Pay Attention!  5 Things You Need to Know (but don’t) About ADD/ADHD

Dr. Craig Liden | The Being Well Center

Based on my observations and studies treating ADD for the past 30 years, it’s fair to say that ADD touches upward of 20% of our population.  More than ever, we need to understand this often misunderstood, misaligned disorder.

People who are treating their ADD are living and thriving.  Let’s make the path to accurate diagnosis and effective treatment plans clear for all.

5 Things Everyone Should Know About ADD/ADHD:

1.    Attention Deficit Disorder is very common in adults. It is suspected that 1 in 25 adults has ADD.  However, only half have been properly diagnosed and less than a quarter are being properly treated.

2.    Untreated adult ADD can result in many chronic issues: obesity, chronic bowel problems, addiction disorders, depression/anxiety, and college failure, not to mention failed relationships, accidents, or poor job performance.  Properly diagnosing and treating ADD could have a huge impact on our society and health care system.

3.    Proper treatment of ADD with medication and counseling always starts with a comprehensive, diagnostic evaluation that includes objective testing, feedback from various members of the patient’s life, and a look at the whole person.

4.    Risks associated with correct medication use are minimal compared to the risks of untreated ADD.  Medication is often necessary but never sufficient and should always be paired with supportive counseling.  Stimulant medications used to treat ADD are generally very safe and are not addictive.

5.    The preferred name for ADD/ADHD is ADD since “Hyperactivity” is only one of many symptoms of ADD patients and shows up in less than 10% of those diagnosed.

Dr. Craig Liden is the Founder and Medical Director of The Being Well Center, an ADD/ADHD diagnostic and treatment center in Pittsburgh, PA that has helped more than 10,000 people worldwide living with ADD.

TRANShealth Inc. is sponsoring a free download of Dr. Liden’s book, ADD/ADHD Basics 101, in which Dr. Liden gives 10 steps to securing a diagnosis and treatment plan you can trust. 

 

Why ADD/ADHD is Frequently Misdiagnosed

image via Flickr, Raul Hernandez Gonzalez

image via Flickr, Raul Hernandez Gonzalez

The ways that ADD shows itself are highly variable from person to person depending upon an individual’s age, unique personality characteristics, profile of strengths and weaknesses, and the stresses and demands place upon him.  Differences in any one of these areas combine with the characteristics of ADD to produce an unlimited variety of problem behaviors.

For example, the preschooler with ADD who is strong-willed, sensitive, and intense may be labeled as a behavior management problem; the school-age child with ADD, who has difficulty organizing his thoughts into words and following directions and has problems with phonetics may be diagnosed as language disordered; the adolescent with ADD who is defiant and unkempt and whose grades are suddenly slipping with the new academic demands may be suspected of abusing drugs and alcohol; and the adult with ADD who is shy, socially withdrawn, overweight, and has a low self-esteem may be seen as being depressed.

Because of our limitations as observers of human behavior, we tend to judge the book by its cover. Our snap judgments often interfere with responsibly looking below the surface to investigate the possible role of ADD in these problems.

Our suspicions regarding the cause of a problem naturally influence to whom we go for help. Commonly, this means we seek help from a single professional who has expertise in the area in which we think the problem lies. This increases the possibility of misdiagnoses in several ways.

Even good clinicians’ approaches to problems are colored by their disciplinary bias and training; that is, they generally find what they are looking for. The psychiatrist makes a psychiatric diagnosis; the neurologist makes a neurological diagnosis; and the school psychologist makes an educational diagnosis. Furthermore, depending upon their training and experience, many clinicians may not even consider the possibility of ADD.

All of this serves to reinforce the need for a comprehensive, systematic, team approach to evaluating all behavior, learning, social, life performance, and chronic health problems.

The fact that there is no definitive test for ADD further complicates diagnosis. While there is some general agreement, there are not universally accepted diagnostic criteria for ADD. This means that making the diagnosis of ADD requires qualitative data interpretation and decision-making. Unless it is highly systematic, such qualitative diagnostic techniques are susceptible to multiple sources of error. Pediatricians, family practitioners, and other health-related professionals who have received training in transdisciplinary approaches to diagnosis and treatment are uniquely qualified to conduct effective team evaluations.


How do you know if your chosen health care provider is qualified to diagnose ADD/ADHD accurately?  Dr. Liden gives you a series of criteria and key questions to ask when seeking an accurate diagnosis for ADD in ADD Basics 101.

Losing Sleep Over ADD?

How does ADD impact sleep?

image via Flickr, Vic

image via Flickr, Vic

In our practice, about 70% of people with ADD come to us with sleep problems—trouble getting to sleep, staying asleep, or waking up in the morning. This makes all the sense in the world—as a key feature of ADD is low arousal, it falls to reason that an event that involves arousal in the day will play a role in the sleep-wake cycle at night.

Some of my patients who have trouble falling asleep at night experience wakefulness, in part, because they are unable to turn off their minds; as they lay in bed, distractibility keeps their minds active, moving from one thought, worry, or plan to another never quieting sufficiently to shift into the sleep mode. Others seem to struggle with getting to sleep as a consequence of a second wind: they come home wiped out; they zone in front of the television until 10:00 PM; get a surge of energy, act on it and find it tough to come down to sleep when they try.

It is not uncommon for my patients with ADD to experience nighttime wake ups. For some of these individual’s this is actually related to sleep apnea—periods of cessation of breathing during sleep. Research suggests that sleep apnea occurs in the ADD population more frequently than in the general population; it is likely that this is a function of a higher incidence of obesity in people with ADD and obesity is a key contributor to sleep apnea. Many of my patients do not suffer from sleep apnea but still more often wake up during the night. My understanding of this is a function of a less than good sleep-wake cycle in ADD population.

Probably, one of the hallmarks of ADD is trouble waking up in the morning. While this is particularly difficult for those who get their second wind at night and don’t fall off to sleep until very late, it is also experience by ADD individuals who have had the benefit of eight hours of sleep. Again, it is likely that this is a result of the disorder arousal system in the ADD population.

Apart from its being a drag, sleep difficulties are a serious problem for the ADD individual; we know that sleep deprivation on top of an arousal problem only intensifies his impulsivity, distractibility, poor monitoring, and weak vigilance.


Don’t fight those sleepless nights alone!  A thoughtful doctor or therapist can help you tackle the challenges of ADD and restful sleep.  For help finding the right care provider, Dr. Liden offers a step-by-step guide to finding a diagnosis and treatment plan you can trust to succeed: ADD/ADHD Basics 101

How ADD Messes Up Marriage

image via Flickr, kylesteed

image via Flickr, kylesteed

What is the impact of ADD on marriage?

The impact of ADD on marriage is often profound. Over the years, in working with couples I have found extremely common events occur over and over and over again.

ADD and the Impulse Spouse

Frequently, marital difficulties begin before the wedding: the impulsive ADD individual meets someone; he quickly gets caught up in feeling—feeling loved, feeling sexual, feeling connected; with all the intensity of feeling, thinking does not occur; before the two really know each other, they get married. Maybe in a week, or a month, or six months, but very soon, one or the other and, often, both know they have made a terrible mistake.   Years later, they are in my office trying figure out what to do now.

ADD and the Child-Spouse

For couples that chose to marry after getting to know each other, the key issues are different. Frequently, I see them when the spouse who does not have ADD has reached his limit.   When they married, he loved her but now he has had enough. He is tired of getting her out of bed with a morning phone call or two or three, tired having to walk through an obstacle course of stuff to get to the shower, tired of ordering pizza for dinner, tired of the of the impulsive spending, tired of paying late fees because the bills were lost, tired of folding the laundry at midnight . . . he wanted a partner and feeling resentful that he has a child.

ADD and the Insensitive Spouse

There are still other couples that make their way to my office when the partner without ADD feels that her spouse is just not as connected to her as she had hoped. While he is a nice guy, he seems insensitive to her emotions, oblivious to her stresses, and in his own little world from after dinner to bedtime when she needs to talk.   Her conclusion is that she either has married an insensitive jerk or he doesn’t love her anymore. My experience with these couples is that, most often, neither of these is true. Rather, she has married a good man with ADD who still loves her. His poor attention, however, interferes with his ability to read between the lines, tune into nonverbal cues, and monitor his own lack of responsiveness.


Have you had relationships struggle or fail and now suspect the roots trace back to ADD’s challenges?  Looking for a change?  Get started with Dr. Liden’s book, ADD Basics 101, currently available as a free download e-book.

ADD: High Risk for Poor Communication?

ADD and Poor Communication | The Being Well Center

image via Flickr, Jesper Sachmann

Good attention is critical for efficient communication. In order to understand a message–to break it down and to process the elements–we must first pay attention to it. Similarly, to generate a response, we must focus on our own thoughts, translate them into words and sentences, organize them into a coherent message, and reflect on their appropriateness.

Attentional weaknesses, therefore, place the individual with ADD at high risk for poor communication skills.

The requirements for effective communication are at odds with the characteristics of ADD. Poor focus, distractibility, and short attention span lead the person with ADD to miss, get only part of, or totally misinterpret messages. The result is that he is frequently in a position where he must ask for repetition, request clarification, fake his understanding, or present himself as “out in left field.” Further, impulsivity, distractibility, and poor monitoring lead the person with ADD to produce messages that are disorganized, incomplete, and characterized by on-going revision.

Throughout the process of communicating, we must forever monitor our language and our behavior in order to be certain that we adhere to the unstated rules of communication such as being polite and using appropriate body language. This represents one of the biggest challenges for the person with ADD as these rules are rarely, if ever, explicitly taught.

Generally, we learn communication rules by paying attention!

We watch the people around us follow the rules and see the subtle signals we get when we break the rules. These critical rules include the following:

  • Take turns while you talk.
  • Do not monopolize the conversation.
  • Look at the person to whom you are listening or talking.
  • Talk on the topic.
  • Talk politely to adults.
  • Do not interrupt.
  • When changing the topic, introduce the change.
  • Let the person who is talking know that you are listening, that you understand, and that you are interested.
  • Carry your share of the conversation.
ADD and Poor communication | The Being Well Center

image via Flickr, Bruce Wunderlich

Because he has failed to learn the rules of the game, a person with ADD is frequently behind the eight ball even before the conversation begins!

For a person with ADD who has learned the rules, the challenge is no less–following the rules of communication, even when they are known, requires constant and efficient impulse control, filtering, and monitoring.


Successful treatment of ADD includes addressing all areas of an individual’s life, including communication.  Dr. Liden has been helping patients overcome the challenges of ADD through conscientious medication and creative approaches to life coaching for the past 30 years.  A more in-depth exploration of ADD/ADHD can be found in Dr. Liden’s best-selling book, Pay Attention!

 

Boost Creativity by Treating ADD

Are people with ADD more creative and does medication treatment interfere with creativity?

 

image via Flickr, telmo32

image via Flickr, telmo32

There is a fine line between creativity and impulsivity and distractibility.

When it comes to having new and unique ideas, there is something to say for the ADD population.

The rub, however, is that the impulsivity and distractibility that work together to promote the free flow of ideas usually combine with poor focus, inefficient monitoring, and short attention span to prevent even the best ideas from going anywhere.

In my experience, successful treatment allows the creative ADD mind to be focused, reflective, purposeful and planful enough so that the ideas it generates have a chance to become something in the real world.

To illustrate the difference successful treatment can make in the life of someone with ADD, let us introduce you to one of our patients, who we will call “Kory.”

Kory’s Story

medication add diagnosisWe first met Kory when he was 8 years old and in the second grade. At that time, he was making life miserable for his family, his teacher, and his peers. His parents described life with him as “bedlam.” Chaos and disruption seemed to happen whenever he was around. The same scenario seemed to play itself out at each and every social event Kory and his family attended. Without apparent reason, Kory started to “act-up.” His parents quietly scolded him. As Kory continued, his parents repeated their reprimand with hushed intensity. Kory explosively retaliated, physically and verbally. Startled, others stared in their direction. Angry and embarrassed, the family prematurely called it an evening. In response to this recurring scenario, family members began to walk on eggshells, hoping to avoid setting off Kory’s violent reactions.

Kory’s parents complained that getting him to assume any responsibility was nearly impossible. He required constant nagging to get anything done whether that was bringing his homework home, practicing his piano, or getting up in the morning. His parents resented Kory tremendously for the black cloud that seemed to be hanging over the family.

Kory’s teacher reported that he was not working to his potential. He was not following classroom rules, not listening to directions, and not being courteous to anyone. Reportedly, Kory attempted to take over all interactions with his peers. He was always punching, pinching, pushing, or tripping someone. Needless to say, Kory had no friends. His parents were worried about Kory’s future–they actually feared that he might end up in prison.

Kory is now in the sixth grade. For four years, Kory, his family, and his teachers have been involved in a comprehensive treatment program that we developed after a thorough evaluation. Life with Kory is no longer chaotic. His parents feel comfortable taking him nearly anywhere. Moreover, they are beginning to actually appreciate what Kory brings to the family. Generally, Kory is able to express his feelings appropriately now and is genuinely open to feedback concerning his behavior.

Kory, independently completes his homework and studies for upcoming tests on a daily basis. He is earning A’s and B’s in school. He has excelled in music and practices his piano and trumpet every morning without a hassle.

Kory is working hard to dispel his bad reputation with his peers. In fact, he has succeeded in establishing a few very nice friendships.

Kory continues to have his rough edges. However, for a 12 year old, he has a wisdom about him. He knows his strengths and weaknesses. He knows himself better than most of us do and because of this, when life’s challenges come his way, he will be able to creatively, responsibly, and wisely tackle them.


The Being Well Center treats individuals with ADD/ADHD from ages 3 to 93.  For more guidance on how to find successful treatment for ADD/ADHD, download Dr. Liden‘s guide ADD Basics 1o1.

Living on the ADD Edge

Why do so many people with ADD live life on the edge?

image via Flickr, Riccardo Palazzani

image via Flickr, Riccardo Palazzani

Living life on the edge: procrastinating and procrastinating only to complete the task, once again, at the eleventh hour, pushing the limits of the car’s maneuverability at 75 miles per hour, scheduling ten meetings in a five-meeting block of time, attacking the black diamond slope with beginner’s skills.

Each of these events provides the ADD individual with a “rush”—an adrenalin rush that is a consequence of the stress response. For all of us, the perception of danger sets off this response resulting in increased arousal; this allows us to hyperfocus.

By hyperfocusing in times of danger, we are more likely to save ourselves.

This series of events is clearly helpful for the ADD individual who struggles with focus otherwise.   By using the stress response, the competent individual with ADD is able to pull it all off again and again, making procrastination an art form.

The rush allows him to experience intense focus and, in this way, pull it off at 2:00 AM the morning it’s due, behind the wheel of the car, during meeting number four, and on the ski slope.

There is a rub to all this however; the stress response also results in elevated heart rate, increased blood pressure, and chronic anxiety.

The ADD individual living life on the edge thinking he has, time and time again, successfully avoided disaster in his life is actually a time bomb waiting to detonate.


What helps you hyperfocus?  Is it living “on the edge,” or have other strategies worked for you?  Dr. Liden discusses other ways to avoid the “ticking time bomb” approach in his best-selling book, Pay Attention! Answers to common questions about the diagnosis and treatment of Attention Deficit Disorder.

ADD and Temperament Extremes

Temperament Extremes | The Being Well Center

image via Flickr, Austin Kirk

Individuals with ADD seem to have a greater frequency of extreme temperamental characteristics, those inborn behavioral response patterns that shape how an individual approaches and responds to life’s events and circumstances.

The most common temperamental extremes identified in individuals with ADD appear to be high activity level, low threshold of response, high intensity of reaction, negative mood, slow adaptability, short persistence, and unpredictability of basic bodily functions such as eating, sleeping, and bowel habits.

This means that people with ADD tend demonstrate a short fuse, a low frustration tolerance, a tendency to demonstrate temper outbursts, and difficulty adjusting to change. In addition, they often seem more excitable, sensitive, cranky, and unpredictable.

Why is it that so many individuals with ADD seem to have extreme temperaments?

It may be that individuals with ADD come into the world with a greater number of these temperamental extremes. However, it is also possible that these behaviors seem to be more common in individuals with ADD because their attentional differences interfere with their awareness of and ability to control these built-in personality characteristics.

That is, it may be that extremes in temperament such as high activity level, high intensity, low threshold, negative mood, slow adaptability, and short persistence occur just as frequently in the non-ADD populations as in the ADD population.

In order to exert control over these temperamental characteristics, an individual must be aware of his extremes, monitor his behavior, and develop effective ways to keep his extremes in check. As this requires efficient monitoring, problem-solving, vigilance, and impulse control, it is likely that individuals with ADD will struggle with their temperament more frequently and as a consequence, demonstrate these characteristics more often.

What’s your experience with ADD and Extreme Temperaments?  Do you or a loved one fall strongly on one end or another of the temperament spectrum?  The Being Well Center follows The Being Well System, which looks beyond the symptoms of ADD/ADHD to take into account a person’s in-born temperament traits.  Treating the whole person is crucial to a successful ADD/ADHD treatment.  Talk to your doctor or care provider about your temperament traits.