Is your ADHD disrupting your potential or that of a loved one?

• Do you often have trouble initiating tasks that would be beneficial for you in the long term?

• Do you struggle to regulate yourself emotionally and often find it difficult to quiet your mind?

• Do you act impulsively, making choices and decisions that you normally would not agree with?

ADHD impacts task coordination across time. This makes it difficult to know what to do. Even worse, it can make it difficult to do the things we know we ought to do. It’s not about intelligence or effort. ADHD is a performance disorder that affects your ability to follow through, stay organized, regulate emotions, and manage time effectively. These challenges can impact school, work, relationships, and self-esteem—but they don’t have to define your life.

Treatment that develops the ability to coordinate effective behavior to reach the life you want.

ADHD is a neurological and genetically caused disorder. This means that biological determinants impact the domain of executive functioning abilities disrupting normal developmental functioning. A 2012 meta-analysis demonstrated that of all adults diagnosed with ADHD 23% of them had a co-occuring Substance Use Disorder. (Oortmerssen K 2012) This example demonstrates just one way that untreated ADHD is more likely to impact you across the lifespan. Children with ADHD are twice as likely to die by age ten compared to their peers and Adults with untreated ADHD are five times more likely to die by midlife compared to adults without the disorder. It is imperative that we intervene upstream in order to impact the developing human across their lifespan.

The most effective approach to managing ADHD combines targeted strategies that support both brain function and emotional regulation. This includes medication, which helps regulate executive functioning along with behavioral tools that create structure, reduce potential for impulsivity, and make success more achievable in real-world settings. It is important to understand that ADHD is a disorder in the same way that diabetes is a disorder; that is to say it is a chronic, handicapping condition that requires medication.

In order to understand why we medicate we must understand the impact of medication on the symptoms we are trying to measure. In a statistical analysis, effect size measures how effective an intervention is compared to a population that does not receive the intervention. SSRI’s for instance have an effect size of about .35 when treated anxiety and depression. ADHD medication on the other hand has an effect size of .90 in improving symptoms of ADHD. in other words about 70-90% of people with ADHD who take an ADHD medication receive improvement in their symptoms.

Emotional dysregulation is just as impacted as executive functioning skills in ADHD.

Have you ever noticed that your initial emotional response seems to lead to decisions you do not always fully agree with? Do you recognize in the moment, that these decisions seem to leave you feeling worse?

A technical understanding of what emotional regulation is will be helpful here. Emotional regulation consists of several steps:

1. inhibit inappropriate behavior related to strong negative or positive emotion,

2. self-soothe any physiological arousal that the strong affect has induced(c)

3. refocus attention

4. organize for coordinated action in the service of an external goal

   (Gottman and Katz (1989).

   People with ADHD experience the same levels of emotional intensity as people without ADHD. The difference is that people without ADHD do not register that they are automatically inhibiting inappropriate behavior to their external goal.

Effective ADHD treatment occurs at problematic points of performance in natural settings.

The medical industry has become focused on the deliverable outcomes of ADHD, ie grades, performance at work. To be fair these are extremely important facets of life. However, we must not miss the greater significance of what it means when every event and behavioral response you face includes wrestling with maladaptive instincts.

Imagine that you are a soccer player on your high school varsity team. You and your teammates experience similar levels of anxiety before an important match. You could not suppress your initial anxiety, and a cascade of less than ideal behavioral responses ensues. You begin over-thinking noting that the results of the match, could influence whether or not you receive a college scholarship. Suddenly, your future is up for evaluation and you notice that you are now in your head and your body feels tight. The outcome is that you don’t play at the level you are capable of playing.

The difference is that your teammate without ADHD did not even register that they were able to successfully inhibit their initial anxiety response. as a result they had a significantly easier time soothing their initial response and did not experience subsequent rumination about their future and thus their nerves didn’t affect their performance. Two very different outcomes.

ADHD disrupts the developing identity

By focusing our treatment on effective medication & improving points of performance in your life, you have the opportunity to develop a different identity. Your sense of Effectiveness, control, & potency, influence the type of person you understand yourself to be. By working with these levers, we make a profound impact across your life span.

Frequently Asked Questions:

Will Medication change me?

In my experience, the answer to this is yes but not how you might think. I notice that when my clients are on the, “right” ADHD medication they often seem to become more themselves. Many of my patients report feeling as if they have more options available to them and as a result, are better able to coordinate their behavior to achieve what they want.

I am not ready or willing to take medication. Will you still work with me?

Yes. Ultimately it is your choice. I will always try to make my best recommendation to you based upon my understanding of your needs. Our treatment together will still focus on treating problematic points of performance. Nevertheless, I believe it is my responsibility to give you as full a picture as possible so that you may evaluate and make informed decisions for your care.

Can you recommend any resources for further information?

I highly recommend Dr. Russel Barkley’s YouTube channel. Dr. Russel Barkley is widely considered to be the foremost expert on ADHD research & treatment. He was a distinguished professor at Virginia Commonwealth University for many years. In later years he developed his YouTube channel as an accessible means to provide education to the public. He has the demeanor of your favorite grandad and has also written several helpful workbooks which I will also include below.

https://youtube.com/@russellbarkleyphd2023?si=d8pVQQE-uvVjrc_T

https://a.co/d/0dNx1Z3U “12 Principles for Raising Your Child with ADHD”

https://a.co/d/0ezcYJJB “Taking Charge of Adult ADHD”