December 2011 | Centre for ADHD Awareness, Canada | (416) 637-8584

Newsletter CADDAC UPDATES

CADDAC Annual ADHD Conference 2011 We had three days of fantastic presentations at York University

about ADHD! The conference was successful despite a few issues with locating the venue and parking. On Friday evening, we began the presentations by introducing the winner of our ADHD Awareness Contest: Ms. Amanda Yali de Keijzer, who developed a beautiful video and success story entitled “ADDays and ADDventures.” Dr. Ross Greene then spoke about the “Collaborative Problem Solving” approach he developed to understand and help children with social, emotional, and behavioural challenges. Finally, Dr. Anthony Rostain presented on current research surrounding ADHD and coexisting disorders to help parents better understand their child’s specific challenges. On Saturday, Dr. Greene once

again presented about his “Collaborative Problem Solving” approach, but with a heavier emphasis on the classroom and even

the school system itself. Dr. Rostain spoke about ADHD and how it and its often coexisting disorders present in the classroom, along with many practical strategies for classroom implementation. Finally, on Sunday, we had

myriad speakers, all exhibiting a different facet of adult ADHD within their presentations. Dr. Rostain began with several studies that clearly showed Cognitive Behavioural Therapy (CBT) to be a very valuable tool in the multi-modal treatment of ADHD. He spoke about the Multi-modal Approach being the best management for ADHD symptoms – which includes medication as just one part of a treatment plan. He explained how medications work and how the ADHD brain functions with and without them at an anatomical level. Shanna Tator-Pearson, an ADHD Coach with One Focus, Total Success, presented on the definition and value of ADHD coaching and shared seven strategies for ADHD management techniques that she uses in her

practice. Rose Ritchi and Sue Potter, Organizer and ADHD Coach

respectively, spoke about ADHD in the Workplace and some strategic solutions they have put in place in the past for particular clients. Sue Potter and Lisa Booth, also an ADHD Coach, then talked at length about strategies for a successful relationship when one or both partners has ADHD. They

Volume 3, Issue 4

CADDAC, the Centre for ADHD Awareness, Canada is a not-for-profit organization that provides leadership in education and advocacy for ADHD organizations and individuals with ADHD across Canada. We thank you for becoming a member of our growing support.

Is there someone you know that would be interested in becoming a member? Have them visit Membership at www.caddac.ca.

Contents

CADDAC UPDATES

CADDAC ADHD Conference 1

Barkley Presentation 2

CADDAC Notices & Initiatives 3

ADHD Awareness Story 4

ADHD Research Studies 5

Guest Columns

ADHD and Couples 6

Working with ADHD 8

Update on ADD/ADHD for

Educators 10

ADHD Events

Tutorwiz Holiday Camps 9

ADHD in the News

ADHD News Stories 13

gave the audience some key tips about healthy communication and some important factors adults must consider within themselves, too – like lifestyle, acknowledgement, timing, and self-advocacy. Empathy was also a strong theme in this presentation. Finally, Dr. David Teplin presented about parenting when the parent themselves has ADHD. Parents with ADHD are often in a better position to provide help, advice, explanations, and education about ADHD than others! The important thing about

being a parent with ADHD is modeling how to manage the ADHD with strategies that your child can emulate. It is also important that the adult try to be consistent. Footage from the conference will be developed and hosted on the website sometime in spring 2012. At that website sometime in spring 2012. At that time, the printed packet information that contains the notes for the presentations will be on sale.

Dr. Russell A. Barkley Presentation CADDAC hosted a special presentation this year for parents on October 16, 2011, featuring renowned ADHD expert and researcher Dr. Russell Barkley, Ph.D. Dr. Barkley presented about the importance of bringing emotion back into our fundamental understanding of ADHD, and placing emotion into the framework of managing ADHD. Dr. Barkley maintains that a key component of ADHD is the inability for one to self-regulate or control emotion. Left untreated, the emotional dysregulation component of ADHD can develop into other disorders, like oppositional defiant disorder, anxiety disorders, and depression. Dr. Barkley discussed the anatomy of the ADHD brain, and which parts are responsible for the emotional dysregulation that we see with ADHD. He explained that self-regulation in a person with ADHD is like a gas tank that is already starting with less fuel than most. The fuel is the ability to inhibit emotion (restraining yourself from calling your boss “pig-face” for making you stay late, for example). Also, self-regulation takes MORE fuel to accomplish in a person with

ADHD than in a person without ADHD. Therefore, the tank empties much faster and frustration is apparent. Dr. Barkley does mention that there are ways to replenish the fuel tank: “greater rewards and positive emotions, statements of self-efficacy and encouragement, ten minute breaks between demanding tasks, three or more minutes of relaxation or meditation, visualizing and talking about future rewards before and during emotional settings, and routine physical exercise.” Dr. Barkley also gave the audience a bonus presentation about his recommended twenty best principles for managing a child with ADHD. The PowerPoint for both of these discussions is on the front page of our website and will eventually be moved to the drop-down menu under the “Parent” section of our website. You can download and print both PowerPoints from the website, but we were unable to film this presentation. You can, however, view any of his lectures on his website: www.adhdlectures.com.

2 CADDAC UPDATES

National Online ADHD

Survey Reminder

CADDAC would like to remind you to take our National Online ADHD Survey if you have not yet done so. We are asking parents, caregivers, and adults about their experiences with ADHD, the medical system, and the educational system. The information gathered will assist us to not only better understand the needs of families with ADHD across Canada, it will help us advocate to medical, education, and government systems in the future. To access the survey, simply go to our website www.caddac.ca, scroll to the bottom of the page, read the introduction and review the glossary terms, and then a link will take you from our website to “Survey Monkey” where the National Online ADHD survey is hosted. Click on the link that applies to you; or both if they both apply. We will be CLOSING our survey and calculating the results at the end of December. So if you know anyone else who is eligible for the survey, please pass the link onto them as well! This will help us help those impacted by ADHD.

ADHD Awareness Week: October 16th-22nd

The United States has had an officially-recognized ADHD Awareness Week since 2004, with a national resolution proclaimed at the federal level in the U.S. Senate. Canada has had none: not at the provincial level and not at the federal level.

But that changed this year for one Canadian city: Vancouver. On Tuesday, October 18, 2011, the Vancouver City Council pronounced the 16

th to the 22

nd of October as

“ADHD Awareness Week.” Pete Quily, Adult ADHD Coach and Advocate was instrumental in getting the proclamation made. Click on this for the original article and click on this for the Youtube video footage of the proclamation.

In the spirit of ADHD Awareness Week, CADDAC launched a press release about dispelling the myths

surrounding ADHD and announcing our speaker, Dr. Russell Barkley. We produced an ADHD information sheet about the significance of ADHD, a dispelling the myths document, and launched a contest for video footage or stories about ADHD and the stigma experienced as a result.

You can see this information on the home page of our website:

Link to Press Release

Contest Poster

ADHD Information

ADHD Facts and Myths

Link to Dr. Barkley's Presentation: The Importance of Emotion in Managing and Understanding ADHD

Link to Dr. Barkley's Presentation: 20 Best ADHD Management Principles

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CADDAC’s Fall Initiatives: Back-to-School with ADHD

and College and University ADHD Awareness Campaigns CADDAC launched two initiatives this fall. The first of these two

initiatives was a campaign addressing the stress experienced by parents of children with ADHD in elementary and secondary school during the hectic back-to-school time. The second was a campaign to build awareness of ADHD at the post-secondary level. Both initiatives were announced in a press release. You can find all details on these campaigns on our website, www.caddac.ca.

There you will find access to:

Brief Back to School Guide

Complete Back to School Guide for Canadian Families

Press release August 31, 2011

Article: “Back to School Tips with ADHD” by Dr. Kenny Handelman

Information available in English and French.

Ten Ways to Achieve Success in College or University with ADHD

Ten Best Resources for University and College Students

Ten Questions to Ask Yourself at the College/University Level That May Be a Sign of ADHD

ADHD Medication

Dispensation Alert

for Ontario

The Ontario Ministry of Health is changing the way doctors prescribe and pharmacists dispense most drugs used to treat ADHD as of November 1, 2011. You need to make sure you have identification when you see your doctor. Your doctor will record it on the prescription. If this is not done, the pharmacist will not be able to provide you with your medication. Prescriptions currently on file at your pharmacy are exempted from this requirement. When you pick up your medication from the pharmacy, the person who picks up the prescription will need to provide identification to the pharmacist too.

Drugs affected by this change:

Adderall XR

Biphentin

Concerta & so-called generics

Any form of Dexedrine & generics

Any form of Ritalin & generics

Vyvanse

This change does NOT apply to Strattera.

For forms of identification that will be accepted and more information, refer to the Ontario Ministry of Health website: http://www.health.gov.on.ca/en/public/programs/drugs/ons/

CADDAC UPDATES

ADHD Awareness Week Contest Winner

Our ADHD Awareness Contest Winner was Ms. Amanda Yali de Keijzer, who developed a beautiful video and success story entitled “ADDays and ADDventures.” You can see her video here: vimeo.com/23031516

Amanda’s full story is posted on our Facebook page (click on) facebook.com/CADDAC where she shares some tips for her personal success with ADHD:

1. FAITH. I know who I am and I believe in myself a little bit more every hour, every day, yet I’m still struggling to keep that belief in myself when nobody else can see my progress.

2. FAMILY. I have very patient boyfriend and an amazing Mom. My mother feels sometimes overly guilty that, being a doctor,

she couldn’t help get my diagnosis and treatment sooner.

3. ADVENTURE. I am aware of my gifts and challenges. I embrace my expansive consciousness and I am physically and spiritually active. I also have a small circle of people who love me, accept me and support me and my creative vision no matter what.

4. AWARENESS. Thanks to the research and community of ADHD specialists, families and role models, I’m inspired and not limited by my challenges. I challenge my limits and create systems, and learn tools to keep me grounded and focused.

5. TREATMENT. I have a wonderful coach and therapist, and I also take medication

6. ACCESS. I can afford a team of specialists when I can't I ask my family and boyfriend for help.

7. FREE INFORMATION. When I am having issues or setbacks, I go online and utilize the amazing amount of info I am having issues or setbacks, I go online and utilize the amazing amount of info in the World Wide Web.

If You Have an ADHD Story, Please Send It! If you have an ADHD story,

submit video, pictures, or write an article about how ADHD has impacted your life. Feel free to include success stories, your experience with diagnosis and/or treatment, strategies you’ve learned to manage your ADHD, stigma surrounding ADHD you may have encountered, or

or anything else that relates to your ADHD experience. Please submit your ADHD story using your contact information, but we will keep your name anonymous if you wish. We may share it with our social media, on our website, or in our newsletter with your permission (with or without a pseudonym as you request).

4 CADDAC UPDATES

Health Canada

Warning about

Strattera

Note from CADDAC: Health Canada has added the same warning to Strattera that is already on other stimulant medications. We strongly suggest that you also read the article just below that states that ADHD medications do not increase heart risks.

****** Strattera (atomoxetine) is a medication used for the treatment of ADHD in children and adults. Atomoxetine can increase heart rate and blood pressure. Atomoxetine should not be used in patients with severe heart-related disorders. Atomoxetine should be used with caution in patients whose underlying medical conditions could be worsened by increases in blood pressure or heart rate, such as patients with high blood pressure, a faster than normal heart rate, or other problems relating to the heart or blood vessels to the brain. Patients or their caregivers should tell their doctor if they or their child with ADHD have any heart problems, heart defects, high blood pressure, or a family history of these problems. Patients or their caregivers should call their doctor right away if they or their child with ADHD have any signs of heart problems such as chest pain, irregular heart rate, palpitations, and shortness of breath, dizziness, or fainting while taking atomoxetine. Patients should not stop treatment with atomoxetine or modify the dosage, without discussing their condition with their healthcare professional. In addition to this advisory, a letter is being issued to health care professionals concerning this information. Patients and their caregivers should be aware of the recommendations accessible at this link.

ADHD Research Studies

ADHD Medication Doesn’t Increase Heart Risks

Two studies have been published regarding the use of ADHD medication (stimulants) and increased risk of heart problems. One was a study published in the New England Journal of Medicine utilizing the medical records of over one million children and young adults, ages 2 to 24, in which the study concluded that there was no evidence of increased heart risk. The other study published by the Journal of the American Medical Association on December 12, 2011, found that ADHD medications were not associated with an increased risk of serious cardiovascular problems in young or middle-aged adults.

ADHD Drugs Do Not Increase Heart Problems in Children ADHD Medications and Risk of Serious Cardiovascular Events in Adults

ADHD and Internet and Video Gaming Addiction In a journal article published in ADHD Attention Deficit and Hyperactivity Disorders, Volume 3, Number 4, on pages 327-334, researchers have reviewed studies in order to discover correlations between Internet addiction and gaming and the ADHD population. The article confirms that various studies have shown a strong correlation between psychiatric disorders (ADHD in particular) and overuse of Internet and video gaming. Also interesting to note, the more severe the ADHD, the higher the amount of use. Though there is no empirical research yet on effective treatment, this is an alarming concern for ADHD youth. Internet and gaming addiction rates are as high as 25% of the population.

The Screens Culture: Impact on ADHD

Executive Functions Development in Children

Abstract from National Institute of Health Journal (Science 2011: August 19):

“To be successful takes creativity, flexibility, self-control, and discipline. Central to all those are ‘executive functions,’ including mentally playing with ideas, giving a considered rather than an impulsive response, and staying focused. Diverse activities have been shown to improve children’s executive functions – computerized training, non-computerized games, aerobics, martial arts, yoga,

mindfulness, and school curricula. Central to all these is repeated practice and constantly challenging executive functions. Children with worse executive functions initially, benefit most; thus early executive-function training may avert widening achievement gaps later. To improve executive functions, focusing narrowly on them may not be as effective as also addressing emotional and social development (as do curricula that improve executive functions) and physical development (shown by positive effects of aerobics, martial arts, and yoga).” Interventions Shown to Aid Executive Function Development in Children 4-12 Years Old

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Adult ADHD and Asthma is

Linked

Findings published in BioMed Central Psychiatry Online Journal have found that a comorbidity of ADHD and asthma exists. These patients may represent a clinical subset of adults diagnosed with ADHD. The prevalence of asthma was significantly higher in the patient group diagnosed with ADHD compared to the control group. Females with ADHD had a higher prevalence of asthma than males with ADHD.

Adult ADHD is Associated with Asthma

Sugar and ADHD: Makes

ADHD Worse? Myth!

Is sugar to blame for your child’s ADHD? No, ADHD is a neurobiological disorder that is genetic and often persists into adulthood. Does sugar make ADHD worse? You might be surprised to hear that the answer is also no! “None of these studies, not even studies looking specifically at children with ADHD, could detect any differences in behavior between the children who had sugar and those who did not. This includes sugar from a variety of sources, including sweets, chocolate, and natural sources. Even in studies of those who were considered ‘sensitive’ to sugar, children did not behave differently after eating sugar full or sugar-free diets.”

Kinsbourne M. Sugar and the hyperactive child. N Engl J

Med1994;330:355-6.

Medical and Health Myths

Are you frustrated because your spouse’s ADHD is affecting your marriage? What if ADHD is a factor in the marriage from both partners? My spouse has combined ADHD subtype and has known it since childhood; but I was only recently diagnosed with combined ADHD subtype as an adult. We have been married for two and a half years, and are both young professionals without children. The “honeymoon” period of our marriage was extremely rough due primarily to the ADHD issues that created undercurrents of tension in our relationship. In this article, I will share with you some of the things we have learned, starting from my point of view. Then I will share some tips and strategies my husband provided. Finally, I will provide you with some research about ADHD couples. Here are my tips for dealing with ADHD in the marriage:

1. Research ADHD. Learn as much as you can about the symptoms so that you can clearly identify what can be attributed to the disorder. This will help you take things less personally when frustration is imminent. 2. Leave time between a request and the expectation of action. An ADHD person’s brain has a difficult time switching from one task to another (even if it is from watching a football game to doing the dishes). This will avoid arguments due to frustration. Example: “You don’t have to do it right now, but I’d like it if you could please do the dishes sometime before bed tonight.” There might be some grumpy complaining (ignore this), but it usually gets done! 3. This brings me to my next point. Ignore the minor complaints. It can be difficult not to take it personally, but choose your battles. Most of the time, the ADHD person forgets they even did this about ten minutes later. It’s not personal. It’s a frustration effect

of executive functioning issues. 4. Along with the last point: avoid escalating the frustration. It will turn into a contest of seeing who can hurt the other the most, and no one ever wins this contest. If tempers flare, it’s always best to walk away and revisit the situation once feelings have calmed. 5. Give your ADHD partner clear instructions. Do not assume they know your needs or desires. They must be explicitly told what you want them to do. Guessing games are a recipe for disaster. 6. When communicating your feelings, try to avoid placing blame, but do be explicit about your needs. Example: “I feel like I hardly ever see you anymore, and I really miss doing things together. I really need some time with you this weekend.” 7. Organization is important. Use a system with plenty of visual reminders (it’s harder for the ADHD person to stay organized if everything is behind a door or a drawer). Make it easy and convenient to put things away, so if there is a pile that usually happens in one spot, this is where you need an organizational tool. Example: Place various hooks by the door for keys, backpack, purse, scarves, hats, etc. 8. Allow your partner to decompress after work. ADHD people need transitional time from one activity to the next. Try not to bombard them right after work. Give them some time to transition to family

activities, for instance. Here are tips from my husband for dealing with ADHD in the marriage:

1. Be aware that frustration may not be the other partner’s fault, but due entirely to the ADHD. The partner isn’t even usually aware of their tone, and is only frustrated at having to refocus their attention. 2. Clearly define roles for household chores with a schedule of completion (I think he’s trying to tell me something here). 3. When there are things to be remembered (appointments, grocery lists, etc.), both partners should make a list and put it somewhere where both partners can see it and remind each other. 4. When arguing, things are sometimes said due to impulsivity that are not meant. Forgiveness is key.

Research indicates that adults with ADHD receive many detrimental messages from those around them because people do not understand the disorder. “If only you tried,” “why can’t you just do it,” or “you have such potential if only you’d use it” are especially damaging because no matter how much the person with ADHD tries, they are unable to concentrate, complete tasks, or sit still. It is not an issue of willpower. So when the individual with ADHD tries their hardest to no avail, they are forced to conclude that they are “lazy, stupid failures.” An equally difficult message for an ADHD adult to receive is “You are doing that wrong.” ADHD individuals tend to think outside the box and have unique approaches to working through a task.

6 GUEST COLUMN

ADHD and Couples by Erin Bernhardt

“Research ADHD. Learn as much as you can

about the symptoms so that you can clearly identify what can be

attributed to the disorder”

To be shut down by more traditional thinkers again brings home a message of worthlessness. It’s no wonder many people with ADHD have low self-esteem! Being in a relationship with an adult with ADHD brings some difficulties:

Difficulty staying tuned into conversations.

Difficulty with time management and commitments.

Difficulty saying no and setting boundaries and limits.

Difficulty finishing tasks due to distraction.

Difficulty coping with change.

Individuals with ADHD spend untold amounts of energy just maintaining focus throughout their day. When they arrive home from work, there is little energy left for focus at home. It takes a lot of effort to maintain attention, suppress impulsivity, stifle hyperactivity, constantly remind oneself of tasks and push oneself to finish said tasks. Individuals with ADHD do need time to decompress and restore their energy for a period of time after work. Setting up a routine for household chores, keeping in mind decompression time, with larger projects during weekend hours is helpful. Follow-through is difficult for those with ADHD and intensely frustrating for the partner, especially because the

ADHD partner will agree with you! Try not to take this personally; the ADHD person’s brain is so “noisy” they may not have even heard you, or they have forgotten entirely in the wake of the “brain noise.” For a person with ADHD, it is like five conversations going on in their brain at one time. It’s no wonder they have difficulty remembering that you told them to take out the garbage. Don’t blame yourself for not “doing enough to help my ADHD partner.” Don’t attempt to micro-manage your spouse. It’s not good for you, and it’s not good for the partner. Eventually, this kind of relationship breeds resentment because it begins to feel more like a parent-child relationship than a relationship between spouses. You can only change yourself and how you respond to your partner; you cannot change your partner. Boundaries and limits are important for the non-ADHD partner, too! Positive reinforcement is important. Notice when the ADHD individual does something you asked, especially if they do it without you having to ask! Also realize that people with ADHD may try to control a situation because they feel so out of control with their thoughts and behaviours. Realize that at times, an argument exists only because it is an ADHD issue,

not as a result of the subject you are arguing about! Try to focus on your partner’s talents, accomplishments, and positive attributes. Regarding ADHD treatment, it is important for the spouse to be aware of the treatment plan. Educate yourself about ADHD and learn about what type of treatments are available to your spouse. Contribute by perhaps visiting his/her therapist or coach for a session together. Perhaps even consider couples counseling as a part of the treatment plan. Despite these issues, often adults with ADHD are bright, articulate, and interesting. They tend to be quite attractive to the people they meet. They are exciting, energetic people who know how to have fun and often have a fabulous sense of humour. Those with ADHD are often creative and see the world in an “outside the box” way. They tend to have varied interests and sometimes cycle through them quickly, but this can make for fantastic conversation! Most are caring and empathetic people. They are persistent and determined, quite capable of picking themselves up after a setback and dusting themselves off to try again. Adults with ADHD have attractive personalities; it’s no wonder we are attracted to them! These tips will help your relationship with your ADHD partner flourish. Further information about couples in an ADHD relationship can be accessed by the links below.

Resources: Hallowell, E and Ratey, J. (2004). Tips on ADD in Couples. ADD ADHD Advances. Retrieved August 11, 2011, from http://addadhdadvances.com/couples.html McCarthy, Laura. (2007). Married to ADHD: Relationship Advice for You and Your Spouse. ADDitudeMag.com. Retrieved August 11, 2011, from http://www.additudemag.com/adhd/article/print/1593.html White, Melinda. (2004). How Adult ADHD Affects Relationships: Strategies for Coping. ADD Consults. Retrieved August 8, 2011, from http://www.addconsults.com/articles/full.php3?id=1448 What Affect Does ADHD Have on Relationships? 4Therapy.com. Retrieved August 11, 2011, from http://www.4therapy.com/conditions/adhd/what-affect-does-adhd-have-on-relationships (2004) How Do You Cope With An ADD Spouse? ADDers.org. Retrieved August 11, 2011, from http://www.adders.org/info75.htm

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Working With ADHD by Sue Potter

GUEST COLUMN

I would like to share a couple of experiences with you. Two young people with ADHD were struggling with the “tasks at hand”. One was getting very bored in her job tasks and needed to be able to re-focus on her work; the other one was feeling frustrated and hopelessly upset as he was so far behind. In both cases you could hear their creative ADHD brains trying to get them to relinquish responsibility and give up on the work at hand. You could hear it making excuses, and providing justifications for the individual to get out of starting and following through with obligations that, in both cases, if completed, would make the individual feel much better about themselves, and of course, much worse if they gave up and listened to their ADHD brain. Getting started, and following through, are a frequent struggle for the person with ADHD, especially if they are stuck in an un-stimulating activity, one which is routine, highly repetitive and requires a great deal of concentration without much movement or variety.

What to do? Where to start?

Here are a few pointers that would give to help these individuals minimize the occurrence and/or the impact of these situations. They will make it easier to boost determination and commitment. With practice, these strategies will help the person to get started, get “the job” done, and to assert control over their ADHD thinking (this is boring, I can’t get at this, I’ll never finish this, I’ll never get caught up, I’ll take a break and surf the net) which would take them down a much less fulfilling path.

exactly what you are trying to accomplish in that period. It brings clarity as to how you will use your time. This puts a little pressure on the brain (like waiting until the last minute to do something) to wake up and start. And it certainly adds another ‘mental push’ when the alarm goes off!

Second: o Set your timer for 15 minutes. (the

choice of timing is yours but keep the blocks of time very small at the beginning, 5 or 10 minutes, and never longer than 30 minutes or you may get into hyperfocus and write too much, or material that isn’t relevant – or you will get frustrated again and quit)

o Break it down (that one most important thing) into small, concrete steps, and write the steps out in point form.

o Use a bright coloured paper or your favourite coloured pen. You do this to give colour and pizzaz to what may otherwise seem like a very dry and tedious bit of work. BBBBrrriingg!

o Use point form to avoid getting caught up in sentence structure, and semantics. Just the points!

Third: o Set your timer for another 10 minutes. o Complete JUST the first small step.

BBBBrrriingg! o Now here you do something that is

often contrary to how you would normally think. Normally you might say “Oh – look what time it is and I only have a small piece of this done, what am I going to do, I’ll never get finished”.

o DON’T SAY THAT. o Instead, tell yourself that you have now

“identified your highest priority, have broken it into easy doable steps, and have already completed the first step”. What a difference in the message you are giving yourself! This is positive reinforcement for what you have accomplished. It comes from the most important person as well – you!

o When you do this consistently, following a strategy that works, making it work, and dutifully congratulating yourself, you will begin to see the “possibilities” as opposed to all the negatives.

o This change in your self-talk is very important to keep you motivated and to help you begin to realize that “yes you can accomplish things”. But with ADHD, it always helps to have a system that meets the needs of your different brain wiring. Structure, colour, clarity of intent, focusing on one small thing at a time to prevent overwhelm and shut down are important. Working for short time periods and timely self-acknowledgement for your accomplishments are critical.

Fourth: o Fun time! (but also an important part of

the strategy) o You have worked for half an hour

already. Good for you. o Now set your timer for a 10 minute

break. Go wild. If you are at school or at work you can always get up and go for a brisk walk, meditate, go to the

Identify your highest priority. Break it into easy, doable

steps. Single-handle the task to completion using a timer.

Follow with positive reinforcement.

Set a timer (you can get them at the Dollar Store) for 5 minutes.

First: o Pick the one most important

thing that needs to be done, (absolutely essential that you do it, big consequences if you don’t get it done on time). You have 5 minutes in which to do this. BBBBrrriingg!

o Your 5 minutes is up. You only had to work on that one thing – and only for 5 minutes. Nothing else. Congratulate yourself when you are finished, even if you had to set your timer twice for 5 minutes each.

The timer gives you structure, makes it easy to hold the end in sight, and helps you focus in on the task for such a short time. The process described helps you define

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o the washroom etc. At home - do sit-ups; dance on the spot; sing your favourite song; write yourself a silly note, draw pictures, eat an apple – anything that gives you a complete and utter break from your activity..

But as soon as your timer goes off “BBBBrrriingg” re-set it, perhaps for 15 minutes this time and now complete the second small step of your most important thing. Keep following this pattern until you have your most important thing accomplished. This is a wonderful strategy to get started, keep going, and complete something. You learn to appreciate yourself for the things you accomplish. You start to see that you can get things done. Of course, it must be obvious that if you don’t use this strategy it doesn’t work. Thinking about it or trying it only once simply doesn’t cut it! Many people

with ADHD indicate that this has helped them to get started on very difficult and complex pieces of work. So try it for a week and see what you think. If anything it will teach you to focus on what you do get done and what you have achieved. Other tips that feed your ability to get things done: o Remember how good you will feel

after each tiny accomplishment. SOOOOOOOO much better

o Remember how you felt the last time you accomplished what you set out to do – these are good feelings and they are the ones you need to keep in mind.

o Be vigilant about your health. People with ADHD tend to have somewhat heightened sensitivities – to food, to environment, to sleep (or lack thereof), to emotional events, it is very important to make sure you are doing everything you can to be healthy. Good health makes us feel good about ourselves and supports optimal brain function.

o If you start to get overwhelmed with all the thoughts in your head, get them out of your head and onto a sheet of paper, in point form (not long sentences). Leave them and come back later to review them. Put a #1 next to your top three priorities and then re-write these top three.

o Schedule a time to do the most important one and follow the steps above. This way you will at least get the most important one accomplished, rather than putting them all off and getting further behind.

Do what you need to do to get excited about what needs to be done. Get it done. Acknowledge your achievement. Know that you can do it again. Cheers! Sue

"Forum on Abilities" Rogers TV Durham hosted by Donald Reist, Director and Special Education Specialist of the Tutorwiz Education Centre ON ROGERS TV DURHAM Click here for program schedules. The show will focus on providing people with various types of disabilities including cognitive/learning and physical disabilities with information which will help them maximize their abilities. We will also address the barriers that the community faces and provide advice on how to overcome them. Furthermore, each week my guest(s) and I will handle questions and inquiries emailed or tweeted through Twitter. I will also invite viewers to email in topics for future programs. Hopefully this will provide the viewers with a voice. Presently the show has not yet been picked up by any other Rogers community station. If you are outside the Durham region and you are interested in the "Forum for Abilities" program, please request that the program be picked up by your local Rogers TV channel. Contact: Donald Reist OCT,B.Sc.,B.Ed. Director & Special Education Specialist Tutorwiz Education Centre Tel: 905-683-6341 Email: don@tutorwiz.com Website: www.tutorwiz.com

While burgeoning numbers of children and adolescents are being diagnosed with attention deficit disorders (ADD or ADHD), a large number of teachers and school administrators report uncertainty about how they should respond to parents who ask, “Do you think my child has ADD or ADHD?” or who insist that their child be given multiple accommodations for presumed ADD/ADHD. Many feel even more uncertain about what interventions are appropriate when school staff believe a child may be impaired by ADD/ADHD while the parents are skeptical or refuse to consider that possibility. Epidemiological studies estimate that 5 to 10% of school aged children are currently diagnosed with Attention Deficit Disorder (ADD) or Attention Deficit/Hyperactivity Disorder (ADHD). This means that most teachers are likely to have in every class they teach, on average, at least a couple of students with ADD/ADHD (those terms are used interchangeably in this article). Yet very few educators have had opportunity to learn about major changes that have recently emerged from scientific studies of ADD or about implications these findings have for schools... For decades, most educators, physicians, psychologists and parents have thought of ADD/ADHD as essentially a cluster of behavior problems, a label for children who can’t sit still, won’t stop talking, and often are disruptive in class. Discussion about ADD has centered mainly on controversy over whether children with this diagnosis should be treated with stimulant medication, an intervention generally thought of as a paradoxical tranquilizer to calm down overactive bodies and brains. Recent research has produced a radically different understanding, a new paradigm, for understanding this disorder and a totally different view of how medication treatment actually works within the brain. Few researchers still think of ADD as a simple behavior disorder. Increasingly specialists are recognizing that ADD is a complex syndrome of impairments in development of the cognitive management system of the brain. It is a syndrome that involves chronic impairments in a wide cluster of cognitive management functions of the mind. These include the capacity:

• to organize and get started on work tasks • to attend to details and avoid excessive distractibility • to regulate alertness and processing speed; • to sustain and, when necessary, shift focus; • to utilize short-term working memory and access recall • to sustain motivation to work; • to manage emotions appropriately.

This extended, interacting cluster of cognitive functions impaired in ADD is generally referred to as “executive functions”

or EF. One way to imagine the cluster of cognitive functions involved in this new model of ADD is to visualize a symphony orchestra in which all of the musicians are very good at playing their instruments. Regardless of how talented those musicians might be, there must be a competent conductor who can select what piece the orchestra will play, who will start their playing together and keep them on time, who will fade in the strings and then bring in the brass, who will organize and start and manage them as they interpret the music. Without an effective conductor, the symphony will not produce very good music. The problem of individuals with ADD is not with parts of the brain that would correspond to the individual musicians of the symphony; those work perfectly well in certain situations discussed below. Impairments of ADD involve those neural circuits that function as the conductor of the symphony of the brain.

Executive Functions

Impaired in ADD Syndrome

Executive Functions(work together in various combinations)

Organizing, prioritizing,

and activating to work

1.Activation

Focusing, sustaining

and shifting attention to

tasks

2.Focus

Regulating alertness, sustaining effort, and processing

speed

3.Effort

Managing frustration

and modulating emotions

4.Emotion

Utilizing working memory

and accessing

recall

5.Memory

Monitoring and self-

regulating action

6.Action

[TE Brown (2005)

Several models have been developed to describe these executive functions. Figure 1 shows the model that emerged from my research with children, adolescents and adults (1996, 2001, 2005). Although each of the six components of this model has a single word label, they are not unitary variables like height, weight or blood pressure. Instead, each could be thought of as a basket containing a cluster of related cognitive functions. For most tasks of daily life these six clusters of cognitive functions operate, often without conscious thought, in integrated and dynamic ways to accomplish a wide variety of tasks in daily life. These executive functions do not constantly work at peak efficiency for any of us; everyone has difficulty with these various functions from time to time. What is different for those diagnosed with ADD is that they have substantially more impairment in their ability to utilize these EF than do most other of the same age and developmental level. ADD, as now conceptualized, is not an all-or-nothing concept. It is not like pregnancy where one either is or is not pregnant, with nothing in between. ADD is more like depression. Everyone feels sad or unhappy from time to time, but being sad for a couple of days does not warrant a clinical diagnosis of depression. Only when a person is significantly impaired by depressive symptoms over a substantial period of time does it make sense to diagnose and treat them for depression. In the same way, the diagnosis of ADD/ADHD is not warranted for people who have just occasional difficulty with the

10 Guest Column

An Update on ADD/ADHD for Educators by Dr. Thomas E. Brown, Ph.D.

As a new school year begins, many parents of children or adolescents with ADD/ADHD will

discover that teachers educating their children lack updated, accurate information about this disorder.

Offering a copy of this article to interested teachers may help to facilitate more productive conversation about how parents and educators

can work together to support students with ADD/ADHD.

relevant symptoms. It is only when an individual is significantly impaired by the cluster of ADD symptoms over a longer period of time that the diagnosis of ADHD/ADD is legitimately made. As every teacher knows, a child’s capacity to exercise these various self-management functions develops slowly from early childhood until late adolescence or early adulthood. We hold very different expectations for 8 year olds than for 5 year olds and for 15 year olds than for 10 year olds in their capacity to sustain attention, to follow directions, to keep information in mind, etc. We also know, of course, that within any given age group, some children develop these abilities much more quickly and in more refined ways than others. Diagnosis of ADD/ADHD is appropriate only when the individual’s impairment from the stipulated cluster of symptoms is significantly greater than most others of the same age and developmental level. Scientific evidence has now demonstrated that networks of the brain which support these executive functions develop quite slowly. While some basic elements of executive functions emerge during early childhood, these complex self-management networks are not fully developed until the late teens or early twenties. Most governments will not allow anyone to drive a motor vehicle until they are at least 16 years old. This is not because their legs are too short to reach the pedals; rather, it is because critical executive functions of the brain are not developed sufficiently until mid or late adolescence for an individual to manage the complexities and high stakes responsibilities of driving a car. Since normal development of executive functions is not completed until late adolescence or early adulthood, it is not always possible to identify during childhood those students for whom development of these functions is impaired. For some students, ADD impairments become obvious during preschool. They may be wildly hyperactive, unable to sit still or follow even the most basic directions. Yet other students may learn and behave quite well during their elementary school years, showing signs of ADD impairments only as their self-management abilities are challenged when they move into middle school or high school, leaving the classroom where one teacher is helping to guide their executive functions. Some students do not manifest their ADD impairments in noticeable ways until they encounter the more demanding world of secondary school. There they may display noticeable ADD impairments for the first time as they try unsuccessfully to manage diverse demands for study, classroom performance and homework from five to seven different teachers each day while also trying to cope with ongoing conflicts and demands in family and social interactions. Other students with ADD may not have their symptoms noticed until much later. Their parents may have been so successful in building compensatory scaffolding around a son or daughter that their ADD impairments do not become apparent until the scaffolding is suddenly removed as the student moves away from home to go to college or university. Existing diagnostic criteria for ADHD stipulate that an ADD diagnosis requires at least some ADD symptoms apparent before age 7 years, but experts have discredited that requirement because it contradicts clinical experience and is without any empirical support. Most specialists are now willing to diagnose ADHD in adolescents and young adults, even if the individual had no apparent symptoms until adolescence. The most perplexing aspect of ADD diagnosis is the situational specificity of the symptoms. Every child, adolescent or adult with

ADD that I have ever seen has a few types of activity in which they have no difficulty in exercising cognitive functions that are quite impaired in almost every other circumstance. My favorite example is Larry, a high school junior who was the goaltender for his ice hockey team. His parents brought him for evaluation the day after the team had just won the state championship in ice hockey. As they described his performance, it was clear that he was extraordinary goalie, one who kept careful track of the puck throughout each game. He was very bright; IQ was in the very superior range. Yet this same student was always in trouble with his teachers. They reported that he occasionally made comments in class that were impressively perceptive, yet most of the time he was distracted and “out to lunch”, unable to follow the class discussion. Their question: “If you can pay attention so well when you are playing hockey, why can’t you pay attention in class?” Not all individuals with ADHD focus best in sports; some get intensely involved in video games or drawing or building with Legos or doing mechanical tasks. All seem to have a few specific activities in which they can focus very well, often for long periods of time. Yet they have great difficulty in focusing for many other tasks that they recognize as important and want to do well. One of my adult patients suggested that having ADD is like having “erectile dysfunction of the mind.” He observed that “If the task you’re trying to do is intrinsically interesting, you’re ‘up’ for it; but if it’s not really interesting to you, you can’t ‘get it up’ regardless of how much you may want to because it just isn’t a willpower kind of thing.” Often ADD looks like a problem of willpower—“You can do it here, why can’t you do it there?” Despite appearances, ADD is not a problem of willpower; it is a chronic impairment in the chemistry of the management system of the brain. There is now considerable evidence showing that ADD is a highly heritable disorder with impairments related to problems in the release and reloading of two critical neurotransmitter chemicals in the brain---dopamine and norepinephrine. There is also a massive body of evidence showing that 8 of 10 individuals with ADHD experience significant improvement in their functioning when treated with appropriately fine-tuned medications. However, these medications cure nothing. ADD is not like a strep infection where you can take a course of antibiotics and knock out the infection. It is more like impaired vision. Wearing appropriately prescribed eyeglasses will usually improve one’s vision significantly, but the eyeglasses do not cure the vision problem. They work only when they are actually being worn. Similarly, medications for ADD may help to alleviate symptoms, but only for those hours of the day when that medication is actually active in the brain. Some students with ADHD impairments respond dramatically to adequately tailored treatment with appropriate medications. For them, if the chemical problems are adequately addressed, they can perform most self-management tasks quite well, so long as the medication is in place. Their deficit is not in knowing what they should do; it is primarily in being able to get themselves to do what they know they should be doing. For others, medication treatment is necessary to alleviate EF impairments of ADHD, but medication alone is not enough to help these students function significantly better on tasks requiring EF. They lack the necessary skills to do what needs to be done. For these students, medication treatment does not create the skills,

11

but it can help the student to be more available to learn to perform these skills, if appropriate instruction is available. This has important implications for students with both ADHD and specific learning disorders. Among students with reading disorder, math disorder or disorder of written expression, many also have ADHD. If students with concurrent ADHD and LD are not provided adequate treatment for their ADD impairments, it is not likely that they will benefit much from special education instruction. Likewise, about 50% of students with ADHD also have one or more specific learning disorders. Medication treatment alone cannot reasonably be expected to alleviate their LD problems; it can only make them more available to learn. Often they still require accommodations or special education services. In earlier days when ADHD was seen as a simple behavior disorder, it was quite easy to diagnose. Students who were chronically inattentive, restless and impulsive could readily be recognized in the classroom and on the playground by simple observation. Operating with this new paradigm of ADD as developmental impairment of executive functions requires a very different kind of evaluation, an approach that can pick up more implicit and subtle cognitive impairments that may or may not be accompanied by hyperactivity or any other readily observable symptoms. To assess for ADD/ADHD as understood in this new paradigm requires different methods. The most important element of assessment is an individual clinical interview with the student to query about a variety of cognitive functions in everyday life. This requires a clinician who is well-trained to recognize ADD and to differentiate it from many other learning, emotional and behavioral problems that may be present in addition to or rather than ADD. The evaluating clinician also needs to gather information from parents and from teachers who can describe strengths and impairments of the student as she encounters various tasks like keeping track of assignments, doing homework, reading for understanding, organizing thoughts for writing projects, etc. as well social interactions within and outside of school. Often rating scales such as the Conners, BASC, BRIEF, or Brown ADD Scales are helpful to gather data for such evaluations, but none is sufficient in itself for making or ruling out a diagnosis of ADD. Standard IQ scores or achievement test scores cannot help to make or rule out a diagnosis of ADD. However, IQ index scores on the WISC-IV or WAIS-III tests can be suggestive of ADD impairments if the student’s score for the Working Memory and/or Processing Speed Index is one standard deviation or more below that student’s index score for Verbal Comprehension or Perceptual Organization. Any student who is underachieving in school and has such discrepancies between basic cognitive abilities and his executive functions should be carefully evaluated for possible ADD. Among students who chronically underachieve, there are three groups where students with ADD are often overlooked. 1) Very bright students: Often students with ADD who are very bright are seen as lazy; some mistakenly assume that one cannot be very bright and still have significant ADD impairments; 2) Female students with ADD are often overlooked because they do not generally call attention to themselves with dramatic disruptive behavioral symptoms that draw the attention of parents and teachers; 3) students with ADD coming from families with multiple social stressors, e.g. divorce, unemployment, poverty, multiple relocations, etc. are often seen as unlikely to have ADD.

Teachers and others may assume that the academic problems of such students are just reactions to their psychosocial stressors; such observers may not realize that ADD is more common in families with such severe psychosocial stressors. Students with ADD who are especially bright are likely to be at particular risk of having their ADD impairments unrecognized until late in their educational career. Many educators and physicians believe that anyone with a high IQ is not likely to suffer from ADD. When very bright students do poorly in school, many blame boredom, lack of motivation, or insufficient stimulation in the classroom. Our group recently published a study of 117 children and adolescents with IQ scores of 120 or above, in the top 9% of their age group, all of whom fully met diagnostic criteria for ADHD. Data showed that these very bright students, despite their high IQ, suffered from significant impairments in working memory, processing speed and many other executive functions that are critical for success in school. The full text of that research report is available on my website www.DrThomasEBrown.com. When a student of any level of ability is chronically underachieving, with or without hyperactivity or behavior problems, educators should consider whether evaluation for ADD/ADHD might be appropriate. If so, school staff can systematically gather relevant information from teachers and the school psychologist about specific impairments observed in the student’s academic work, classroom performance and/or social interactions. This information can then be presented to parents with suggestions about how they can arrange in the school or community for an appropriate evaluation to identify causes of the student’s chronic difficulties and possible options for intervention. Yet, before school staff can adequately assist parents in identifying students in need of evaluation for possible ADD, it is necessary for teachers, school psychologists and administrators to develop a solid understanding of this new paradigm for ADD, what this disorder is and what it is not. Resources to develop such an understanding can be found online at the caddac website: www.caddac.ca.

Thomas E. Brown, Ph.D. is Associate Director of the Yale Clinic for Attention and Related Disorders in the Dept. of Psychiatry at Yale University School of Medicine. More information about his work is available at www.DrThomasEBrown.com.

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ADHD Should Be Taken Seriously

Earlier in the fall, National Post columnist George Jonas wrote an article called “Diagnosis: Attention Surfeit Disorder” in which he basically states that he doesn’t believe ADHD exists and mocks all those who have the disorder. Our National Director, Heidi Bernhardt, wrote an editorial piece on how another journalist perpetuates stigma and ignorance, and the Post never would have published the same comments about

disorders like autism, learning disabilities, anxiety, depression, bipolar disorder or Tourette’s Syndrome. The Post gave our Director the opportunity to write a rebuttal piece that they published a few days later.

Vancouver Park Commissioner Sarah Blyth comes out with her personal struggles with ADHD, hoping that her success inspires other children and youth.

CLICK HERE TO VIEW FULL ARTICLE.

The American Academy of Pediatrics has recently issued updated guidelines for the diagnosis and treatment of ADHD in young children and adolescents. They recommend screening earlier (beginning at age 4) and continuing longer (to age 18) for any child who presents with the symptoms of ADHD. They also urge adherence to the DSM-IV criteria for ADHD when diagnosing, and assessing for comorbid disorders. Medication is not recommended as first-line treatment in children under 6, however if behavioural therapy proves ineffective, methylphenidate can be prescribed. For children ages 6-11, ADHD medications and behavioural therapy should be prescribed. And in adolescents ages 12 to 18 years, the physician should prescribe ADHD medication with the patient’s consent and consider behavioural therapies.

CLICK HERE TO VIEW FULL ARTICLE.

Adult ADHD is a legitimate diagnosis, despite the arguments against it. 4-5% of all adults have ADHD; and as many as two-thirds of children with the disorder carry it into adulthood. It’s a serious issue, but once diagnosed, accepted, and treated, those with ADHD can experience great successes.

Adult ADHD Red Flags:

History of impulsive behaviour and difficulty regulating attention

Problems with time management

Checkered work history and low

productivity compared with potential Anger issues

Marital problems

Being over-talkative, interrupting, speaking too loudly

Parenting problems

Money problems

Substance abuse

Addictions

Unsafe driving

Being the parent of a child with ADHD

CLICK HERE FOR FULL ARTICLE.

13

ADHD in the News

CLICK HERE TO VIEW EDITORIAL. CLICK HERE TO VIEW ARTICLE.

CLICK HERE TO SEE ORIGINAL ARTICLE.

Coping with Adult ADHD: First you need a Diagnosis

Opening Up About ADHD Helps Kids

and Adults

ADHD Screening from AAP: Begin Earlier and

Continue Longer

Exam Time Especially

Taxing on Students with

ADHD

Problems with executive functioning can lead to especially difficult issues in University and particularly at exam time. Students with ADHD have a hard time sitting still for such long periods, may be distracted by others easily (cough, pencil tapping, etc), and may read their test questions over and over. Often, those with undiagnosed ADHD in University or College tend to overcompensate by studying longer hours, pushing themselves harder, and ending up with anxiety and depression as a result. Lack of time management skills often produces procrastination; which can also be utilized as a mechanism to create self-motivation, something else those with ADHD lack. Treatment for ADHD should be multi-modal, including not only medication but the teaching of strategies and skills for coping. They may also need accommodations. Most universities and colleges have programs to assist them through their student health and counseling services departments. Assessment is also often available through their university health system. This article begins with the personal story of a 23-year-old student from the Toronto area and ends with the debunking of some common misconceptions about ADHD.

CLICK HERE TO VIEW FULL ARTICLE

“I would always be scared to end my own life, but I think, when you

don’t fit into the world the way everyone else does, and you

don’t understand why and you don’t really know what to do

about it… you know you’re just as smart as everyone else, but

you’re just not able to do the same things. I think that it can be

confusing, especially for young people… I am sure there were

times [I was suicidal], but I could never do it. I’ve thought about

it.”

If you are receiving this newsletter, you are a member of CADDAC. If you have not renewed your membership fee ($25.00 annually for individuals/families and $50.00 annually for organizations), this will be the last seasonal newsletter from CADDAC that you will receive unless you choose to renew your membership. With your CADDAC membership, not only will you receive our seasonal newsletters, but you will receive members-only updates on CADDAC activities and initiatives and 10% off the price of future conferences and events. Here is a link to the membership form: http://www.caddac.ca/cms/CADDAC_pdf/CADDACMembershipForm.pdf

Centre for ADHD

Awareness, Canada

3950 14th Avenue, Suite 604 (416) 637-8584 905-475-3232 erin.bernhardt@caddac.ca

Promoting ADHD awareness and advocacy for those who have or are affected by ADHD.

Find us on the Web: www.caddac.ca www.facebook.com/CADDAC twitter.com/CentreforADHD www.caddacblog.ca

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CADDAC Membership