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.

Releasing Toxic Shame

December 21, 2009

“To feel shame is to feel seen in an exposed and diminished way. …you turn your eyes inward, watching and scrutinizing every minute detail of behavior. This internal critical observation is excruciating.”                                                                                                                                     John Bradshaw

There is perhaps no human emotion more paralyzing than shame, greater even than fear itself. Unfortunately, many of the people who walk into my office are consumed with an overwhelming sense of personal shame. The reasons are as varied as the people themselves.
• I have not succeeded in school because I am too lazy.
• I was victimized as a child and I believe I should have done something to stop it from happening.
• I gamble because it’s the only way I can imagine finding financial freedom, but when I lose, it only makes things worse.
• I don’t speak to my wife the way I should.
• I don’t trust other people.

For one such shame-filled client, I put a sign up in my office which reads:
Attention: You have just entered a shame-free zone
The wording of this sign is purposeful since I believe that therapeutic progress cannot be made if one is mired in that sense of shame. The coat of shame needs to be taken off and left at the door before the real work can be done.
It is important to define the type of shame I am referring to. When we mess up, whether it’s joking with someone in an insensitive manner, or something more egregious, embarrassment assists us in the process of recognizing our mistakes, taking responsibility for them and then making amends for our transgressions. Shame, on the other hand, is a toxic belief that we are unworthy, loveless or unredeemable. “Toxic shame feels much worse than guilt. With guilt, you’ve done something wrong; but you can repair that – you can do something about it. With toxic shame there’s something wrong with you and there’s nothing you can do about it; you are inadequate and defective.”                                                                                                                                                                                                               (Leo Booth/John Bradshaw)

Toxic shame seems to condemn us to an existence of self-loathing, endless emotional pain or existing in a state of numbness to the world around us. Shame anesthetizes us to the possibilities of growth and relationship with others. Shame binds us and holds us captive, no different than a prison cell. It is the toxic shame that we need to recognize as destructive and unhelpful if we ever hope to find peace and connection.
There is always a reason why we do the things we do. The fact that we blame ourselves or see ourselves as defective is a construct that most often other people gave us. Take my examples above.
• I have not succeeded in school because I am too lazy.
o If, like many of my clients you have ADHD, you weren’t organically designed to be immediately successful in a classroom. If teachers and parents keep telling you that you just need to work a little harder, what option did you have other than to blame yourself and feel shame?
• I was victimized as a child and I believe I should have done something to stop it from happening.
o This is common reaction of children who have been abused. Adults have the power. It is their responsibility to keep a child safe; not the child’s, and yet most victims take on the burden of trying to figure out how they could have prevented the abuse.
• I gamble because it’s the only way I can imagine finding financial freedom, but when I lose, it only makes things worse.
o When we find ourselves in this type of financial bind, it is easy to understand how desperation drives us toward unlikely hopes about how we can be delivered from our anxiety and fear. Most people don’t confront overwhelming challenges with rational thoughts. And while it is normal to wish financial woes away by gambling, it virtually never works. These are times to ask others for help and ideas about how to move forward to resolve the dilemmas.
• I don’t speak to my wife the way I should.
o While there are many reasons why this may be true, there is usually some environmental factor which fuels this difficulty. If we lacked role models, for example, on how to speak with a spouse, or we struggle with a low self-appraisal, intimate communication with others is never easy.
• I don’t trust other people.
o Trust is something we learn from our parents and other important people in our early years. If adults proved to be untrustworthy, why would we trust anyone? In my experience, most individuals with this type of history have a “wish/fear” related to intimate connections with others. They both long for intimacy and, given the dominant, fearful expectations held tightly within, they reject it. The promise of intimacy and unconditional love is experienced as nothing more than a shallow or empty gesture. The recipient of such an offering, in order to keep themselves safe from the harm of disappointment, believes that they must reject the overture and assume it is not real. They remain “safe” but alone, isolated and shame-filled that they cannot obtain that which they crave.

All of these situations involve people who are simply doing what they were programmed to do, or are responding to painful situations the way most of us would. Why then, is it appropriate to feel guilt and shame for doing what makes sense? I don’t like it when I see people misunderstand their capabilities, or blame themselves for being victimized, or utilizing flawed strategies to make things better, or keeping a distance between themselves and others, but I understand it. I don’t judge it, rather, I attempt to help those “afflicted” with shame understand where it came from and how to put it down! If there is “fault” to be assessed, usually the fault sits with someone or something else. And when people are caught up in shame and guilt, they almost always fall back on the very behaviors and attitudes that keep them in distress or alone.

Once freed from the shame, individuals can then utilize all of their cognitive energies to managing their lives more effectively. No one deserves to sit with crippling and paralyzing shame. Shame doesn’t move people forward, it merely keeps them held back from experiencing life in its fullest form. While we all need to learn from our mistakes, we all too deserve to live an existence free of toxic shame.

Walter Sherburne, LICSW
68 Park Street
Andover, MA 01810

Moving and Fidgeting

December 6, 2009

I was watching a video piece about a stand-up, school-room desk and was pleased to see an accessory it features, a foot swing. Let me back up.

I find myself more and more interested in stand-up desks as a way to counteract the effects of sitting long hours. When I get time to reply to emails or work at my computer, it feels like a great time to be on my feet, moving and maybe even burning a few calories.

So, as I have been perusing the web exploring stand-up desk options. I discovered a company that makes stand-up desks for students that has a “U” shaped metal rod to rest a foot on, and the rod swings. The kids report that it helps them manage their energy and even stay out of trouble – sometimes. I love the idea and have always provided something similar for my clients, many of whom have ADHD.

Every chair in my therapy room has at least one fidget object near it, soft stress balls, clear plastic magic wands with floating confetti inside, coasters, pillows and foot rests are the current selection. Clients find wonderful things to do with these items as they work off enough energy to sit and talk with me. The balls are constantly flying from hand to hand or being thrown in the air and caught one-handed in a continual game of catch, squeezed to a pulp.

The magic wands get twirled between fingers, rolled between hands, stared at with hypnotic attention as the confetti floats languidly down only to have the wand flipped on its end sending the confetti floating down once more, or beat like a drum stick, with an occasionally desperate rhythm, against clients’ legs.

Pillows get hugged, folded, punched and prodded. Coasters are slid, balanced on end, tossed and tapped. Foot rests are pushed and pulled. An observer of my sessions would be hard pressed to find a moment of complete inactivity during the 60 to 90 minute sessions.

One client told me that he knew I understood ADHD the minute he saw the “toys.”

Szifra (Shifra) Birke

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Thanksgiving and Giving Thanks

November 25, 2009

Holidays can be a wonderful time to reconnect with others and with ourselves. It can be a time of reflection and rejuvenation. A time of love and sharing. But holidays can also be incredibly stressful as we all know too well. With the added responsibilities and challenges associated with planning, traveling, errands, gifts, and entertaining cousin Fred, we may all find our working memory maxed out. This time of year can be particularly stressful if you are someone struggling with ADHD.

One way to combat the holiday stress is to remember to focus on strengths  – yours and others. We spend so much time venting to our friends and families on what is wrong in our lives that perhaps we have lost sight of what is right. Thanksgiving is a perfect time to try a new outlook. It is a day for giving thanks, a day of affirmations. We can thank ourselves for our accomplishments, which on some days may simply be the ability to get out of bed in the morning or managing our frustrations with a modicum of finesse. Perhaps on a larger scale we can thank our family, friends and colleagues for being in our lives. Or maybe we can be spiritually thankful for simply “being”.

What is it that you are thankful for? Remember, changing behaviors is not about punishment, it’s about reinforcement. Wouldn’t it be nice if what you are reinforcing is the positives? To change your outlook I suggest you may need to change what you choose to focus on. Spend more time thinking your way into a better place. With each thought you are creating a memory, a track in your brain forever. Choose carefully. Be kind to yourself.

Today I am thankful for some simple pleasures that I often overlook: my daughter’s smile, the smell of my old golden retriever, my health. I am thankful for working in a field of medicine that I love and for the opportunities to lecture nationally on a topic near and dear to my heart – ADHD. I am thankful for my patients and their families, some of whom I’ve had the privilege of treating and sharing in their lives for over 10 years.

Happy Thanksgiving and Giving Thanks.

Theresa Cerulli, M.D.

Not as Bad as it Seems

October 27, 2009

Most of us grew up hearing many messages from our families, school teachers or other kids that suggested we had a lot we should feel bad about; we heard about everything we did wrong and very little about what we did right. Our school work was covered with marks that pointed out everything we did wrong; our mistakes at home got the most attention; and the nearly all the most dramatic feelings we heard were about our failures. It’s not surprising then that after all the repetitions of the negative we often end up feeling we’re not very worthy of positive feedback.

Negativity narrows us. We tend to have a narrower range of emotions, less creativity, fewer social connections, have a harder time with self-insight and more. The effects of negativity go even further though, we tend to be more affected by illness, have less resilience and be more prone to responding to others negatively.

Many of my clients find that it is as hard as anything they’ve done to try to find the good in themselves. I ask them to appreciate themselves and they freeze. I ask them point out the positive changes, or where they’ve succeeded and I get blank stares and a, “This stuff is hard!”

After we’ve worked together for awhile my questions will begin to bring a pause and sometimes a big laugh – they have caught themselves in a negative, dead-end thought process. Recently, one of my clients explained just how hard it was for him to notice the positive. He said with a wry grin, “What you’re asking is just about as hard as giving myself a frontal lobotomy.” Awareness and humor are a transition point for many of my clients.

They start noticing and sharing a few things they are proud they did, or an aspect of their personality they like. They discover that when they look at themselves carefully there are many more positive things to report on than negative. The day they interrupt me to be sure I noticed a positive piece of growth or success in an area we’ve focused on, that’s the day they realize this positive stuff isn’t as bad as it seems; in fact, eventually, it’s no harder than eating an ice-cream cone on a hot day.

Therapy is about working to bring more joy and meaning into your life. If you’re ready for a transition or even assume you can’t change, give me a call and let’s find a way to discover the positives.

Szifra Birke

Contact Szifra

Singing Our Own Songs

June 5, 2009

“The mass of men lead lives of quiet desperation.”

Henry David Thoreau


“Alas for those that never sing, but die with all their music in them.”

Oliver Wendell Holmes


Recently, a therapy client referenced Henry David Thoreau’s quote about men who live in “quiet isolation.” This individual felt a strong connection to the notion that most of us live within ourselves, hidden from those around us. When I went to research more about Thoreau’s work, I happened upon the famous Oliver Wendell Holmes line, “for those that never sing, but die with all their music in them.” The quotes from these two authors are often merged to read, “Most men lead lives of quiet desperation and go to the grave with the song still in them.”

The words of Thoreau and Holmes were penned in the mid-1800’s, but I suspect that they are more relevant today than ever before. What a sin it is to quietly despair, not sharing our thoughts, joys, worries and hopes with others. There are many reasons why so many of us live in hiding. One of the most obvious is the fact that, as a society, we have placed such an ever-increasing emphasis on independence that we have left little room for the importance of “community.” We communicate through text messages and emails with people across the globe while too often not even knowing our neighbors.

But there is an even more pervasive reason why we keep ourselves hidden from those around us. Too many of us are burdened by a sense of shame. As a therapist, I can attest to the power of shame, and there is no shortage for the causes of shame. We feel shame about our shape, size, professional status, athletic performance, and school achievement. Feelings are also a powerful source of shame. When we experience depression, self-doubt, anxiety and fear, we mistakenly believe that no one else would understand, and even worse, that we will be ridiculed after admitting to feeling frail. In short, we hide from others so they won’t see how “deformed” we feel we truly are.

Just this morning, a member of my men’s group summed it up like this: “I’ve been hiding out…being this way in life is not very fun.” Another group member, while sharing a recent breakthrough in communication with his wife, said, “telling others how you feel is the center of everything.” Having the freedom to share ourselves fully is, to paraphrase Oliver Wendell Holmes, the act of singing our own deeply personal songs.

And so I ask you, what songs have you sung lately? Who knows how you feel? Who have you cried to, laughed with or held? “Dan” was right, life without connection to others isn’t very much fun at all. And if you are reading this and saying it’s too late for me, IT’S NEVER TOO LATE to connect to others. There are probably those around you already who would sit and listen. And if you don’t think you have anyone there for you, it’s okay to ask for help from a family member, a friend, someone at your house of worship, and yes, even a therapist. Life is too short to postpone the joy of connection!

Walter Sherburne, LICSW

Make an Appointment with Your Anxiety

May 5, 2009

Keeping Anxiety in Its Place

I was recently invited to give a talk to a group of clients from a financial planning firm. These successful people had good jobs, adequate savings and potentially rich lives. They were in no danger of losing it all in the current market situation, but there was an awful lot of worry and anxiety in the room.

Worry and anxiety are fear of something that might happen in the future; fear of something that hasn’t happened, isn’t happening and may never happen. When we allow worry to become a major player in our life, we are letting our fear of the future hijack our enjoyment of the present.

I wanted to give my audience some simple, practical methods to reduce their worries so I shared a technique with them that I teach some of my therapy clients.

Corral your worries into a specific time and place. Since worry is focused on a vague and uncertain time and event in the future, it isn’t anchored to any particular time and place now and therefore it can easily begin to creep into all your activities and situations. It’s crucial that you find away to give yourself a break from it.

Trying to ignore a worry is often no more effective than trying to not think about white elephants.  Thinking about not thinking is thinking about it. You get the idea. So I suggest you try giving the worry a specific time and place all of its own. Make an appointment to worry.

Imagine looking at your calendar. Choose a time when you will bring your attention to worries. For example, you can decide that you will worry from 3 to 3:30 every other day. When you find yourself starting to worry at any other time, your job is to stop, notice what’s happening and promise to spend time worrying tomorrow between 3 and 3:30. Then you attempt to return to a productive or pleasurable activity. If the worry comes up again, you note it and promise to spend time at the next designated worry appointment . If you have multiple worries, keep a list of all the things you want to worry about during your scheduled time so you don’t forget any.

For this to work you have to fulfill your commitment to actually take the time to worry. You won’t put the worry aside if you know you might not take the time to focus on it later. Keep your appointment and worry. You may find that worry takes another form; it might end up being less like diffuse fretting and more like actual problems to be attended to. Build credibility with yourself and follow through by paying attention to whatever is on your mind that is concerning and preoccupying. Write, talk out loud—whatever is the best form of attending to your worries.

Each time you put aside the worry and make it wait for its time, you develop your ability to do that with less effort the next time. It’s like exercising in order to build a “wait for it” muscle. The new pattern begins to build new circuitry in your brain and it becomes easier and easier.

For more information about managing worry and anxiety you’re welcome to call for an appointment.  978-446-9600 or send me an email with your contact information.

 Szifra Birke 

(My name only looks impossible; it’s pronounced SHifra).






Knowing it’s Time to Change is a Great Start

March 13, 2009

Change is a process and by definition, a process is something that happens gradually. So, if you’re feeling like it’s time to change, celebrate the beginning of a process.

Creating change in yourself is a campaign that starts with recognizing a pull within yourself toward something new or away from something familiar. What hook will get you thinking about change? Your too-tight pants might bring the idea to your attention. Puffing your way up a flight of stairs is hard to completely ignore. Losing a large client interrupts the bliss. Feeling burned out suggests something is off. Having your spouse discouraged with you is a strong clue.

What we’re likely to miss are not these in-our-face examples, but the ones we turn away from without a thought; “You’re frustrating me! You don’t understand me! My client just doesn’t get it! Why is it so hard to explain simple ideas to people? Are these people stupid?” The situation is crying out for change, but we deflect the responsibility to someone else. We miss the full role we play in the miscommunication.

Noticing that we have the leverage to start the ball rolling is not a small accomplishment. Being aware of ourselves – insight – is not a commonly held skill. Coaching may ignite it; therapy can nurture it; pressure from a loved one occasionally forces it. But it isn’t easy to grab insight or to hold on to it.

So, if you feel it’s time for some change, celebrate. Even if you don’t know how you got there, pat yourself on the back and take a breath; you’ve taken a good step and you’re already beginning to change.


ADHD Client Self-Awareness and Confidence

February 9, 2009

 I was struck by the pain a very successful entrepreneur shared with me. He grew up hearing that he was lazy and stupid because he couldn’t manage his time and stay ahead of his school work. Even after he was diagnosed with ADHD late in high school, his family couldn’t understand what he was struggling with and accused him of being undependable and dumb.

This bright, creative, kind man still carried many of the weaknesses that you might expect from someone with ADHD, but he does well with the occasional support of medication. He has made an impressive life for himself with huge successes in his personal and business life.  He is the CEO of the midsized company he founded and has two great kids.

What hurts me is that he doesn’t know how good he is. He still feels like that kid his parents mistakenly thought he was. He has carried that false image forward through college graduation, a successful start-up business and the current, profitable company he has grown into a recognizable brand.

He came to me because inside he feels like a fraud. He wonders how others can keep from seeing the truth about him. This is one of the tragedies of ADHD, a person is functioning well, but hasn’t taken time out to correct and update their personal-awareness file. They are in an enviable position in their lives, but can’t enjoy the success.

My entrepreneurial client was stunned to hear from me that many around him were almost assuredly also feeling anxious about their competence, that early information so impresses itself on our brains that it’s difficult to shake up our primal self-image.

Understanding what was happening and having a chance to talk it out gave my client a great boost of self-confidence.  He is surprised and pleased that there was this next level of confidence that he didn’t even know was available to him.

I asked him what kind of difference he thought this increased confidence would make in his life. He grinned and said that with everything he had going for him, he figured he could change the world if he wanted. He just might!

Power Outage & The Power Within

January 20, 2009

Like many in the New England area, I recently endured a 9-day power outage. After the initial shock, the first few days were like an adventure. Light, heat, boiling water and hot food were all provided by a wood stove. No lights, no television, no phone, no computer, no running water, no modern conveniences to clutter the mind. It was quiet and dark.


After days became a week, primitive living seemed endless. What had been novel became drudgery. As the days went by, however, I came to a realization. In those long hours of silence, I could hear myself think. The business of life gave way to a time of contemplation and peacefulness.


No matter how unwelcomed, the power outage gave me the opportunity to allow other “circuitry” to come back to life. I was thinking again. I was not just sitting back and watching or listening. I had the time to think about my dilemmas and dreams, my conflicts and comforts, my jealousies and joys. I was examining the very fabric of my existence.


Socrates once proclaimed an “unexamined life is not worth living.” What is an examined life?  As adults, we are controlled and influenced by our experiences beginning in the very earliest stages of development. Our brain takes in whatever our environment teaches us, and these “lessons” become chemically “hardwired” over time. Perceptions, or as Robert Gerzon would describe them, “toxic voices,” take up residence, make themselves at home and begin to influence how we feel about ourselves for many years to come.


These are well rehearsed and powerful thoughts that are always with us, often tricking us into believing that we are flawed, incompetent, stupid, inferior, less than, and defective. We feel guilt, a lowered self-esteem, in short that we don’t matter as much as others. We begin to believe that we must keep our deformed and hideous selves hidden from others, often from ourselves.


When I once asked the participants of a men’s group what was so hideous that they needed to hide it from others, there was a long pause.


·                    I got teased for having a smaller chest than the other guys in gym class

·                    I was overweight and had to wear glasses

·                    my father always yelled at me

·                    teachers refused to deal with me and banished me to the hall

·                    my father made me cry and then ridiculed me for crying

·                    I wasn’t smart enough


“Who taught you to see yourselves in these ways?”


·                    parents

·                    teachers

·                    peers


“And who encourages you to see yourselves in these ways now?”


“We do!”


Then, at that moment magic begins to happen. There is, even if for only a brief moment a light that shines down on the prison cells they are held within. With illumination comes the insight that they are both the prisoner and the prison guard, the punished and the punisher. Then, and only then, change begins to happen. Men begin to see themselves anew, often because of the perspective of their comrades, they see themselves as not so flawed, not so damaged, not so hideous after all.


And so, perhaps inspired by the ever-present glow of the wood stove, I took the time to illuminate my own prison walls. Within the surrounding silence, I examined my life and decided to free myself from anxiety and worry. As a result of the power going out, I discovered the power within.


An unexamined life is not worth living. Truer words were never spoken.


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