Gifts of ADD
November 7, 2013
People used to think ADD was a childhood issue. We know now that a large percentage of adults who had ADD as kids will continue to deal with it to greater and lesser degrees. On my cable TV show, I did a segment on Adult ADD which I’ve been told has been very helpful to many people with ADD and for their families.
Having works with hundreds of folks with AD/HD in the past 30 years, I know that ADD is not a one-size fits all label. And, in addition to difficulties posed by having AD/HD, let’s keep in mind that many of our greatest minds, successful CEO’s and entrepreneurs, artists and others have ADD. Einstein, DaVinci and many other talented inventors, writers, artists, CEOs, athletes had ADD. A good coach helps the person find their strengths and talents.
To watch this show, just click: http://www.chelmsfordtv.org/index.phpoption=com_content&view=article&id=70&Itemid=314
Quotient ADHD Test Meets Major League Baseball
June 23, 2012
As a neuropsychiatrist specializing in ADHD, I meet many talented clients who have succeeded and exceled using their positive ADHD traits such as high energy and creativity. Recently I had the privilege of performing ADHD evaluations for a group of such clients – the MLB. Yes, major and minor league professional baseball players can have ADHD too! There are approximately 50 of us certified in the U.S. to perform these extensive diagnostic assessments for professional baseball. In order to qualify for medication treatment for their ADHD, professional athletes must be approved for a “Therapeutic Use Exemption”, more commonly known as a TUE. The players undergo a diagnostic evaluation including a medical and psychiatric history, lengthy rating scale questionnaires, family interviews, and screening for co-existing conditions. Faced with the ultimate challenge of recommending TUE’s for only the appropriate professional players, I decided to add a step to this already involved diagnostic process – the Quotient ADHD test.
Why objective testing? Simply stated, it adds data; measurable, quantitative, and qualitative data. In such an important decision tree for professional baseball medication exemption status, I was relieved to have the additional computerized information. Indeed the Quotient is not a stand-alone diagnostic tool, but its’ adjunctive use in ADHD assessments can be invaluable to the clinician and client alike. And with the demanding travel schedule in professional sports, the portable version of the Quotient can easily rack up frequent flier miles in an overhead compartment to meet the athletes when and where they need to be.
As for the professional baseball players, they showed great sportsmanship, true to their profession, in doing the testing with me. They strapped on the Quotient head and leg sensors with initial apprehension, but for most this evolved into a healthy curiosity by the end of our session. The players benefitted from immediate feedback via the Quotient testing report, available minutes after completing the test. In user friendly color and graphics, we reviewed their own unique pattern of attention and impulse control.
As a specialist in ADHD, I do not need the Quotient ADHD test to make a diagnosis. I’m capable and confident without it. However, I appreciate the added value of an objective piece of data for myself and the players to share in the assessment process, raise awareness, educate clients, and assist in treatment planning. I’m grateful the Quotient made the trip to Spring training with me this year and hope the professional players were too.
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…
Choosing a Coach for Adults with ADHD
January 7, 2012
If you have ADHD or similar brain wiring, then in order to get the most out of your coaching experience you will need a coach who is experienced working with individuals with ADHD and understands the challenges you face. What specifically would I suggest you look for?
• Your coach needs to help you continually return your focus to the work throughout a coaching session. Perhaps you will also need shorter sessions. If this feels inconvenient to a coach, they shouldn’t be working with clients with ADHD.
• Chances are that you may fidget and squirm if you try to sit still for an hour. It’s not very helpful to fight it; save your mental energy for better things. Look for a coach who isn’t distracted by it. Taking a walk during your session may help – are they ok with that?
• You will need and want to work towards getting to your appointments on time. If your coach feels upset by your lateness or takes it personally, understand that that’s their issue.
• Trying to do tasks alone at home or work may not be a tactic that works well for you. Be sure your coach is flexible and will adjust their “normal” process to make things work for you. If projects take longer than is usual with their other clients, that’s a fact of life that they must be comfortable with.
• I’d be surprised if you haven’t gotten into a life-long habit of “adjusting the truth” to sidestep criticism. This is very common for individuals with ADHD. A coach has to understand this, help you take the time to give the most truthful answer and never take it personally.
• It is typical to forget, get distracted, go off on tangents, to get caught by an interesting idea or get bored. When your neurobiology is a certain way, you need to have coaching that doesn’t ignore the facts.
It may not be obvious whether a coach has the experience and understanding you want until you’ve worked with them for a while. But these “issues” are an everyday part of life for many people with ADHD and your coach must not only accept these behaviors as a typical starting point, but must patiently address them as fundamental aspects of your work together.
Jay Livingston can be reached at LivingstonServices.com. Just use Jay@
Self-Control Can be Learned
December 7, 2011
Self-control is a predictor of success. Research shows that children who learn to control their impulses do better in school, college, work and relationships. But adults who never perfected their self-control can make significant and life-changing improvements with a few simple techniques and
practice. Picture this:
You’re ready to head for bed, emotionally and physically wound down. Just a few simple routines to complete and you can drift into the mysterious state called sleep – check the doors, turn off the lights, brush, floss and settle into the embrace of your bed and sleep.
As you shuffle through the kitchen one last time, the image of a bowl of ice cream snaps into your mind. Wouldn’t the creamy, sweet, cold taste of a small bowl of chocolate be delightful? If
you slow your steps, you’ll likely open the drawer for the ice cream scoop.
It is possible to learn to resist at will. Try picturing something else. Focus on images of your bed or an experience you had of stepping on a scale that stopped short of where it previously was. Too hard? Picture a great play from the last game you watched or some other really good experience. Just know that if you stare at the freezer, you are more likely to indulge.
Have you had the experience of walking away from temptation and having the image weaken and lose its urgency? Try it as an experiment; walk away and see what happens over the next few minutes. Focus on paying attention to your reactions and the process of learning instead of the treat.
Controlling your impulses can be learned, whether it’s to stop putting junk food in your mouth or quieting your frustration with yourself, employees, colleagues or clients. Maybe you’ll never find it easy, always have to push to keep your focus, even fall off track sometimes when you’re
tired, but you can develop improved strength and technique with desire and practice.
Eight Quick Hints:
- Use distractions to pull your attention away from temptations
- Don’t re-evaluate previous decisions when you’re under the influence of temptations
- Develop an unbending pattern of behavior until you’re past thinking about a temptation
- Understand that developing will power (self-control) is a process of learning and practice
- Dump the old notion that your abilities or attitudes are set – they aren’t, you can learn new ways
- Notice, celebrate and savor small bits of progress
- Have a support person or group who you feel accountable to – who bolsters your self-control
- Live for the changes that you’re working on and practice them into being
Multiple past failures to grow your self-control simply mean you haven’t yet found the right approach. It’s discouraging, but learning is often a process of gaining knowledge from failures until you start getting a hint of which directions are successful. Try getting a new perspective (a coach’s
point of view) and more emotional support. Remind yourself, “With practice I can learn this.”
Want a more complete primer on how to improve self-control and self-discipline? I help people develop new habits and behaviors; it’s what I’ve been doing for over 30 years. Change takes practice and support, but the actual process is simple.
Jay Livingston
Emotional Impulsivity – A Core Component of ADHD
June 6, 2010
Throughout history disorders of attention were described to include symptoms of emotional impulsivity, as seen in writings by Alexander Crichton (1798) and George Still (1902). Problems with regulating emotion were intially recognized as a core feature of ADHD. But during the 1960’s and 1970’s symptoms of emotional impulsivity/emotional self regulation were split off from the core criteria of ADHD as we know them today: inattention, hyperactivity, and impulsivity. Dr. Russell Barkley just published a wonderful discussion article in the Journal of ADHD and Related Disorders arguing that emotional impulsivity should be returned to its proper status as a core symptom of ADHD.
What do we mean by emotional impulsivity? Why does this matter? Examples of emotional impulsivity include impatience, quickness to anger, easily frustrated, over-reactive, and easily excited. These characteristics are frequently seen with ADHD, yet often unrecognized as a core part of the condition. Frighteningly, these folks may be misdiagnosed as having a mood problem such as depression or bipolar disorder instead of what is really going on – their ADHD!
Over the years in practice I have seen many ADHD kids mistakenly labeled as bipolar. Their over-reactive nature gives an impression of a mood problem when the child is instead struggling with self regulation of attention and behavior. They have difficulty putting on the brakes in their brain. Similarly adults with ADHD can be impatient or emotionally over-reactive, which could lead to misdiagnosis. Unrecognized and untreated these features of ADHD can lead to problems at work and home.
I should also mention ADHD frequently does co-exist with Depression, Anxiety, Sleep Disorders, Bipolar disorder,etc so it is indeed possible to have more than one condition. Making an accurate diagnosis can be tricky. If you are seeking an evaluation for ADHD, I encourage you to work with professionals who are specialized in this area. Getting an accurate diagnosis is essential to getting the right treatment.
Theresa Cerulli, M.D.
A New Way to Help Change Your Behavior
May 1, 2010
David told me he needed help getting things done on time, but when I started talking with him about how he managed the details of his life, he stopped talking about changing and started talking about how he had always been late and would never change.
“I always say I will get a project done early, but I never have. I always just end up feeling like such a loser and then I do it again the same way next time. I can’t change.”
Ron came into our first meeting and said his wife was about to leave him because he was never on time.
“I promise to be home before the kids are in bed, but then I just get caught in a project at work and it’s 9:00 PM before I get home. I’ve tried everything, but I’m just not going to change.”
Sheila and Ted were referred by Ted’s doctor for couple’s coaching. When I asked, “What would your life look like if it suddenly improved?” Sheila’s frustration just burst forth.
“He keeps telling me that he’ll do better, but it’s been fifteen years and he still never gets anywhere on time. Am I supposed to act like that’s normal?”
Ted looked up sheepishly and reported, “I feel terrible and I know I’m impossible to live with, but no matter what I try it doesn’t work. I’m just a mess; what can I do?”
Each of these clients ended up making changes that made life easier for them and for their spouses and work colleagues. And where did I suggest they start? By forgiving themselves.
A study by M. Wohl et al, detailed in a paper entitled, “I Forgive Myself, Now I Can Study: How Forgiveness for Procrastinating Can Reduce Future Procrastinating,” gives some interesting evidence that forgiving yourself for messing up can help free you to give a better effort at trying again.
In my practice I’ve seen that an increased ability to implement a new approach, along with an effective technique and the support of an understanding ally can make a huge difference. I encourage my clients to pay close attention to the fact we’re talking about forgiving themselves. And while it may be helpful for their spouse to forgive them, it’s the self-forgiveness and then a sincere new effort that is key.
Did you know that old dogs can learn new tricks? And people of all ages can and do learn new ways to act in their lives, especially if they can forgive themselves for past mistakes.
Give a call if I can help, 978-446-9600.
Telling Stories
April 5, 2010
“We were at the store and she began telling me that I couldn’t buy the lawn mower. But I wasn’t going to buy it; I was just asking to see if I could get a discount. She got moody and…”
I surprise many of my new coaching clients when I tell them we’re going to skip the rest of the story. Many of them have been encouraged in therapy to tell these “war” stories. And I can imagine times it might be helpful, but most of the time I don’t want or need to hear them.
My coaching takes a forward pointed approach – “Where do you want to go from here?” not so much “Where have you been?”
When I begin to hear a story that is full of the kind of passion and even blame that underpins most disagreements with partners, I just barge right in and call a stop. I’m interested in only one aspect of the story. What could the speaker have done differently to have a more effective conversation, to reach their goal, to create an alliance with their partner, to change their behavior?
I know life is hard and conversations with partners can be very difficult, but the chances of changing your partner are slight if you haven’t changed yourself. So, I start with the most interesting part, how to change your behavior – the one area of life we all have some control over.
Stories allow us to rehearse our past mistakes and support our old, tired way of seeing things. Looking for new ways to redo the same old situations lets us practice new behaviors and ways of seeing things. Start your new behavior by imagining how to redo the old patterns.
What to do with your feelings about how you’ve been treated or spoken to is trickier. But you have to be careful that you don’t just fan the flames of your feelings by telling the story.
Growth and change, that’s what’s important. When I see my clients changing, I know we’ve hit the right balance.
Jay Livingston
One Approach to Procrastination
February 26, 2010
If you tend to procrastinate until a deadline is on top of you and forcing you to get things done, and you know this is hurting the quality of your work, causing stress to you and probably to your clients, boss or family, then how do you stop procrastinating about dealing with your procrastination?
This might be a fun puzzle if it weren’t so crucial that you find a way to get started changing your approach. One of the common side effects of procrastination is that people in your life lose trust in you and get angry. As you well know, this is usually matched by your own anger at yourself. But this pressure usually doesn’t translate into motivation to get started.
If life were a sport and you were critiquing yourself for missing critical shots because you didn’t keep your eye on the ball, I’d be pointing out that your focus on past mistakes is taking your attention away from the current situation, taking your “eye” off the ball again. Drop the self-critique, get a bit of help with your technique and try again.
The best hitters in baseball look for, and can see, the stitching on the ball as it comes at them at up to a hundred miles an hour. They know that they need to look for this detail to pull their attention to the ball; just looking in the direction of the ball doesn’t allow them to see the tiny changes in directions that they need to see in order to connect with the pitch. Golfers watch the dimples on the ball as it sits on the tee.
To get started on a project, focus on the details of getting started. What project will you start? Schedule it in your calendar. What small, discreet aspect of the project will you do? Define it and plan on doing just that much. What exactly will your next action on the project be? Write it out very simply as a task.
Think about teeing up the project – choose which one you’re going to work on. Keep your head down, your eye on the ball and hit it just well enough to move it down the course and keep it in the fairway – do a small piece of it. Now you’re ready for the next shot – concentrate on the new swing no matter whether you’re in the rough or on the course.
For you baseball fans, what you’re looking for is a single, not a home run; don’t over reach. Just connect with the pitch. Basketball aficionados, take one step and move the ball down the court. Every foot closer to the basket increases the odds of a score. Tennis players, make a solid smooth hit and get the ball across the net and into the court. Now set up for the next shot.
What do you need to get done? Right now schedule a time to work on it, and resolve to treat it like an important meeting. What is the first little step to getting the project started or moving it ahead? Write it down on your task list.
Procrastination can be head faked that easily.
Couples Coaching
January 21, 2010
What is “Couples Coaching”?
Many of my clients who have ADD have exasperated spouses who are upset with them about starting too many projects and finishing too few, interrupting mid sentence, being late, losing keys, cell phone, etc.… I’m sure you can add to this list.
When I suggest the option of couple’s coaching to them, they’re surprised. Couple’s coaching is a relatively new offering for couples struggling with the affects of ADD or ADHD in the family. Couples’ coaching has similarities to, but is quite different from couples counseling, marriage counseling, and psychotherapy.
A traditional coach will work with you or your spouse. A couple’s coach works with you and your spouse. This person is not a life coach, and may or may not be an ADD implementation coach. Couples’ coaches that I recommend have a deep knowledge of relationships, ADD and ADHD, and some training in family work.
Many issues that couples contend with are completely unrelated to ADD. Expectations, communication styles, different ways of figuring things out, needs for intimacy and connection, and money can all create challenges to smooth and comfortable relating. Then there are the ADD-related issues like disorganization, losing focus, clutter, a different sense of time, starting and not completing tasks, impulsive communication and/or decision making… You get the idea.
Partners (non-ADD or less ADD) may contact the coach because they are frustrated or annoyed. People struggling with ADD symptoms may also initiate the call because they really want to please their partners, are trying very hard to make things work better, don’t want to have conflicts, and want to make positive lasting changes.
Coaching can be helpful for both newlyweds and couples who have been together 25 (or 45) years.
At Cerulli and Associates, we have a variety of professionals, including a couple’s coach; Jay Livingston does executive coaching and ADHD coaching, alongside his skillful couples coaching. He and I work closely, sometimes seeing couples together. I’ve found this blending of skills and approaches to work really well for certain couples.
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