Today's post starts like so:
Welcome to the first in a series of lessons called Clueless, designed for anyone aspiring to say something entirely wrong about ADHD. This is a public service I offer to ADHD non-believers whose baseless assertions are the fodder for this column. Without rampant misinformation, the Internet has less need for this blog....
The rest of the post is here. Please join us at the new site.
Monday, January 13, 2014
Sunday, January 12, 2014
Parents, Secure Your Oxygen Masks Before Assisting Others
There's a really good reason flight attendants go through all the "just in case something terrible happens" instructions before every flight. It's not because they are afraid that we've never heard this before. And it's not because the oxygen mask demonstration fluffs up their hair-dos.
It's because experience has proven time and again that humans in danger will often do panicky and impulsive things that increase the danger for themselves and others. If flight attendants can coach most of us to do some proven, but counter-intuitive things, lives can be saved. They aren't reminding us of safety protocols because we're stupid, but because cognitive reminders rehearse and prepare cognitive mental systems just in case they need to over-ride our fear systems penchant for panic and hysteria.
When a plane depressurizes and the oxygen masks come down, parents sitting next to their children will instinctively protect their child first. Unfortunately, putting an oxygen mask on a fear-filled child can easily take long enough for an adult to pass out. To be able to help your child, you must be conscious and breathing, much less thinking clearly. Parents, secure your masks before assisting others.
70% of children with ADHD have a parent who has it, too. Parents researching ADHD on behalf of their children often have 'Aha' moments and realize that one or both parent(s) probably has it, too. Still, because parents naturally feel protective of their children, most would never think of getting themselves help before their children. There's a tendency to feel that "I've been okay so far, but my child is struggling right now,"
But with both oxygen masks and ADHD, the parent is the one who delivers the key treatments to the child. ADHD parents administer medications, watch for side effects, observe for improvements, conference and coordinate with teachers, manage behavioral point systems, manage homework, deliver forgotten lunches, consult with therapists and go to bed exhausted on even the very best days.
But with both oxygen masks and ADHD, the parent is the one who delivers the key treatments to the child. ADHD parents administer medications, watch for side effects, observe for improvements, conference and coordinate with teachers, manage behavioral point systems, manage homework, deliver forgotten lunches, consult with therapists and go to bed exhausted on even the very best days.
ADHD doctors write the prescriptions, but we do not deliver the care. Getting children to us is not the most important issue. Managing the child's environment is the substance of treatment. It is a brutally demanding job that taxes non-ADHD parents to the limit. And it is is exactly the type of work that treatment can help the parent with ADHD do better.
Adult ADHD parents don't have anyone to craft the environment. Adult cognitive demands are much higher than children's, and the adult world isn't full of cognitive helpers in the same way a school is. Adults with ADHD are perhaps more reliant on medication, because the support structure is more meager.
It runs counter to powerful instincts for parents to take a treatment first before providing it to their children. With oxygen masks and ADHD, though, that is how it needs to be done.
When both the child and her mom have ADHD, and there's only one pill left for today, I'm giving it to her mom. That way, both can still receive treatment.
Parents, secure your cognition before assisting others.
Parents, secure your cognition before assisting others.
Wednesday, January 8, 2014
Reading Patterns and Trends
It's been quite cold for a couple days. So cold, in fact, that every news crew in the country has rushed outside to film live interviews with bundled up people who confirm on-camera that they, too, even as we speak, are very cold. Live camera crews often grab this footage in front of the snow mounds that parking lot clearing services leave. Odd fact.
This use of the power of The Press a little bit sad. Sadder still, a couple political analysts speculated that this cold snap would finally settle the debate over global warning. Really? With one observation in one little corner of the planet a century-long trend is halted? That's like a man with ADHD thinking he's cured the first time he arrives on time for an appointment.
ADHD becomes evident not in a moment or an incident, but across years. Not everyone with ADHD loses cellphones, shows up late for appointments or forgets to feed their pets. You can't look at the events of a day or the behavior in a single situation and figure out whether it's there or not. It's not that simple.
To diagnose ADHD, we have to look across the landscape of a person's life to the best of our ability and watch the patterns of executive function. The things that routinely go worse for a person with ADHD are important but not engaging and are typically addressed with skills that arise from the executive centers of the brain. They involve cognition: timeliness, importance, priority, organization, prudence, forethought, self- and social-awareness. Think tax forms.
The things that go routinely well for people with ADHD are addressed with skills that arise from the emotional centers of the brain. These involve emotional engagement: passion, interest, fear, anxiety, shame, guilt and enjoyment. Think video games.
We can't look at a few data points and figure these patterns out. We look for these trends across a whole life. In the future I'll go into some of these patterns in more detail.
Just went outside. The air is crisp, 5 degrees and calm. The heavy snows are dramatically beautiful. Big snowflakes are drifting down. Turn off the news and experience it yourself if you have a moment.
This use of the power of The Press a little bit sad. Sadder still, a couple political analysts speculated that this cold snap would finally settle the debate over global warning. Really? With one observation in one little corner of the planet a century-long trend is halted? That's like a man with ADHD thinking he's cured the first time he arrives on time for an appointment.
ADHD becomes evident not in a moment or an incident, but across years. Not everyone with ADHD loses cellphones, shows up late for appointments or forgets to feed their pets. You can't look at the events of a day or the behavior in a single situation and figure out whether it's there or not. It's not that simple.
To diagnose ADHD, we have to look across the landscape of a person's life to the best of our ability and watch the patterns of executive function. The things that routinely go worse for a person with ADHD are important but not engaging and are typically addressed with skills that arise from the executive centers of the brain. They involve cognition: timeliness, importance, priority, organization, prudence, forethought, self- and social-awareness. Think tax forms.
The things that go routinely well for people with ADHD are addressed with skills that arise from the emotional centers of the brain. These involve emotional engagement: passion, interest, fear, anxiety, shame, guilt and enjoyment. Think video games.
We can't look at a few data points and figure these patterns out. We look for these trends across a whole life. In the future I'll go into some of these patterns in more detail.
Just went outside. The air is crisp, 5 degrees and calm. The heavy snows are dramatically beautiful. Big snowflakes are drifting down. Turn off the news and experience it yourself if you have a moment.
Tuesday, January 7, 2014
Science vs Wishful Thinking
There is a new book coming out next month by Dr. Richard Saul called "ADHD Does Not Exist". Let's not both waste time reading it. I'll do that for you, if you like, then report back here, where I plan to shred his conclusions. That's right--the ones I haven't even read yet. Please forgive the chutzpah. Here's how I can be so sure I'll be disagreeing with him.
I would know a little about this, because I didn't believe in ADHD for many years. I was a physician who didn't know very much about it, except that the diagnosis was confusing and time-consuming, the monthly prescriptions were burdensome, and I couldn't technically explain why we were giving stimulants to hyper people. Even though stimulants work, they are inconveniently counter-intuitive, and they get very bad press.
But the real, deep down reason I didn't believe in ADHD, was that I needed not to know I had it. I wasn't ready to see it, because discovering I had it would change my concepts of myself and the universe I lived in. So I made sure not to find ADHD in me or my patients.
That began to change for me when I started reading the science behind ADHD. If you go through the whole US National Library of Medicine and read all 24,358 entries for ADHD, [full disclosure--I haven't finished yet.] there is a mountain of evidence that is beginning to show what goes on in the brains of children and adults who struggle with poor self-awareness and self-control. The science is early, but a coherent picture is emerging.
Once my ADHD was diagnosed and treated, I gradually began to see it in some others, too. Not everyone, just some. In the past I disbelieved in ADHD. Now, I accept it.
"ADHD does not exist" cannot be a fact, but it can be a wish. I'm going to read Dr. Saul's new book, because I wonder why he needs to believe that ADHD doesn't exist. What about his world will change when he finds out it does?
Simply put, the title of the book, the first four words, is a gigantic scientific red flag: Science cannot prove non-existence.
Science can confirm that a thing exists and demonstrate connections between things, but it cannot prove that ADHD or any other construct does not exist. Science can't examine the whole universe and report back on what the universe does not contain. It can only examine a tiny fraction of the universe and say, "Yep, found it!" or "Nope, didn't see any." "It doesn't exist" is maybe just for God to say, probably not for scientists.
For forty years of medical practice, Dr. Saul has been thoroughly checking his corner of the universe--Northbrook, IL--which, if you haven't been there, is a suburb of O'Hare Airport. Since he didn't find any ADHD, his conclusion should probably be the "Nope, didn't see any" version, and the title of his book, "ADHD, maybe not?"
This brings up an interesting question. Thousands of doctors worldwide look for ADHD and subsequently find it. How could someone examine children for forty years and not find ADHD? What impairment of attention could prevent a man from seeing something right under his own nose?
For forty years of medical practice, Dr. Saul has been thoroughly checking his corner of the universe--Northbrook, IL--which, if you haven't been there, is a suburb of O'Hare Airport. Since he didn't find any ADHD, his conclusion should probably be the "Nope, didn't see any" version, and the title of his book, "ADHD, maybe not?"
This brings up an interesting question. Thousands of doctors worldwide look for ADHD and subsequently find it. How could someone examine children for forty years and not find ADHD? What impairment of attention could prevent a man from seeing something right under his own nose?
I would know a little about this, because I didn't believe in ADHD for many years. I was a physician who didn't know very much about it, except that the diagnosis was confusing and time-consuming, the monthly prescriptions were burdensome, and I couldn't technically explain why we were giving stimulants to hyper people. Even though stimulants work, they are inconveniently counter-intuitive, and they get very bad press.
But the real, deep down reason I didn't believe in ADHD, was that I needed not to know I had it. I wasn't ready to see it, because discovering I had it would change my concepts of myself and the universe I lived in. So I made sure not to find ADHD in me or my patients.
That began to change for me when I started reading the science behind ADHD. If you go through the whole US National Library of Medicine and read all 24,358 entries for ADHD, [full disclosure--I haven't finished yet.] there is a mountain of evidence that is beginning to show what goes on in the brains of children and adults who struggle with poor self-awareness and self-control. The science is early, but a coherent picture is emerging.
Once my ADHD was diagnosed and treated, I gradually began to see it in some others, too. Not everyone, just some. In the past I disbelieved in ADHD. Now, I accept it.
"ADHD does not exist" cannot be a fact, but it can be a wish. I'm going to read Dr. Saul's new book, because I wonder why he needs to believe that ADHD doesn't exist. What about his world will change when he finds out it does?
"There is none so blind as he who will not see." --Ray Stevens
Sunday, January 5, 2014
Why I Took Five Years Off...
Here's the thing about taking a couple weeks off from writing your blog. Before you know it, a couple weeks becomes five years, and it's too embarrassing to explain the absence. I didn't mean to take that much time off. Really, didn't mean it.
Just kidding. Happily, I don't have to grovel, claim that I was busy, or otherwise make weak excuses for going almost 5 years between blog posts. You see, it wasn't procrastination, and I don't feel guilty. Honest truth is, Attentionality was just a trial balloon that barely survived its launch and was promptly forgotten.
I only decided to become a blogger earlier this week after writing a short deadline open topic article for Attention magazine. The experience was quite enjoyable and generated a byproduct of the brainstorming list of worthy but discarded topics. The "reject list" in Evernote got renamed "future blogposts", and I set out to find a blogging platform.
I re-discovered Attentionality at blogger.com quite by accident. I started to sign up for a new account when a popup jumped out and said 'You already have an account". Then a new screen opened, and they dredged the 2009 post out of their archives . I didn't even recognize my own work at first. The name sounded inventive and I wondered who had thought it up, then remembered that a younger me had thought it up and braced myself to therefore start disliking it. Somehow it kept sounding right. Hope you like it too.
That's how I went from wanting to become a blogger to being a 5-year veteran blogger in about one second.
Oh, and the other reason that no excuses are needed is that there were only 10 views of the first post. I'll bet most of them were me checking to see how it looked on various browsers. So nobody was really waiting for this second post. Which is why I don't feel bad posting such a feeble excuse for five years off.
See you quite soon. Unless plans for the 5 year blogging anniversary take up all my writing time.
Just kidding. Happily, I don't have to grovel, claim that I was busy, or otherwise make weak excuses for going almost 5 years between blog posts. You see, it wasn't procrastination, and I don't feel guilty. Honest truth is, Attentionality was just a trial balloon that barely survived its launch and was promptly forgotten.
I only decided to become a blogger earlier this week after writing a short deadline open topic article for Attention magazine. The experience was quite enjoyable and generated a byproduct of the brainstorming list of worthy but discarded topics. The "reject list" in Evernote got renamed "future blogposts", and I set out to find a blogging platform.
I re-discovered Attentionality at blogger.com quite by accident. I started to sign up for a new account when a popup jumped out and said 'You already have an account". Then a new screen opened, and they dredged the 2009 post out of their archives . I didn't even recognize my own work at first. The name sounded inventive and I wondered who had thought it up, then remembered that a younger me had thought it up and braced myself to therefore start disliking it. Somehow it kept sounding right. Hope you like it too.
That's how I went from wanting to become a blogger to being a 5-year veteran blogger in about one second.
Oh, and the other reason that no excuses are needed is that there were only 10 views of the first post. I'll bet most of them were me checking to see how it looked on various browsers. So nobody was really waiting for this second post. Which is why I don't feel bad posting such a feeble excuse for five years off.
See you quite soon. Unless plans for the 5 year blogging anniversary take up all my writing time.
Wednesday, February 4, 2009
Do You Believe in ADHD?
-->
Do you believe in ADHD? Don't you ever wonder if rowdy, little kids aren't just a bit of exercise, a steady climate of discipline and a few healthy meals away from normal kids? Do you ever think that the adults who claim to have it really need no more than a kick in the pants and a healthy dose of “trying harder”?
Is it reasonable to disbelieve in ADHD? A lot of people think so. Google returns more than 10,000 hits to a search for "believe in ADD [or ADHD]". As questions of belief go, that's a small Web presence. It was easy to find bigger issues of belief that people discuss much more often. "Believe in Jesus" returns 1,700,000 hits. Belief in Santa Claus gets almost half that. Belief in God was #2 in my survey with 3.7 million hits, and #1 was believing in either "you" or "yourself". There are over 7.5 million references to such positive thinking.
Belief--or lack of it-- in ADHD is a minor feature of the Web landscape. To get ADHD's 10,000 hits in perspective, here are a few more relative Google-o-meter readings:
Belief in "each other" - 1,150,000 hits
Belief in "something" - 960,000 hits
Belief in Islam - 134,000 hits
Belief in Buddha or Buddhism - 25,000 hits
Belief in Bush - 76,000 hits
Belief in Obama - 90,000 hits
Belief in McCain - 8,700 hits
Belief in peanut butter - 1,430 hits (most referring to the 1975 ad for Peter Pan Peanut Butter).
So believing in ADHD is a topic of discussion less often than believing in Buddha and George Bush, but more common than John McCain and Peter Pan's peanut butter. At first blush, it appears that there is only a modest amount of discussion on the World Wide Web about "believing in ADHD".
But look again. Everything we have compared to the ADHD belief-o-meter is either a belief system or a political figure. (Or a nut spread.) But ADHD is none of those. It is a mental disorder, the subject of over 15,000 academic studies and papers archived in the United States National Institute of Health Library of Medicine.
How does ADHD compare to the other disorders and diseases from that library?
Belief in coronary heart disease - 0 Google hits
Belief in liver cancer - 0 hits
Belief in chronic lung disease - 0 hits
Is it reasonable to disbelieve in ADHD? A lot of people think so. Google returns more than 10,000 hits to a search for "believe in ADD [or ADHD]". As questions of belief go, that's a small Web presence. It was easy to find bigger issues of belief that people discuss much more often. "Believe in Jesus" returns 1,700,000 hits. Belief in Santa Claus gets almost half that. Belief in God was #2 in my survey with 3.7 million hits, and #1 was believing in either "you" or "yourself". There are over 7.5 million references to such positive thinking.
Belief--or lack of it-- in ADHD is a minor feature of the Web landscape. To get ADHD's 10,000 hits in perspective, here are a few more relative Google-o-meter readings:
Belief in "each other" - 1,150,000 hits
Belief in "something" - 960,000 hits
Belief in Islam - 134,000 hits
Belief in Buddha or Buddhism - 25,000 hits
Belief in Bush - 76,000 hits
Belief in Obama - 90,000 hits
Belief in McCain - 8,700 hits
Belief in peanut butter - 1,430 hits (most referring to the 1975 ad for Peter Pan Peanut Butter).
So believing in ADHD is a topic of discussion less often than believing in Buddha and George Bush, but more common than John McCain and Peter Pan's peanut butter. At first blush, it appears that there is only a modest amount of discussion on the World Wide Web about "believing in ADHD".
But look again. Everything we have compared to the ADHD belief-o-meter is either a belief system or a political figure. (Or a nut spread.) But ADHD is none of those. It is a mental disorder, the subject of over 15,000 academic studies and papers archived in the United States National Institute of Health Library of Medicine.
How does ADHD compare to the other disorders and diseases from that library?
Belief in coronary heart disease - 0 Google hits
Belief in liver cancer - 0 hits
Belief in chronic lung disease - 0 hits
Belief in streptococcus – 0 hits
Belief in hip fracture – 0 hits
Basically no one is talking about whether it is right to believe in these common medical disorders. How about neurologic (brain-based disorders)? Do people debate beliefs regarding neurologic disorders more than cardiovascular or orthopedic disorders? The answer is mixed:
Basically no one is talking about whether it is right to believe in these common medical disorders. How about neurologic (brain-based disorders)? Do people debate beliefs regarding neurologic disorders more than cardiovascular or orthopedic disorders? The answer is mixed:
Belief in epilepsy - 8 hits
Belief in dyslexia - 390 hits
Belief in anxiety - 600 hits
Belief in psychiatrists/psychiatry - 4,000 hits
Belief in depression - 5,000 hits
And ADHD, as you recall garnered 10,000 hits.
Apparently, ADHD (and depression to some degree) is handled more like a belief system than a medical disorder in the public marketplace of ideas. People feel free to post on the internet that they do or do not “believe in ADHD” and other neurologic disorders whereas they do not publicly declare beliefs about the existence of general medical disorders.
Whether it is appropriate or not, a lot of people feel that ADHD is more like an opinion than a fact, and that their personal opinion should help guide the treatment. So, how many of the 15,000 studies in the Library of Medicine do you think most folks read to help them form their opinion….?
Subscribe to:
Posts (Atom)