ADHD: a four letter word?



There is so much discussion and talk about what I refer to as: the “diagnosis de jour”, ADHD.  Attention Deficit Hyperactivity Disorder, formerly known as Attention Deficit Disorder or ADD, seems to be thrown around like a hot potato in many circles. I see this as a hot-bead of controversy, particularly for school aged children, many of whom are being prescribed stimulants by their pediatricians without any sort of behavioral or psychotherapeutic interventions and proper assessment to determine an accurate diagnosis. Psychotropic medications do have their place, but my opinion is that they should be the option of last resort after other methods of treatment have been seriously explored and only prescribed by a skilled Psychopharmacologist specializing with the age group of the patient receiving the medication.

So, what is ADHD exactly? The symptoms of this “disorder”, according to the Diagnostic and Statistical Manual used to categorize psychological conditions include:

Symptoms of Inattention:

a) Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
b) Often has difficulty sustaining attention in tasks or play activities
c) Often does not seem to listen when spoken to directly
d) Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
e) Often has difficulty organizing tasks and activities
f) Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
g) Often loses things necessary for tasks or activities (eg, toys, school assignments, pencils, books, or tools)
h) Is often easily distracted by extraneous stimuli
i) Is often forgetful in daily activities

Symptoms of Hyperactivity:

a) Often fidgets with hands or feet or squirms in seat
b) Often leaves seat in classroom or in other situations in which remaining seated is expected
c) Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
d) Often has difficulty playing or engaging in leisure activities quietly
e) Is often “on the go” or often acts as if “driven by a motor”
f) Often talks excessively

Symptoms of Impulsivity:
g) Often blurts out answers before questions have been completed
h) Often has difficulty awaiting turn
I) Often interrupts or intrudes on others (eg, butts into conversations or games)

In order for any of the above to be considered “clinically significant”, they must present in clusters and appear over a marked period of time. More importantly, though, they must represent a degree of “functional impairment”. This means that, for example, a child is failing their classes despite being quite capable, cognitively. An adult is frequently late with work assignments despite hours upon hours of working toward a task because of an inability to stay focused for sustained periods of time. And in both cases, these conditions are causing distress for the person for whom they occur.

It is my belief, just like may psychological conditions, that people find ways to adapt and cope with these types of issues a good amount of the time. The human brain and spirit are quite adept at doing just this. However, it is when adaptation cannot or does not occur, that I find a parent in my office with their child who is constantly in the principal’s office, or an adult who feels like a “failure” time and time again despite her best efforts toward success.


Posted in ADHD, School Aged Children | 1 Comment

Is it “anxiety” or am I just stressed out?

I’m not a big fan of labels, but I’ve found that it does help to think about categories of symptoms and feelings to help you determine when and if to seek outside help.   In truth, I don’t subscribe to the whole idea of “normal” when it comes to one’s inner world, but as a therapist, I tend to see patterns in my clients which helps me sort out when someone would benefit from intervention.

For example, when someone experiences the death of a loved one or the sudden loss of a job, you certainly expect to see a marked period of grief and sadness which can take many forms:  withdrawal, isolation, crying episodes, sleep disruption, hygiene changes, eating pattern changes, feelings of hopelessness, etc.  This isn’t rocket science.  In fact, if you don’t see one or more of these after a major life event, that is of more concern because it demonstrates some sort of “stuckness” and inability to move through the experience.

It is when one or all of these symptoms become persistent, intrusive, and disruptive to our daily lives and functioning that one might consider professional support.  Don’t get me wrong; you can certainly desire this support during a major life event, even if you aren’t on your knees in pain as a preventative measure.  But, the reality is that most people don’t enter into therapy under these circumstances.


Everyone has a tipping point.  “Stress”, simply put, is usually time limited, somewhat manageable, and typically event specific.  “Anxiety” is stress run amok. It is our own natural biological instincts, the fight or flight scenario, gone haywire.   The brain no longer can distinguish between what is going on outside our bodies and what our negative thoughts on the inside are telling us to be scared of.  Anxiety, whether it takes the form of panic attacks, phobias, or a general feeling of “dis”ease, is truly a beast, and for those of you who know it well, this adjective is fitting.  But, it is very treatable, and that is welcome news for the long time sufferer.

So, how can therapy help with any of this?  The first thing is to identify the specific thought patterns and firmly held beliefs that trigger anxious thoughts.  After we know the triggers, we empty our old “tool box” which some have filled with drugs, alcohol, credit card debt, sex, over/under eating, etc. with new and improved ways of coping.  Throughout this, we begin an honest dialogue with ourselves about who we are and what we want to become, and ultimately, what we are willing to do to achieve our goals.  After our goals are set, the path is wide and varied.  Some simply want to “eliminate” the specific symptom and go on about their lives.  Some have a deeper desire to understand why the symptom evolved and the real roots of our discomfort.  Still others find themselves on a journey of self-exploration that strays far from the original “symptom” and is a source of surprise and wonder.

Posted in Anxiety, Parent-Child Relationships, Trauma | Leave a comment