In the article “ADHD Catastrophizing in Times of Crisis: What To Do When Fear Spirals,” author Tamara Rosier describes that when you experience fear taking over, it is important to take a second to regroup and calm your ADHD brain in order to release the anxiety and problem solve appropriately. Managing ADHD during a pandemic may increase feelings of confusion, frustration, and anxiety and this may make it difficult to adjust to new situations, such as distance learning or working from home.

Below, Rosier states some strategies for managing this illness.

• Conduct a Daily Check Up: This means evaluating a situation. Not only looking at a situation from a different perspective, but taking a second to check in with yourself and your emotions and anxiety level. Based on these levels, regroup and figure out what can be cut out, minimized from, or added to your daily routine.

• Reorient yourself: Individuals may have irrational thoughts focus on the worst possible situation and thereby spending less time regrouping or problem solving. By combining the daily, reality checks of your reality and taking deep, slow breaths, you are allowing yourself to regroup. 

• Recalibrate yourself: Do a brain dump and get rid of all your thoughts and worries that are making you anxious by writing them down on a piece of paper. Visually seeing what is causing you stress allows you to realize what is or isn’t manageable and realistic to possibly keep or get rid of. Rosier suggests asking these three questions to check in with yourself:

  • How am I feeling right now?

  • How is that feeling affecting my day?

  • Do I want to change how I am feeling right now?

• Keep a Daily Schedule: By scheduling a routine, you can prevent the tendency to leave plans open-ended and instead, improve your productivity. Rosier suggests following the usual routine with sleeping, eating, and exercising regularly like you would on weekdays, prior to the COVID-19 pandemic. You can do this by asking yourself what needs to get done in the day and doing it during your designated productivity time. 

• Set a Rhythm for the Day: Create and follow the usual routine that works for your brain and the tasks that you need to complete. For example, when you know you are not a morning person, wait for your medications to kick in before you seriously start working. While waiting, you can prepare yourself for the day by following the strategies listed above.

• Avoid Unhealthy Hyper focus: It is important to block out the things that make you lose track of time, whether this is social media, worries, or people. This could be setting a few boundaries to limit one’s self of spending too much time on a task.

• Stay Social: It is crucial to stay connected with the outside world and with others in order to build that emotional bond. Find time and ways each day to have a conversation with someone. Connecting and talking with others increases your mental health and thereby your ability to manage your day.

Although it can be difficult at first to accommodate these new strategies, practice does make better. In times of crisis as this COVID-19 pandemic, it is important to make connections, have conversations, and seek guidance. For more information on how we can help manage your ADHD symptoms and create routines that work for you, please contact us or visit Hilber Psychological Services. 

• Written by Lily Schmitt and Tanya L. Hilber, PsyD

References

Rosier, Tamara. “ADHD Catastrophizing in Times of Crisis: What To Do When Fear Spirals.” ADDitude. 24, April 2020. https://www.additudemag.com/adhd-catastrophizing-coronavirus-fear/

Author Wes Crenshaw illustrates that poor sleep and attention deficit disorder (ADHD or ADD) are actually related. In detail, Crenshaw notes that “Poor sleep can lead to ADHD-like symptoms and complicate a diagnosis.” In fact, researchers, in the “ADHD Is a Myth” crowd, found that individuals with ADHD are declared to have sleep apnea, narcolepsy, or primary insomnia. It is then suggested that parents should start monitoring their child’s sleep patterns; ”quality of sleep must be considered in making an ADHD diagnosis” (Crenshaw). 

In crenshaw’s experience of working with two dozen teens and young adults for sleep studies, he found that the best solution to poor sleep patterns resulting from ADHD is stimulant medication. Results show that “Some teens will sleep better after beginning stimulants [and] A few will have daytime sleepiness despite taking them” (Crenshaw). Be aware that by treating ADHD with stimulants, sleep patterns will improve for some people while remaining or possibly limiting the effectiveness of the treatment for others, especially those with ADHD-related insomnia. Crenshaw notes that ”we find the Daytrana patch helpful for those with stimulant-induced insomnia, because it’s the only medication that can be shut off early (by removing the patch).” 

For those who have not had sleep problems before and have not overused napping but start to lose sleep after starting a medication, it is recommended that either they stop using stimulants and/or switch to a non-stimulant for ADHD. However, Crenshaw declares that “if the stimulants are working, we prefer to tinker with their timing and release to improve sleep.” This is why it’s important “to assess sleep problems before any medication is prescribed” (Crenshaw).

When trying to help teens develop a consistent sleep-cycle, it is import to remember that the results will not be apparent right away. Children, especially teens and those with ADHD, will first resist having restrictions on when they can sleep. For example, when trying ”to help a client manage stimulants and sleep, [scientists learned] that the client is staying up late and, in extreme cases, reversing the sleep-wake cycle” (Crenshaw). This is why good sleep is critical in treating one‘s poor habits and crucial to understanding the ADHD-sleep conundrum (Crenshaw). Because, if they do start to have a regular cycle, their quality of sleep will improve. 

In efforts to try to help teens with ADHD sleep better, try to 

1. Make time for it. Eight hours are recommended, especially with an hour of prep time. 

2. Turn off screens. They wake up our brains even more with all of the games and light they produce. 

3. Say goodnight to the (artificial) sun. It is important to shut off/block out (using shades) all artificial light in the evening. The body will then signal the brain that the night cycle is coming and that it should start preparing for sleep. 

4. Rise with the light. Progressively increase the brightness of a light in one’s bedroom (by using a timer) like the rise of the sun. 

5. No napping. Although ”many teens compensate for poor sleep by taking naps” (Crenshaw), researchers discovered that naps actually cause unhealthy sleep. In actuality, a 10- to 15-minute nap in mid-afternoon is recommended instead; “These may improve functioning and improve sleep” (Crenshaw).

For more information on therapists at Hilber Psychological Services can help your children and your family with parenting, sleep hygiene, and ADHD symptoms, please visit our website or contact us. 

For more information on how Neurofeedback services can assist your child with ADHD and sleep issues without the use of medications, please contact San Diego Center for Neurofeedback.

- Written by Lily Schmitt and Tanya L. Hilber, PsyD.

Reference

Crenshaw, Wes. “What Comes First: ADHD or Sleep Problems?” ADDitude. 18, June 2019. https://www.additudemag.com/adhd-sleep-problems-solutions/

In the article “The Building Blocks of a Good ADHD Diagnosis,” author Thomas Brown notes that ADHD should not be taken lightly and a complete diagnostic workup with multi-step procedures and a medical history review should be ordered and understood by the patient. An evaluation is recommended to be completed by an experienced licensed psychologist in order to provide the full evaluation and avoid a misdiagnosis.

In an ADHD evaluation, the clinician has several options to determine if your child has ADHD and would likely include the following steps or refer to another clinician who can provide a full psychological assessment that includes these steps.

Clinical interview: Find the root causes of ADHD by talking directly to the patient: “Why do you think you (or your child) may have ADHD?” “When? How do you notice it? When is this difficulty most evident? Has this pattern existed most of your child’s life, or is it something that started happening recently?”

Brown states that ”the clinician’s job is to identify patterns that may point to ADHD, or recognize that symptoms actually stem from something else.” Brown notions that a clinical review should cover:

• Challenges, symptoms

• Strengths, skills

• Family life, day-to-day stressors

• For children: school performance — grades, tests (including standardized test scores and how long they take to complete tests), whether or not they can complete homework on their own or need a parent’s help, etc.

• For adults: work performance — deadlines, productivity, etc.

• General health — including sleep and eating habits

• Family medical history, including other possible instances of ADHD

• Drug use (both prescribed and illicit)

• Previous evaluations (if any) and their results

• Related and comorbid conditions — mood disorders, anxiety, and learning disabilities are common in people with ADHD

DSM-V Symptom Review: Determine if a patient has the ADHD symptoms (at least 6 of the 9) listed in the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-V). 

Normed rating scales: These rating scales (Connors Scales, BASC, the Brown ADD Scales, or the Barkley scales) are used to see where a patient is at relative to others their age given their rated symptoms in various situations. Brown declares that “it is also often helpful for adults to have someone who knows them well complete a scale from their perspective.”

Standardized psychological assessments: There are many psychological tests that could help evaluate one’s reading, writing, and math skills that could help determine where one’s strengths and weaknesses lie and what could help. Sometimes ADHD is misdiagnosed if these assessments are not completed as there are other factors that affect focus and concentration, such as anxiety, depression, or learning disabilities. Brown states that “the vast majority of children with ADHD have at least one specific learning problem [which could] overlap genetically and in terms of functions like working memory. These tests include Woodcock-Johnson Test of Cognitive Abilities, Wechsler Individual Achievement Test (WIAT), Wechsler Intelligence Scale for Children (WISC-V).

Physical exam: Because ADHD-like symptoms are sometimes caused by internal medical problems such as thyroid conditions, physical exams ensure that a medical problem has not been overlooked and may be requested by the clinician.

In Brown’s opinion the following evaluation tools may be used in some cases to add to an ADHD assessment, however these are not known to be accurate tools for such an evaluation.

• Brain imaging: “ADHD is not a problem of brain structure, rather, it’s about communication within the networks of the brain” (Brown). However brain imaging may be helpful in providing Neurofeedback Treatment, which is a known treatment for ADHD symptoms.

• Online “reaction” tests: These tests dictate whether a subject has ADHD based on their ability to hit or retain from hitting a certain key every time a particular target comes into view. 

• Genetic testing: The testing of a few genes to see if they make up the genes in ADHD. 

ADHD Diagnosis Red Flags:

• Too quick to grab the prescription pad: When a clinician or doctor does not take their time to do a full evaluation but instead quickly prescribes a medication for ADHD.  

• Failure to include information from the school: When a clinician does not review a patient’s sense of how they function to the fullest by completing rating scales or interviewing closely related persons, teachers, or parents as part of the clinical interview.  

• Failure to use rating scales and psychological assessments: If a clinician does not decide to use rating scales and psychological assessments, then they will likely base their diagnosis of the patient’s symptoms on their personal opinion which can lead to a misdiagnosis. 

• Too fundamentalist about symptoms: If your clinician is too strict on the 6 symptom rule and neglects you from having the possibility of getting a prescribed medication to adhere to your ADHD because you only have 5 of the symptoms, then that is a red flag. 

• Saying, “Don’t worry, it’ll pass!” When your clinician dismisses you or your child’s concerns about ADHD symptoms that are disrupting your life and mental health.  

After the full assessment is completed a complete understanding of why the ADHD symptoms are present and what the next steps would be in managing the symptoms. A good report of the evaluation will provide specific recommendations for treatment along with an accurate diagnosis.

For more information on how Hilber Psychological Services can help you with understanding your or your children’s ADHD symptoms and the next steps for ADHD treatment, as well as connect you with experienced psychologists who can provide an evaluation, please contact us.

References

Brown, Thomas. “The Building Blocks of a Good ADHD Diagnosis.” Additude. 11, Oct.  2019. https://www.additudemag.com/how-to-get-diagnosed-for-adhd-ensuring-a-good-evaluation/

In the article, “Lazy Days of Summer? For ADHD Moms, That’s Not a Thing,” author Tricia Arthur describes how her never-ending, changing weeks can take a toll on her mental health. She notes that ”changes in a routine are very difficult for a person with attention deficit hyperactivity disorder (ADHD or ADD)” to juggle. Especially during the summer, one’s stress levels and self-doubt can increase because it is so hard to keep track of everything going on in not only your life but the rest of the family’s and still believe it is possible. 

Arthur’s life coach said, “that neurotypical people are a tad quicker and more intuitive than ADHD-brained people in making adjustments when changing circumstances require it.” Knowing this, it is understandable why you, who struggles with ADHD, has a harder time comprehending changing plans all the time. During this time, it is important to relax and give yourself a break and realize that everything will work out; you just have to take it step by step, day by day. 

Summer is the hardest season for most parents to get used to. From a routine every day to different plans each week, and even every day, is a lot to think about. It takes a lot of time to pan every little detail out, which can be exhausting. Although it may seem like you have the appropriate med regiment to reduce ADHD symptoms and the right amount of help and brain rest and self-care to keep a clear, open mind, it may also seem like you can snap at any moment because all these things are on your mind (Arthur). Each day something probably increases your stress level which makes you more anxious, however, it does not have to always be like that. Touching base with your therapist can also assist with these big changes to help it become a little smoother. As long as you acknowledge your stresses and take a step back to see how you can counterbalance them, whether that is by delegating or taking breaks in between, it is okay to be stressed.

Unfortunately, even if you are doing everything right, or just simply getting through the day, you will have to do it all over again. Arthur suggests writing a motivational note to yourself that reminds you that you are doing great and that stress is okay that says something like this:

“Dear Tricia, You have ADHD, and it’s for real. Know that everything it takes to run your family and your life is way more difficult for you than it is for others. This means you gotta take care of yourself more than others have to take care of themselves. This also means you gotta give yourself a crap ton of grace. You really are rocking it and you really are intelligent and when you don’t feel you are either, be patient. Also, layer on the self-care, consult with your ADHD-specialized psychiatrist, and did I say be patient? Breathe and be patient. Now is not forever. Healing, a better grip, and inner calm always return in time. Hang on. Remember: You rock! Love, Tricia”

For more information on ADHD and its symptoms, please contact us. To learn how we can help you or your child who may be struggling with being successful with ADHD, contact us or visit our website. For more information on therapy, visit Hilber Psychological Services.

To learn how Neurofeedback can help with ADHD symptoms, visit San Diego Center for Neurofeedback, APPC or contact SDCNF for for more information.

- Written by Lily Schmitt and Tanya L. Hilber, PsyD

References:

Arthur, Tricia. “Lazy Days of Summer? For ADHD Moms, That’s Not a Thing.” Attitude. Web. 7,  Aug. 2019. https://www.additudemag.com/i-hate-summer-adhd-mom