adhd across the lifespan - adults · adhd across the lifespan ... rewrite life story to include a...
TRANSCRIPT
Agenda
Diagnosing adults
Creating an ADHD-friendly Living Environment
Executive functioning challenges facing adults with ADHD
Relationship challenges
Workplace challenges
Parenting challenges
Issues in later adulthood
Diagnosing Adults with ADHD
Clinical interview to review
Family history
Developmental history
Academic history
Workplace history
ADHD questionnaires
Brown ADD Scales
Best if significant other can also complete questionnaires
Presenting Issues for Undiagnosed Adults
Constant stress
Feeling of overwhelm
Anxiety and depression common
Can’t manage demands of daily life
Under-functioning at work
Constantly creating dilemmas that increase daily stress
Self-reported Adult Criteria
Disorganized
Distracted
Avoid mental effort
Lose things
Fail to follow/finish
Forgetful
Poor sustained attention
ADHD symptom profiles in Medication-Treated Adults Entering a Psychosocial Treatment Program. Knouse, Sprich et al. Journal of ADHD and Related Disorders, Vol. 1, #1, 2010. pp. 34-48.
Most adults can’t find psychiatrists that recognize and treat their ADHD
Undiagnosed adults commonly diagnosed with
Generalized anxiety
Recurrent depression
Bipolar disorder
Significant Under-diagnosis of Females
“Underdiagnosis of females is a significant public health issue” - Biederman et al., 1999
Girls currently studied not representative of larger population of girls with AD/HD (Gaub & Carlson, 1997)
Current diagnostic criteria more descriptive of males (Ohan & Johnston, 1999)
Parallel Issues in Diagnosis of Adults & Females
AD/HD in adults considered a “residual” form of AD/HD in children
AD/HD in girls considered a “paler” version of AD/HD in boys
Such views result from use of inappropriate diagnostic criteria.
Strong need to develop diagnostic criteria derived from the populations being diagnosed, not derived from studies of young, hyperactive boys.
Diagnosis of Women More Likely than Diagnosis of Girls
Self-referral increases chance of diagnosis
In school, inattentive type overlooked.
Among “inattentives,” boys more likely to be referred than girls.
Course of AD/HD may be different in females - with later onset of clear symptomatology
“Associated Features” of ADHD may be more descriptive of females
Mood lability
Bossiness,
Stubbornness
Demoralization
Dysphoria
Rejection by peers
Poor self-esteem
Diagnosing High Achieving Adults with ADHD
Compare to peers, not average adult
Often function well in one arena at expense of all other arenas
History of extraordinary effort to reach current level of achievement
High Functioning Adults Should be Compared to Peers
Legal “disability” concept leads to under-diagnosis of highly intelligent adults
Need to take not just achievement, but effort into account
Often able to engage in high-level thinking, but still struggle with daily life management issues
May impact interpersonal interactions more than work/career tasks
Some examples of gifted adults with ADHD
David Neeleman – former CEO of Jet Blue
Kary Mullis, Ph.D. – Nobel prize winner
Steven Stanley, Ph.D. – paleo-biologist at Johns Hopkins and Smithsonian
Who can help?
ADD coaches
Adult Tutors
Speech Therapists
Psychotherapists
Career counselors
Professional organizers
Life partners
Physicians
Approach the Challenges from a Brain-based Perspective
ADHD-friendly environments
Brain-friendly Daily Habits
Accommodations
Technology tools and supports
Brain-friendly Choices
Strategies to build Executive Functioning Skills
Solution-focused Psychotherapy
Reframe ADHD in balanced, constructive terms;
Help partner to understand and reframe ADHD conflicts
Set reasonable, reachable goals that build self-esteem
Rewrite life story to include a focus on gifts and talents
Collaboratively monitor medication response
Engage in problem-solving rather than self-blame
Supporting Better Executive Functioning Skills
ADD Coaching
Professional Organizing
Using day planners
Learning Time Management
Building reminder systems
Creating daily habits
Executive Functioning
These higher cognitive functions include the ability to: Organize, Plan, Self-monitor, Control impulses, Analyze Compare current and past events Working memory
Improve Executive Functioning with Brain-friendly Daily Habits
Sleep management – sleep deprivation has direct impact on functioning of pre-frontal lobes
Nutrition – protein to stabilize blood sugar levels, nutritional supplements, neuro-toxins
Exercise
Exposure to nature
Stress management
Improve Executive Functioning through Managing your Living Environment
Creating an ADD-friendly Living Environment User-friendly furnishings
Uncluttered
Organized
Working with a professional organizer
Paperwork Procrastination – work with someone to develop:
Mail systems
Bill paying systems
Tax info systems
Getting the help you need – you don’t need to do it all alone Reading about ADD-friendly system
Help from family and friends
Help from a coach or organizer
ADD-friendly Dig-outs
Make it fun – music, companionship, encouragement
Offload immediately – charity donations go into bags in the car; throw-aways go into bags by the outdoor trashcans
“Age” reluctant off-loads in out-of-the-way storage or even paid storage
Dig-outs should be incremental
Define small area
Tie the bow – complete the entire organizing project in one work session
Use inexpensive, but attractive storage containers
Use label maker
Don’t keep working until overwhelm takes over
Too many interests, too little time
ADD pattern of “too much at once”
If you can’t “give up” an old dream (involving never or rarely used items) set a schedule of “rotating” activities
Set a plan to either use the items at the time of scheduled rotation or lose them (agree to give them up).
Look for ways to improve mood and increase organizing productivity
Color
Lighting
Convenience
Adequate storage
Micro and Macro Organizing
ADD adults have a tendency to:
over-complicate organizational tasks
move into micro-focus while ignoring larger issues
ADD-friendly Ways to Organize Your Life
Many of the ideas in this presentation come from
ADD-friendly Ways to
Organize Your Life
coauthored with
Judith Kolberg, Professional Organizer
ADHD-friendly Relationships
May be attracted to those with same tendencies
Best relationship is with someone that complements areas of weakness
But is NOT overly dependent or critical
ADD-friendly Social Environment
Choose people that Understand ADD
Support your strategies for change
Appreciate the best in you
Help you problem-solve
Help you laugh at your foibles
Don’t add to the chaos
What is an ADD-friendly job?
One that Minimizes paperwork and record-keeping
Provides adequate structure to stay on track
Provides adequate stimulation to maintain interest
One that calls on your strengths with minimal demands in areas of weakness
One with a supportive and accommodating supervisor
Multi-part Career Assessment
Putting together the pieces of the puzzle:
Your strengths
Your challenges
Your temperament
Your interests
How you are affected by ADHD and what job characteristics will accommodate them best.
To find good career match – all the puzzle pieces need to fit together
Strengths
Challenges
Interests
Temperament
To find a good job match within your career
Minimize paperwork or have adequate admin support
Look for a well-organized, employee-friendly employer
Look for a job with variety and flexibility
Look for a job with adequate structure and supervision
Self-employment vs. Working for Others
Self-employment appeals to many with ADHD due to freedom and flexibility
Need to find ways to have structure and support within self-employment
Dangers are disorganization, poor time management, lack of direction
Many with ADHD are not suited for self-employment – need more structure and support
ADHD Parenting Challenges
Difficult to parent consistently until own ADHD patterns are better managed
Parents may respond too emotionally to frustrations of parenting
May over-identify with child and not set firm limits and expectations
Double-challenge When parent and child has ADHD
Parenting groups VERY helpful –provides support and realistic comparison
Your children AREN’T like children without ADHD
Need professional support to change parenting patterns that are:
too lenient,
too inconsistent,
too emotional or
too negative
Family can provide young adults with a model
Provides a model for ADD-friendly Living
Parents with ADD become role models for their children with ADD
ADD is treated with Understanding
Patience
Humor
Appreciation
ADD Challenges Later in Life
Three S’s Suddenly Removed
Retirement removes the
Stimulation of the workplace
Structure of having a job
Support network of the workplace
Surveys Suggest Two Very Different Pictures for Retired Adults with ADHD
Active Enjoyment Loneliness/Withdrawal
What are the determining factors?
Environment that Supports Engagement
Over-50 active adult communities
Elderhostel
Community volunteer activities
Range of interests that promotes interaction and activity
Relationships with Others
Hard to initiate and maintain relationships
Sleep patterns often shift and contribute to isolation – up all night, sleeping all day
Needs involvement with groups that provide organized social activities
Needs are similar at every age
Structure, Support and Strategies to manage daily life challenges
Find or create environment that will promote optimal functioning
Need supportive social environment
Make life choices that don’t over-tax EF abilities and that tap abilities and interests
Meet some Adults with ADHD Learning to Take Charge of Their Lives
Mark – challenged by sleep, time management, money management and anger outbursts
Jason –job losses despite education and effort; juggling work and family responsibilities; seeking career direction
Amy – “hiding” at home and at work – procrastinating and avoiding until she learns to communicate and advocate
Spencer – falling into anger and isolation as ADHD increases and retirement is looming