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Better Sleep for Teens with ADHD

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). 

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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/

Tips for the COVID-19 Pandemic and Anxiety

Whether you already have an anxiety disorder or not, living in a pandemic is scary. For many, it takes an emotional and physical toll when even thinking about COVID-19, but you are not alone. The first step to persevering through any situation is identifying the emotions you are experiencing. Author Simran Sethi stated in The New York Times that there are ten ways to ease your coronavirus anxiety according to Dr. Harriet Lerner, a psychologist and author:

1. Know the facts of the situation - that “The Covid-19 pandemic has infected more than 500,000 people globally, rattling financial markets, upending local economies and resulting in thousands of deaths worldwide, with numbers expected to climb” (Sethi). However, it is also dire to manage the number of times you check the media in order to keep your stress level under wraps. If you are going to check the news, make sure it is from a reliable source such as the CDC, the World Health Organization, and your local public health authorities. Yes, this is happening in our own backyard, but we need to stay focused on what is most important, which is staying safe not just for yourself but for others.  

2. Put the pandemic in perspective - It is normal to feel overwhelmed but it is important that we do not bring ourselves down or compare ourselves to others because we feel this way. We need to realize that this pandemic is happening whether we like it or not and for who knows how long. The best way we can control it on our part is by not having any social interactions even though it is in our human nature and our own behaviors and emotions, focus on the things you can control. The Help Guide by Smith and Robinson, suggests that you can do the following tasks to help:

  • Wash your hands frequently (for at least 20 seconds) with soap and water or a hand sanitizer that contains at least 60% alcohol.

  • Avoid touching your face (particularly your eyes, nose, and mouth).

  • Stay home as much as possible, even if you don’t feel sick.

  • Avoid crowds and gatherings of 10 or more people.

  • Avoid all non-essential shopping and travel.

  • Keep 6 feet of distance between yourself and others when out.

  • Get plenty of sleep, which helps support your immune system.

  • Follow all recommendations from health authorities.

3. Identify the source(s) of your anxiety - If you can first label your emotions, then you know and understand that they are real and need to be taken care of. Plan for what you can by:

  • Writing down specific concerns you have about the coronavirus and how it may affect your lifestyle. If you feel overwhelmed, it is okay to take a break.

  • Making a list of all the possible solutions you can think of. There is no such thing as a perfect solution so just start writing down the first idea that comes to mind.

  • Focus on concrete things you can change, rather than specific circumstances beyond your control.

  • Create a plan of action once you have brainstormed all your options. When you’re done, sleep on it overnight and then change anything if you need to, but otherwise, try to refrain from coming back to it until your circumstances significantly change.

4. Refrain from shaming or blaming - When in survival mode, it is easy to blame others and forget that we are all in this together. We don’t want to fully suppress our emotions, but we can learn more about anxiety, how it works, the triggers, and the steps we can take to decrease and manage anxiety. Anxiety provides us with more information about our lives and can help motivate us to take steps to decrease or solve problems, as well as encourage us to reach out to support systems and connect with others.

5. Don’t be afraid to ask for help - When filled with fear, our judgment tends to get blurred and we are afraid to show that we need help. However, this could be the best time to ask what to do because none of us are knowledgeable enough to do this all alone without the right help. This could mean speaking to your kids’ teachers, reading the latest research from the CDC, and reaching out to your therapist.

You can help others in the process as well which will ultimately help you feel better. Even as simple as dropping off groceries or picking up medications for those you can’t  leave the house (the elderly or disabled), following guidelines for preventing the spread of the virus, or donating to food banks.

6. Don’t procrastinate about preparing for the worst - Anxiety, as Dr. Lerner states, can trigger individuals to over- or under-react, meaning some may start to compulsively wash their hands more than necessary and others may not take precautions with germs at all. Also, going to the store to obtain food and supplies that you would need for a couple weeks is preparing, however stocking up on a year’s worth of toilet paper may be too extreme.

7. Connect, connect, connect - Social distancing can be very difficult to maintain for some people, which is why it is important to stay in communication with the outside world and family/friends. Studies illustrate that teens have the hardest time social distancing and finding other ways to find happiness. Isolation can exacerbate stress for some people so it is important to stay connected even when physically isolated. The Help Guide recommends: 

  • Making it a priority to reach out to friends and families even if it means scheduling a regular phone call. 

  • Make face-to-face contact possible by face timing or using skype regularly

  • Utilize social media to connect with friends, family, and acquaintances but also the outside world. You are a part of a pandemic just as much as anyone else and it this is a convenient reminder that you are not alone. 

  • Stay mindful of how social media is making you feel. There are going to be times when having too much access to our screens can overwhelm us, so don’t hesitate to take a step back and turn off your device or remove things or people that are causing you anxiety.

  • Don’t let the coronavirus be the topic of every conversation, instead, take this time to catch up with others and focus on other aspects of your life. For some people, be aware that talking about the coronavirus can bring up even more fear when it’s not even your intention in the first place.

8. Practice self-compassion - Be gentle on yourself during these difficult times. This is the best time to practice eating healthy meals, getting plenty of sleep, exercising and meditating. Anxiety and fear also have physiological processes and may go in phases so sleeping, eating, exercising and meditating can be helpful in managing these to curb the extreme phases. Dr. Lerner reminds us that “Fear isn’t fun, but it signals that we are fully human.”

9. Don’t skip the self-care - This could be as simple as getting up and washing your face in the morning to feeding yourself throughout the day, try to maintain your regular routines. Any type of activity could help as well: exercise, yoga, meditation, reading, or religious and spiritual practices. All activities help you release your anxiety, relieve stress, and manage your food

  • Be kind to yourself especially if you are experiencing more depression or anxiety than usual, you are not alone.

  • Maintain a routine as best as you can to make it all feel a little less out of the ordinary 

  • Take time out of your day for activities you enjoy such as reading a book, playing a board game, learning a new language, working on a craft project etc.

  • Get out in nature, if possible. Just a simple walk around the block may make your day feel better.

  • Find ways to exercise.

  • Avoid self-medicating. This not a good way to avoid depression and anxiety.

  • Take up a relaxation practice such as deep breathing, meditation, and yoga.

  • Connect with friends and family via face time or skype

10. Don’t let fear and anxiety become pandemics, too - In other words, don’t let fear and anxiety take over your life, take over them and keep your anxiety at a manageable rate. Dr. Lerner reports, “we should not let fear lead us into isolation or stop us from acting with clarity, compassion and courage. Terrible things happen, but it is still possible to move forward with love and hope.”

We are all living in a scary time, one that many of us have never experienced before. For more information on how to lower your stress levels, manage your anxiety and Telehealth services, please visit our website at Hilber Psychological Services.

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

References:

Sethi, Simran. “10 Ways to Ease Your Coronavirus Anxiety.” The New York Times. 27, March. 2020. https://www.nytimes.com/2020/03/18/smarter-living/coronavirus-anxiety-tips.html

Smith, Melinda. Robinson, Lawrence. “Coronavirus Anxiety: Coping with Stress, Fear, and Uncertainty.” Help Guide. March. 2020. https://www.helpguide.org/articles/anxiety/coronavirus-anxiety.htm

HPS and Coronavirus

*Edited: The HPS Office is now closed to in-person or face to face therapy sessions, effective 12:00 on March 19, 2020 for the time being, due to the Shelter in Place order given by the California governor. We will open our doors and allow in-person sessions again when the order has lifted and it is safe.
Telehealth sessions are still available from the comfort and safety of your own home.

In light of current events and the contagious nature of COVID-19, the clinicians at Hilber Psychological Services request that all clients experiencing cold or flu like symptoms do not attend in-person sessions at the HPS office. We are able and happy to provide Telehealth sessions through our secure, HIPAA compliant video portal. If you have not attended a session with us using Telehealth before, your therapist can help instruct you on how to set up the connection on your computer or mobile device. Our clinicians have also been encouraged to stay home and offer video sessions if any of us experience symptoms indicative of COVID-19 or other contagious illness. The health and safety of our clients and staff are our priority.

Here are the steps we are taking to help prevent spread of germs to protect you and our staff so we can provide necessary services:

  • Offering Telehealth to all clients when clinically appropriate

  • Encouraging clients to reschedule or cancel 24 hours in advance if they have flu or respiratory symptoms, or to choose Telehealth instead.

  • Setting up a hand washing station

  • Asking all clients & families to wash hands when entering the waiting room and using hand sanitizer before and after entering office rooms

  • Providing information for COVID-19 facts, hand washing, and Telehealth options. 

  • Completing steps to ensure doors, furniture, toys, etc are clean

  • Completing UV light disinfectant in our offices & the waiting room

  • Keeping up to date with the latest information with the CDC and local services. 

Talk to your therapist about Telehealth Sessions for you and your family. Some may prefer to attend therapy in person and while the office will be available, Telehealth is very helpful and can provide the necessary support for many clients.

Please let us know if you have any questions

Sincerely,
Tanya Hilber, PsyD, Licensed Psychologist, PSY24479
And our Providers at Hilber Psychological Services

ADHD and Executive Functioning

In the article “What Is Executive Function? 7 Deficits Tied to ADHD,” author Russell Barkley discusses that an executive function “is the cognitive process that organizes thoughts and activities, prioritizes tasks, manages time efficiently, and makes decisions.” This is essentially the project manager for your brain.

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Executive function skills are skills that motivate us to keep moving forward whether that is with a project or daily activities. Barkley states that ”Individuals with executive dysfunction often struggle to analyze, plan, organize, schedule, and complete tasks at all…” These executive functions are executed by the prefrontal cortex of the brain. 

Barkley notes that there are four circuits in the ADHD Brain and Executive functions:

  • The “What” Circuit: Goes from the frontal lobe — linked to working memory and helps guide us on daily activities 

  • The “When” Circuit: Goes from the prefrontal area to the cerebellum — it is the timing circuit of the brain —it determines the sequence in which we do tasks — explains why people with ADHD often have difficulties with time management.

  • The “Why” Circuit: Goes from the frontal lobe to the central part of the brain to the amygdala — linked to our emotions —  helps us make final decisions based on how we feel. 

  • The “Who” Circuit: Goes from the frontal lobe to the very back of the hemisphere —  where self-awareness originates from. 

By understanding these four circuits and relating them to those who have ADHD, you can see what types of symptoms an individual may or may not have with certain deficits with emotion regulation, time management and memory deficits. 

Executive functions helps people reach goals and future plans. Furthermore, ”it’s about how we behave toward our future goals and what mental abilities we need to accomplish them” (Barkley).

Executive function is determined by the strength of these seven skills and how they affect/change one’s behavior and self regulation:

  1. Self-awareness

  2. Inhibition

  3. Non-Verbal Working Memory

  4. Verbal Working Memory

  5. Emotional Self-Regulation

  6. Self-motivation

  7. Planning and Problem Solving

These seven executive functions develop over time generally in chronological order. People who exhibit classic ADHD symptoms may have trouble with these seven executive functions. For example, those with ADHD who have problems with inhibition may have impulsive behaviors.

With awareness of these executive functions, parents can look for a professional evaluation to determine if their child has ADHD early on before it is apparent in their learning or grades at school. Then, those with ADHD can use knowledge, tools, techniques, and other treatments to improve their executive functions over time. 

For more information on how Hilber Psychological Services can help you or your child/teen with ADHD and executive functions, please visit our website or contact us for more questions.

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

Reference
Barkley, Russell and ADHD Editorial Board. “What Is Executive Function? 7 Deficits Tied to ADHD.”  ADDitude. 3 Oct. 2019. https://www.additudemag.com/7-executive-function-deficits-linked-to-adhd/