Why is Neuropsychological Testing Important?

According to the Centers for Disease Control and Prevention (CDC), roughly five percent of children have AD/HD without a learning disability, five percent have a learning disability without AD/HD and four percent have both AD/HD and a learning disability. Thus, almost as many have AD/HD and a learning disability, as have AD/HD alone.

This is why testing is so important in the diagnosis of AD/HD and its common comorbid disorders. Since AD/HD has such a high rate of comorbidity (i.e. if a person has AD/HD, they likely have other at least one other disorder), it is very helpful to test for other disorders in addition to testing for AD/HD. Moreover, even if an individual does not have AD/HD, they may have another disorder such as a learning disability that negatively affects their daily functioning. Thus, focusing solely on the possibility of an attention deficit often hinders individuals from understanding the full extent of their difficulties; thorough neuropsychological testing designed to investigate several potential diagnoses provides a more accurate view of the problem, as opposed to simply honing in on AD/HD.

An accurate diagnosis is also very important in treatment. Treating AD/HD does not treat other comorbid issues such specific learning disabilities; similarly, treating learning disabilities does not treat AD/HD. Instead, each issue should be addressed individually to reap the maximum treatment benefit. Otherwise, treating one or the other may yield some positive results, but an individual will not be able to reach full potential until all difficulties are effectively addressed.

Adult ADHD is Real: How to Convince the Unconvinced

Living with unrecognized ADHD, in a loved one or in oneself, can feel like being lost in the fog—often on a roller coaster.

“I hope others can be spared from stumbling through the fog like my husband and I did,” Edith says. “For our first 25 years together, I thought Joe was lazy or selfish or both.”

Edith also wondered if she was failing as a wife because she had so little success in motivating Joe to be more cooperative and thoughtful toward her and the children. At times she chalked it up to she and Joe marching to the beat of different drummers. “For years, I went back and forth in confusion, with no idea that adult ADHD existed,” she says. “Then he was diagnosed at age 55.”

Adults with ADHD also use the fog metaphor, including this woman, who was diagnosed at age 52:

I don’t quite know how to describe my life to people who haven’t experienced ADHD the way I have. Imagine driving a car in heavy fog. You get tense, because you can’t see the edges of the road or what’s in front of you. In other words, you often can’t see how your actions will result in predictable consequences, which instead seem to come out of nowhere. So you inch along, gripping the wheel, anxious that you’re going to crash into something.

That’s how my life was for a half century, until I figured out ADHD. Few people other than my family members would have guessed I had ADHD just by looking at me or talking to me. I worked hard to “pass for normal,” had earned some impressive college degrees, and had tons of plausible excuses for my goof-ups.

When I started taking the stimulant medication, though, the fog suddenly lifted and the road ahead was clear. I could relax my hold on the wheel and enjoy the drive. I could even appreciate the scenery without worrying that I’d get distracted and run off the road. The things most people take for granted, most people with ADHD struggle over for years until they figure out they have it.

Until now, perhaps you have been slogging through serious mental fog, not understanding how your life got so confusing. Even if you have learned about ADHD, maybe you harbor concerns or misconceptions about the validity of the diagnosis or the safety of the medication that help treat it. You are not alone. Everything about ADHD seems to cause confusion, including its name, until you get the facts.

Below are five statements or questions I sometimes hear from skeptical partners of adults with newly diagnosed ADHD (and, phrased slightly differently, from some adults with ADHD themselves). So, let's take some time to debunk each one.

Q: My Partner Has Lots of Attention—for Some Things!

That’s true for most people with ADHD, and that’s one big reason why unrecognized ADHD symptoms can cause hurt feelings between partners. “You can pay attention when you want to” is the tiresome phrase that has echoed throughout the lives of adults with ADHD. Chalk it up as more unfortunate fallout from the misleading words Attention Deficit Disorder. It has nothing to do with attention deficits or even short attention spans.

“ADHD is really not so much a disorder of attention as it is a disorder of self-regulation,” says psychologist Russell Barkley, who detailed his theory in 1997 in the landmark book ADHD and the Nature of Self-Control. Recent brain science discoveries have indicated that ADHD affects specific brain areas, including the frontal lobe, the basal ganglia, and the cerebellum. These areas show less activity and less reactivity to stimulation than in people without ADHD symptoms.

What does having “less reactivity to stimulation” mean? And how does it relate to regulating attention? All humans need stimulation. It engages us in life and helps us meet our goals. Our mere interest in something—an appealing object, thought, or event and even potential danger or risk—triggers the release of brain chemicals that help arouse and maintain attention until the goal is met.

Given genetic differences in people with ADHD, you might say they sit at one end of the human spectrum, the end that requires higher-than average stimulation in order to trigger interest and release those chemicals. That’s why one psychiatrist calls ADHD Search for Stimulation Syndrome. For example, these adults might find themselves doing “stimulating” activities (such as talking on the phone or playing video games) when they should pursue “boring” activities (such as falling sleep and paying bills). In fact, one support-group member jokingly suggests a name much more explicit than ADHD: If It’s Boring, It Ain’t Gonna Happen Unless You Make Me Disorder.

These adults know that the “more mature” pursuits are important, but knowledge alone cannot fuel motivation or attention; the payoff is simply neither sufficiently immediate nor rewarding. (In fact, it’s the mere anticipation of a reward that our brains find most stimulating; in comparison, the actual reward can feel like a letdown.) Moreover, what might feel boring or tedious to you might feel unnerving and undoable to your partner—like physical and mental “static” or even pain.

Once you understand this, it’s easy to see why many adults with ADHD flock to highly stimulating activities that offer quick rewards—driving fast, spending money, smoking cigarettes, picking fights, eating junk food, jumping out of airplanes, playing video games, being the life of the party, or even pushing themselves into a workaholic frenzy, to name a few. These activities produce initial feelings of focus and a paradoxical inner calm, but over time, over-the-top stimulation typically makes everything worse. The challenge: Finding healthier ways to get sufficient stimulation and feelings of being rewarded.

In fact, given what you’ve learned about ADHD and stimulation, it should come as no surprise that the first-line medical treatment for ADHD is called stimulant medication.

Q: My Partner Gets the Fun, and I Get the Drudgery?

Unfortunately, this is a common scenario when ADHD remains both undetected and unaddressed. Understanding why these disparities exist marks the first step toward rectifying them.

For example, no one enjoys cleaning out the garage, but most people without ADHD can drum up the motivation to complete this tedious task. Why? Perhaps because they remember how annoying it is to search for items in a messy garage or park the car on the street in the wintertime. Moreover, they can integrate information from both the past and future and keep it in mind as they temporarily put the brake on fun distractions and bite the boring bullet. Simple, eh? Not quite.

People with ADHD can possess challenges in each of those critical areas that most of us take for granted:

• summoning motivation
• thinking of future consequences
• remembering past difficulties
• “putting on the brakes” and
• following through on tasks that aren’t immediately gratifying or stimulating.

What about the consequences they know will take place—for example, the utilities being shut off mid-winter for lack of payment or arriving at retirement age without savings? That’s where challenges occur in what psychologist Barkley calls cross-temporal organization. It might sound like a term from Star Trek, but it actually means that people with ADHD tend to view two kinds of time: Now and Not Now. And if you can’t possibly imagine yourself in the time of Not Now—where the consequential chickens come home to roost—it might as well be a million years in the future. Something that irrelevant to Now simply doesn’t kick the attention machine into gear.

Q: My Partner is Consistent—at Being Inconsistent!

Congratulations. Your observation matches that of most ADHD experts. That’s why some prefer the term Variable Attention Syndrome.

Some people with ADHD might find only a few subjects or activities highly stimulating or rewarding, and they lock on those targets to the exclusion of all else. (This is often referred to as hyperfocus, a phenomenon touched upon several times in this book.) Others find so many things interesting that they can’t pick out the most relevant.

This man, diagnosed with ADHD at age 42, describes what it’s like to constantly deal with both challenges:

The way I experience ADHD is like being at a loud party where everyone’s talking and the music is blaring, and you’re trying to hear what one person is saying but you can’t because you’re seeing, feeling, and hearing everything happening around you—at the exact same time.

Then five minutes later, it’s like you’ve finally locked into what that one person is saying, but the focus is so intense you’re no longer aware that the rest of the universe exists and so you miss your ride home. Repeat this situation 100 times a day.

Q: So My Partner Can’t “Try Harder” to Pay Attention?

Now you’re catching on. In fact, trying harder can make things worse. Here’s why. One thing our brains need in order to sustain attention is glucose. Glucose fuels our brain cells, and because they cannot store it they demand a steady supply. Groundbreaking research in 1990 using brain-imaging techniques showed lower than average glucose metabolism in the brains of adults who had been hyperactive since childhood.8 The largest reductions were in brain areas known to be involved in the control of attention and motor activity.

The fun doesn’t end there, though. Typically, when we need to concentrate, more glucose flows to our brain. Yet, when a person with ADHD (remember, who already has lower glucose levels) tries harder to concentrate, the brain activity slows even further. Some describe it as “brain freeze.” The bottom line is this: People with ADHD typically can’t just decide to find an activity interesting or to perform on demand. Their brain chemistry must cooperate, and no amount of your crying or pleading will help. In fact, it usually makes things worse.

Q: Maybe My Partner Just Needs to Grow Up!

It’s true. Adults with ADHD often catch flak for being irresponsible and immature. After all, we commonly associate maturity with establishing and meeting priorities while still managing to pay bills, perhaps earn a living or take care of the house and children, and tend to our own health and relationships. But, in fact, these are a few of the ways in which ADHD’s core challenge in self-regulation can, when left untreated, thwart mature behavior.

We’ll use a simple, everyday metaphor to explain. Consider three key areas in which a person’s poor self-regulation impairs the ability to drive an automobile:

Challenge #1: Stepping on the accelerator

In psychological lingo, this is called motivation or arousal. People with ADHD can have difficulty getting started on a task. Instead of initiating the first step, they might procrastinate, waiting until the last adrenaline-spiking moment to step on the gas. (Or they never begin, vexed by all the planning and distractions and lacking the motivation to overcome them.) Then, even once they gain forward motion, they might fail to regulate acceleration, which brings us to:

Challenge #2: Putting on the brakes

“My boyfriend just doesn’t know how to stop,” says Linda. “Stop talking. Stop spending. Stop to think of consequences. Stop to think about me for a change.”

In fact, many ADHD symptoms reflect an inability to stop, or inhibit, undesirable behavior, as born out by more than 200 studies in the literature. The “mental brakes” just don’t grip very tightly. “When you put the brakes on your actions, you’re inhibiting, or controlling, behavior,” says one leading ADHD authority, private-practice physician Patricia Quinn, author of the classic book for children with ADHD: Putting on the Brakes: Young People’s Guide to Understanding Attention Deficit Hyperactivity Disorder.

In fact, the “big three” common ADHD traits—inattention, impulsivity, and hyperactivity—each relate to the act of braking. A concise summary comes from pediatric neurologist Martin Kutscher, assistant clinical professor at the New York Medical College and author of Kids in the Syndrome Mix of ADHD, LD, Asperger’s, Tourette’s, Bipolar, and More!:

• Inattentive—Unable to put the brakes on distractions

• Impulsive—Unable to put the brakes on thoughts

• Hyperactive—Unable to put the brakes on acting upon distractions or thoughts

Braking plays a pivotal role in self-regulation because a lot of what we do in life is based upon what we don’t do. Drivers must also know when to move forward and prepare for doing so, which brings them up against:

Challenge #3: Shifting gears, steering clear, changing routes

Driving from point A to point B efficiently, enjoyably, and safely requires self-regulation. The driver must coordinate a delicate balance of braking and accelerating, turning and going straight, and watching the road and avoiding obstacles while taking in the scenery (not to mention taking rest stops and refueling).

With challenges in self-regulation, some adults with ADHD might find it tough to create balance in any activity, behavior, or thought, much less coordinate many things at once. To the outside observer, it might look like the person is living at the extreme of any behavior. For example, he or she might be super frugal or super extravagant, super productive or super slothful, the super fun parent or the super disciplinarian.

In fact, if the adult with ADHD was not diagnosed until well into adulthood, the scene in the rearview mirror might resemble this, from a man diagnosed at age 40:

I now see how I spent much of my life veering down a highway where only a cliff on one side and a guard rail on the other kept me on the road, bouncing against one to the other and back again. It seems that I was always either overshooting or undershooting, overworking or underworking, overdetailing or underdetailing, and never doing anything consistently right.

Stopping something when they should stop. Starting something when they should start. Not underdoing and not overdoing, but finding the middle ground in being a mature adult. That’s the challenge for all of us humans, but it looms even larger for people with ADHD.

The good news: Whether you have ADHD or love someone who does, this road trip called Life needn’t feel like being whipped around on an out-of-control roller coaster. The first step off the coaster—and out of the fog—is getting the facts.

Adapted from Is It You, Me, or Adult A.D.D.? Stopping the Roller Coaster When Someone You Love Has Attention Deficit Disorder

For more information, visit THIS blog.

AD/HD and Social Interactions

Because many people with AD/HD are inattentive, impulsive and hyperactive, they often experience social difficulties such as rejection and relationship problems. These issues can perpetuate a negative cycle of family and relationship conflicts, as well as feelings of inadequacy on the part of the individual with AD/HD; they could also contribute to the development of co-morbid emotional problems such as mood and anxiety disorders.

Effective social interaction requires attention and the ability to control impulses. However, those with AD/HD tend to be inattentive, causing them to miss details about friends or family, have difficulty “reading between the lines,” forget meaningful events (e.g. birthdays), or become distracted and “zone out” of conversations; they are also frequently impulsive, resulting in them interrupting others or blurting out information that probably should have never been verbalized in the first place. Thus, it is very easy to see how these tendencies could interfere with successful social interaction.

Moreover, friends or family may not even be aware that an individual has AD/HD. As a result, they likely think he or she is egocentric, rude or simply disinterested in the relationship. Either way, it is not likely that they will go out of their way to socialize with that person. Such social rejection or avoidance often causes emotional pain or feelings of inadequacy in the lives of those with AD/HD, and it frequently results in the dissolution of friendships or even marriages.

This is why education is so important. Those with AD/HD should be aware of their symptoms; sometimes just understanding their weaknesses helps people moderate their more problematic symptoms. They should also consult their doctor about the various medication and treatment approaches and proactively seek out one that effectively manages their symptoms. However, educating the individual with AD/HD is only one part of the social puzzle. It is also important to include spouses or significant others, friends and family about AD/HD and the ways it can negatively impact social skills and interpersonal behaviors. Once people know about the diagnosis and understand the effects, they are much more likely to be sympathetic and patient with their AD/HD friends.

Although AD/HD clearly poses unique challenges to social relationships, it is possible for those the disorder to have fulfilling social relationships. By educating yourself as well as those around you, and pursuing effective medication and/or treatment plans, you will likely be able to enjoy close, healthy relationships.

Information taken from www.help4adhd.org

Tip of the Day-Other Conditions and AD/HD

While AD/HD does not cause other psychological or developmental conditions, several other disorders such as anxiety, depression, Oppositional Defiant or Conduct disorders, learning disabilities, etc. frequently occur in conjunction with AD/HD. Make sure you engage in treatment that addresses not only your AD/HD symptoms, but also any other comorbid conditions.

Tip of the Day-AD/HD Research

Many individuals with AD/HD find it helpful to research the disorder for themselves. The newly redesigned Neuropsychology Clinic website (http://npclinic.com/) includes helpful information regarding AD/HD as well as links to other informational sites.

Clear the Road, Here Comes an AD/HD Driver

While most people realize that AD/HD affects things like work or school performance, many do not realize that it also affects other areas, such as driving. In fact, a person with untreated AD/HD can wreak havoc on the road, endangering themselves and others. Let’s consider some facts to better illustrate this point; individuals with AD/HD are involved in more and worse traffic accidents, receive more citations (e.g. speeding, running red lights, etc.) and have more license suspensions or revocations than those without the disorder. This all makes sense when we stop and think about the symptoms of AD/HD, namely inattention and impulsivity; the tendency to make rash, impulsive decisions, coupled with difficulty focusing attention creates a recipe for disaster behind the wheel. However, there are some things parents of driving-age AD/HD children can do to moderate these difficulties.

First is educating teens about the risks and dangers associated with AD/HD drivers. Since statistics will likely go in one ear and out the other, a more hands-on approach may be more effective; for example, many U.S. cities display badly damaged post-accident automobiles on the sides of the road to send a message to drivers; if your city does not have such a display, you could find images on the internet of badly damaged auto accident vehicles or visit an auto-repair shop to let your child see the damage an accident can do; if you know an adult driver with AD/HD, you could also ask him or her to discuss with your child the difficulties they experience as a result of the disorder.

Next is closely supervising your child. One way to do this is to self-impose a longer “permit” time, even after a license is issued; you could also establish rules regarding the number of passengers your child is allowed to have in the car, as well amount of time per day, time of day (e.g. only during daylight hours, non-rush hour, etc.) and places he or she is allowed to drive. To ensure compliance, you could go so far as installing vehicle cameras, such as those offered by DriveCam Inc., or GPS monitoring devices, like those sold by MobileTeen GPS.

Since cell phone use affects even “normal” drivers, restricting cell phone use and texting while driving is an important step to keeping your AD/HD child and other drivers safe. Don’t know how to do it? Here’s a suggestion; the Key2SafeDriving device is a Bluetooth transmitter that connects to car keys to disable the driver’s cell phone while the vehicle is in use; a message is sent to the parent’s phone if the driver attempts to use a cell phone while operating the vehicle. For more information, see: key2safedriving.net

Finally, don’t allow your child to take “medication holidays.” Once again, AD/HD affects ALL aspects of daily life; just because your child is not in school right this very second doesn’t mean his or her AD/HD symptoms aren’t having an effect on every other aspect of life, including driving.

Hyperfocus

Why can some people with AD/HD focus intently on an activity when AD/HD is described as an “attention deficit?” The answer is hyperfocus, or the tendency to become absorbed in tasks that are particularly stimulating or rewarding. AD/HD is more appropriately described as a condition in which individuals have difficulty regulating their attention; though they may have difficulty focusing on, organizing and completing certain tasks, they are often able to focus intently on activities that interest and engage them.

While the ability to hyperfocus and block out extraneous sights and sounds can at times produce positive outcomes, if not managed properly it can also produce negative results; for example, a person can become so engrossed in an activity that he or she inadvertently neglects other commitments or relationships. When this occurs, school and work performance can suffer, and relationships become strained.

The following are strategies designed to help parents and adults put hyperfocus to good use.

Parents:

· Set firm time limits around activities in which your child tends to hyperfocus (e.g. watching television, playing video games, computer use, etc.) If the child is old enough, it may also help to sit down with your child, discuss the issue, and work together to establish these time limits.

· When necessary, provide verbal or physical reminders to move on to another task. Sometimes verbal direction just doesn’t cut it; for example, telling your child to turn off a video game may very well go in one ear and out the other, so to speak. You may need to give a tap on the shoulder or even stand directly between your child and the video screen to get the child’s attention and him or her shift to another activity.

· Help your child find areas of interest and motivation (e.g. reading, crafts, physical exercise) outside the things on which he or she tends to hyperfocus. You can also meet with teachers to discuss ways to make school lessons more engaging; for example, rather than completing a worksheet on a topic, your child may be more interested in a hands on approach to learning (e.g. building and explaining a shadowbox).

Adults:

· Like children, adults can also hyperfocus on their interests. Avoid this by limiting the time you engage in activities that exclude you from other obligations and the outside world. Figure out a predetermined amount of time to engage in the activity (e.g. the length of a particular television show), and stick to it.

· Establish cues (e.g. watch alarm, phone alert) to remind you when it’s time to take a break from an activity.

· Try to match your career to your interests and strengths. Chose a career path consistent with what you tend to hyperfocus on; this way, you are using your tendency to hyperfocus to your advantage.


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