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Great Articles from the Archives ADD & School Conquering ADD in the Workplace Parenting Tips What A Coach Can Do How to Get the Sleep You Need Women & ADD Nutrition and Your Child SPECIAL COLLECTION

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Page 1: ADD Living With ADD

Great Articlesfrom the Archives

ADD & School • Conquering ADD in the WorkplaceParenting Tips • What A Coach Can Do

How to Get the Sleep You Need • Women & ADDNutrition and Your Child

S P E C I A L C O L L E C T I O N

Page 2: ADD Living With ADD

contentsparenting

3 ......The Surprising Secret to Happy Days6.......Mothering Without Smothering

school9.......Be Your Child's Strongest Advocate!11 .....Distractibility12.....Disruptive Behavior14.....Disorganization

health & medicine/diagnosis16 .....Better Late Than Never18.....Bedtime Battles23 ....“I'm Not Hungry, Mom”

adult AD/HD26 ....Is It Time to Get a Coach?29 ....Ten Keys to Conquering AD/HD in the Office30 ....AD/HD in Women

back page32 ....25 Things to Love About ADD

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Living with ADD is a special publication of ADDitude Magazine (ISSN-1529-1014). ADDitude is publishedbimonthly by New Hope Media LLC, 42 West 38th Street, Suite 901, New York, NY 10018. Copyright 2004 New Hope Media LLC. All rights reserved. Reproduction in whole or in part without permission is prohibit-ed. Web site: www.additudemag.com. To purchase additional copies or other reprints, go to www.additudemag.com/additudebooklets.asp or call 646.366.0830.

The information herein is offered only for general information and does not constitute medical or psychological advice. Please do not act on the information herein without first seeking the advice of your physician or a qualified mental-health professional.

Throughout articles in this booklet, an asterisk* denotes that a name has been changed to ensure privacy.

Page 3: ADD Living With ADD

To subscribe, call 1-888-762-8475 3

Every parent of a child with AD/HDhas heard the routine about rou-tines: All kids need structure, and

kids with AD/HD need even more. Set upa morning routine to get out the door ontime. Make sure homework happens atthe same time and in the same settingdaily. Do something fun to unwindbefore a regular bedtime. On paper, thisseems pretty basic. But when you’re rais-ing a child with real attention difficul-ties in the real world, setting and main-taining such routines can seem down-

right hopeless. Yet there is hope—evenhappiness—in sight. The keys: belief inthe power of family routines and a long-term commitment to them.

Well-intentioned parents may startout enthusiastically, yet throw in thetowel after a few weeks (or even days).“Billy just won’t listen. He doesn’t wantto go along with it.”

Routines can’t work if parents giveup too soon. To make structure trulyeffective, routines must be seen andimplemented as a way of life.

1parentings e c t i o n

the Surprising Secretto Happy Days

[Hint: It’s all routine] B Y P E T E R J A K S A , P H . D.

Page 4: ADD Living With ADD

Multiple BenefitsRoutines affect life positively on two lev-els. In terms of behavior, they helpimprove efficiency and daily function-ing. A predictable schedule offers struc-ture that helps kids feel safe and secure.

In addition, your whole family willbenefit psychologically. We experienceless stress when there’s less drama aboutwhen you’ll eat and where you’ll dohomework. And family identity is solidi-fied when everyone has a role (Anna setsthe table, Brian clears the dishes).

In these hectic times, a structuredlife may seem impossible. Everyone isjuggling schedules: work, school, pianolessons, soccer practice, and so on. Yet insuch times, structure becomes mostimportant. A review of 50 years of re-search, recently published in The Journalof Family Psychology, shows that even in-fants are healthier and exhibit better-regulated behavior when the familysticks to predictable routines.

Effective routines take commit-ment and consistency, with all familyadults presenting a united front.Routines should be established whenchildren are young and applied consis-tently as they grow—but it’s never toolate to start. Above all, don’t give up.

Here are suggestions to get youstarted. Just remember that successtakes time—sometimes months or years.But the benefits will last a lifetime.

Good MorningsThe goal each morning is to get every-one ready and out the door on time.Preparations made the night before,such as packing bookbags and layingout clothes, are crucial to a smoothmorning. Because many AD/HD chil-dren (and adults) are highly distractible,

avoid stimuli that are likely to throwthe routine off course. For example:

■ Leave the TV off in the morning.■ Don’t get on the computer to

check your e-mails.■ Ignore that new magazine or

catalog until the evening.

Homework HelperIt’s often said that the only consistentthing about children with AD/HD istheir inconsistency. This is particularlyproblematic when it comes to academiceffort. Not surprisingly, parent-childhomework battles are common. But anestablished study routine (time, place,methods) goes a long way towarddecreasing their frequency and inten-sity—if not eliminating them entirely.

■ Enforce a consistent start time.Make homework a habit.

■ Stay close to your child. Manychildren with AD/HD concen-trate better when an adult workswith them or is nearby.

■ Take breaks. Short breaks helpalleviate the boredom and men-tal fatigue that result from the struggle to maintain focus.

■ Have fun afterward. Your child ismore likely to apply herself tohomework when she knows thata fun activity, such as playing agame or watching TV, will follow.

Dinner’s ReadyFor hundreds of years, family membershave forged bonds around the dinnertable. In this age of the Internet and TVmovies on demand, a dinner ritual isstill beneficial, if not crucial.

Ideally, mealtimes should be apleasant social time, with business,school, or family problems left off the

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Page 5: ADD Living With ADD

table. It takes time and work to preparea family meal, but you’ll find the bene-fits are well worth the effort:

■ Family members stay connectedto one another’s lives.

■ Events are discussed and plansget made with everyone’s input.

■ Responsibility is encouragedthrough the regular chores of set-ting and clearing the table.

Good NightsYour goal at bedtime is to help your childwind down and get to sleep at a usualtime. Research shows that children withregular bedtime routines fall asleepsooner and awaken less often during thenight than those without them.

Children with AD/HD fight bed-time because, quite simply, going to bedis boring to them. Routines that offer

rewards and encourage relaxation canovercome the boredom. Things to try:

■ Have a light, healthy snack, likean apple or a rice cake.

■ Play a quiet, low-stakes game, orread a book.

■ Have a sweet and personal nightly lights-out ritual.

■ Try to get your child into bed atthe same time each evening.There’s no question that establish-

ing family routines takes a great deal oftime and effort. You may ask yourself,“Can we afford the time and the energyto do all of this?” A better questionmight be, “Can we afford not to?”

Dr. Peter Jaksa is the Parenting Editor and aScientific Advisor for ADDitude Magazine. He ispresident and clinical director of ADD Centers ofAmerica and a board member of the AttentionDeficit Disorder Association.

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To subscribe, call 1-888-762-8475 5

Top 10 Routine Builders1) Give specific instructions. “Put away your toys on the shelf in the closet.”

Be consistent—if the toys are stored on the shelf one night, they shouldbe put there every night.

2) Assign tasks that your child is capable of doing on his own. Success buildsconfidence. The goal is to teach your child to do things independently.

3) Involve your child in discussions about rules and routines. It will help himunderstand goals and teach him to accept responsibility.

4) Post routines, broken down into two to five tasks, in a visible location(refrigerator, bathroom mirror) and review lists regularly with your child.

5) Be realistic about time. Make sure you’ve set aside enough time for all thesteps. To be safe, add an extra five minutes.

6) Expect gradual improvement. It takes time to change old habits.

7) Praise effort—not just results. If your child set the table but forgot thenapkins, acknowledge that she’s trying. Reward good behavior more often than you punish bad.

8) Allow for free time in daily routines. Kids—and adults—need downtime.

9) If your child isn’t taking to the routine, seek help from a counselor whospecializes in AD/HD. A pro can help get you on track.

10) Stay focused on the long-term goals. Above all, don’t give up!

Page 6: ADD Living With ADD

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I first evaluated Donny* for AD/HDshortly after his eleventh birthday.Like many other parents, his moth-

er, Christine*, had a mixed reaction todiagnosis. There was sadness that herson was not “perfect,” but relief at find-ing answers that finally made his inat-tentiveness, impulsivity, and tantrumsunderstandable. There was hope for abetter future based on a treatment planthat would include academic accom-modations, therapy, and medication.Most of all, there was a powerful deter-mination on Christine’s part to dowhatever was necessary to help her son.

Donny’s mom soon became his

champion, protector, and advocate. Sheread books and browsed the Internet forinformation. She coordinated withDonny’s teachers, school counselors,soccer coaches, piano teachers, and par-ents of friends to make sure that theyunderstood and treated him fairly. Sheattended IEP (Individualized EducationPlan) meetings and helped shape hisacademic planning. She establishedmorning, homework, and bedtime rou-tines to make life at home more struc-tured, predictable, and manageable.The caring and supportive structurehelped Donny thrive. He was still ahandful compared to others his age, but

Mothering without

SmotheringWhen Conscientious Parenting Is Too Much of a Good Thing B Y P E T E R J A K S A , P H . D.

Page 7: ADD Living With ADD

he became a more successful, better-adjusted, happier child.

I saw the family again about fouryears later. Donny was backsliding. Athome, he was angry and defiant. Atschool, his grades were sufferingbecause of his procrastination, disor-ganization, and poor planning. Gettinghim to do anything was a battle of wills.He wanted to stop taking medicationand refused after-school academic sup-port. Grounding and other forms of dis-cipline had little effect on his behavior.

Christine was also worried abouthis choice of friends. They were not, shewas certain, a good influence. He waswithdrawing from family life and spend-ing more time alone in his room orhanging out with peers. Christine wasstill the concerned and motivated par-ent, but Donny wasn’t responding any-more. What happened, she wondered?

What happened is that Donnygrew up. At 15, he wasn’t the sameyoungster he had been at 11. His per-ceptions, expectations, and needschanged—some of them drastically so.Donny now described his caring anddedicated mother as controlling anddemanding, someone who constantlynagged him. She was always lookingover his shoulder, he said, always bug-ging him about his friends. And shetreated him like a baby; all of hisfriends’ parents gave their childrenmuch more freedom. Couldn’t she get alife and get off his back?

The family’s dilemma was similarto many I’ve seen over the years. Anordinary mother becomes Supermomin an attempt to build a decent life forher challenged child. But the interde-pendency becomes so entrenched thatMom can’t let go when it’s time. She’s

spent so many years protecting himfrom the blows of the outside world,she fears he’ll fall to pieces without herconstant support.

Whether or not a child has AD/HD,a take-charge, proactive parenting style—no matter how well-intended—feels likecontrolling and smothering to teens.Teens don’t want to be taken care of.They want independence and autonomy.

Donny felt embarrassed that hismother checked with his teachers everyweek to monitor his schoolwork. He wasmortified that she wouldn’t let himtake driver’s ed until his gradesimproved. The schedules and routinesat home made it feel like living in acage. All household rules and, for thatmatter, taking medication, felt likeways of controlling him. In fact, Donnywas tired of everything about AD/HD.

Donny wanted more responsibilityand found his way blocked by—of allpeople—his caring and well-meaningmother. By trying too hard to be help-ful, Christine was keeping her teenageson a dependent child.

Something had to change—and ithad to start with Christine. Nothingmajor, just a gradual loosening of theapron strings that would foster Donny’sindependence without constantly get-ting him into hot water. Here are theTen Rules of Mothering WithoutSmothering that I suggested to helpChristine become the parent that herteenage son needed now.

1Keep your goals realistic. AD/HDcannot be “cured.” The goal is to

manage the disorder as effectively aspossible. Your AD/HD child will never beperfectly behaved (nor will any otherchild). Expecting too much will onlyfrustrate both of you.

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Page 8: ADD Living With ADD

2Don’t let guilt or fear make youoverprotective. AD/HD is nobody’s

“fault.” Your child is not doomed to alife of failure if you don’t protect herfrom every danger and solve her everyproblem. Overprotecting is smothering.

3 Don’t bail out the child fromevery mistake. Let the child live

with “safe” mistakes in situations thatwon’t cause irreparable damage. Lethim learn from the natural conse-quences that result from his behavior.To learn responsibility, there must beaccountability.

4 Respect the child’s need for privacy. Everyone needs some space

that is private and personal. Knock onclosed doors before entering. Don’tsearch the child’s room or go throughher possessions unless there is good rea-son to believe you’ll find somethingunhealthy or unacceptable.

5 Don’t try to choose your child’sfriends. This strategy usually back-

fires, particularly with teens. Before you forbid your child to see a certain friend,be sure that you can follow through andenforce your decision.

6 Provide monitoring based on thechild’s needs and developmental

level. Children with AD/HD need to bemonitored more closely, and up to anolder age, than children without it.Lack of monitoring increases thechance of getting into serious trouble.Too much monitoring causes conflicts,resentment, and rebelliousness. Takeyour cues from the child’s behavior.

7Allow freedom and privilegesbased on your child’s develop-

mental level. As he demonstrates anability to behave responsibly, increaseprivileges and freedoms. “If you abuse

it, you lose it” is a good rule of thumb.

8 Encourage and support independ-ence. Our ultimate job as parents is

to raise a child who no longer needs us.Confidence, self-esteem, and the abilityto tackle life’s challenges come fromfeeling competent and self-sufficient.

9 Don’t misinterpret teenage inde-pendence and mild rebellious-

ness as disrespect or rejection.Individuation, developing one’s ownsense of identity separate from par-ents, is the major developmental taskof adolescence. Allow your teen toexpress mild rebellion in “safe” areas.

10 Pick your battles. Not every-thing is worth fighting over.

Otherwise, everything becomes a battle.Take a stand on the important issues,and don’t sweat the small stuff.

Once Christine realized that Donnywas no longer the helpless, fragile childshe’d started out with, she adjusted herparenting style to fit his current needs.He still needs structure at home, butnot the kind of structure that’sdesigned for a 12-year-old. He still needsto have his schoolwork monitored, butnot as much as when he was younger.

And he also needs the freedom tomake his own decisions, possibly fail,but then learn to regroup—much moreso than when he was younger.

No doubt there will be mistakesalong the way. Let some of those slip-ups happen while you’re still in a goodposition to help your child make senseof his mistakes and learn from them.

Dr. Peter Jaksa is the Parenting Editor and aScientific Advisor for ADDitude Magazine. He ispresident and clinical director of ADD Centers ofAmerica and a board member of the AttentionDeficit Disorder Association, and the author of 25Stupid Mistakes Parents Make.

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Page 9: ADD Living With ADD

To subscribe, call 1-888-762-8475 9

For the parent of a child withAD/HD, advocacy is not a role ofchoice—it is a responsibility thrust

on us the day the child is born. Thequestion is not whether the child willneed us to speak for his or her educa-tional needs, but rather when, withwhom, and to what purpose.

Being an effective advocate for yourchild requires:

■ Fully understanding your child’s

strengths, weaknesses, and needs. ■ Knowing about educational

rights, how the system works,and what resources are available.

■ Communicating effectively andworking cooperatively with yourchild’s educators.

■ Involving the child in planningand decision-making, to demon-strate unequivocally that you areon the same side all the way.

2schools e c t i o n

Be YourChild’s

StrongestAdvocate!

Be YourChild’s

StrongestAdvocate!

BY PETER JAKSA, PH.D.

Page 10: ADD Living With ADD

UNDERSTAND YOUR CHILD For the past15 years, I’ve given parents the samemessage: “I have a Ph.D. in psychologyand I’m an expert on human behavior,but YOU are the expert on your child.”There is no substitute for parentalinsights about the nuances and detailsthat make a child unique.

To be an effective advocate, youmust understand your child’s strengthsand weaknesses from both the “clini-cal” and the personal perspectives.Beyond that, it is vital to communicateyour knowledge about your child’s

needs to educators and other profes-sionals. You will share your informationwith many educators over many yearsuntil the child grows up.

LEARN THE LAW Every parent of achild with AD/HD should be familiarwith the legislation contained in IDEA(Individuals with Disabilities EducationAct) and Section 504 of the Americanswith Disabilities Rehabilitation Act.

COMMUNICATE EFFECTIVELY The mosteffective advocacy is collaborative, not abattle between parents and educators.The parent who is assertive, considerate,

and respectful will likely make moreprogress than one who goes in with anaggressive or confrontational stance.

Sadly, there are exceptions. Insome instances, the child’s needs areclear, reasonable accommodations orservices are requested, and the parentsrun into an implacable teacher orschool administrator. The parents’ taskat that point is to fight like a tiger forthe child’s needs.

INVOLVE YOUR CHILD The most impor-tant person in this process is yourchild. It can be daunting for a child ofany age to be singled out for specialinterventions, but it is even worse ifthe reasons are not clear to the childand he doesn’t feel included in thedecision-making. Their parents andteachers are asking them to do thingsthat none of their friends have to do!Younger children may internalize thefeelings of shame and the sense ofbeing “bad.” Older children feel stig-matized and react with resentmentand noncompliance.

It is better to feel like a participantthan a pawn. Even very young childrenwill accept interventions when the rea-sons and benefits are explained in away that makes sense to them.

Equally important is the parent’sattitude about advocacy and interven-tion. It’s not enough to provide disci-pline and guidance. (“It’s time to startworking on your homework; turn theTV off.”) Let your child see you as cheer-leader and knight in shining armor. (“Ibelieve in you, I want the best for you,I’m behind you all the way.”)Educational interventions always workbest when children see their parents asa source of unflagging support.

10 Subscribe online at www.additudemag.com

ONLINE RESOURCES FOR ADVOCACY

>> Wrightslaw:www.wrightslaw.com.

>> The Advocacy Institute:www.advocacyinstitute.org.

>> ADDitude’s ClassroomAccommodations to HelpStudents with AD/HD:www.additudemag.com/PDF/Accommodations.pdf.

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THE PROBLEM: The student doesn’tseem to be listening or paying attentionto class material. He may daydream,look out the window, or focus on irrele-vant noises or other stimuli. As a result,he misses lessons and instructions.

THE REASON: AD/HD is not just aninability to pay attention. It is an inabil-ity to control what one pays attentionto. Studies suggest that children withAD/HD have a lower level of brain arousal, and are easily distracted whenan activity is not sufficiently stimulat-ing. They are unable to tune out distrac-tions, both internal and external.

THE OBSTACLES: Children withAD/HD struggle to stay focused on anytasks that require sustained mentaleffort. This distractibility may appearintentional—which works against theirgetting the help they need. Remarkssuch as “Earth to Amy!” will not correctthis attention deficit. If they could paybetter attention, they would.

WHAT HELPS IN THE CLASSROOM:

Where you place a student with AD/HDin the classroom is very important.

What is considered preferentialseating may vary among youngsters,but keeping AD/HD kids close to theteacher and away from doors or win-dows is usually best.

To prevent singling out the AD/HDchild, let everyone in the class try studycarrels, privacy dividers, earphones, orearplugs to block distractions duringseat work or tests.

Try to alternate between high- andlow-interest activities. Using a variety ofstrategies to accommodate differentlearning styles allows every student tolearn the way he learns best.

■ Try to include visual, auditory,and kinesthetic facets to all les-sons, as well as opportunities towork cooperatively, individually,and with the group.

■ Keep lesson periods short, and

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To subscribe, call 1-888-762-8475 11

BY ELLEN KINGSLEY

Distractibility

>>>> THE REST OF THE SECTION on school is adapted from ADDitude’s back-to-school booklet, Ready to Learn. The next five pages describe three behaviorsassociated with AD/HD, and offer practical, time-tested strategies for helpingyour child succeed in the classroom and at home. Read on to learn how to handle distractibility, disruptive behavior, and disorganization, and see the boxon page 15 to learn how to order a complete copy of Ready to Learn.

Page 12: ADD Living With ADD

12 Subscribe online at www.additudemag.com

vary the pacing from one lessonto the next.

■ Students who become distractedshould not be reprimanded, butredirected in a way that does notcause embarrassment.Sometimes, asking the child aquestion you know he cananswer, or giving nonverbal cues,such as patting the child on theshoulder, can bring him backinto focus.WHAT HELPS AT HOME: Help your

child avoid distractions and procrasti-nation that interfere with homework.First, establish a daily homework rou-tine. Maybe your child needs a breakbetween school and homework. Somechildren need frequent breaks betweenassignments.

■ AD/HD kids may need more “set-ting up” help than others theirage. Some need a distraction-freeenvironment, while others dobetter with music in the back-ground. Experiment until youfind out what works best.

■ Sit down with your child andmake sure he understands whatis required.

■ AD/HD children may need con-stant adult supervision to keepon task. As situations improve,and the child matures, however,a parent can check in frequently,rather than sitting by the child’sside throughout the process.

■ Providing short breaks betweenassignments, and allowing thechild to stretch or have a snack,often makes the workload seemmore manageable. If your child feels overwhelmed,

he’s likely to become distracted. Breakdown a large assignment into a set ofsmaller, easier tasks with stretch orsnack breaks in between. Divide thetask up with your child, and designate aclear end point for each segment.

Alert the teacher if you think yourchild does not have the skills to com-plete an assignment, or if it seems totake an inordinately long time.

THE PROBLEM: Children with AD/HDare often labeled unruly or aggressivebecause of their impulsive physical andsocial interactions. Though these chil-dren can be caring and sensitive, theyhave trouble controlling their impulses.

THE REASON: Children with AD/HDact before they think, often unable tocontrol their initial response to a situa-tion. The ability to “self-regulate” iscompromised; they can’t modify their

behavior with future consequences inmind. Some studies show that differ-ences in the brain in those with AD/HDare partly responsible for this symptom.

THE OBSTACLES: Many children withAD/HD seem to spend their lives in timeout, grounded, or in trouble for whatthey say and do. Lack of impulse controlis perhaps the most difficult symptomof AD/HD to modify.

WHAT HELPS IN THE CLASSROOM:

BY ELLEN KINGSLEY

Disruptive Behavior

Page 13: ADD Living With ADD

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Posting rules and routines lets the childknow what’s expected of him through-out the day. It is also a visual reminderfor children who act before they think.

■ Some children need “behaviorcards” taped to their desks(“Raise hands before speaking,”etc.). If privacy is an issue, tapethe cards to a sheet of paper thatremains on the desk during classbut can be stored inside the desk.

■ Writing the day’s schedule onthe blackboard and erasing itemsas they are completed giveAD/HD students a sense of con-trol about their day. Alert theclass in advance about any revi-sions to the daily routine.

■ Transitions are another stresspoint. Avoid meltdowns by givingthe class a five-minute warning,then a two-minute notice of animpending transition, so thatAD/HD kids have adequate timeto stop one activity and startanother.

■ Some children need teachers toanticipate potentially explosivesituations, such as those that canhappen in unstructured play.Overstimulation—lots of noiseand running around—can over-whelm AD/HD kids.

■ Have a plan ready in case lack ofstructure or another circum-stance sets off an impulsive reac-tion. Give the AD/HD child a spe-cial job such as “monitor” or“coach” to help him stay focusedon self-control.

■ Discipline can and should beused in certain situations. WhileAD/HD is an explanation for badbehavior, it is never an excuse.

AD/HD may explain why Johnnyhit Billy, but it did not make himdo it. Children with AD/HD needto understand their responsibili-ty to control themselves.

■ Discipline should be immediate,short, and swift. “Natural conse-quences” (such as detention) tendto be delayed, which doesn’twork for kids who have difficultyanticipating future outcomes.Consequences must be instanta-

neous. If he pushes another childon the playground, suspendrecess for 10 minutes. If he usesfoul language in class, respondwith a quick time-out.

■ Provide immediate, positive feed-back for good behavior. Be specific in labeling what AD/HDkids are doing well, such as shar-ing ideas with a partner, raisingtheir hand, or waiting their turn.

■ With younger children, establishat the beginning of the year thebehaviors you expect and postthem in the classroom (“Respect

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Others,” “Use an Indoor Voice,”etc.) as visual reminders.

■ Younger children often respondwell to a “point system” in whichthey earn pennies or stickerseach time they demonstrate apositive target behavior. They canredeem their points at the end ofthe week for a prize.WHAT HELPS AT HOME: Always pro-

vide AD/HD kids with clear, consistentexpectations and consequences.Children with AD/HD have difficultymaking inferences about right andwrong, so parents must be specific.

Telling your child to “be good” istoo vague. Be explicit: “In the store,don’t touch the dishes, look with youreyes.” “At the playground, wait in linefor the slide, and don’t push.”

■ Be proactive in your approach todiscipline. Recognize and remarkon positive behavior. Respond topositive actions with praise,

attention, and rewards. ■ Holding your child accountable

for his actions is imperative inmolding a responsible adult.However, punishment that takesplace long after the fact may pre-vent a child from fully under-standing its relationship to themisbehavior. Punishment mustcome soon after the misbehavior.

■ Let the punishment fit the crime.Hitting calls for an immediatetime-out. Dinnertime tantrumscan mean no dessert. Keep pun-ishments brief and restrained,but let them communicate toyour child that he’s responsiblefor controlling his behavior.

■ Let minor misbehaviors slide. Ifyour child spills the milk whilepouring a glass, talk to him aboutthe importance of moving slowlyand carefully, help him clean upthe mess, and move on.

DisorganizationTHE PROBLEM: The child forgets to

bring the right books and supplieshome or to school. His desk, locker,backpack, and notebook are in disarray.He forgets deadlines and scheduledactivities.

THE REASON: The neurologicalprocess that keeps us organized iscalled “executive function.” This is theability to organize, prioritize, and ana-lyze in order to make reasonable deci-sions and plans. Children with AD/HDand related neurobiological problemshave impaired executive function skills

due to abnormal dopamine levels in thefrontal lobe of the brain.

THE OBSTACLES: Punishment will notchange disorganized behaviors relatedto brain pathology. It’s confusing toteachers and parents when studentswith AD/HD are inconsistent in theirability to organize. Such children aresometimes labeled “sloppy” or “lazy.” Ifa child handles one task in an organizedway, it is tempting to believe he canalways be organized “if he wanted to.”

WHAT HELPS IN THE CLASSROOM:

AD/HD medications may somewhat

BY ELLEN KINGSLEY

Page 15: ADD Living With ADD

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improve ability to stay organized; how-ever, kids still need teachers and par-ents to provide support and teach com-pensatory skills. The key to helping kidsstay organized is constant communica-tion among teachers and parents.

■ Provide the student with two setsof books and supplies—one forhome and one for school—so hehas less to remember. This helpsconserve the mental energy thechild needs for his most impor-tant task: learning.

■ Never penalize AD/HD childrenfor messiness or forgetting sup-plies. These behaviors are symp-toms of their disability. However,helping children become moreorganized is an admirable andpartially achievable goal.

■ Provide a special assignmentnotebook with larger-than-usualspaces in which to write. A spe-cial “Trapper Keeper” binder withpockets in which to stuff papersis better than the standard three-ring binder.

■ Teachers should give assignmentsin writing, or check what thechild has written himself, toensure accuracy.

■ Color-code books and supplies bysubject. For example, use yellowfor all geography book covers,notebook dividers, and files. Usered for everything related to his-tory class, and so on.WHAT HELPS AT HOME: Organizational

skills rarely come naturally. Spend sometime with your child teaching the basicsof planning and organization.

■ Double-check assignment note-books to make sure that home-work is in its proper place once

completed. ■ Make multiple copies of all per-

mission slips, event announce-ments, and other paperwork topost in several areas of the house.These will serve as visualreminders of important dates anddeadlines.

■ Keep a three-hole puncher onyour child’s desk, for punchingpapers to be inserted into theschool binder.

■ Check belongings daily andorganize weekly by cleaning outand reordering backpacks, assign-ment notebooks, and binders.

■ Set up a color-coded file system,with colors matching the systemdevised for school, to store relat-ed papers that don’t need to betoted around every day.

■ Provide a place for everything: abox for school supplies, a storagerack for CD’s, a shelf for books, abulletin board for announce-ments, an under-bed box for oldartwork and papers.If your child rejects your efforts to

help him stay organized, impose logicalconsequences. If he loses a CD, for exam-ple, you don’t have to replace it.

Log on to www.additudemag.com/additudebooklets.asp toorder Ready to Learn. The 16-pagebooklet contains nine mini guidesto AD/HD behaviors (including thethree you just read) and an outlinefor success at school. We encourageyou to share and discuss the infor-mation with your child’s teacher!

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We knew early on that there wassomething different about ourson. Kevin had more than the

usual number of bumps and bruises.There were disastrous fights with hissiblings; angry outbursts; and impul-sive, attention-getting behavior. Butteachers and medical professionalsassured us that these “behavioral prob-lems” would improve in time. We beganto feel that maybe our expectationswere unrealistic or, even worse, that ourparenting style was flawed. Despite ourconcerns, we had to admit that hebrought much delight to our home.

DEALING WITH LATE DIAGNOSIS Tenyears passed before the situation brokewide open. One fall evening, we

received a call saying that Kevin, then16, had been arrested for a potentiallyserious prank at his high school. It wasduring the blur of court appearances,lawyer meetings, compulsory commu-nity service hours, and counseling ses-sions that the term “AD/HD” arose.Deconstructing the puzzle of his life—his uncontested title of class clown,short attention span, low self-esteem,refusal to conform, rocky relationships,sometimes dangerous and accident-prone behavior—it became clear thatthis was likely the underlying cause.

Why hadn’t his teachers sensedthis? How could his pediatrician, a med-ically trained professional, be unawareof the problem? But wondering why the

“BetterLateThanNever”BY PHYLLIS HANLON

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diagnosis was so late was useless. Thetask at hand was to help our son.

SEARCHING FOR ANSWERS We began tountangle the legal situation while con-sulting with one behavioral healthcounselor after another. Trying to makesense of disparate suggestions regard-ing medical therapy, disciplinary meth-ods, and assigning or withholding priv-ileges made our heads reel.

With Kevin, we began meetingweekly with a psychologist. For themost part, the sessions were uneventful,if not unproductive. The psychologist’sgentle manner proved ineffective in thehostile atmosphere of mandatory visits.By the time the sessions ended, we hadtaken mere baby steps toward a solu-tion. Our understanding of AD/HD hadbeen enhanced, but no clear-cutanswers had been found.

WHAT FINALLY WORKED The end offamily therapy coincided with Kevin’sgraduation from high school. Collegeheld no appeal for him—he was thrilledto escape boring lectures on subjects hethought were irrelevant to his life.Entry into the real world and a place of

his own were eventually more effectivethan any book or therapist.

After drifting aimlessly for a while,he found an occupation that exciteshim, and married a wonderful younglady. Although he’ll always be the life ofthe party and the one to blurt out state-ments that shock, Kevin has become afocused, motivated young man withmeaning and direction in his life. Hisrelationships with his siblings, formerly tense, have taken on a com-fortable, adult quality. Unwavering family support, thousands of prayers,and the excitement and encouragementof a love worked their magic on him.

Had Kevin received an AD/HD diag-nosis at an earlier age, our lives mighthave been very different. However, oncethe problem was identified, ongoingefforts to help the entire family acquireunderstanding and learn coping meth-ods produced a happy ending to whatmight have been a tragic story.

Phyllis Hanlon is a freelance writer in Charlton,

Massachusetts.

Are They Ready to Be on Their Own?“Young adults with AD/HD must reach the level of maturity where living,working, and relating to others like an adult is possible,” says Larry Silver,M.D., chairman of ADDitude’s Scientific Advisory Board. Dr. Silver recom-mends that, before moving out, the young adult and the family should all feelconfident that he or she can:

Manage his AD/HD through behavioral/medical intervention and be fullyeducated about the disorder.Practice basic life skills—the ability to eat right, get to work or school, budget finances, keep her home environment “livable.” and plan meals.Earn a living. Once on the job, the adult needs to be dressed and groomedappropriately, and work up to an employer’s expectations. The ability to think in an organized manner, problem-solve, and maintain a positiveattitude should be in place before entering the workforce.

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Ah, the thought of getting a goodnight’s rest, of falling asleep eas-ily, staying asleep through the

night, and then waking up easily—andrefreshed. For most people, this sce-nario is achievable. But for many withAD/HD, it seems only a dream.

People with AD/HD know howtheir sleep can be disturbed by mentaland physical restlessness. But, as withmost of our knowledge about adultAD/HD, we’re only beginning to under-stand a stronger AD/HD-sleep link.

Sleep disturbances caused byAD/HD have been overlooked for a num-ber of reasons. Sleep problems did notfit neatly into the American PsychiatricAssociation’s Diagnostic and StatisticalManual of Mental Disorders (DSM) state-ment that all AD/HD symptoms must bepresent by age 7. Sleep disturbancesassociated with AD/HD generally appear

later in life, at around age 12. The arbi-trary age cutoff prevented recognitionof sleep disturbances in AD/HD untilrecently, as studies of adults becomemore common. Just as AD/HD does notgo away at adolescence, it does not goaway at night either. It continues toimpair life functioning 24 hours a day.

Many researchers expect sleep dis-turbances to return as a diagnostic cri-terion when adult AD/HD appears inthe DSM V in 2010. For now, sleep prob-lems tend either to be overlooked or tobe viewed as coexisting problems, withan unclear relationship to AD/HD itself.Sleep disturbances have been incorrect-ly attributed to the stimulant-class med-ications often used to treat AD/HD.

THE FOUR BIG SLEEP ISSUESEven though no scientific literature oninsomnia lists AD/HD as a prominent

Bedtime BattlesBY WILLIAM W. DODSON, M.D.

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cause of sleep disturbances, adults withAD/HD know that the connectionbetween their condition and sleep prob-lems is real. Sufferers often call it “per-verse sleep”—when they want to beasleep, they are awake; when they wantto be awake, they are asleep.

The four most common sleep dis-turbances associated with AD/HD are:

1INITIATION INSOMNIA Three-fourths ofall adults with AD/HD report inabil-

ity to “shut off my mind so I can fallasleep.” Many describe themselves as“night owls” who get a burst of energywhen the sun goes down. Others reportthat they feel tired throughout the day,but as soon as the head hits the pillow,the mind clicks on. Their thoughtsbounce from one worry to another.Unfortunately, many of these adultsdescribe their thoughts as “racing,”prompting a misdiagnosis of bipolarmood disorder.

Prior to puberty, 10 to 15 percent ofchildren with AD/HD have trouble get-ting to sleep. This is twice the ratefound in children and adolescents whodo not have AD/HD. This number dra-matically increases with age: 50 percentof children with AD/HD have difficultyfalling asleep almost every night by age12; by age 30, more than 70 percent ofadults with AD/HD report that theyspend more than one hour trying to fallasleep at night.

2RESTLESS SLEEP When individualswith AD/HD finally fall asleep, their

sleep is restless. They toss and turn. Theyawaken at any noise in the house. Theyare so fitful that bed partners oftenchoose to sleep in another bed. Sleep isnot refreshing, and they awaken as tiredas when they went to bed.

3DIFFICULTY WAKING More than 80 per-cent of adults with AD/HD in my

practice report multiple awakeningsuntil about 4 a.m. Then they fall into“the sleep of the dead,” from whichthey have extreme difficulty rousingthemselves. They sleep through two orthree alarms. AD/HD sleepers are com-monly irritable, even combative, whenroused before they are ready. Many saythey are not fully alert until noon.

4INTRUSIVE SLEEP Paul Wender, M.D., a30-year veteran AD/HD researcher,

relates AD/HD to interest-based per-formance. As long as persons withAD/HD were interested in or challengedby what they were doing, they did notdemonstrate symptoms of the disorder.(This phenomenon is called “hyperfo-cus” by some, and is often considered tobe an AD/HD pattern.) If, on the otherhand, an individual with AD/HD losesinterest in an activity, his nervous sys-tem disengages, in search of somethingmore interesting. Sometimes this disen-gagement is so extreme as to inducedrowsiness to the point of fallingasleep. Marian Sigurdson, Ph.D., anexpert on electroencephalography(EEG) findings in AD/HD, reports thatbrain wave tracings at this time show asudden intrusion of theta waves intothe alpha and beta rhythms of alert-ness. We all have seen “theta wave intru-sion,” in the student in the back of theclassroom who suddenly crashes to thefloor, having “fallen asleep.” This wasprobably someone with AD/HD whowas losing consciousness due to bore-dom rather than falling asleep.

WHAT’S GOING ON HERE?There are several theories about the

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causes of sleep disturbance in peoplewith AD/HD, with a telling range ofviewpoints. Physicians base theirresponses to their patients’ complaintsof sleep problems on how they interpretthe cause of the disturbances. A physi-cian who looks first for disturbancesresulting from disorganized life pat-terns will treat problems in a differentway than a physician who thinks ofthem as a manifestation of AD/HD.

Thomas Brown, Ph.D., longtimeresearcher in AD/HD and developer ofthe Brown Scales, was one of the first togive serious attention to the problem ofsleep in children and adolescents withAD/HD. He sees sleep disturbances asindicative of problems of arousal andalertness in AD/HD itself. Two of the fivesymptom clusters from the BrownScales involve activation and arousal:

■ Organizing and activating tobegin work activities.

■ Sustaining alertness, energy, andeffort.Brown views problems with sleep

as a developmentally-based impairmentof management functions of the brain—particularly, an impairment of the abil-ity to sustain and regulate arousal andalertness. Interestingly, he does not rec-ommend treatments common toAD/HD, but rather recommends a two-pronged approach that stresses bettersleep hygiene and the suppression ofunwanted and inconvenient arousalstates by using medications with seda-tive properties.

The simplest explanation is thatsleep disturbances are direct manifesta-tions of AD/HD itself. True hyperactivityis extremely rare in women of any age.Most women experience the mentaland physical restlessness of AD/HD only

when they are trying to shut down thearousal state of day-to-day functioningin order to fall asleep.

The fact that 80 percent of adultswith AD/HD eventually fall into “thesleep of the dead” has led researchers tolook for explanations. No single theoryexplains the severe impairment of theability to rouse oneself into wakeful-ness. Some AD/HD patients report thatthey sleep well when they go campingor are out of doors for extended periodsof time. Baltimore-based psychiatristMyron Brenner, M.D., noted the highincidence of AD/HD individuals amongthe research subjects in his study ofDelayed Sleep Phase Syndrome (DSPS).People with DSPS report that they canexperience a normal sleep phase—getinto bed, fall asleep quickly, sleep undis-turbed for eight hours, and awakerefreshed—but that their brains andbodies want that cycle from 4 a.m. untilnoon. This is a pattern reported by morethan half of adults with AD/HD.Brenner hypothesizes that DSPS andthe sleep patterns of AD/HD have thesame underlying disturbance of circadian rhythms. Specifically, hebelieves that the signal which sets theinternal circadian clock (the gradualchanges in light caused by the sun’s set-ting and rising) is weak in people withAD/HD. As a result, their circadian clockis never truly set, and sleep drifts intothe 4 a.m.-to-noon pattern or disappearsentirely, until the sufferer is exhausted.

One hypothesis is that the lack ofan accurate circadian clock mayaccount for the difficulty that manywith AD/HD have in judging the pas-sage of time. Their internal clocks arenot “set.” Consequently, they experi-ence only two times: “now” and “not

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now.” Many of my adult patients do notwear watches. They experience time asan abstract concept, important to otherpeople, but one which they don’t under-stand. It will take many more studies toestablish the links between circadianrhythms and AD/HD.

HOW TO GET TO SLEEPNo matter how a doctor explains sleepproblems, the remedy usually involvessomething called “sleep hygiene,”which considers all the things that fos-ter the initiation and maintenance ofsleep. This set of conditions is highlyindividualized. Some people needabsolute silence. Others need whitenoise, such as a fan or radio, to maskdisturbances to sleep. Some people needa snack before bed, while others can’teat anything right before bedtime. Afew rules of sleep hygiene are universal:

■ Use the bed only for sleep or sex,not as a place to confront prob-lems or argue.

■ Have a set bedtime and a bedtimeroutine and stick to them.

■ Avoid naps during the day.■ Get in bed to go to sleep. Many

people with AD/HD are at theirbest at night. They are most ener-getic and think clearest after thesun goes down. This is their mostproductive time. Unfortunately,the jobs and families to whichthey must attend in the morningare not easy to handle on inade-quate sleep.

■ Avoid caffeine after dinner.Although many people withoutAD/HD report that coffee actuallyhelps them sleep, there is usuallya fine line between the rightamount and too much caffeine.

TREATMENT OPTIONSIf a patient spends hours a night withthoughts bouncing and his body toss-ing, this is probably a manifestation ofAD/HD. The best treatment is a dose ofstimulant-class medication 45 minutesbefore bedtime. This course of action,however, is a hard sell to patients whosuffer from insomnia. Consequently,once they have determined their opti-mal dose of medication, I ask them totake a nap an hour after they have takenthe second dose. Generally, they findthat the medication’s “paradoxicaleffect” of calming restlessness is suffi-cient to allow them to fall asleep. Mostadults are so sleep-deprived that a nap isusually successful. Once people see forthemselves, in a “no-risk” situation,that the medications can help themshut off their brains and bodies and fallasleep, they are more willing to trymedications at bedtime. About two-thirds of my adult patients take a fulldose of their AD/HD medication everynight to fall asleep.

What if the reverse clinical historyis present? One-fourth of people withAD/HD either don’t have a sleep distur-bance or have ordinary difficulty fallingasleep. Stimulant-class medications atbedtime are not helpful to them. Dr.Brown recommends Benedryl, 25 to 50mg, about one hour before bed.Benedryl is an antihistamine sold with-out prescription and is not habit-form-ing. The downside is that it is long-act-ing, and can cause sleepiness for up to60 hours in some individuals. About10% of those with AD/HD experiencesevere paradoxical agitation withBenedryl and never try it again.

The next step up the treatment lad-der is prescription medications. Most

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clinicians avoid sleeping pillsbecause they are potentially habit-form-ing. People quickly develop tolerance tothem and require ever-increasing doses.So, the next drugs of choice tend to benon-habit-forming, with significantsedation as a side effect. They are:

MMeellaattoonniinn, a naturally occurringpeptide released by the brain inresponse to the setting of the sun. It isavailable without prescription at mostpharmacies and health food stores.Melatonin may not be effective the firstnight, so several nights’ use may be nec-essary for effectiveness.

PPeerriiaaccttiinn.. The prescription antihis-tamine works like Benedryl but has theadded advantages of suppressingdreams and reversing stimulant-induced appetite suppression.

CClloonniiddiinnee.. Some practitioners rec-ommend a 0.05 to 0.1 mg dose one hourbefore bedtime. It exerts significantsedative effects for about four hours.

AAnnttiiddeepprreessssaanntt mmeeddiiccaattiioonnss, suchas trazadone (Desyrel), 50 to 100 mg ormirtazapine (Remeron), 15 mg are usedby some clinicians for their sedativeside effects. Due to a complex mecha-nism of action, lower doses of mirtazap-ine are more sedative than higher ones.More is not better. Like Benedryl, thesemedications tend to produce sedationinto the next day, and may make get-ting up the next morning harder.

PROBLEMS WAKING UPProblems in waking and feeling fullyalert can be approached in two ways.The simpler is a two-alarm system. Thepatient sets a first dose of stimulant-class medication and a glass of water bythe bedside. An alarm is set to go off onehour before the person actually plans to

rise. When the alarm rings, the patientrouses himself enough to take the med-ication and goes back to sleep. When asecond alarm goes off, an hour later,the medication is approaching peakblood level, giving the individual afighting chance to get out of bed andstart his day.

A second approach is more high-tech, based on evidence that difficultywaking in the morning is a circadianrhythm problem. Anecdotal evidencesuggests that the use of sunset/sunrise-simulating lights can set the internalclocks of people with Delayed SleepPhase Syndrome. As an added benefit,many people report that they sharpentheir sense of time and time manage-ment once their internal clock is setproperly. The lights, however, are exper-imental and expensive (about $400).

Disturbances of sleep in peoplewith AD/HD are common, but arealmost completely ignored by our cur-rent diagnostic system and in AD/HDresearch. These patterns become pro-gressively worse with age. Recognitionof sleep disturbance in AD/HD has beenhampered by the misattribution of theinitial insomnia to the effects of stimu-lant-class medications. We now recog-nize that sleep difficulties are associat-ed with AD/HD itself, and that stimu-lant-class medications are often the besttreatment of sleep problems ratherthan the cause of them.

Dr. William W. Dodson is a board-certified psychi-atrist in Denver, Colorado. He specializes in thetreatment of adults with AD/HD. His researchinterests are in sleep disorders and in the applica-tion of theoretical research to everyday practice.An earlier version of this article appeared inADDvance, the online e-magazine for womenwith AD/HD: www.addvance.com.

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AD/HD medications often triggerloss of appetite and, thus, loss ofweight. Here’s what you can do

for your child.About a decade ago, when we

started our daughter on medication, weknew there would be challenges. Butback then, information about AD/HDwasn’t as accessible as it is today. Onething we weren’t prepared for was herimmediate loss of appetite and weight.

Our pediatrician dismissed ourconcerns with a brief explanation that,during the first few weeks of medica-tion, we should expect our daughter tobe less hungry. We later found the real

explanation for our daughter’s weightloss: AD/HD stimulants may givepatients the feeling of being full and, atthe same time, drive up their metabolicrate. Fortunately, after a few months onstimulants, she began to gain back theweight she had lost. But for the nextdecade, our (now) 17-year-old daughterexperienced cycles of weight loss andgain due to a variety of medications.And she’s not alone.

WEIGHT MATTERS AD/HD medica-tions and appetite disruption often gohand in hand. “The main group of med-ications used to treat AD/HD are calledpsycho-stimulants,” says Larry B. Silver,

“I’m Not Hungry, Mom”BY GWEN MORRISON

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M.D., a clinical professor of psychi-atry at Georgetown University MedicalCenter in Washington, D.C. “Thesedrugs, methylphenidate (Ritalin), dex-tro-amphetamine (Dexedrine), andmixed dextro- and levo-amphetamine(Adderall), can cause a loss of appetite,which may lead to weight loss if themedication is continued.” But theeffects needn’t be extreme, especially ifmonitored by a physician and handledwith understanding by parents.

Katerina Cole-Slaughter’s son, now14, was diagnosed with AD/HD at age 6and was prescribed 5 mg of Ritalin,three times a day. The immediate sideeffect was loss of appetite, within 30minutes of taking the drug.

Cole-Slaughter combated this bygiving her son breakfast before he tookhis medication and holding his nextdose until after lunch. It worked, and heexperienced no weight loss. “After get-

ting up to 60 mg of Ritalin a day, weswitched him to Adderall, three times aday. Again, the side effect was lack ofappetite for several hours after taking it.And he made up for his lack of appetiteduring the day at dinnertime!”

This is not uncommon, saysAndrew Adesman, M.D., associate pro-fessor of pediatrics at Albert EinsteinCollege of Medicine in New York City.“All medications have the potential tocause side effects. With stimulants, oneof the side effects is decreased appetite,but this usually occurs only at midday.”Dr. Adesman says that the effect onweight is modest, usually seen in thebeginning of treatment. “Parents canminimize the effects by being flexiblewith meal schedules. Don’t force yourchild to eat, but offer him snacks when-ever he is hungry. He may eat later inthe day, and snack in the evening.”

Numerous studies have shown that

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Hunger Management> FEED NUTRIENT-DENSE FOODS. Pack a lot of nutritional value into a single serving

with foods like avocado, yogurt, peanut butter, turkey, and granola.

> FILL UP ON BREAKFAST. Offer your child a high-protein, high-calorie breakfast beforethe medication takes effect—food first, pill second.

> OFFER LIQUID MEALS. High-protein drinks, shakes, and smoothies are a fun way toensure that your child gets his share of daily nutrients. Vary flavors to add interest.

> ENCOURAGE GRAZING. Eating four to five small meals a day can keep her well-fed.Snacks should be healthy—avoid refined foods with empty calories.

> LIMIT JUICE INTAKE. Discourage your child from drinking more than eight ounces ofjuice each day, especially with meals, or she may feel too full to eat.

> SCHEDULE OUTDOOR PLAY BEFORE MEALS. Fresh air and physical activity help sparkyour child’s metabolism, prompting him to feel hungry.

> TRY NEW FOODS. Engage your child in the choice and preparation of new recipes toraise her interest in eating.

> GIVE VITES. A daily multivitamin helps protect against nutrition deficiencies.

> BUY FORTIFIED FOODS. Milk’s not the only fortified item on the market anymore.Look around your grocery store for enriched breads, calcium-infused juices, orsnack bars with a full day’s dose of several vitamins and minerals.

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decreased appetite generally tapers offover the first several weeks of a medica-tion regimen. Observe your child’s eat-ing patterns, try to get him to eat a goodbreakfast, and accept the fact thatlunchtime may not be his hungry time. Feed your child nutrient-dense foods topack a lot of nutritional value into a sin-gle serving [see “Hunger Management”on previous page].

Meds AdjustmentIf your child experiences more than a 10percent weight loss over a few weeks,his dose may need to be adjusted or theregimen changed entirely. The sideeffects of stimulants vary by child. Notall kids will lose weight, and some willhave to try several medications beforefinding the one that provides benefitswithout adverse reactions.

“For patients who don’t tolerateamphetamine-based stimulants well,there are alternatives, such asStrattera,” says Lisa Routh, M.D., direc-tor of medical health at the Universityof Texas Medical Branch at Galveston.Often, the slower-acting drugs are bet-ter for kids. “Appetite suppression is stillan issue with the amphetamine deriva-tives, but longer-acting drugs seem tohave a milder effect on appetite.”

When dealing with my daughter’sups and downs, I often felt more like apharmacist than a mother when itcame to monitoring medications andthe resulting weight changes. Stayingopen to new options, and being patientwith the current regimen of medica-tion helped us all survive.

Gwen Morrison is an Atlanta-area writer whosework has been been published in several nationalmagazines. Her article about her daughterappeared in the November/December 2003 issue of ADDitude.

THE OTHER SIDE OF WEIGHT LOSS

The American Academy ofPediatrics estimates that nearly halfof all children with AD/HD also suf-fer from depression, learning dis-abilities, or anxiety disorders. Thetreatment of these co-existing dis-orders often includes medicationsthat can cause weight gain. Forteens already struggling with com-plex social issues, this can be devas-tating. What can you do?

>> CONSULT YOUR PHYSICIAN ABOUTYOUR CHILD’S MEDICATION options,and be sure to note the side effectsof any new medication, suggests Dr.Lisa Routh. Several mood stabilizershave lower metabolic impact.Sometimes the benefit of a newmedication doesn’t outweigh theside effects. Weigh all the optionsbefore changing medication.

>> BE AWARE OF WHAT YOUR CHILDIS EATING. A medication may causeincreased appetite in children, so it’sup to you to have nutritious foodson hand to feed his cravings.

>> WATCH THOSE EATING HABITS.“Food should not be used as areward,” says Carmen de Lerma,M.D., medical director of SouthMiami Hospital’s Child DevelopmentCenter, in Florida. Also, have yourchild practice mindful eating by din-ing at a table, not in front of a TV,computer, or video machine.

>> ENCOURAGE PHYSICAL ACTIVITY.Exercise releases pent-up energy,burns calories, and improves mood.“Be creative in choosing physicalactivities so your child won’t getbored,” adds Dr. de Lerma. Adjustfor different weather scenarios, timeof day, days of the week, and soloversus group activities.”

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Kelly Bentley* wasn’t being para-noid. She was really about to befired. The law firm was no longer

willing to cut the 33-year-old attorneyany slack. She wasn’t billing her shareof hours, she was chronically late forcourt, and she could barely get to herdesk by 11 a.m. And she had no ideahow to make things right.

To make matters worse, her per-sonal life was in shambles. Kelly wantedto get pregnant, but to do that, you haveto spend time with your spouse. Thatrarely happened because she was sohopelessly backed up with work at theoffice. Although she desperately tried tocatch up, the cycle continued becauseshe was too exhausted to be effective.

How did a savvy lawyer get into thismess? And how would she ever get out?

Enter Nancy Ratey, the Harvard-trained educational psychologist who,along with her colleague Sue Sussman,is credited with creating a new profes-sion: coaching adults with AD/HD.

“Most of my clients are stuck in thespin cycle,” says Ratey, who has AD/HDherself. “People with AD/HD lose sightof their goals easily. I help people getout of their own way and move for-ward.” As for Kelly, the task was formi-dable, but she now meets her billablehours and is expecting a baby soon.

No Miracle CureCoaching doesn’t cure your AD/HD, andit doesn’t have an impact on your symp-toms. In fact, coaches frequently workin tandem with clients’ psychologistsand psychiatrists, who continue to pro-

Unproductive?Disorganized?

Can’t Get Started?

Stuck?

4adult AD/HDs e c t i o n

Is It Timeto Geta Coach?BY ELLEN KINGSLEY

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vide patients with needed mentalhealth and medical care. Coaching issimply a way of getting help with figur-ing out what you want in life and devel-op strategies to get there—step by step.

Nancy begins by analyzing aclient’s life on a daily basis. In Kelly’scase, AD/HD was causing problemsevery step of the way.

DISTRACTIBILITY Even when Kelly gotto the building on time, distractionskept her from getting to her office.Often, the culprit was the fresh flowerarrangement in the hallway. Kellywould stop to rearrange it, and getstuck on the task for hours.

PROCRASTINATION Kelly spent a lot oftime on things she didn’t need to do,leaving inadequate time for the thingsshe did have to do. The backlog was vis-ible in the stacks of paper on her desk.

TRANSITIONS Kelly had difficultyswitching from case to case, whichmight be required several times a day.Since she couldn’t handle the process ofputting one thing away and starting onanother, she’d often avoid it altogether.

DISORGANIZATION Kelly never devel-oped a system of tracking her billablehours. Even though she might work 10billable hours a day, it never showed upon her time reports.

POOR TIME MANAGEMENT Kelly couldn’t predict how long it would taketo review a case for court. She usuallystarted too late, and was often tardy forher scheduled court appearances.

FIGURE IT OUT Nancy Ratey is expen-sive, as coaches go. Her rates range from$60 to $300 an hour—more than manyphysicians charge. But good coaches—and Nancy is one of the best—areinsightful and efficient. She predicted itwould take about nine months to get

Kelly on track.The process is intense at first.

Someone like Kelly may need coachingevery day. But sessions aren’t long—usu-ally less than half an hour—and takeplace over the phone or by e-mail.

“Coaching is getting a person tofigure out how to do things for them-selves so that, after a coach is finished,the skills will last a lifetime,” saysNancy. “A coach should never tell aclient what to do.”

When you hear Nancy coachingKelly, it’s clear she’s doing her job.

KELLY: Hi, Nancy. It’s eight a.m. and I’msitting at my desk.NANCY: Okay. As your coach, what do youwant me to do?KELLY: Ask me which project I’m avoiding.NANCY: Okay. What next?KELLY: Ask me to take that folder on mydesk and open it.NANCY: Can you identify the next step nowthat the file is open?KELLY: To call the opposing attorney.NANCY: Can you do that right now andcall me back?KELLY: Yes, I’ll do that right now.

Kelly hangs up, calls the attorney,and calls Nancy back.

NANCY: Great. Now, can you name thenext three steps?

Kelly names the next three steps,lists her other priorities for the day, andpromises to report back to Nancy at five.

“You know you’ve done your jobwhen the person has learned to askthemselves the right questions, and canavoid their instant gratification distrac-tions,” Nancy explains. “Kelly is finally

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in that groove.”SUCCESS NOT GURANTEED Clearly,

Kelly is strongly motivated to change—and that’s a requirement if you wantNancy Ratey as a coach. “I retain theright to fire clients and end the coach-ing process,” says Nancy, who workswith clients about four hours eachweekday. “The client has to be in a posi-tion to develop goals, follow through,and be accountable. Otherwise, it’s notgoing to work.

“I won’t coach people with maritalissues. I can’t coach someone who isseverely depressed or addicted to drugsor alcohol. Coaching is a partnership,and clients must be ready, willing, andable to fulfill their end of the deal.” Inshort, if you aren’t willing to beaccountable to Nancy Ratey, you’re out.

Likewise, thereare many coacheswho aren’t up to par.Coaching is an unreg-ulated field. Anyonecan hang out a shin-gle, which is why it’simportant to checkcoaches’ backgroundsand training, andhow much they knowabout AD/HD. “ADDcoaching is totally dif-ferent from otherkinds of coaching,”says David Giwerc, anADD coach andfounder of the ADDCoach Academy inupstate New York.“You need to under-stand the particularways in which the ADD brain is ‘differ-ent,’ the frequent habit of

negative thinking, and the kinds ofthings people tell themselves that standin the way of success.”

Sometimes, for example, a problemisn’t exactly what it seems. “WithAD/HD, what sometimes looks like pro-crastination is actually a problem initi-ating something because they don’tknow how to break down a task,” saysNancy Ratey. “As a coach, you get themto identify the first, smallest thing theycan do. That usually gets them started.

“The disasters I’ve seen usuallystem from the coach not understandingAD/HD,” she says. “They may tell theirclients, ‘try harder’ or ‘you’re just toowillful,’ or ‘you’re not motivatedenough.’ There has to be a balancebetween pushing and encouraging.”

To coaches like Sandy Maynard,ADDitude’s Coach onCall, encouragement isat the heart of the pro-fession. “One clientcalled because she hadjust cleaned out herrefrigerator. She was soexcited! She kept say-ing, ‘Sandy! Sandy! Ifinally did it!’ Cleaningout the fridge was abig step for thiswoman. She neverthrew anything away,ever. I was glad to hearthat she had learnedhow to use a trash can.Together, we celebrat-ed her clean refrigera-tor. No victory is toosmall a step.”

“If she had calledher mom, her mom would only havesaid, ‘Well, it’s about time.’”

Finding a Coach>> ADD Coach Academy:

www.addca.com

>> American CoachingAssociation (ACA):www.americoach.org

>> ADDitude’s CoachDirectory: www.addi-tudemag.com/self-help.asp?DEPT_NO=407&SUB_NO=1

>> Optimal FunctioningInstitute (OFI): www.addcoach.com

>> ADDA Yellow Pages:www.add.org/help/professionals/coaches.html

>> A.D.D. Consults:www.addconsults.com

28 Subscribe online at www.additudemag.com

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To subscribe, call 1-888-762-8475 29

Here are 10 easy ways to reduce thestress related to communicationand organization difficulties for

adults with AD/HD:

1COMMUNICATE CLEARLY Ask questionsto be sure you fully understand your

assignment. Repeat directions to makesure you heard them correctly. Ask forspecific deadlines and start early, soyou’re not forced to bring work home.

2 STOP PROCRASTINATING Don’tlet perfectionism thwart

your ability to get things done.Focus on the most importanttasks and delegate others. Trycalling instead of e-mailing.

3 CURTAIL PHONE CONVERSA-

TIONS Time flies when we’reon the phone. Preface each callwith a limit: “Hi, Tom. I onlyhave five minutes, but I wantedto ask you....” The person youcalled will most likely keepremarks short and to the point.

4 USE ONE TIME-MANAGEMENT

SYSTEM Use the same system(notepad, PDA) for both work and per-sonal appointments. Choose one loca-tion at work and one at home to keep it,so you’ll always know where to look.

5 CHECK YOUR AGENDA SEVERAL TIMES A

DAY Set a timer if you think youmight get engrossed in an activity andforget to go to a scheduled meeting.Make it a habit to check your scheduleevery time you get a cup of coffee, takeout the trash, or check the mail. Habitsform by consistency and frequency.

6 WORK AT PROFESSIONAL DEVELOPMENT

Twice a year, pick one professionalor social skill to improve upon. Being agood conversationalist can be learned,but it takes practice. Practice giving oth-ers a chance to respond before reacting.

Ask a trusted friend what areas shethinks you need to improve on.

7 LEARN TO DELEGATE Decide what oth-ers can do for you and let them do

it. Moving ahead often means master-ing the fine art of delegating. Make alist of things others can do to help you.

8 KEEP YOUR PRIVATE LIFE PRIVATE Don’tbroadcast your personal business at

work, or let excessive family responsi-

bilities and phone calls make a badimpression on your boss.

9 LET YOUR WORK STAY AT WORK Likewise,leave your work worries at your

desk when you clock out for the day.You’ll actually feel like tackling themtomorrow morning if you’ve had achance to spend time on what's impor-tant to you outside of work.

10 PUT YOUR PERSONAL HEALTH FIRST

Let your mental and physicalhealth come first. Find work that ismeaningful to you personally, andwatch the weekdays fly by. Can’t cut thedullness from your job? Nourish your-self at home with hobbies you enjoy.Take time for yourself whenever possi-ble to rejuvenate your spirit—and usethose vacation days!

Ten Keys to

ConqueringAD/HD in

theOfficeBY SANDY MAYNARD

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30 Subscribe online at www.additudemag.com

Somewhere along our way towardan egalitarian society, we lost sightof the fact that women are differ-

ent from men. Likewise, AD/HD inwomen does not always look like AD/HDin men. Applying male symptoms, likeaggression and hyperactivity, to a femalewith AD/HD doesn’t provide an accurateframe of reference for diagnosis.

Noticing the DifferenceGirls with AD/HD don’t usually standout in a classroom. “They’re the ones sit-ting in the back, looking out the win-dows, twirling their hair,” says TerryMatlen, vice president of the NationalAttention Deficit Disorder Associationand host of ADDconsults.com(http://addconsults.com). “People writethem off as space cadets.” As far asAD/HD is concerned, these girls are neg-lected children. They grow up to

become neglected women.Sari Solden, whose book, Women

with Attention Deficit Disorder, is a must-read for any woman with AD/HD, talkedabout this neglect in an interview con-ducted at an ADDA conference. “A sig-nificant number of women with ADDweren’t picked up for diagnosis becausethey weren’t hyperactive and didn'tcause problems at school.”

According to Solden, these womenare often misdiagnosed and treated forsomething other than AD/HD. “Even ifthey complain to their doctor or thera-pist of feeling overwhelmed or disorgan-ized, they're more likely to be given adiagnosis of depression instead of ADD.”

A woman who has AD/HD may alsohave depression, but treating thedepression is only part of the solution.Once the depression is under control,she is left with untreated ADD.

AD/HD in WomenBY BOB SEAY

Page 31: ADD Living With ADD

Living with itThe first step is to get an accurate diag-nosis from someone who understandsAD/HD in women. Doctors, psycholo-gists, psychiatrists, and other mentalhealth care professionals can make thediagnosis. In choosing a professional,ask how many adult ADD patients hehas and how many of those are women.What treatments has he tried, and howsuccessful have those treatments been?

Keep in mind that AD/HD can occursimultaneously with other disorders,such as depression or PMS. Ask aboutpossible co-existing conditions, knownas “comorbidities,” and how much expe-rience the doctor has in treating some-one who has more than one problem.

Kathleen G. Nadeau offers moresuggestions about living with AD/HD inher book, Adventures in Fast Forward. Herfirst suggestion is to give yourself abreak. Women are taught to be“pleasers,” and often put unrealisticdemands on themselves as they try tobalance family, career, and otherresponsibilities. Accept the facts thathouses get messy and some things don’tget done. Just do the best you can. Enlistthe help of other family members forhousehold chores.

One step toward eliminating theneed for Superwoman is to simplifyyour life. Decide what is important andwhat isn’t. Reduce commitments thatdrain time and energy. Learn to say“no,” or, at the very least, “I’m sorry, butthat doesn’t work for me.”

Christine A. Adamec talks aboutlearning to choose your responsibilitiesin her book, Moms with ADD. “When any-one asks you to perform any task that isdue after today and that requires morethan five minutes, hold yourself back

from saying ‘yes’ immediately. Instead,say that you must think about it. Resistthe pressure that may emanate fromothers: that you’ve ‘always’ done this,that it’s easy, that it won’t take muchtime, etc. Tell the person you mustthink about it and let them know.”

This technique gives you time todecide whether or not you can—orwant to—do this. If you decide that youcan do it, say “yes.” If not, then call theperson and tell him or her that youwon’t be able to do it.

Working Through it AllMost women have a lot of pressure,working a full-time job and then com-ing home to a second full-time job ofcaring for others. For women who haveADD, this workload can be especiallystressful. But with proper diagnosis andtreatment, you can learn to manageboth your home and your AD/HD.

Resources for Girls andWomen with AD/HDWEB SITES> National Center for Gender Issues

and AD/HD (www.ncgiadd.org).> ADDvance (www.addvance.com).

BOOKS> Women with Attention Deficit

Disorder, by Sari Solden> Understanding Women with

AD/HD, ed. Kathleen G. Nadeau,Ph.D., and Patricia Quinn, M.D.

> Understanding Girls with AD/HD,by Kathleen G. Nadeau, Ph.D.,Ellen Littman, Ph.D., and Patricia O. Quinn, M.D.

Find these books and more at theADDitude bookstore, online atwww.additudemag.com.

To subscribe, call 1-888-762-8475 31

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by Bob Seay

Innovative.

The drive of hyperfocus.

Creativity.

Insomnia makes for more time to stay up and surf

the net!

Ability to meet someone, fall deeply in love, fight, hate,

and break up—all in about 35 minutes or less.

A sparkling personality.

Can drop names like Edison, Einstein, Walt Disney, and

Beethoven in conversations.

Can fixate on one object while the rest of the world

goes down the toilet.

Can see all of your worldly possessions at one

time…because they are all over the floor.

Generosity with money, time, and resources.

Enthusiasm.

Ingenuity.

Having a strong sense of what is fair.

Willingness to take a risk.

Resiliency.

Making far-reaching analogies that no one else

understands.

Joining the ranks of artists, musicians,

entrepreneurs, and other creative types.

Spontaneity.

Keeping business meetings lively.

Possessing the mind of a Pentium—with only 2MBs

of RAM.

Aesthetically oriented.

Constantly and pleasantly surprised by finding clothing

you had forgotten about.

Ability to tie seemingly unrelated ideas together.

Being goofy.

Independence.

Ability to see “The Big Picture” while others stumble

around in the dark.

Demanding to know Why?

Being the last of the romantics.

Constantly and pleasantly surprised by finding money

you had forgotten about.

Being a great conversationalist.

Having an innately better understanding of

intuitive technologies, such as computers

or PDAs.

In class popularity contests, always voted “Most

Entertaining, “ “Most Energetic,” or “Most likely to

Self-Immolate.”

Great improviser.

Honestly believing that anything is possible.

Quickly assimilating new information.

Rarely being satisfied with the status quo.

Empathy.

Can replace missing childhood photos with

panels from Calvin & Hobbes.

Being an unstoppable dynamo of human energy.

Optimism.

Compassion.

Persistence.

Spunk.

Constantly and pleasantly surprised by finding spouses

you had forgotten about.

Always able to provide a different perspective.

Visionary.

A tolerance for chaos.

Willingness to fight for what you believe in.

Excellence in motivating others.

Being highly organized, punctual, and generally

responsible ...(OK, so I lied!)

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Things to Love About ADD50