Pay Attention…we’re starting something exciting!

As the saying goes, “Time sure flies when you’re having fun.”  It’s hard to believe that it has been more than 30 years since I first began studying and treating ADD and 26 years since I published my first best-selling edition of Pay Attention.

I have now participated in the care of more than 10,000 children, adolescents, and adults with Attention Deficit Disorder.  I have seen some of them regularly for more than 20 years.  This has given me a chance to watch ADD evolve across the lifespan from early childhood to late adult life.

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While this experience has probably contributed to the graying of my hair, it has also made me much wiser about ADD, its varying manifestations, its impact on health and well-being, and its chronic, unremitting nature.  I have also gained more insight about why ADD can be so difficult to recognize and accept, and how empathy and caring from loved ones cal lead to enabling and unhealthy codependency.

The basic philosophy and principles that I have used to address problems like ADD remain the same today as they were more than three decades ago when I first started working with ADD.  This solid foundation has been a stabilizing force that has made it easier to absorb and integrate the many changes that have occurred within the ADD field and in health care in general.  Despite sophisticated technological advances that have refined our understanding about the biological underpinnings of ADD, diagnosing it remains a clinical art that requires a systematic approach, effective communication skills, and time.

Similarly, even though we have many more medication options available to us to treat ADD, successful management is still best achieved by employing a systematic approach that embraces the unique characteristics of each ADD individual and strives to provide symptom relief in all life arenas throughout the waking day.

Over the past 30 years, I have also had a variety of exciting professional activities out of the office, which have enriched my perspective about ADD.  I have visited the offices of hundreds of primary care physicians in order to teach them how to identify and treat ADD and, in turn, have gained a greater appreciation regarding the barriers they face in trying to meet the needs of this challenging group of individuals.

I have been privileged to lecture about ADD to numerous lay and professional audiences from Florida to Alaska.  I was invited to make a presentation entitled: “TRANSACT: Toward a Standard of Care for ADD” at one of the first international conferences about research and practice in ADD in Jerusalem, Israel.  I recently helped establish an ADD clinic, Servyr, in El Salvador using the same principles and procedures that I have found so successful in my practice in Pittsburgh, Pennsylvania.

OWN: Oprah Winfrey NetworkMost recently, I had the pleasure of working with Lisa Ling and her production team as they highlighted the diagnostic and treatment strategies of The Being Well Center in Lisa’s docu-series “Our America” on the Oprah Winfrey Network.  Lisa’s passion for the investigation stemmed from her personal quest to determine, “Could ADHD be the cause of my struggles?”  The positivity and enthusiasm Lisa and her team exhibited were noteworthy as I guided her through The Being Well System diagnosis.

These experiences, along with many others, have reinforced the fact that ADD is a common, serious problem that can be found everywhere.  All this means that there is an even greater need today for a practical resource like Pay Attention than there was when I wrote the first edition almost 30 years ago.  I hope and pray that, by sharing my experience through this upcoming Pay Attention blog series, I can positively affect some of the millions of individuals around the world whose lives are touched by ADD.

Pay Attention to our upcoming blog posts…I’ll dive into some of the most compelling issues surrounding the controversies of living with and successfully treating ADD/ADHD.  Together, we’ll raise awareness and acceptance of this disorder.  We’re starting something exciting with ADD.

Dr. Craig Liden, MD is the Founder and Medical Director of The Being Well Center, an ADD/ADHD diagnostic and treatment center located in Pittsburgh, PA.  Dr. Liden’s first book, Pay Attention, along with his other publications, are available for purchase at The Being Well Center.

ATTENTION-The sleepy, under-aroused college student

When we think about ADD/ADHD in a college student, we can easily imagine how impulsivity, distractibility, short attention span, problems with following through with directions, poor organizational skills, weak task/time management and procrastination, can wreak havoc on her success.  What may not come to mind, however, is one of the most common attentional weaknesses that contribute to college failure – low arousal level.

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So what is low arousal level anyway?

Well, at a very basic level, we must maintain a certain level of alertness in order to pay attention and regulate our behavior.  Arousal level refers to how awake and alert we are at any point in time.  Based upon our clinical experience with thousands of patients, we have found that many individuals with ADD/ADHD have a low arousal level; they are not alert and sufficiently awake to pay optimal attention.  This statement can be confusing to some people who presume that because some individuals with ADD/ADHD are “hyperactive” that they are hyperaroused when, in reality, the opposite is probably true!

A student with low arousal level can demonstrate a wide range of behaviors.  She may become fatigued during mundane activities (like listening to lecture or completing a 60-page reading assignment), yawn excessively, have a glazed look in her eyes, or actually fall asleep at her desk.  Commonly, ADD/ADHD students blame these behaviors on the task, the subject matter or the professor . . . “too boring.”  On the other hand, some ADD/ADHD students who are under-aroused demonstrate “hyperactivity” ranging from leg bouncing, wiggling in the chair, fidgeting, aimlessly playing with materials, and stretching or actually getting out of their seat and wandering around.  Our clinical experience suggests that these “hyperactive behaviors” are actually unconscious attempts by the ADD/ADHD student to self-stimulate herself in order to increase or sustain her arousal in a learning (or should we say “boring”) situation.

Other conditions or co-morbidities can magnify an ADD/ADHD student’s struggle with alertness or arousal including sleep deprivation, obstructive sleep apnea, iron deficiency anemia, poor nutritional habits (like skipping meals, pigging out, or self medicating with carbohydrates), depression and certain temperamental extremes (such as low frustration tolerance or short persistence) to name a few.  All of these conditions are very common in students with ADD/ADHD.  Sometimes these conditions even mimic ADD/ADHD in students who don’t have the diagnosis.

Commonly, low arousal can signal the possible need for medication treatment in a student with ADD/ADHD.  In those students already taking medication, it can indicate the need to refine the dosage level (generally it means there is a need for more) or dosage regimen (adding medication dosage(s) to provide all-day coverage into the evening when most students study and read those “boring” text books!)

At the very least, the tendency toward low arousal suggests the need to establish and maintain healthy daily routines for sleeping, eating, exercise and relaxation.

It should be obvious that unmanaged low arousal can be a major risk factor for college failure.  Dealing with it means getting a comprehensive evaluation to determine all the possible contributors and then developing a targeted, individual treatment plan to address each contributing factor.  That’s what we do at the BWC!  Contact us today so we can help your child “wake up” and start experiencing the success he or she is capable of!

Click here to download our Confidence@College screeners

Contact us to schedule a Discovery Session, and let us get to know you

ADHD – An All Day, All Life Problem

In the overwhelming majority of cases, ADHD appears to have a genetic basis.  The attentional weaknesses and executive dysfunctions that characterize ADHD appear to be the result of genetically based differences in the parts of the brain that control paying attention and regulating behavior.

This means that the core characteristics of ADHD including low arousal, impulsivity, distractibility, short attention span, and inefficient executive functions (i.e. poor working memory, time/task management, problem solving, response generation, emotional regulation, and self-monitoring), are there from the moment an ADHD individual wakes up in the morning until the time he/she goes to bed at night.

As a result, any life task that requires some degree of focused attention or executive self monitoring can be adversely affected by untreated ADHD.  As it turns out, this is a pretty profound statement!  Reflect back on your day today…try to think of one thing you did that did not require efficient attention or executive functioning skills.

Getting up?  Sorry.  Doing your morning routines?  No way.  Arriving at work on time?  Really?  Doing your job?  C’mon.  Taking to co-workers?  Hardly.  Making the right choices at lunch?  Think about it!  Driving home safely?  Huh?  Preparing dinner?  You’re kidding me, right?  Supervising homework?  Get real.  Getting to bed on time?  I doubt it!

When you think about it, its pretty unbelievable, isn’t it?  This is what makes ADHD such a serious and complicated problem.  And as life goes on, there are more and more demands placed on our attention and executive functions.  ADHD is clearly an all day, all life problem!

I have included with this post a set of Daily Activities Checklist that I use at The Being Well Center to establish the fact that a person’s ADHD is pervasive, impacting daily tasks in all areas of life.  This in one of the key criteria that needs to be met to establish the diagnosis of ADHD.  There’s one for kids and one for adults.  Try it and examine the impact ADHD has on your or your child’s life!

ADD Daily Activities Checklist – Child

ADHD Daily Activities Checklist – Adult

Watching ADHD Across the Lifespan: The Gray Hair Advantage

As Founder and Medical Director of The Being Well Center, Craig B. Liden, MD has charted new pathways to successful treatment of ADHD across the life span.  Today, he shares his professional journey from Harvard to The Being Well Center with the encouraging message that everyone, not just kids 18 and under, can live renewed lives with custom-tailored ADHD success programs.

Dr. Craig Liden of The Being Well Center

After I finished my fellowship program at Harvard and the Children’s Hospital Medical Center in Boston, I joined the faculty at the University of Pittsburgh School of Medicine and founded the Child Development Unit at the Children’s Hospital of Pittsburgh.   I recruited a multidisciplinary team of professionals and implemented a series of clinical programs, established training activities for Pediatric Residents and Fellows, and conducted research, all focused on ADHD in children and adolescents.

I lasted almost eight years in academia before I decided to leave for the “real world” and set up a private practice in Developmental and Behavioral Medicine, a forerunner to my Being Well Center that operates today in the northern suburbs of Pittsburgh.

Not long after opening the doors of my practice, I had two important realizations.  First, the kids with ADHD that quit coming to the Child Development Unit when they hit age 18 hadn’t really grown out of their problems.  Once there was no longer “Pediatrics” or “Children’s” on a sign of the building, they came rushing in the front door, now struggling at college or just to make it in “big life.”  No one was out there to pick up where my team and I left off.  So, I started to see many young adults with ADHD and refining my protocols to meet their needs.

Secondly, many of the parents of the kids I worked with started to come forward: “Hey, Doc, I don’t know if you’ve noticed it, but I have all the same problems my kid has.  Can you help me?”   In reality, I had noticed!  But, I didn’t know where to send them because at that time no one was taking care of adults with ADHD.

Having established my own practice, I now had the freedom to open the door a crack and to start seeing a few select adults with ADHD.  I quickly got reinforced to do a lot more; not only did these adults start living healthier lives, but, not surprisingly, their kids started doing much better as well…the home was more structured, there was better follow through with discipline, medication was consistently taken on time and so on.

These two realizations and the steps taken to address them have given my team and I a unique opportunity to watch the natural history of ADHD across the life span in more than 9,000 patients over the past 30 years.  Currently, our youngest patient is three years old and our oldest is in her 90’s! So, we’ve been able to watch ADHD go from early childhood into young adult life, from adolescence to mid-adult life, and from mid-adult life to late-adult life.

This extensive experience watching ADHD across the life span has given The Being Well Center a unique perspective on what’s really important in treating ADHD successfully.

Have you ever thought, “I wish I knew then what I know now about _______?”  with regards to your daily habits, efforts at school, your parenting, your relationships, your health, or some other important aspect of your life?  Well, I have–about ADHD!  My gray hair and the wisdom that has come with it have given me special insights about ADHD, its impact on health and daily routines, its interaction with other characteristics like temperament, its proper treatment, and much more!  This blog will be dedicated to sharing this wisdom with you so that your life, your child’s, or your student’s will become more successful!

Dr. Liden is an internationally recognized expert in the diagnosis and treatment of ADD/ADHD. He is a board certified physician who graduated with honors from the University of Michigan and the Ohio State University College of Medicine.  He completed his pediatric training and a postdoctoral fellowship at the Harvard University Medical School/Children’s Hospital Medical Center. Dr. Liden has served on the faculty at the University of Pittsburgh School of Medicine where he started the Child Development Unit and spent years researching ADD/ADHD, training pediatric and psychiatry residents and other post doctoral students, and establishing a fellowship program in developmental and behavioral pediatrics.  Since the 1980’s, Dr. Liden has been in private practice evaluating and treating behavior and developmental issues across the life span. He has treated more than 9,000 patients with ADD/ADHD and related co-morbidities.

The Being Well Program

The Being Well Program

ADD is not an illness.  Rather, we like to think of it as the result of an inborn individual difference.  Some of us come into the world with blue eyes and some with brown.  Some have a tendency to be tall and some to be short.  Likewise, some people come into the world with good attention and some don’t.

ADD/ADHD affects our life in almost every imaginable way–it touches our confidence, our relationships, our performance, our health, and our future.  So how can we effectively treat ADD with a quick trip to the doctor’s office?

We treat the common cold with medication.  Treating ADD, and its impacts on our life, is far more complex.

That’s why The Being Well Center has established a 5-step program to equip  individuals and families with the tools, resources, and knowledge to thrive with ADD in a practical, confident way.

If you have the sniffles, go see your doctor.  If you want a lifestyle strategy for living with ADD, come to The Being Well Center.

Here’s how we’ll determine a unique, individualized plan for your situation:

The Being Well Program

1.  Discovery Session – Listening and Understanding

A thorough question-and-answer session, patients are given the chance to ask questions, express their concern, and tell their story.

2.  Assessment Session – Examining and Clarifying

A one-hour examination that assesses both physical and neurobehavioral health.

3.  The Being Well Plan – A Whole-Person Lifestyle Roadmap

A plan that defines the objectives and strategies for treatment and medication options, as well as a roadmap to overcome setbacks and get the most out of treatment.

4.  Continuous Support – Measuring Progress and Setting Goals

Regular follow-up visits to implement the plan, make adjustments, answer questions, review next steps, and celebrate victories.

5.  Independence – Preparing for the Long-Term

Cultivating and achieving a sense of confidence, self-dependence, success, and productivity for the future.

 

Contact The Being Well Center to get started at step one on your road to confidence, self-dependence, success, and productivity.