Do people have ADD from birth?

ADD Basics FamilyAs we continue laying out the truth about ADD/ADHD, we turn to some of the most common, burning questions my patients, friends, family, and colleagues most commonly ask me.  The answers to these questions form a critical foundation to understanding the truth about Attention Deficit Disorder.

If people are born with ADD, why don’t problems show up right after birth?

ADD becomes apparent only when the inborn attentional differences interfere with the individual’s ability to meet expectations in the environment. Depending upon the severity of a person’s attentional differences, his temperament, the status of other skills and abilities, and the specific nature of environmental expectations, ADD can crop up at any point along the life span from infancy to old age. Let’s take a look at how this can happen.

Typically, individuals with ADD appear to be normal at birth. As children, they are minimally, if at all, delayed in meeting major milestones of accomplishment such as walking and talking. They generally reach school age with only minor problems in controlling their behavior and interacting with peers. The first grade classroom is often the first place where specific expectations for paying attention occur. As a result, the entry into school is one of the more common times when ADD first shows up. Other key transition points in the individual’s life where expectations for increased efficiency of attention can lead to the emergence of ADD include the following:

  • Movement to the upper elementary grades where time constraints are imposed and increased demands are placed on children to function independently
  • Movement to junior/senior high school where more refined organizational and study skills are required
  • Movement to college where fewer supports are available and the ability to function independently is essential
  • Movement into a new home away from parents where there are no supports and the ability to function independently is even more critical
  • Marrying or cohabiting with a partner where functioning impacts upon the quality of life of another person and demands for efficient problem-solving are high
  • Becoming a parent where responsibilities for keeping it all together, all the time is essential

Individuals with ADD who have strengths in other areas (e.g., strong language skills, a charming personality, intellectual giftedness) can go a long time in life without being identified as having a problem. I have seen many children go through elementary school with A’s and B’s only to have the bottom fall out upon entry to middle school or junior high school. In these circumstances, careful probing of the educational history of these children often reveals evidence of attentional weaknesses that have either been overcome with sheer brain power or been overlooked by parents and teachers because these subtle weaknesses hadn’t really led to failure.

While failure to meet increasing school demands is a very common way for ADD to be uncovered, it can also happen as a result of failure to meet increasing demands for independent functioning, social interaction, or problem-solving at home, in childcare, in the neighborhood, or on the job.

Meet Michael

Michael is a good example of this. He is a 10-year-old boy who has always done very well, academically and socially. He has learned new concepts quickly, has shown a gift for memorizing facts, has been easy to get along with, and has always been a great conversationalist.

Until two months ago, he had also functioned very well at home. At that time, however, his mother got a new job that meant she was no longer able to be with Michael after school. And, despite all of her attempts, she had been unable to find someone who would stay with Michael until her new workday ended. So, for the first time, Michael was on his own everyday from 3:00 p.m. to 6:00 p.m.

The new expectation for him was “keep yourself busy and stay out of trouble for three unsupervised, unstructured hours.” This new demand uncovered Michael’s impulsivity, distractibility, and lack of ability to think through the ramifications of his behavior. He broke a living room lamp by rough housing in “off-limits territory”; he burned a hole in the new family room couch while “fooling around” with a butane lighter; and he soaked the bathroom carpet when he ran to answer the telephone, forgetting to first turn off the faucet.

Without his mom around to help him structure his time, to remind him of the house rules, and to watch over his activities, Michael had become dysfunctional.

Meet Emma

Emma’s story is similar. She is a 22-year first year elementary school teacher who has just married. Emma is gifted, kind, funny, sensitive, and very hardworking. Until now she has done well in almost every sphere of her life, but she has never been asked to establish her own home, to share finances, nights, and laundry with someone else, to complete daily lesson plans for five subjects, to effectively manage thirty fifth-grade children for six hours every day, and to negotiate unclear work politics all at the same time.

Emma is a mess. Despite her intelligence, her hard work, her sense of humor and her likeability, she is not experiencing success anywhere in her life.

Catch up on previous posts in the Pay Attention series.

Patients of all shapes, ages, and sizes come to The Being Well Center and Dr. Craig Liden for diagnoses and treatment plans they can trust. Can we help you too? Visit The Being Well Center for more information about Dr. Liden’s services.

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.

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Jeff is a great kid! He just forgets.

Do you recognize these people?

bwc_lifespan

Annie, age 35

Annie is an attractive mother of three.  To look at her you would never guess what a disaster every area of her life has been since college.  As a young teacher, she never developed lesson plans and couldn’t control her classes.  She wanted to do something else but didn’t feel she had the skills.  Instead, she started a family.  As a homemaker, she rarely cooks a meal, struggles to pick up the house before her husband gets home from work, and has 45 half-done projects.  She manages the family finances–writes the checks, but forgets to mail them.  Her relationship with her husband is poor, and she feels guilty about not meeting her children’s needs.  She’s depressed, and her self-esteem is in the pits.

Adam, age 19

In high school, Adam was the class clown; everyone liked him.  Now, he goes to college because “that’s what everybody does!”  With the distractions of college life–being away from home for the first time, fraternity parties, weekend football games, and wild roommates–he is no longer able to get by on his quick mind and entertaining personality.  By the end of his first semester, he is on academic probation.  Despite this warning, threats by his parents, and all his good intentions, at the end of the second semester, Adam is asked not to return next fall.

Jeff, age 11

Jeff is a great kid!  He just forgets.  He forgets what his homework is.  He forgets to bring home the science book to study for tomorrow’s unit test.  He forgets to bring home his instrument for band practice.  He forgets to hang up his coat, to put his shoes away, and to throw his dirty clothes in the hamper.  He forgets to take out the garbage and to feed the dog.  He forgets to brush his teeth, to tuck his shirt in, and to make his bed.  If Mom wasn’t there to nag him, he’d probably forget everything–but still, he is a great kid.

Do you recognize Justin, Karen, or Lisa?
Do you recognize Melissa, Mark, or Betty?
Do you recognize Tina, Doug, or John?

These are my patients.  You may have recognized your son or daughter, your spouse, your parents, even yourself.  I’ve come to appreciate how ADD can look quite different across the lifespan, depending on circumstances, temperament, and expectations.  For some people, managing a home and family brings the conflict with ADD to a head.  For others, it’s the high expectations (and failures) at college.  Still others struggle in the smaller ways, like chronically forgetting homework.

Our current blog series is here to help you sort through the challenges of identifying and treating ADD / ADHD.  You might find there are a number of things you don’t know about ADD (but should).  You might find that you recognize my patients.  If you’re seeking answers, you’re always welcome at The Being Well Center, or you can download my free e-book, ADD Basics 101, in which I guide you through 10 clear steps to securing a diagnosis and treatment plan you can trust.

Patients of all shapes, ages, and sizes come to The Being Well Center and Dr. Craig Liden for diagnoses and treatment plans they can trust. Can we help you too? Visit The Being Well Center for more information about Dr. Liden’s services.

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.

Helicopter Parenting at College

For many college students, going away to school represents the first real opportunity to be on their own…some relish it, some fear it!  For many parents, this is a time when they may struggle to let go and allow their child to demonstrate self mastery, to show responsibility in meeting multiple new expectations, and to dig down deep to grow, achieve and, ultimately, graduate!

Navigating college challenges: the temperament of your significant others

Navigating college challenges: the temperament of your significant others

Large numbers of parents can’t negotiate the difficult transition from encouraging dependency to facilitating independence.  As a result, they become “helicopter parents,” hovering over every aspect of their college student’s life…daily “how are you doing” phone calls, repeated text reminders, wake-up calls, go to bed admonitions, daily grade checks on the college website, over the phone sobriety checks, tightly managing the bank account, and not so subtle threats about what will happen if he or she messes up!

It never ceases to amaze us how far co-dependent parents will go to protect their child from the reality of college life challenges.  One young man who recently came to us for help because he was struggling to meet expectations (i.e., submitting monthly reports, generating narratives to describe sales calls, etc.) in a job he secured with a Fortune 500 Technology Company after graduation.  As it turns out, these were demands he never really had to face at college.  “I never wrote one paper at college.  I would send the syllabus or the rubric for an assignment to my Mom who would do the whole thing and send it back to me to give to my professor!”

Most parents sense that this degree of co-dependency is wrong but persist because the pattern is deeply ingrained.  Oftentimes, it developed years earlier in elementary or middle school.  Nagging about homework.  Making flash cards for their child to use to study for exams.  Obsessive editing of papers and essays.  Doing the homework.  Eliminating chores.  Tolerating underage drinking or drug use.  Minimizing problems.  Blaming the teachers.  Providing rewards for doing the basics.

Once this pattern is established, it can grow ugly in high school.  The child oftentimes is dependent upon a nag or a reminder to get things done, yet becomes resentful, disrespectful, and manipulative when they get one:  “Quit nagging me!  I’ll get it done!  Why don’t you trust me?”  Such interchanges can put parents back on their heels:  “Damned if they do” (having to tolerate an “attitude” brimming with anger, intensity and negativity” or “Damned if they don’t” (fear of their child failing, losing opportunities, and not experiencing success).

When college comes along, it all gets magnified.  Parents can justify their enabling behaviors because they are only “rightfully” protecting their financial investment!

As parents, the forces behind enabling/co-dependent behavior are particularly powerful…love, protection, empathy, fear, sensitivity, sacrifice, and guilt.  So powerful, in fact, that they can sabotage all the positive things parents can do to promote their child’s independence and chances for success.

Here are some of the things they can do to trip parents up:

  • — Interfere with their ability to take an honest look at their child’s strengths and weaknesses
  • — Make them feel defensive when their child fails to meet an expectation
  • — Blind them to their child’s role in his difficulties
  • — Lead them to do for their child rather than support him to do for himself
  • — Inhibit them from imposing necessary and appropriate consequences
  • — Encourage them to blame others when things do not go smoothly
  • — Act as a barrier that prevents them from allowing their child to take on ever increasing responsibilities for himself

Because co-dependency is so common (particularly in parents of children with ADD/ADHD) and it can be a critical barrier to success at college, we encourage parents to examine their enabling tendencies before and during their child’s college years.  In our new book, Accommodations for Success we have a simple survey called “First Things First” that can help parents assess their enabling tendencies.  Check it out!  Be honest and see where you stand!  “What’s you enabling quotient?”

Sometimes, just being more aware of enabling tendencies helps parents reduce or control them.  However, when enabling tendencies interfere with a parent’s ability to develop and /or follow through with doing the right things to promote their child’s success parents may need to reach out for help.  This may be as simple as requesting a significant other to be a source of feedback when one demonstrates thinking and behavior that is enabling in nature.  Of course, inherent in this strategy is the need to be committed to being non-defensive and accepting of the feedback!

Some parents find that it is important to develop a support network or a buddy to regularly meet with to discuss some of these difficult issues.  Some find it most helpful to meet individually with knowledgeable professionals to help find a pathway to healthy thinking and behaving when it comes to promoting their child’s growth and development.  If you need some extra support with your co-dependent tendencies, give us a call at the Being Well Center…we’ve helped thousands of parents get their act together.

Failure to get these enabling behaviors under control can be a major barrier to independence and success.  Sometimes parents have to step out of the way in order to allow their child/student to move forward and reach his/her full potential.  If this is hard for you, then it is important to reach out to a spouse, a co-worker, or a professional for support to meet this most difficult challenge!  Stay on guard and work to avoid allowing these tendencies to interfere with your child’s success at college.

COMPARISONS: Self-Esteem in the College Student – It’s an inside job!

Life has taught most of us that thinking you can accomplish a task or reach a goal is half the battle.   There is little doubt that a strong self esteem and realistic self confidence can be a key to success in many of life’s endeavors.  Success at college is no exception.

c@c_whole_you_blog_comparisonsThe new demands that college presents to our kids require a significant degree of self confidence to successfully meet.  Academic challenges that are far beyond anything they have experienced before, meeting and establishing relationships with all types of new people from roommates to professors, advocating for themselves, remaining resolute and acting on their values, and being honest with themselves and us about how they are really doing  are a few of the biggies that require a strong self esteem.

It’s no wonder that as parents, we often go to great lengths to boost our child’s self esteem when it comes to college.  Encouraging her to “reach” for a prestigious school that will look good on the resume even though it stretches her capabilities or our finances too far.  Outfitting our child’s wardrobe and room with only the best in an attempt to ensure that he will fit in when he  arrives on campus.  Setting up bank accounts so that she always has plenty of spending money without ever establishing a budget.  Subtly promoting permissive attitudes about indulging in drinking so he fits in socially (i.e., “we know you’re going to do it so . . .”)

During the high school years ramping up to college, we (and teachers) may cut our kids breaks through easy grading or opportunities for “extra credit” to cover up an inadequate performance.  As a result, our child never has to face failure and come to grips with her strengths and weaknesses, thereby, limiting her ability to develop coping and compensating strategies.  The lack of coping strategies is compounded by many of us excessively structuring our child’s life, providing repeated reminders and hovering over them to foster success.  Accountability and its rewards are replaced with endless pep talks . . . “You’re the greatest… you can do it if you put your mind to it!”

These kinds of parental efforts provide short-term “feel goods” at best.  They fail to recognize self esteem and self confidence don’t come from pats on the back and external circumstances but are cultivated from within . . . when our child independently works hard, faces and overcomes barriers, meets a realistic expectation, and is able to proclaim, “I did it!”

So how can we promote the development of self esteem and self confidence in our college student?  Here are some simple steps:

  1. As early as possible, help our child to truly understand himself…to know his strengths as well as his weaknesses.  This involves staying tuned into our child’s academic and social life, and communicating regularly and honestly.
  2. Based upon an understanding of who our child is, help her to set realistic expectations academically, socially, and behaviorally.  This means setting expectations that are not too high or too low, but “just right” . . . ones that stretch her, maybe even involve taking a bit of a risk, but in the end are attainable with effort and hard work.
  3. Ensure that our child has a plan to meet the realistic expectations including the structure and unique supports he needs to succeed.
  4. Don’t expect perfection from the start.  Let go and allow for “practice” that might involve stumbling and falling some.  Be there to help her get back on her feet.  Debrief what happened and what went wrong.  We all learn the most about ourselves and what it takes to succeed when we are picking ourselves back up as compared to when we are cruising along smoothly.
  5. Brainstorm compensatory strategies by asking our child what he could have done, said, or thought differently to have the performance or situation turn out more successfully.  By taking the time to help him generate his own solutions rather than lecturing or dictating what he should do, we promote the development of effective problem solving skills…a cornerstone of self esteem and self confidence.
  6. To close the loop and help our child become accountable, we need to set limits and provide effective consequences when she fails to meet realistic expectations when she has the tools (i.e., plan) to do so.  Appropriate, short-term, negative consequences promote self reflection while threats, lectures, and name calling only stir up intensity, anger, resentment, self pity and fear; all barriers to success and the development of strong self esteem and self confidence.

For more of the “How To’s” check out our recently released Accommodations for Success guidebook and workbook.  Take the “First Things First” survey to see if you have enabling behaviors that are getting in the way of your child’s success.  “Letting go” is imperative no matter how hard or scary it seems.  Enabling only postpones the inevitable, usually at a much greater cost for everyone.  If you need more guidance and support, call our office and set up an appointment.  We’ll walk along with you and help make sure you’re helping your child to be an independent, self esteem grower!

STRESSES – The Challenge of Taking Medication at College

When students arrive on campus, the demands for efficient attention and self management skills (that is executive functioning) immediately soar . . . challenging academics, consistent study habits, maintenance of healthy daily routines for sleep, eating and exercise, money management, and more complex social decision making.

c@c_whole_you_blog_stresses

Meeting college demands is particularly challenging for students with ADD/ADHD and for the overwhelming majority of them, this means having the aid of a medication regimen that provides benefits throughout the whole day.

We’ve learned from our experience in our Confidence@College program that college is a bad time to try to “fly on my own” and go without medication treatment.  In fact, in our C@C patient population, we have found that acceptance of the need for medication and compliance with an appropriate all-day medication regimen is near the top of the list of factors that contribute our 81% success rate.

For some ADD/ADHD individuals who have been able to get by without medication in the past, entrance into college with its increased demands means having to seriously consider the use of medication for the first time.  For others who have been able to get by with a medication regimen geared to get them through the school day, it means revising their regimen to provide coverage into the evening hours.  And for others, it means committing to taking the medication 7 days a week!

Don’t let an improper use or lack of medication keep you or your student from success at college!

At The Being Well Center, patients who enroll in our Confidence@College program always start with a Discovery Session where we identify the key problem areas and survey the whole person so we can pinpoint the barriers to success and uncover strengths we can mobilize to meet these new challenges.  We then develop an individualized Success Plan.  When medication is a part of the success plan we conduct systematic medication trial testing using objective testing procedures to find the right medication and a treatment regimen that provides efficient attention throughout the waking day.

Before students arrive on campus we brainstorm with them and their parents how they are going to get their medication and how to securely store it.  We go over the logistics of when they will take the medication based upon their weekly schedule.  In addition, we review the dangers of diversion of the medication and make sure we have a mechanism in place to closely track the quantity of medication we provide them.

Once students are on campus, we use innovative technologies and support from our staff through our GuideU video counseling sessions to ensure the student complies with the medication regimen and maintains healthy daily routines, the foundation for a successful medication experience.  We identify signs of sub-therapeutic treatment and possible side effects quickly and our medical staff fine tunes the treatment regimen as needed.

We’re there to ensure success during the whole college experience not just in the classroom, library or study carrel.  We make sure our patients are aware of the importance of taking the medication during evening hours and weekends where social activities provide high risk challenges for un-medicated ADD/ADHD students.  Impulsivity, poor self awareness, weak self monitoring and ineffective problem solving can lead to social decisions that can be disastrous . . . alcohol intoxication, substance abuse, unprotected sex leading to unplanned pregnancy or STD, or illegal activities.  One night of un-medicated “fun” can lead to expulsion from school and life-long consequences.

If you’re at the top of your game, college can be an exciting and enriching experience intellectually, developmentally, and socially, and can provide you with what it takes to independently fulfill your dreams and aspirations through life.  Compliance with the right medication regimen helps this become a reality for students with ADD/ADHD!

Be confident with your child’s success at college . . . call us at the BWC and set up an appointment to participate in our C@C program.  We’ll make sure your child has all the tools, including an optimal medication regimen if needed, to succeed at college.