Consumer Reports Publishes Results of Survey on Most Effective Treatments for ADHD

CHADD commends Consumer Reports for increasing parental, professional, and public awareness of ADHD by documenting parental experiences.

By examining the published science and parental experience through twenty-three years of CHADD member sharing, multiple coordinated interventions—known in the science as "multimodal" treatment—are the most effective interventions for those with more substantial forms of ADHD. "Multimodal treatment for children and adolescents with ADHD consists of parent and child education about diagnosis and treatment, behavior management techniques, medication, and school programming and supports. Treatment should be tailored to the unique needs of each child and family," according to the consensus statement produced by CHADD's Professional Advisory Board.

ADHD is a "spectrum disorder" with symptoms ranging from mild to severe, complicated by co-occurring mental disorders in seventy to eighty percent of children with ADHD (National Institute of Mental Health) and by co-occurring learning disability in fifty percent of children with ADHD (Centers for Disease Control and Prevention). The Consumer Reports survey study did not differentiate between individuals by severity of ADHD and those further complicated by co-occurring mental disorders or learning disability.

CHADD agrees with the Consumer Reports finding of the essential parental task of "care coordinator" in effectively dealing with multiple treating professionals and supports. Given this finding, CHADD repeats the American Academy of Pediatrics advocacy and national health reform promotion of the "medical (or health care) home," coordinated with the availability of electronic medical records to parents.

Given inconsistency in professional practice across the nation, CHADD encourages all health care professionals involved in ADHD to become trained in the assessment/diagnosis/treatment evidence-based guidelines of the American Academy of Pediatrics (AAP) and American Academy of Child and Adolescent Psychiatry (AACAP). Unfortunately, similar evidence-based guidelines for adults with ADHD have not been issued by medical societies.

Missing from the Consumer Reports survey study is the important role of parent support groups. Many parents of children with ADHD instinctively seek support, typically first from family and close friends. These natural supports frequently have limitations and many parents turn to ADHD parent support groups, such as those operated by CHADD. Parents gain knowledge of the disorder and develop a more realistic view of their child. They learn what is helpful and what is not. With the support of other parents, they have the opportunity to practice new skills in a nonjudgmental atmosphere.

Consumer Reports has issued a supplemental piece on the role of parent support groups featuring an interview with CHADD's past president, Marie Paxson. Marie is the parent of two young adult children. Growing up, one child had learning issues and the other had behavioral issues. Her son was diagnosed early, at age seven, and he fared better than her daughter, who didn't receive a diagnosis until the age of fifteen (the age that young people want to be identical to their peers). Both are experiencing success as young adults, but it has been a longer and more complex journey than for those of the same age who don't have ADHD.

Read the survey findings at ConsumerReportsHealth.org (some content public, some available only to CRH subscribers).

Read the Consumer Reports supplement about parent support groups.

Read the Consumer Reports blog, ADHD: The stigma is gone.

Study Habit Tips

Students with AD/HD may find it especially difficult to attend to particularly uninteresting tasks such as studying or writing essays. When engaging in boring activities, I may be helpful to go to the library or work in a quiet room to help minimize distractions. Additionally, taking frequent breaks, working on only one project at a time and completing each assignment before beginning another will help you better focus on the task at hand.

Working Together when a Spouse/Partner has ADHD

Join us Wednesday, July 14 at 3:00 pm (Eastern time) for our monthly Ask the Expert online chat. To join the chat, please click here at 2:45 pm (Eastern time) on the day of the chat and follow the instructions on that page. This is an online chat only and no pre-registration is required!

When:		Wednesday, July 14, 2010, 3:00 pm - 4:30 pm (Eastern Time)
What:		Working Together when a Spouse/Partner has ADHD
Who:		Nancy Ratey, EdM, MCC, SCAC

When one or both partner(s) in a relationship have ADHD, it can lead to challenges above and beyond what other couples experience. ADHD symptoms can often have a negative impact on social skills and relationships. People with ADHD are prone to making impulsive statements which can cause hurt feelings and to interrupting others who are speaking. In this month's Ask the Expert online chat, Nancy Ratey, a nationally recognized ADHD coach, will discuss common difficulties couples who are in this situation often face, and will offer strategies in working together to improve the situation.

About Nancy Ratey

Nancy A. Ratey, EdM, MCC, SCAC, is a Strategic Life Coach specializing in coaching professionals with ADHD. She has a master's degree from Harvard's Graduate School of Education, and is a Master Certified Coach and a Senior Certified AD/HD Coach. Nancy was instrumental in establishing the field of ADHD coaching and is a former member of the CHADD Professional Advisory Board.

She has written extensively on the topic of coaching, including co-authoring three books. Her most recent book isThe Disorganized Mind, (St. Martins Press, 2008). Nancy runs a private practice in Wellesley, MA, and lectures internationally.

For more information, visit this website: CHADD

Staying Organized Despite AD/HD

If those with AD/HD manage to overcome the initial hurtle of getting organized, they are immediately faced with a second - staying organized. Recently, we talked about organizational strategies; today, we will discuss how to stay organized.

You’ve just organized an area, so how do you keep it that way? First, realize that paper is the enemy. So many of us horde away various notes, newspapers, magazines, bills, etc. If you’re going to stay organized, you’ve got to eliminate the paper clutter. Do this by immediately throwing away all junk mail, unneeded notes, etc. If you receive a bill in the mail, pay it immediately, then file it away. Even better, help the environment and eliminate clutter by signing up for online bill-pay. You can also call the companies that send all those unwanted catalogs and opt out of the mailing list.

Next, make space-saving storage bins your best friends. Purchase stacked drawers so you can store up and not just across the space you're working with; once, while living in an apartment, I even draped a table cloth over my file-cabinet style storage drawers and used them as a makeshift stand for my fish aquarium. Organizers that hang from the backs of doors are also a great way to inconspicuously store things like shoes, jewelry, accessories, makeup, etc. I like to store some of my least used items (e.g. Christmas decorations) in long, thin plastic containers under my bed. Either way you do it, try to pack storage containers with similar items (e.g. arts and crafts materials, clothing/ accessories, holiday decorations, etc.) - if you randomly jumble things together, you'll never be able to find what you need. Also, try to store containers with similar items close together. Where appropriate, label the outside of the storage containers with the types of items they hold. If, like many individuals with AD/HD, you constantly lose important items (e.g. keys, wallet, phone), keep a small basket in a conspicuous location (e.g. near the door, on the kitchen cabinet) to place these necessary, yet easy to lose items.


Finally, continue to maintain your newly organized area. If you see something out of place, pick it up and put it where it belongs. Instead of throwing your clothes on the floor at the end of the day, put them in a clothes hamper until you have enough for a full wash load. You should set aside five to ten minutes each day just to tie up these little loose ends. You need to nip the clutter in the bud before it can become a problem again; otherwise, you're back to square one.

Information taken from www.help4adhd.org

Getting Organized Despite AD/HD

Being quite the little neat freak, organization is very important to me. In fact, if my office or home is messy, I literally cannot function until I get it all straightened and organized. I’m pretty sure there is a diagnosis for this (i.e. OCD) but I must admit that my self diagnosed ‘OCD tendencies’ have helped me excel in life far more than they have hindered me. Conversely, individuals with AD/HD often find it very difficult to get organized. In this entry, I will impart some organization skills designed to help those with AD/HD overcome the madness to finally get organized.

My first point is very basic; determine what needs to be organized. If you’re like many people with AD/HD, this could include your entire house, office, car, etc. etc. This is where you start categorizing. Let’s take the house for example. The whole place is a wreck; you can’t find anything when you need it and, when you do finally locate it, you don’t need it anymore. Start by making a list of all the areas that need organizing. You can rank these areas from least to most involved. Start with one of the smaller, easier projects and work on that area only. When you finish the first easy project, move on to the next until you finally reach the more difficulty areas at the end of your list. Starting with relatively simple projects will ease you into the process of organizing and help you find a system that works before tackling the more in-depth organizational tasks.

Next, Make sure to set a schedule and stick to it. If your goal is to clean your bedroom, you may want to allow yourself two or three days, depending on the size of the room and the extent of the disorganization. If you’re only organizing a small closet or drawer, you might only allow yourself a half day. Either way, make sure to work on a consistent schedule so you finish the project by the ‘due date’; otherwise, you’re likely to be left with an even bigger and more disorganized mess.
Plan a way to reward yourself with each area you complete. Rewards could include treating yourself to dinner at a nice restaurant, buying an item you’ve wanted for a while or engaging in an activity you enjoy but don’t get to do very often. The reward should be appropriate to the task. For a small task, only give yourself a small reward, but allow bigger rewards for more involved tasks. Make sure you only give yourself the reward AFTER you have finished organizing the area – don’t reward yourself for something you didn’t do.
Now, gather everything needed to do the job. This could include boxes, plastic storage containers, garbage bags, masking tape, markers, pencil and paper, cleaning supplies, labels, etc. Start with three boxes and a trash bag. Label the boxes "Keep here," "Take Elsewhere," or "Undecided." Put everything except trash into one of those three boxes; put the items that need to stay in the area you are organizing in the "Keep Here" box; if the item is still needed and useful but doesn’t belong in the area you’re organizing, put it in the "Take Elsewhere" box. If you cannot decide whether or not you should keep or discard the item, place it in the "Undecided" box. Do this until all the items are sorted. When you’re done, put all the items in the "Take Elsewhere" box wherever they belong, even if the places they should go are not yet organized – you can deal with these areas after finishing the task at hand. Close and seal the “Undecided” box with masking tape. With a marker, write a future date a few (e.g. three to six) months away on the outside of the box. This is the date when you will re-open the box and review the contents. Mark the re-open date on a calendar or in your day planner (see “The Daily Planner” entry) to remind yourself when it is time to open the box. Place the box in a storage area. When you review the items on the designated day, make one of the following choices: 1.) If you have not looked for the item during the three to six month storage time, then you don't need it. Put it in the trash or donate it. 2.) If you have looked for the item or have decided to keep it, put it in the appropriate place. Neatly organize the items in the “Keep Here” box in the area you just cleaned out.
Put all trash in the trash bag. Since you’ve probably accumulated a lot of clutter over the years, throw away or donate everything you don’t absolutely need. Try to consolidate the things that you do still need, but don’t use on a regular basis. For example, I have kept every single paper and every single class note I’ve written since high school (it’s part of the OCD thing). I still occasionally use these things for references or the basis for other papers or blogs such as the one I’m writing now; however, I don’t use them regularly. So what should I do with this huge pile of material? The answer, of course, is to organize! I have everything organized by subject matter (e.g. history, psychology, English, previous papers, etc.) They are all stored in a three-ring binder labeled on the outside, and placed on a shelf. This way, I still have the things I need, they’re just organized and out of my way.
You will likely need regular breaks during your organizing session; however, make sure to set a time limit (e.g. no more than five or ten minutes for a half-day project). If necessary, set a timer to remind you when your time is up. When your break is over, go right back to organizing.
Make sure you don’t stop at just the one room, closet, drawer, etc. Keep repeating these steps until every area on your list is organized.

Information taken from www.help4adhd.org

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

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