Sharing ADD/ADHD in the Workplace

What should the ADD adult share with his coworkers and employer?

When adults are first diagnosed and beginning treatment for ADD, often, they are excited to finally have an answer to a lifetime of frustration and struggle. In their excitement, they frequently want to share their experience with everyone who will listen. Unfortunately, this invariably leads to problems, particularly at work.

add_workplace_being_well_centerCoworkers and employers, who do not have a good understanding of ADD or the effects of medication, commonly put the ADD adult under the microscope looking for immediate positive changes and assuming any new unproductive behaviors are negative effects of medication use.

Because the newly diagnosed adult needs time to learn strategies for improved work skills, organization, interpersonal skills, and problem solving, this microscopic observation sets everyone up for disappointment.

Except when employment is already at serious risk, in my experience, it is wisest for the newly diagnosed adult to keep his personal medical affairs to himself, immediate family members and close friends.

 


The Being Well Center supports the whole person through all of life’s demands. We specialize in accurate diagnosis of ADD at any age, and we have extensive experience guiding adults with ADD through expectations across the lifespan.


Our current blog series is excerpted from Dr. Liden’s best-selling book, Pay Attention!: Answers to Common Questions About the Diagnosis and Treatment of Attention Deficit Disorder.

What should happen when an ADD child fails?

Exactly what should happen when an ADD child fails to meet an expectation?

What should happen when an ADD child fails?An individual who fails to meet a realistic expectation should experience a consequence. Consequences are events that occur as a result of our actions. They provide us with the opportunity to reflect on the appropriateness of our behavior.

Parents and teachers have an important responsibility to think about how best to use consequences to promote positive behavior change, improve responsibility, and encourage independent functioning. Some general guidelines are helpful in selecting effective consequences:

  1. Consequences should occur only when expectations are determined to be realistic and appropriate, that is, achievable for a given child.
  2. Consequences must be negative. This is true despite the fact that this notion goes against the grain of what feels best for most of us.  It is critical to remember that a negative consequence does not mean a physical punishment or a highly punitive measure. Rather, a negative consequence is simply an undesirable event.
  3. Consequences must be individualized. What is negative for one person is not necessarily negative for another. For the shy, withdrawn child, missing recess, where the expectation is to play with other children, may not be negative at all. On the other hand, to the outgoing, active child, missing recess may indeed be negative.
  4. Consequences must be short term. When given a long-term consequence, most children, and particularly ADD children, will do one of three things: forget why they have received the consequence, adapt to the consequence so that it becomes meaningless, or badger the authority figure until the consequence is removed or negotiated, in which case the authority figure becomes less powerful the next time around.
  5. Consequences should be immediate. Although this is not always possible, it is best that a consequence occur as soon after misbehavior as possible. Immediacy helps to link the consequence with the misbehavior.
  6. The magnitude of the consequence should fit the misbehavior.
  7. Threatened consequences must occur.
  8. Consequences should occur after the first instance of an inappropriate behavior rather than after one, two, or three warnings.

Did you know The Being Well Center is a team of experts who are here to support parents and teachers?  In addition to doctors and PAs, we are counselors, nurses, dietitians, and behavioral therapists.  We support the whole person through all of life’s demands.


Our current blog series is excerpted from Dr. Liden’s best-selling book, Pay Attention!: Answers to Common Questions About the Diagnosis and Treatment of Attention Deficit Disorder.

Structuring the ADD environment

Treating ADD: What works, what doesn’t, and why…

How far should parents and teachers go in structuring the environment?

Structuring is a method of managing behavior, promoting responsibility, encouraging independent functioning by changing the physical surroundings or by providing the organization necessary for completion of a task. It is a valuable tool for increasing the likelihood that the individual with ADD will achieve success.

ADD ADHD structure teacher parentParents, teachers, and others need to find the balance between too little and too much structure. Too little structuring generally guarantees failure. Too much structuring can actually be detrimental to the individual with ADD. If the environment is too controlled or a task is too tightly organized, it actually takes away, from the individual with ADD, his need to control his inattention and to organize himself.

When over-structuring occurs, parents and teachers are actually allowing the individual with ADD to become overly dependent. They make it possible for the individual with ADD to avoid facing his weakness, accepting it, and developing appropriate compensatory strategies.

As a rule of thumb, to avoid over-structuring, parents, teachers, and childcare providers should only use structuring that is practical and applicable to the real world. Individuals with ADD need to learn to cope with the demands of a world where parents and teachers are not always present.


Did you know The Being Well Center is a team of experts who are here to support parents and teachers?  In addition to doctors and PAs, we are counselors, nurses, dietitians, and behavioral therapists.  We support the whole person through all of life’s demands.


Our current blog series is excerpted from Dr. Liden’s best-selling book, Pay Attention!: Answers to Common Questions About the Diagnosis and Treatment of Attention Deficit Disorder.

 

Help for someone resistant to ADD treatment

add treatment, family, the being well center

What can be done to help someone who is resistant accept treatment?

How we can best deal with a family member’s resistance to evaluation and treatment varies dependent upon the individual’s age. In younger children, we rarely see resistance. Once they see the positive impact of medication and other strategies on their school experience, social interactions, and home life, most young children are happy and, actually, excited about treatment.

add treatment, family, the being well centerThere is much more resistance pre-pubertal children and young adolescents who frequently struggle with the notion that ADD and its treatment make them different from their peers. This is a developmentally appropriate response for children this age who can react intensely to anything that sets them apart . . . a pimple on the forehead, not enough pubic hair, or having to take a pill in order to pay attention. Parents of these children can promote acceptance by being empathetic and providing educational materials that demystify ADD and its treatment. In my experience, however, it is important that parents of the resistant young adolescent take charge by setting clear limits about taking medication and participating in follow-up counseling. Typically, resistance and struggles with acceptance at this age fade relatively quickly as the child matures and begins to appreciate that we are all different in some way.

When dealing with older adolescents and young adults, addressing resistance is often more challenging. We frequently see older adolescents or young adults who have struggled for years, been accused of being lazy or stupid, or been told that they could do it if they just tried harder. After years of failure, many of these young people develop a hard exterior shell, an “I don’t give a damn” attitude to cover up a very low and damaged self-esteem, and intense resistance to help. While educational materials and frank discussions about ADD and its long-term consequences can sometimes help to overcome the resistance, it is often necessary for parents to focus on establishing firm limits and to stop enabling in order to motivate the older adolescent or young adult to comply with treatment. This may mean taking away the car, refusing to provide spending money or, in the case of the young adult, withdrawing the comfort and support of continuing to live at home.

Addressing resistance to evaluation and treatment with an adult, particularly a spouse can be tricky. Adults may have many reasons for not wanting to become involved in treatment. Some may have developed a version of that hardened, self-protective shell and, belligerently proclaim, “I’m just fine the way I am!” Many adults with ADD, as a consequence of their poor self-monitoring, truly do not see the problems that a spouse, close friend or even co-worker sees. When this is the case, it is important for significant others to provide direct feedback when problem behaviors occur and be careful to avoid enabling, co-dependent behaviors that can mask the impact of untreated ADD. Learning to detach, let go, and take care of himself are important steps for the spouse of the adult with ADD.


Our current blog series is excerpted from Dr. Liden’s best-selling book, Pay Attention!: Answers to Common Questions About the Diagnosis and Treatment of Attention Deficit Disorder.

Early Diagnosis of ADD/ADHD

add in school children | the being well center

Can ADD be diagnosed before a child enters school?

Yes, but it is often difficult. The reason is that some of the behaviors that are red flags or indicators of ADD can be normal in the preschool-age child. This means that interpretation of behavior and test results is complicated. Interestingly enough, however, experienced preschool teachers can be amazingly accurate in identifying the child with ADD. They have the advantages of making observations over time and being in a position to compare a given child’s behavior to that of his peer group. This makes it possible to identify the child with ADD whose behavior is consistently more extreme.

add in school children | the being well centerEarly identification of ADD should be a goal for parents and teachers. This makes it possible to begin treatment before the child enters a destructive cycle of failure that can interfere with successful growth and development. Sometimes parents and teachers hesitate to identify and investigate an extreme behavior for fear of creating a problem where there really is not one. While this is an understandable concern, over the years I have learned that parents know their kids better than anyone (and teachers aren’t far behind).  Their difficulty, more commonly, is being honest about what they see and holding back, as opposed to inaccurately observing and jumping the gun.

Therefore, my advice to parents and teachers is: “If you think there is a problem, then there is.”

It may not necessarily be ADD, but something is out of sync. All developmental, learning, and behavioral concerns in children deserve some type of comprehensive assessment. The “worst thing” that can happen by taking the step to investigate a concern is that parents and teachers can be reassured that they are handling things in the right way!

And even more importantly, when we evaluate a problem, identify the factors–including ADD–that are contributing to the problem, and implement a specific treatment plan, we are likely to prevent the development of more significant problem.


How can you be sure your ADD/ADHD diagnosis is accurate?  One sure-fire way is to book a Discovery Session with Dr. Liden at The Being Well Center!  Another great way is to download Dr. Liden’s book, ADD Basics 101, currently offered as a free ebook.


Our current blog series is excerpted from Dr. Liden’s best-selling book, Pay Attention!: Answers to Common Questions About the Diagnosis and Treatment of Attention Deficit Disorder.

Should we use medication to diagnose ADD?

medication add diagnosis

Can response to medication be used to confirm the ADD diagnosis?

No, an individual’s response to medication should never be used to confirm the ADD diagnosis. In fact, relying on medication response for diagnostic information is a set up for trouble.

medication add diagnosisUse of medication is complicated and an individual’s response to medication is impacted upon by many variables. The severity of the individual’s attention weakness as well as the particular medication and dose selected interact to determine a patient’s responsiveness. Many, many, times patients come to my office after having been told that because they did not respond to the medication, they do not have ADD. When we conduct a systematic, comprehensive evaluation, however, the patient clearly meets all of the diagnostic criteria for ADD. As a consequence of using medication responsiveness as a diagnostic tool, I find that these patients have unnecessarily experienced more failure, more stress, and oftentimes, feelings of hopelessness about the future.

Sometimes, use of medications to treat ADD can be problematic for individuals who don’t actually have ADD but another disorder that shares some of its characteristics. Use of these medications in an individual who has bipolar disorder, for example, has the potential for setting off a manic episode. So by using medication as a diagnostic tool, rather than systematically evaluating the individual, we run the risk of creating a significant problem for him.

Finally, as we all fall somewhere along the continuum from strong to weak attention, it is possible for each of us to experience an improvement in attention after taking a medication for ADD. So clearly, concluding that, “because I feel more focused on this medication, I must have ADD” is unwise. This thinking, however, is inherent in using medication as a diagnostic tool to confirm the ADD and likely to result in inaccurately applying the label to people who do not have ADD.


How can you be sure your ADD/ADHD diagnosis is accurate?  One sure-fire way is to book a Discovery Session with Dr. Liden at The Being Well Center!  Another great way is to download Dr. Liden’s book, ADD Basics 101, currently offered as a free ebook.


Our current blog series is excerpted from Dr. Liden’s best-selling book, Pay Attention!: Answers to Common Questions About the Diagnosis and Treatment of Attention Deficit Disorder.

ADD and Chronic Health Problems

ADD ADHD health problemsWhat types of health problems are associated with ADD?

There is a wide range of health problems associated with ADD. In some circumstances, the underlying neurological differences that accompany ADD may predispose patients to other related health problems. In other circumstances, ADD seems to be genetically linked to certain other medical problems.

In addition, longitudinal studies in the medical literature along with clinical experience support the fact that failure to properly identify, diagnose, and treat this physically based problem at the earliest possible age, places patients with ADD at a significantly greater risk for other serious health problems.

Some of these health problems are a consequence of unhealthy living patterns and behaviors that can result from ADD, some are related to the chronic stress frequently associated with ADD and unhealthy attempts to cope with it, and some are related to the consequences of the chronic failure associated with ADD.

Health problems, which seem to be associated with ADD through one or more of these mechanisms, include the following:

  • Alcoholism
  • Drug Addiction
  • Eating Disorders – Compulsive Over-Eating/Obesity
  • Anorexia/Bulemia Nervosa
  • Sleep Disorders
  • Enuresis
  • Chronic Constipation
  • Irritable Colon and Related Bowel Problems
  • Hypertension
  • Hypercholesterolemia
  • Recurrent Otitis Media
  • Recurrent Infections
  • Allergies/Immunological Disorders
  • Accidents – Ingestions/Automobile, etc.
  • Suicide
  • Child/Spousal Abuse
  • Chronic Fatigue Syndrome
  • Unplanned Pregnancy
  • Recurrent Headaches
  • Recurrent Abdominal Pain
  • Chronic Back Pain
  • Premenstrual Syndrome
  • Poor Treatment Compliance

At the time of initial presentation, ADD may not clearly seem to be a health problem. However, the relatively minor behavior or learning problems, which may be the first sign of ADD in childhood, may actually be the “red flag” that signals a problem (i.e., ADD) which could ultimately contribute to a variety of serious health problems in children or adults with ADD.


Want to stop the chronic stress, failure, and health concerns associated with undiagnosed or mistreated ADD/ADHD?  Get on a healthier track today!  If you’re ready now, contact Dr. Liden at The Being Well Center.  Or keep learning more about being a good consumer of ADD/ADHD resources.

Our current blog series is excerpted from Dr. Liden’s best-selling book, Pay Attention!: Answers to Common Questions About the Diagnosis and Treatment of Attention Deficit Disorder.

Drugs, Alcohol and ADD

Drugs, Alcohol and ADD | ADD treatment | Dr. Craig LidenHow Does ADD Impact Drug and Alcohol Recovery?

Drug and alcohol recovery often begins with involvement in some type of rehabilitation program. Success in these programs is predicated upon an ability to listen attentively and to participate in group discussions. It is also necessary to read and comprehend various educational materials. Obviously, these tasks can represent a huge challenge for the unrecognized and untreated ADD individual who is simultaneously struggling with withdrawal symptoms and possible long-term impact of the abused substance on his nervous system.

If the ADD individual makes it through detoxification and initial rehabilitation, he must take on the difficult challenge of maintaining sobriety every day. In my experience, this is most likely to happen through participation in a 12-step program. Unfortunately, this can represent another challenge for the ADD individual. One of the mantras of 12-step recovery programs is “90 meetings in 90days.” And what does it take to meet this expectation? Organization, planning, sustained commitment to name a few — all things that are hard for the untreated ADD individual to do even in the best of times.

Furthermore, establishing and maintaining a healthy balanced lifestyle is the foundation of a successful recovery. To maintain sobriety, an individual must find a way to avoid hunger and fatigue through healthy eating and sleeping patterns, to manage stress through exercise and mind-centering activities, and to balance work, family and personal responsibilities – all overwhelming tasks for the untreated ADD individual.

In my experience, if the addicted ADD individual is not receiving proper treatment for his ADD, his ability to effectively participate in recovery and sustain sobriety is doubtful at best. It is no wonder that less than 20% of addicted individuals achieve and sustain long-term sobriety. 

As we come to understand of the nature of ADD and its serious consequences, we can appreciate the serious need for its appropriate diagnosis and treatment.


We’re talking tricky topics this week on the Being Well Center blog.  Check back Friday for our next discussion about ADD and chronic health problems.


Our current blog series is excerpted from Dr. Liden’s best-selling book, Pay Attention!: Answers to Common Questions About the Diagnosis and Treatment of Attention Deficit Disorder.

ADD and Sex

How does ADD impact sexual behavior and functioning?

Over the years, behind the closed door of my office, I have heard hundreds of unusual stories regarding my patients’ sexual activities. I have come to appreciate that, while the topic is often emotionally loaded, the behaviors are generally completely understandable when put into the context of ADD.

ertterdownloadsA certain amount of body exploration and sexual experimentation is normal for all children; in young children with ADD this exploration and experimentation can seem extreme because we see it. Young ADD children often lack that inner voice that says, “Keep your hands out of your pants when others are around” or “Do not touch other kids’ private body parts” or “Don’t draw that in school.”  While other children may have the same impulses, they usually have enough self-control and social monitoring to think first and, in this way, stay out of trouble with their sexual thoughts and feelings.

As children get older it is normal for them to be sexually curious. Oftentimes, older children and adolescents with ADD impulsively act on their curiosity. Then, as a consequence of their poor monitoring and decision-making, they get caught doing something that seems bizarre or perverted to others. The number of older children and adolescents in our practice who have been caught looking at, taking, or even wearing mom’s lingerie, exploring pornographic websites on the computer, using (and running up huge bills) on phone sex hotlines, or sending pornographic photos of themselves to someone they met on the Internet is astonishing. In my experience, upon taking the time to debrief the events with my patients, clearly these behaviors are not signs of perversion or serious mental health problems but rather normal sexual interest in the absence of good self-control.

We all know that in adolescence, sexual exploration continues, and that its consequences can be very serious. Premature experimentation or early sexual involvement can lead to unplanned pregnancy, sexually transmitted diseases, and serious legal trouble. Adolescents with ADD who are struggling with a low self-esteem and lack of acceptance by peers can too easily become involved in sexual relationships to feel good and be accepted never thinking about the potential consequences. In my experience, impulsive kids who struggle in reading the social signals often finds themselves caught up in the heat of the moment and have no idea how to get out.   Many of my ADD adults share with me their scary versions of this story still feeling the regret and guilt.

Dr. Craig Liden | ADD and SexI have found that adults with ADD often struggle with relationships and sexual activities as much as the adolescents do. Impulsivity frequently leads the adult with ADD to jump into relationships and sexual intimacy too quickly. At first, this intimacy feel good; it blots out the pain of loneliness that often accompanies adult ADD. But this quick, feel-good approach to sexuality commonly contributes to promiscuity, addictive involvement in pornography, and risky sexual behavior in the ADD population. In fact, individuals with ADD have been found to have a four times greater risk of acquiring a sexually transmitted disease than the general population.

ADD can also have a significant impact on sexual functioning in “normal” adult relationships as well. It is easy to imagine how the ADD adult with low arousal who finds himself particularly exhausted at the end of the day often has no interest or energy for sex. Many of my patients who have experienced chronic stress as a result managing their weak attention day in and day out struggle with the spectrum of sexual dysfunctions that occur in people who are depressed and anxious — decreased libido, difficulty with arousal, and an inability to reach an orgasm.

Apart from these sexual difficulties, it is not uncommon for the ADD individual’s poor communication and listening skills to interfere with intimacy and, in turn interfere with the quality of his sexual relationships. In my discussions with spouses of ADD individuals, complaints about self-centeredness in the bedroom are the norm.


We’re talking tricky topics this week on the Being Well Center blog.  Check in for discussions about ADD and drug abuse and ADD and chronic health problems.


Our current blog series is excerpted from Dr. Liden’s best-selling book, Pay Attention!: Answers to Common Questions About the Diagnosis and Treatment of Attention Deficit Disorder.

first photo credit: Patricia Mellin via photopin cc

second photo credit:.Andi. via photopin cc

The ADD Adult

lifespan_adultWhat specific behaviors indicate that an adult might have ADD?

Efficient attention is required for success in all areas of life. As an ever-present filter between the individual’s external and internal worlds, it screens all incoming and outgoing information to and from the brain. In this way, attention has a profound influence on how an individual experiences events and behaves in all life spheres: school, job, home, and neighborhood. It interacts with other skills and abilities to shape the quality of social interactions, school/job performance, and independent functioning. Therefore, behaviors that suggest attentional difficulty can appear in any area of a person’s life. The following behaviors identify some of the more common red flags that might signal ADD in adults ages 18 and over.

Adults with ADD

  • Being irresponsible; exhibiting poor follow through
  • Changing jobs frequently
  • Having trouble with money management, characterized by excessive spending and poor budgeting
  • Making repeated careless mistakes on the job
  • Exhibiting poor communication skills that result in repeated misunderstandings
  • Being late
  • Reacting before thinking
  • Lacking a healthy daily routine
  • Having difficulty managing children
  • Being overly dependent on spouse, boss, or co-worker for supervision
  • Abusing drugs and alcohol
  • Experiencing eating disorders
  • Lacking the ability to solve problems effectively
  • Lacking the ability to prioritize things
  • Taking on projects without thinking about what is involved
  • Experiencing depression and/or anxiety

ADD Basics 101 | Dr. Craig LidenIf you just recognized someone you know (maybe yourself?) in this list, go to ADDBasics.org and download Dr. Liden’s free guide, ADD Basics 101. In 10 clear steps, Dr. Liden will guide you to an accurate, trustworthy diagnosis and outline what you should look for in an effective treatment plan.


Check back next week when Dr. Liden discusses how ADD impacts sexual behaviors…

Catch up on previous posts in the Pay Attention series.

Our current blog series is excerpted from Dr. Liden’s best-selling book, Pay Attention!: Answers to Common Questions About the Diagnosis and Treatment of Attention Deficit Disorder.