »

POSITIVE PSYCHIATRY: How does positive psychiatry benefit ADHD patients in the long run?

A: Incorporating positive psychiatry is best viewed as the creation of a supplementary toolbox that allows clinicians an expanded set of focus areas to help patients achieve a more robust and sustained response to treatment… | Keep reading on MDedge »

RELATED RESOURCES

How to Get, Afford, and Refill Your Prescriptions With Minimum Hassle

Expert Webinar with Laurie Dupar, PMHNP, RN, PCC | Listen now on ADDitude »

CBT and DBT for ADHD: How Talk Therapies Reduce Symptoms and Boost Confidence

Expert Webinar with John Mitchell, Ph.D. | Listen now on ADDitude »

7-Week Guide to Treating ADHD, from Medscape x MDedge x ADDitude:

DECISION 1: What should I consider to develop a comprehensive ADHD treatment plan?
DECISION 2: What medications and other approaches should I turn to as first-line treatments for ADHD?
DECISION 3: How can I decide which ADHD medication to prescribe first?
DECISION 4: What challenges and side effects should I anticipate from ADHD medications, and how should I address them?
DECISION 5: How can I improve treatment outcomes for patients with ADHD and comorbid diagnoses?
DECISION 6: What dietary, behavioral, or other complementary interventions should I recommend to patients with ADHD?
> DECISION 7: How should I follow up with patients with ADHD, and what should we discuss during these checkups?

Decision 6: What dietary, behavioral, or other complementary interventions should I recommend to patients with ADHD?

Hope @ ADDitude — Fri, 05 May 2023 17:29:10 +0000

BEYOND MEDICATION: Which nonpharmacologic treatments are proven to benefit pediatric patients with ADHD?

A: Effective behavioral treatments for ADHD do not change ADHD symptoms, but they do help children learn how to manage them… | Keep reading on MDedge »

LIFESTYLE INTERVENTIONS: How can patients optimize nutrition, sleep, exercise, and other lifestyle factors to improve ADHD symptoms?

A: Regardless of whether a child’s treatment includes medication, maximizing exercise, sleep, and nutrition can effectively transform them into natural remedies for ADHD, and arguably establish the foundation… | Keep reading on ADDitude »

EXERCISE: How much and what type of physical activity will benefit a patient with ADHD, according to research?

A: With regular physical activity, we can raise the baseline levels of dopamine and norepinephrine by spurring the growth of new receptors in certain brain areas… | Keep reading on ADDitude »

SUPPLEMENTS: What supplements and/or vitamins can aid with ADHD symptom control?

A: Usually given in the form of fish oil, omega-3s are probably the best-researched supplement for ADHD. Numerous studies… | Keep reading on ADDitude »

PARENT TRAINING: How can Collaborative & Proactive Solutions parent training benefit an ADHD treatment plan, according to research?

A: CPS has been shown in randomized trials with both parent groups and in home counseling to be as effective as Parent Training in reducing oppositional behavior and reducing… | Keep reading on MDedge »

NEUROFEEDBACK: Is neurofeedback an effective ADHD treatment, according to research?

A: A body of research suggests that neurofeedback is a promising therapy for ADHD, but it should be considered a complement to medication and/or behavior therapy rather than… | Keep reading on ADDitude »

ENVIRONMENTAL CHANGES: Which accommodations and environmental changes have the greatest positive effect on children with ADHD?

A: Encourage parents and teachers to use clear and concise instructions with supplementary visual tools. When providing instructions in classrooms, teachers should look directly at the student… | Keep reading on MDedge »

RELATED RESOURCES

The Exercise Rx for ADHD: How Movement Improves Attention, Working Memory, and Executive Functions

Expert Webinar with John Ratey, M.D. | Listen now on ADDitude »

The Whole-Person Treatment Approach to ADHD

Expert Webinar with Lidia Zylowska, M.D. | Listen now on ADDitude »

How CBT and ADHD Coaching Help Adults Manage Their Symptoms Naturally

Expert Webinar with J. Russell Ramsay, Ph.D., and David Giwerc | Listen now on ADDitude »

New Supplement Strategies: Using Trace Minerals and Plant Extracts to Treat ADHD in Children and Adults

Expert Webinar with James M. Greenblatt, M.D. | Listen now on ADDitude »

7-Week Guide to Treating ADHD, from Medscape x MDedge x ADDitude:

DECISION 1: What should I consider to develop a comprehensive ADHD treatment plan?
DECISION 2: What medications and other approaches should I turn to as first-line treatments for ADHD?
DECISION 3: How can I decide which ADHD medication to prescribe first?
DECISION 4: What challenges and side effects should I anticipate from ADHD medications, and how should I address them?
DECISION 5: How can I improve treatment outcomes for patients with ADHD and comorbid diagnoses?
>DECISION 6:What dietary, behavioral, or other complementary interventions should I recommend to patients with ADHD?
DECISION 7: How should I follow up with patients with ADHD, and what should we discuss during these checkups?

Decision 5: How can I improve treatment outcomes for patients with ADHD and comorbid diagnoses?

Hope @ ADDitude — Fri, 05 May 2023 17:28:42 +0000

COMPLEX TREATMENT: How should clinicians approach treatment for patients with ADHD and comorbid conditions?

A: As clinicians, we must expect that adults with ADHD will come to us with complex presentations… | Keep reading on ADDitude »

PEDIATRIC COMORBIDITIES: How should clinicians adjust pharmacological treatment for children with ADHD and comorbidities?

A: Though stimulant medication, paired with behavioral therapy, is the first-line treatment for ADHD in children, contraindications and side effects may limit their use. For example, depression and anxiety can worsen… | Keep reading on ADDitude »

ADHD + DEPRESSION: What is the recommended approach for treating ADHD with depression?

A: Options for patients include an array of psychological and psychopharmacological treatments, along with newer, cutting-edge approaches… | Keep reading on ADDitude »

ADHD + EATING DISORDERS: How should clinicians adjust treatment approaches for patients with ADHD and comorbid eating disorders?

A: Treat both ADHD and the eating disorder together and don’t discount the relevance of ADHD symptoms in driving the eating disorder. ADHD has to be treated in order to unlock effective ED treatment… | Keep reading on ADDitude »

ADHD + EFD: How is executive dysfunction related to ADHD, and how should it be treated?

A: The FDA does not allow prescriptions for stimulants to be phoned into a pharmacy or refills to be added to prescriptions — and this adds to the burden of treating patients who take them… | Keep reading on Medscape »

RELATED RESOURCES

Substance Use Disorder and ADHD: Safe, Effective Treatment Options

Expert Webinar with Timothy Wilens, M.D. | Listen now on ADDitude »

Current Guidelines for Treatment and Behavioral Interventions for Tourette Syndrome and Tic Disorders

Expert Webinar with John Piacentini, Ph.D., ABPP | Listen now on ADDitude »

7-Week Guide to Treating ADHD, from Medscape x MDedge x ADDitude:

DECISION 1: What should I consider to develop a comprehensive ADHD treatment plan?
DECISION 2: What medications and other approaches should I turn to as first-line treatments for ADHD?
DECISION 3: How can I decide which ADHD medication to prescribe first?
DECISION 4: What challenges and side effects should I anticipate from ADHD medications, and how should I address them?
> DECISION 5: How can I improve treatment outcomes for patients with ADHD and comorbid diagnoses?
DECISION 6: What dietary, behavioral, or other complementary interventions should I recommend to patients with ADHD?
DECISION 7: How should I follow up with patients with ADHD, and what should we discuss during these checkups?

Decision 4: What challenges and side effects should I anticipate from ADHD medications, and how should I address them?

Hope @ ADDitude — Fri, 05 May 2023 17:28:04 +0000

STIMULANT + NON-STIMULANT: How can combination therapy improve symptoms with fewer side effects?

A: The term refers to using a stimulant and a non-stimulant to reduce ADHD symptoms. There were no lectures in medical school on this therapy and no studies of it when… | Keep reading on ADDitude »

SLEEP: Stimulant use is associated with an elevated risk for sleep problems. How can clinicians address this side effect?

A: Clinicians should titrate while evaluating a patient’s environmental and familial conditions, screen for primary sleep disorders, and… | Keep reading on ADDitude »

MED CHANGES: When should a patient switch to a different medication and/or dosage?

A: If a stimulant is causing excessive irritability, restlessness, or seriousness throughout the day, a dose reduction… | Keep reading on MDedge »

ADHERENCE IN CHILDREN: How can clinicians improve medication adherence in children with ADHD?

A: ADHD medication initiation and adherence are increased when patients have a strong working alliance with their clinician and trust the health care system… | Keep reading on ADDitude »

ADHERENCE IN ADULTS: How can clinicians improve medication adherence in adults and adolescents with ADHD?

A: As clinicians, we must acknowledge how difficult it is take medications every day. And we must be proactive in asking our patients, “How many times did you skip a dose, and what impact did that have… | Keep reading on ADDitude »

RELATED RESOURCES

How to Optimize ADHD Medication: Strategies for Achieving Better Symptom Management

Expert Webinar with William Dodson, M.D., LF-APA | Listen now on ADDitude »

Why Adults with ADHD Abandon Medication — and How to Improve Treatment Outcomes

Expert Webinar with William Dodson, M.D., LF-APA | Listen now on ADDitude »

How to Optimize Stimulant Treatment for Children and Adults: Better Symptom Management Without Side Effects

Expert Webinar with Thomas E. Brown, Ph.D. | Listen now on ADDitude »

7-Week Guide to Treating ADHD, from Medscape x MDedge x ADDitude:

DECISION 1: What should I consider to develop a comprehensive ADHD treatment plan?
DECISION 2: What medications and other approaches should I turn to as first-line treatments for ADHD?
DECISION 3: How can I decide which ADHD medication to prescribe first?
> DECISION 4: What challenges and side effects should I anticipate from ADHD medications, and how should I address them?
DECISION 5: How can I improve treatment outcomes for patients with ADHD and comorbid diagnoses?
DECISION 6: What dietary, behavioral, or other complementary interventions should I recommend to patients with ADHD?
DECISION 7: How should I follow up with patients with ADHD, and what should we discuss during these checkups?

Decision 3: How can I decide which ADHD medication to prescribe first?

Hope @ ADDitude — Fri, 05 May 2023 17:27:26 +0000

MEDICATION CHART: What are the similarities and differences between the most commonly prescribed ADHD medications?

A: This chart presents the most popular and most commonly prescribed medications used to treat ADHD in children and adults… | Keep reading on ADDitude »

METHYLPHENIDATE: How effective is methylphenidate in the treatment of ADHD?

Dosing and uses, interactions, adverse effects, warnings, administration, images, and more. | See medication information on Medscape »

AMPHETAMINE: How effective is amphetamine/dextroamphetamine in the treatment of ADHD?

Dosing and uses, interactions, adverse effects, warnings, administration, images, and more. | See medication information on Medscape »

DEXMETHYLPHENIDATE: How effective is dexmethylphenidate in the treatment of ADHD?

Dosing and uses, interactions, adverse effects, warnings, administration, images, and more. | See medication information on Medscape »

LISDEXAMFETAMINE: How effective is lisdexamfetamine in the treatment of ADHD?

Dosing and uses, interactions, adverse effects, warnings, administration, images, and more. | See medication information on Medscape »

ATOMOXETINE: How effective is atomoxetine in the treatment of ADHD?

Dosing and uses, interactions, adverse effects, warnings, administration, images, and more. | See medication information on Medscape »

RELATED RESOURCES

Pills and Beyond: A Guide to the Formulations and Delivery Options of ADHD Medication

Expert Webinar with Laurie Dupar, PMHNP, RN, PCC | Listen now on ADDitude »

Medication Management: How to Use and Adjust Stimulants Safely

Expert Webinar with William Dodson, M.D., LF-APA | Listen now on ADDitude »

7-Week Guide to Treating ADHD, from Medscape x MDedge x ADDitude:

DECISION 1: What should I consider to develop a comprehensive ADHD treatment plan?
DECISION 2: What medications and other approaches should I turn to as first-line treatments for ADHD?
> DECISION 3: How can I decide which ADHD medication to prescribe first?
DECISION 4: What challenges and side effects should I anticipate from ADHD medications, and how should I address them?
DECISION 5: How can I improve treatment outcomes for patients with ADHD and comorbid diagnoses?
DECISION 6: What dietary, behavioral, or other complementary interventions should I recommend to patients with ADHD?
DECISION 7: How should I follow up with patients with ADHD, and what should we discuss during these checkups?

Decision 2: What medications and other approaches should I turn to as first-line treatments for ADHD?

Hope @ ADDitude — Fri, 05 May 2023 17:26:07 +0000

MEDICATION: What classes of medication have been shown to treat ADHD effectively?

A: Methylphenidate is the drug of choice approved by FDA for ADHD in children aged 6 years or older. It is the most commonly used drug… | Keep reading on Medscape »

BEST PRACTICES: How can a clinician determine a patient’s optimal dosage of the stimulant medications used to treat ADHD?

A: Many pediatricians are trained to give a certain number of milligrams per kilogram of a patient’s body mass, but there is no evidence that dose is affected by size, age, gender… | Keep reading on ADDitude »

THE MED DECISION: How should clinicians navigate parental concerns around treating children with ADHD medication?

A: While it’s important to educate parents on how medications work and why they might be used, it’s equally critical for clinicians to support… | Keep reading on ADDitude »

HEART HEALTH: Do cardiovascular risks exist for older adults taking ADHD medication?

A: A new meta-analysis concluded that “ADHD medication use was not statistically significantly associated with the risk of any CVD… | Keep reading on ADDitude »

ADHD & SUD: Does ADHD medication increase risk for future substance use problems?

A: No. What’s more, treatment with ADHD stimulant medication prior to age 9 may actually decrease a child’s likelihood of abusing drugs and alcohol later in life, according to research… | Keep reading on ADDitude »

RELATED RESOURCES

ADHD Medication Options and Benefits for Children

Expert Webinar with Walt Karniski, M.D. | Listen now on ADDitude »

Medicating Your Child with ADHD: How to Manage the Feelings of Guilt and Judgment, and Make Peace with Your Decision

Expert Webinar with Roberto Olivardia, Ph.D. | Listen now on ADDitude»

7-Week Guide to Treating ADHD, from Medscape x MDedge x ADDitude:

DECISION 1: What should I consider to develop a comprehensive ADHD treatment plan?
> DECISION 2: What medications and other approaches should I turn to as first-line treatments for ADHD?
DECISION 3: How can I decide which ADHD medication to prescribe first?
DECISION 4: What challenges and side effects should I anticipate from ADHD medications, and how should I address them?
DECISION 5: How can I improve treatment outcomes for patients with ADHD and comorbid diagnoses?
DECISION 6: What dietary, behavioral, or other complementary interventions should I recommend to patients with ADHD?
DECISION 7: How should I follow up with patients with ADHD, and what should we discuss during these checkups?

Decision 1: What should I consider when developing a comprehensive treatment plan for ADHD?

Hope @ ADDitude — Fri, 05 May 2023 17:23:46 +0000

ADHD TREATMENT: What are the recommended first-line treatments?

A: The therapeutic approach to ADHD has been shifting. In some cases, environmental restructuring and behavioral therapy alone has been effective. The medications of choice are stimulants, and… | Keep reading on Medscape »

PEDIATRIC GUIDELINES: What are the AAP guidelines for treating ADHD in children?

A: In 2019, the American Academy of Pediatrics (AAP) released updated guidelines on attention deficit-hyperactivity disorder (ADHD) that… | Keep reading on Medscape »

ADULT GUIDELINES: Do U.S. practice guidelines for adult ADHD exist?

A: APSARD is currently establishing guidelines for ADHD in adults — the first of its kind in the country — set for release in 2023… | Keep reading on ADDitude »

MEDICATION: What are ADHD’s first-line pharmacological treatments?

A: Although stimulants for adult ADHD are associated with the highest treatment response rates, other medications are options… | Keep reading on MDedge »

NON-PHARMACOLOGICAL: What research-validated complementary therapies exist for the treatment of ADHD?

A: Families can positively impact ADHD symptoms by modifying their environments in three simple ways: through sleep, exercise, and food changes. Here’s how… | Keep reading on ADDitude »

RELATED RESOURCES

Integrated Care for Children with ADHD: How to Form a Cross-Functional Care Team

Expert Webinar with Leslie F. Graham, MSW, Douglas Russell, M.D., and Sheryl Morelli, M.D. | Listen now on ADDitude »

Lifestyle Changes with the Biggest Impact on Kids with ADHD

Expert Webinar with Sandy Newmark, M.D. | Listen now on ADDitude »

7-Week Guide to Treating ADHD, from Medscape x MDedge x ADDitude:

> DECISION 1: What should I consider to develop a comprehensive ADHD treatment plan?
DECISION 2: What medications and other approaches should I turn to as first-line treatments for ADHD?
DECISION 3: How can I decide which ADHD medication to prescribe first?
DECISION 4: What challenges and side effects should I anticipate from ADHD medications, and how should I address them?
DECISION 5: How can I improve treatment outcomes for patients with ADHD and comorbid diagnoses?
DECISION 6: What dietary, behavioral, or other complementary interventions should I recommend to patients with ADHD?
DECISION 7: How should I follow up with patients with ADHD, and what should we discuss during these checkups?

The Dope on Dopamine Fasting: Expert Answers to Your Digital Detox Questions

Carole Fleck — Fri, 05 May 2023 09:51:28 +0000

What Is Dopamine Fasting?

“Dopamine fasting” is a buzzy term for the practice of temporarily abstaining from stimulation — via smartphones, social media, video games, and other platforms that deliver reliable dopamine hits — to feel more pleasure later. Here, psychologist Wes Crenshaw, Ph.D., weighs in on the Silicon Valley and TikTok trend that is gaining momentum, particularly among people in their 20s who have ADHD.

Q: People say they go on a dopamine fast or digital detox to “reset their dopamine levels” so that they will feel heightened pleasure when they return to their screens and other forms of stimulation. Does this work?

Our minds are so habituated to a heightened level of engagement from near-constant phone or computer interaction that taking a pause seems wise. But when it comes to video games, TikTok, and other high-dopamine-hit engagements, doing a “fast” isn’t the way to go because you’re not really changing anything about your brain. It’s better to moderate your device usage to have an effect that’s less negative than stopping cold.

[Read: “My Phone Was My Drug”]

Q: Can a digital detox help your brain overcome addictions to compulsive behaviors like checking social media and high levels of stimulus delivered via texts and alerts?

The idea of using abstinence to address addiction is not supported by research. And it’s not a practical solution for behaviors integral to functioning in the modern world, such as using social media and texting. These tools, when used in moderation, are a regular part of modern life. But when these devices draw you away from more necessary activities, or impair your ability to do daily tasks, they become destructive.

I have college-age clients who put their phones in timed lock boxes for, say, three hours during their study time. Once the box is locked, there’s no opening it without a sledgehammer. This technique is referred to as “precommitment,” and in my experience, it is much more effective than other phone apps.

Q: Can individuals exert control over their dopamine levels or is sensitivity to stimulation just baked into your DNA?

[Read: “I Need a Digital Detox. How Do I Break a Social-Media Habit?”]

The timed lock box is a good example of exerting control, except you’re not really controlling your dopamine; you’re moderating your behavior. That’s about the best anyone can do. Another kind of moderation is setting an alarm to signal when it’s time to exit a game or social media, or shutting down the Internet at 10pm to avoid interrupting sleep with multiple dopamine hits.

Q: Are there risks associated with dopamine fasting? Should people be trying it?

I think the risk is that you constantly feel uncomfortable. Unfortunately, feeling uncomfortable is exactly what a lot of people are trying to escape with so-called addictions. They want things that are easy, fun, and stimulating to their brains instead of the tedium of getting business done.

Dopamine Fasting and ADHD: Next Steps

Read: Wasting Time on Social Media? 6 Ways to Stop ADHD Brains from Doom Scrolling
Read: Hooked on Social Media? How to Break the Habit
Read: My ADD Sabotages My Social Skills Online

Carole Fleck is Editor-in-Chief of ADDitude.

“I Feel Judged and Attacked:” A Teen’s Eye View of RSD

Nicole Kear — Thu, 04 May 2023 09:17:40 +0000

Q: “When friends or classmates at school say that one of my favorite books or movies is bad, I feel very hurt. It doesn’t feel like they just disagree. It feels like a personal attack. When I mentioned at lunch that I liked the Jack Reacher book series, Brendan said, “Ew, that’s a bad book. Why are you reading that?” I got very upset because it felt like he was saying I had bad taste, that I was strange and weird for reading that book. I said softly that I liked it and changed the subject. When someone says something that hurts me, I feel like I’ve messed up somehow.

If someone doesn’t value spending time with me as much as I value spending time with them, I feel rejected. Last month, I said to one of my closest friends that I would like to hang out with him more like we used to. He said that he was cool with the way things are. This hurts a lot. What can I do to make this less painful?”

When teens with ADHD struggle with rejection sensitive dysphoria, it affects their relationships — and their self-esteem. Often, they don’t know how to cope with their intense emotions and, feeling overwhelmed, they may lash out at friends and/or family members.

[Read: Why ADD Makes You Feel. So. Much.]

One of my teen clients told me: “When I come home from school, sometimes I just can’t hold it all together. I yell at my mom and then I feel bad afterward, but I know that I can’t get kicked out of my family.” Other kids will withdraw quietly into their rooms and swallow their pain. As parents, there’s a fine line between supporting your adolescent in managing their big feelings and intervening to diminish their distress.

While some ADHD non-stimulant medications or antidepressants, such as SSRIs, can reduce sensitivity and overwhelm, the following behavioral tools can be very effective to quiet the inner critic, shift perspectives, and develop self-confidence.

How to Deal With Rejection: Help For ADHD Teens

1. Identify limiting core beliefs.

Remind them of situations that contradict those beliefs. Help them to recall times when they felt uncomfortable and did something anyway.

[Self-Test: Could You Have Rejection Sensitive Dysphoria?]

2. Challenge negative self-talk.

Name and reinforce their strengths. Pay attention to what is going well. Give examples of their successes.

3. Help quiet their inner critic.

Help them combat the negative messages they tell themselves by prompting them to create positive self-talk phrases. Practice these so they will be familiar and handy when they are needed most.

How to Deal With Rejection: Next Steps

Read: How Does RSD Really, Actually Feel?
Free Download: Understanding Rejection Sensitive Dysphoria
Read: How ADHD Amplifies Emotions
Learn: 3 Defining Features of ADHD That Everyone Overlooks

Sharon Saline, Psy.D., a licensed clinical psychologist, is an expert in how ADHD, learning disabilities, and mental health issues affect children, teens, and families. She is the author of What Your ADHD Child Wishes You Knew.

Decision 7: What diagnostic criteria and tests should I perform as part of a differential diagnosis for ADHD?

Hope @ ADDitude — Wed, 03 May 2023 16:43:07 +0000

CLINICAL REQUIREMENTS: What clinical requirements are required to confirm a diagnosis of attention deficit hyperactivity disorder (ADHD)?

A: All patients must have a full psychiatric evaluation and physical examination. Here is a cautionary note underscoring the need for a full assessment for late-onset ADHD in adolescents and young adults… | Keep reading on Medscape »

PEDIATRIC ADHD: Which diagnostic tests should I administer for the evaluation of pediatric ADHD?

A: Workup in attention deficit hyperactivity disorder (ADHD), previously termed attention deficit disorder (ADD), includes the following… | Keep reading on Medscape »

ADHD DIAGNOSIS: What steps comprise an authoritative ADHD diagnosis?

A: An accurate ADHD evaluation includes several standard diagnostic steps and nuanced considerations; other “tools” are unproven and worth neither your time nor your money… | Keep reading on ADDitude »

COMPLEX ADHD DIAGNOSIS: What tests, assessments, and questionnaires are used to evaluate patients for complex ADHD?

A: Many children and adults begin by taking an online test of common ADHD symptoms and then taking the results to an ADHD specialist for review and evaluation… | Keep reading on ADDitude »

Free Webinar: Expert Guidance for Securing an Accurate ADHD Evaluation

Expert Webinar with Thomas E. Brown, Ph.D. | Listen now on ADDitude »

Free Webinar: How Brain Imaging Helps Us Understand and Treat ADHD

Expert Webinar with Jonathan Posner, M.D. | Listen now on ADDitude »

7-Week Guide to Differential Diagnosis of ADHD, from Medscape x ADDitude:

DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
DECISION 2: What do I need to understand about ADHD that is not represented in the DSM?
DECISION 3: How can I avoid the barriers and biases that impair ADHD diagnosis for underserved populations?
DECISION 4: How can I best consider psychiatric comorbidities when evaluating for ADHD?
DECISION 5: How can I differentiate ADHD from the comorbidities most likely to present at school and/or work?
DECISION 6: How can I best consider trauma and personality disorders through the lens of ADHD?
> DECISION 7: What diagnostic criteria and tests should I perform as part of a differential diagnosis for ADHD?

Decision 6: How can I best consider trauma and personality disorders through the lens of ADHD?

Hope @ ADDitude — Wed, 03 May 2023 16:23:07 +0000

ADVERSE CHILDHOOD EXPERIENCES: How do adverse childhood experiences (ACEs) and trauma influence the development of ADHD in children?

A: Trauma and adversity can alter the brain’s architecture, especially in children, which may partly explain their link to the development of ADHD… | Keep reading on ADDitude »

ADHD AND TRAUMA: What are the symptoms shared by ADHD and PTSD?

A: Poor working memory is associated with ADHD, but also may be the hallmark of a mind avoiding thoughts of a traumatic experience. Practitioners must understand ADHD and trauma to treat a patient effectively…. | Keep reading on ADDitude »

ADHD AND PTSD: Is ADHD caused by PTSD? Is PTSD caused by ADHD?

A: Research increasingly reveals a strong relationship — and reciprocal risk factors — between ADHD and PTSD. What explains this mutual comorbidity? PTSD is associated with dysfunction in areas of the brain implicated in fear extinction learning… | Keep reading on ADDitude »

ADHD AND PERSONALITY DISORDERS: What is the link between ADHD and personality disorders?

A: Personality disorders are mental health conditions like borderline, histrionic, narcissistic, or antisocial personality disorder that cause unhealthy patterns of thought and behavior that persist over time and across situations, causing significant distress or impairment… | Keep reading on ADDitude »

ADHD AND SUBSTANCE ABUSE DISORDER: What is the link between ADHD and substance use disorder?

A: An estimated 15 and 25 percent of adults with a lifetime history of SUD also have ADHD. So how is SUD linked to ADHD? The short answer is we aren’t sure… | Keep reading on ADDitude »

ADHD AND OCPD: Why are individuals with ADHD at higher risk of developing OCPD?

A: Individuals with OCPD may be rigid and stubborn, insisting that others do things according to their strict standards. They may exhibit these behaviors at the expense of flexibility, openness, and efficiency… | Keep reading on ADDitude »

ADHD AND RISKS FOR EATING DISORDERS AND OBESITY: What is the symptom interplay between ADHD, eating disorders, and obesity?

A: Several factors – biological, cognitive, behavioral, and emotional – may explain why ADHD predisposes individuals to eating disorders and challenges… | Keep reading on ADDitude »

7-Week Guide to Differential Diagnosis of ADHD, from Medscape x ADDitude:

DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
DECISION 2: What do I need to understand about ADHD that is not represented in the DSM?
DECISION 3: How can I avoid the barriers and biases that impair ADHD diagnosis for underserved populations?
DECISION 4: How can I best consider psychiatric comorbidities when evaluating for ADHD?
DECISION 5: How can I differentiate ADHD from the comorbidities most likely to present at school and/or work?
> DECISION 6: How can I best consider trauma and personality disorders through the lens of ADHD?
DECISION 7: What diagnostic criteria and tests should I perform as part of a differential diagnosis for ADHD?