Talking about Money

December 17, 2013

This is an article from a monthly newsletter Jay and I write for BirkeConsulting.com that I thought might be helpful for adult children with ADD (or any adult child dealing with money-related issues with parents) or parents wishing or needing to talk with their adult children.

Failure to talk about money while your parent is cogent can be very costly-both financially and emotionally. Before I worked as a financial behavior specialist and family wealth consultant, it didn’t occur to me to help pave the way for my clients to talk with their parents. Unfortunately, many of my clients had compromised emotional and financial well-being because they never had “the talk”.
Having the “Talk”

I admire adults who have the courage to talk with their parents, and parents who have the foresight and willingness to talk with their adult children about money. These sometimes difficult conversations are crucial to reduce stress in the parent’s later years and to smooth the inevitable transitions, as well as the passing of assets to the children.
Here are some tips:
• If you wait too long, your parent may become incapacitated-Unforeseen emotional burdens and financial stresses may be thrust upon on you because you don’t know enough about their financial situation. Questions to pursue include whether there’s a financial planner, a will, enough money to fund their post-retirement years.
• Prepare ahead because the conversation can be awkward-Money is a tough topic to broach. Many of my clients need a meeting or two with me or another professional to figure out how to prepare for the conversation.
• Have a professional present for the discussion-A financial behavior specialist, wealth counselor, attorney or coach who is versed in money and psychology can help give a reason for the conversation.
• Be transparent with your family-“I’ve been reading about how important it is for us to talk about money together. I feel awkward because I know this has been private, but I’d like to try. Would that be okay with you?”
• Start slowly and don’t spring a big conversation out of the blue-Start while your parent is cognizant and can tell you what s/he wants. Some soft openings might be:
o “My financial planner suggested I get long term care. Do you guys have that?”
o “My attorney said we needed to update our wills. I’ve never asked: Do you have a will?”
o “I know you’re worried about running out of money, can I help research some options?”
• Ask vs.Tell-Respect and more respect sets the right tone. The goal is help your parent keep as much control as they want/are capable of.
o “How would you like this bill paid?”
o “Would you like me to call the attorney or would you like to do that?”

My clients are relieved to finally be able to have these conversations. One of them said it best, “I was so worried about seeming greedy, intrusive, or having my parents think I was materialistic and all about their money, that I kept procrastinating so I could avoid their judgment and the overall awkwardness. After you and I practiced, I felt ready. The kicker: My parents thanked me because they said they wanted to bring this up but didn’t know how and didn’t want to burden me.”
What a great outcome.
If you’re having trouble getting started, call or email so we can help you craft a conversation that fits you and your situation. Whether it’s about inheritance, health, staying at home, talking about legacy or family business concerns, a liquidity event or retirement, we’re experienced in helping people talk about money. We can help make these awkward conversations and transitions more comfortable.

Call 978-446-9600 or email us to begin the conversation.

Fish Oil- Omega 3’s- and AD/HD

February 20, 2012

Many people with AD/HD benefit from taking omega-3 fish oil. There are many brands, including some specialized ones that your doctor may recommend because he or she wants you to have the right EPA/DHA dosage for brain health vs. heart health.

Just read an interesting piece in Consumer Reports ShopSmart magazine, January 2012 issue. If you are taking, or thinking of taking, a more standard omega-3, this could be helpful for you.

They tested for:
Do they show the listed amount of omega-3 fatty acids EPA and DHA?
Do they properly disintegrate, show sign of spoilage, or contain contaminants such as lead, mercury, dioxins, or PCBs?

Even brands they recommend contained detectable levels of most contaminants, even though many claim they’re free of them. Consumer’s still recommends them because they don’t exceed USP and other regulatory limits.

Check with your physician before taking fish-oil supplements because they can interfere with some medications. Dr. Cerulli generally suggests high grade fish oil for her AD/HD patients. She tailors the dosage to at least 2,000mg combined EPA+DHA for adults and 1,000mg for children. Some patients need to increase in order to target specific clinical symptoms such as depression. Talk with her if you are taking omega 3 or have questions about your dosage.

Jay and I have taken other more expensive ones to get the EPA/DHA ratio we were looking for…

Here are the 9 that passed all their tests listed in order of price based on cost of taking 1000 milligrams of EPA and DHA daily-the dose they say is recommended for heart health. Check with your doctor to tailor this for you.

1. Spring Valley Omega 3 Walmart
2. Finest Natural Walgreens
3. Walgreens Omega 3 Concentrate
4. Barlean’s Organic
5. Nature Made 1200 mg
6. Vitamin Shoppe Meg 3
7. Carlson Super omega3 gems
8. Norweigian Gold Ultimate Fish Oil’s Critical Omega
9. Nature’s Way

NO
1. Kirkland Signature Omega 3 Costco
2. Nordic Naturals Ultimate Omega
3. CVS Natural
4. GNC Triple Strength
5. Nature’s Bounty Odorless
6. Sundown Naturals

I hope this is helpful for you.

Best to you,

Szifra

P.S. The article suggests keeping them in the freezer or eat with meals for reduced fish burps…

ADHD Med Research Shows No Heart Risk

November 21, 2011

There has been much controversy over the years about ADHD medications and potential cardiovascular risks. So the FDA and the Agency for Healthcare Research and Quality funded a large study on ADHD and potential cardiovascular side effects in both children and adults to examine the evidence. The good news is “This large study showed no evidence that current use of an ADHD drug was associated with an increased risk of serious cardiovascular events” as per the published results in the New England Journal of Medicine, November 17th, 2011 print edition.

The study period was from 1986-2005 and included data from over 1.2 million children and young adults. No increased risk was found for those patients taking ADHD medications. In fact the heart risks for current users of ADHD medications were slightly lower than the risk for non-medication users or for those who had taken medication previously.

Bottom line is that the risk of cardiovascular problems exists at the same rate whether you take ADHD medications or not. If you or your child are considering treatment, this large government funded ADHD medication study can hopefully put your mind at ease that the risks, at least for heart side effects or stroke, are minimal.
See NEJM.ORG for the online article (10.1056/NEJMoa1110212) published Nov 1st, 2011.

Don’t Miss the Virtual AD/HD Conference!

September 24, 2011

Dear Clients and Colleagues,
I’m emailing to tell you about a wonderful opportunity – the 4th Annual Virtual AD/HD Conference® coming soon on Oct 3 – 6. I’ll be presenting at this year’s conference, along with 22 other AD/HD experts including Drs. Daniel Amen, Ned Hallowell, and Patricia Quinn. Learn more at http://addmanagement.com/affiliate.html?w=vac&p=cerulli

The Virtual AD/HD Conference is a unique event that brings together the top experts in AD/HD. Join an international community of people affected by AD/HD, including adults, parents, spouses/partners, doctors, therapists, advocates, coaches, counselors, and many more. Rather than the time and expense of attending a physical conference, the Virtual AD/HD Conference brings the experts to you!
You can learn more about the conference, review the full conference agenda, and read testimonials from people who have attended here: http://addmanagement.com/affiliate.html?w=vac&p=cerulli
5 reasons why I recommend the Virtual AD/HD Conference:
1. You’ll access the top AD/HD experts from the comfort of your own home or office.
2. You’ll get the latest information and strategies on the most important topics in AD/HD. The conference topics cover everything from children to adults, from parenting to marriage, and from alternative treatments to medication management.
3. You’ll connect with a supportive group of your peers. The conference is attended by hundreds of people who understand the challenges of AD/HD.
4. You’ll participate at your own pace. You can choose to attend the sessions live via phone or Internet, or you can download the presentations later. The presentations and materials are available online for 3 months after the close of the conference.
5. You’ll skip the costs and hassles of traveling to a conference. The Virtual AD/HD Conference is cost efficient because it removes the need for hotels, airports, babysitters, and expensive restaurants.
The Virtual AD/HD Conference takes place October 3-6. I think the conference is a great opportunity to connect with your peers and get all the tools you need to succeed from the top experts in the world of AD/HD. I hope you’ll consider joining us!
Once again, you can learn more about the conference, review the full agenda, and read testimonials from people who have attended here: http://addmanagement.com/affiliate.html?w=vac&p=cerulli
The Virtual AD/HD Conference promises to be a value packed 4-day event. Hope to “see” you there!
Warm Regards,
Theresa Cerulli, M.D.

Time-Issues for People with ADD/ADHD

May 24, 2011

Great 4 minute video of Dr. Russell Barkley (a very well known and well respected ADHD researcher) talking about ADD as a “performance” disorder. One salient quote, “…Person with this disorder cannot organize to the delayed future but only to imminent future.”  I think this video is really worth your time.  Hopefully, you can feel less alone and people in your life may have a better understanding.

http://www.youtube.com/watch?v=wF1YRE8ff1g

Szifra

Brand vs. Generic Medications – Does It Matter?

February 23, 2011

Taking prescription medications can be cumbersome. It certainly challenges ones working memory skills to remember the names of medications we take, the dose, what time of day to take it, what the pill is for, the side effects, where we store it in the house so we can find it when we need it, when to call the doctor for a refill, the list goes on. To add more confusion to the mix, most prescriptions have two names, the brand name (like Benadryl) and it’s generic name (diphenhydramine).  So I’ll share a question patients frequently ask me – does it matter?

Traditionally when medication is first approved by the FDA there is a patent placed on the newly “branded” drug. After a certain number of years the patent expires and any other company is welcome to make a copy-cat “generic” of the drug. Is there any difference between the original and the copy? Yes. Does it matter? That depends on who you ask. My opinion -ultimately it depends on the person taking the drug – the patient!

When generics are manufactured, the FDA allows a slight deviation from the amount of active ingredient compared with the original branded version of the medication. Maybe Brand X has 32% of the active ingredient and Generic X has 30%. Probably not a noticeable difference clinically for most people. But, where brands and generics differ the most are in the filler components – the stuff that literally holds the tablet together. These filler components can be completely different, resulting in the pill looking nothing like the original one. The size, shape, and color may be may be unrecognizable when you go to pick it up at the pharmacy. The name – the generic name – may be unrecognizable as well. This is a source of many frustrated phone calls to our office from patients worried that the pharmacy gave them the wrong bottle.

Rule of thumb is that most generics will work fine for most people. However, there are some exceptions so certainly let your doctor know if you are experiencing any change in symptoms or side effects when going to a generic. For example, you could be allergic to the red dye coating of generic Y that wasn’t in brand Y. Or your child may have trouble swallowing generic Z because it’s twice the size of brand Z.

Cost cutting is generally driving the substitution of generic medications in place of the brand. That’s good news if both drugs are equally effective for you. But if you have noticed differences in effectiveness or side effects, ask your doctor to contact your insurance company to do a “Prior Authorization” requesting coverage for the brand. It will usually take 3-5 business days for your insurance company to respond to the doctor’s request so patience and planning are helpful in these situations.

Link found between APGAR scores at birth and future risk of ADHD

February 14, 2011

According to a recent study in the Journal of Pediatrics, Neonatal Health Can be Associated With Risk For AD/HD.

ADHD is known to be highly genetic. Approximately 77% of the time someone diagnosed with ADHD has the condition because of the genes they carry. However, genes are not the only factor. Researchers are finding other issues can “correlate” with ADHD. In this recent study published in January’s Journal of Pediatrics researchers show that neonatal health is an important risk factor for ADHD.

An astounding 980,902 children born in Denmark between 1988-2001 were monitored. The baby’s health immediately after birth was measured by commonly used Apgar scores. Then all children were followed from age 3 until a diagnosis of hyperkinetic disorder, a first medication for ADHD, migration, death, or the end of 2006, whichever came first.

The results – The lower the Apgar score the greater the risk for the child developing ADHD. Compared with children with Apgar scores of 9 or 10 at 5 minutes, the risk for ADHD was 75% higher in children than with Apgar scores of 1 to 4 and 63% higher for those with Apgar scores of 5 to 6.

Doctors concluded from this study that a low Apgar score is associated with risk of ADHD in childhood. Perhaps low Apgar scores and ADHD share common causes, or a low Apgar score reflects at least one possible pathway leading to ADHD.


Working Memory and Public Speaking Anxiety

December 4, 2010

I have been helping speakers with their presentation skills for many years now, and the more I learn about working memory (WM) the more I wonder whether a weak WM can be a source of public speaking anxiety. WM is the ability to hold on to information while you use it in your thinking. A good WM can help a speaker screen out distractions while he/she addresses one point at time. If the mind is preoccupied with audience approval or thoughts of impending calamities, accessing that information no matter how well rehearsed may be faulty. This also goes for the Q and A session where one must screen out distractions, remember the question and relate an answer. Public speaking requires some fancy “multi-tasking” no doubt. The question is: would improving one’s working memory make one more comfortable in front of a crowd?
Rebecca Shafir M.A.CCC

ADHD Assets: Making a Difference

November 15, 2010

Some very successful people think of their ADHD as a tremendous asset. David Neeleman, CEO of JetBlue Airways, for example, credits ADHD with giving him the creativity that helped him develop an electronic ticketing system and pioneer several discount airlines.

So, when I read a recent Boston Globe article on Billy Starr, the founder of the Pan Mass Challenge, I instantly thought of many of my compellingly interesting, non-cookie cutter clients and their strengths.

 You might also find it interesting, so I’ve attached it. (For those of you want to scan, I bolded the parts that made me wonder about ADHD, and took a few sentences out for brevity.)

 Pedalers of Hope  Boston Globe, November 12, 2010

The older I get, the more I realize how little I know, which is exactly what I was thinking as a guy named Billy Starr described the annual event he founded and runs known as the Pan-Massachusetts Challenge.

I had heard of it. Everyone’s heard of it. It’s a bike ride, a big one, in which cyclists in Spandex solicit money from friends to pedal unimaginable distances over a couple of days.

And then these maddeningly cheerful people give the proceeds to a worthy cause.

For the record, he looks like his name, with a mop of sandy hair parted Pete Rose-style in the middle and an athlete’s build that makes him look a decade younger than his 58 years. He is in constant motion, arms flailing, head bobbing, even when he thinks he’s sitting still. The guy rides his bike up Mount Washington on a Sunday with less effort than another man might lug a bowl of Brigham’s ice cream to the couch to watch the Patriots on TV.

His Pan-Mass Challenge headquarters is located in an utterly charmless single-story building in a generic Needham office park.

Things get worse inside. There were cords everywhere. The staff apparently collects trash for a hobby. There’s neither reason nor rhythm to how desks are scattered. The place makes the Globe newsroom seem like the Four Seasons Dorchester.

Billy Starr is proud of this, too. In his separate cinderblock office, I ask him how the Pan-Mass Challenge (PMC, in the lingo of those around it) compares to, say, the Avon Walk for Breast Cancer, or the Walk for Hunger.

He looks stunned.

“We raise more money in Massachusetts than all of them combined,’’ he said.

Where do you rank in terms of the biggest events like this in the country?

Now he looks hurt. “We’re the biggest in the world.’’

… tonight, at Fenway Park, he will present a check for $33 million to the Jimmy Fund and the Dana-Farber Cancer Institute, the entire proceeds from the August ride.

… the PMC’s total contribution to Dana-Farber to a mind-boggling $303 million in cold, hard, lovable cash over 31 years. Dana-Farber is the exclusive recipient of PMC money.

To put this in perspective, you would basically need a charity with $650 million in assets — nearly the size of the Boston Foundation — to reliably spin off $33 million a year in grants. And that charity is going to have a lot more than the half-dozen staffers that the PMC does — and a more expensive office.

Dana-Farber’s chief executive, Edward J. Benz Jr., is unequivocal in the importance of the PMC to his institution. “We couldn’t give the care we want to give, or have the cutting-edge research we want to conduct, if it wasn’t for the PMC,’’ he told me.

What began in 1980 with a group of 36 friends raising $10,000 has turned into 5,000 cyclists raising money from 230,000 contributors to ride as many as 190 miles over two days, all of it staffed by 3,100 volunteers. Starr founded the ride after his mother, cousin, and uncle died of cancer in the 1970s.…

Brian McGrory is a Globe columnist. He can be reached at mcgrory@globe.com

 P.S. If you have ADHD, I hope this story helps you recognize and appreciate the gifts of your biology.  And, for spouses and partners, please take a moment to recall what attracted you to the high-intensity, creative, different-minded man or woman you are with. Wouldn’t it be great if Billy Starr’s partner (if he has one, I didn’t research that!) was able to recognize how much his temperament (maybe ADHD, I don’t know) fueled the success of this amazing project.

Szifra@BirkeConsulting.com

www.BirkeConsulting.com

www.SzifraBirke.com

978-446-9600

ADHD and ADA – The Americans with Disabilities Act

November 14, 2010

I attended the recent American Professional Society of ADHD and Related Disorders (APSARD) conference in Washington DC and would like to share information from a wonderful presentation given by Dr. Kevin Murphy on the Americans with Disabilities Act (ADA) and its relevance to ADHD. What is ADA vs. IDEA? Why is ADA relevant to treating ADHD? Let’s review.

ADA is a civil rights act that evolved from anti-discrimination laws in the workplace. It is not an extension of special education laws such as the IDEA, which supports that handicapped or underachieving kids are entitled to remedial services that facilitate success. Instead the goal of the ADA is to prevent discrimination and ensure equal opportunity for individuals with disabilities. So contrary to popular belief, ADA was NOT intended to facilitate success! It is important to understand this distinction in the law for those seeking accommodations and for their clinicians.

Although the original ADA was signed into law in 1990, an Amendments Act was added in 9/2008. Later the Department of Justice (DOJ) proposed additional rules for law, including testing guidelines for accommodations. The final DOJ rules of the Amendments Act were not enacted until very recently in July 2010. The good news is that the Amendments Act is designed to apply less stringent criteria to establishing disability, but extensive documentation will still be required, generally including testing from a qualified professional with details of why each specific accommodation is being requested. NOTE: Diagnosis does not equal disability. In other words having a diagnosis of ADHD does not automatically qualify you for services.

Since the final ADA Amendments Act was just recently enacted (July 2010) there have not yet been any court cases to establish a baseline. We do not yet know how this will play out in the court system. If you are considering pursuing a case based on the ADA, at least make sure you build it on the concept of anti-discrimination – the true intent of this law and its amendments. For academic or workplace accommodations, I would recommend seeking a diagnostic evaluation that includes neuropsychological testing, which is done by a neuropsychologist (PhD). Neuropsychological testing offers the strongest case for accommodations.

Frequently I have patients arguing that because they have ADHD or a learning disability that academic conditions must be set to ensure their success. This idea is false. Neither IDEA (Individuals with Disabilities in Education Act) nor ADA guarantees success. ADA is an outcome neutral, anti-discrimination law with origins in the civil rights act of 1964, while IDEA supports that underachieving children and entitled to remedial services to facilitate success. Success is still rightfully left in the hands of the individual to achieve.

Theresa Cerulli, M.D.

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