ADHD Counseling

• Predominantly Inattentive Type: It is hard for the individual to organize or finish a task, to pay attention to details, or to follow instructions or conversations. The person is easily distracted or forgets details of daily routines.
• Predominantly Hyperactive-Impulsive Type: The person fidgets and talks a lot. It is hard to sit still for long (e.g., for a meal or while doing homework). Smaller children may run, jump or climb constantly. The individual feels restless and has trouble with impulsivity. Someone who is impulsive may interrupt others a lot, grab things from people, or speak at inappropriate times. It is hard for the person to wait their turn or listen to directions. A person with impulsiveness may have more accidents and injuries than others.
• Combined Type: Symptoms of the above two types are equally present in the person.

The following are some of the criteria for diagnosis listed in the Diagnostic and Statistical Manual of Mental Disorders for ADD/ADHD, which is the standard reference among mental health professionals. While this definition is not perfect, I include it as it is the most commonly accepted definition.

DSM-IV CRITERIA FOR ADHD

• Either A or B:
  • Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is inappropriate for developmental level:
    INATTENTION
    • Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
    • Often has trouble keeping attention on tasks or play activities.
    • Often does not seem to listen when spoken to directly.
    • Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
    • Often has trouble organizing activities.
    • Often avoids, dislikes, or doesn’t want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
    • Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
    • Is often easily distracted.
    • Is often forgetful in daily activities.
  • Six or more of the following symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level:
    HYPERACTIVITY
    • Often fidgets with hands or feet or squirms in seat when sitting still is expected.
    • Often gets up from seat when remaining in seat is expected.
    • Often excessively runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
    • Often has trouble playing or doing leisure activities quietly.
    • Is often “on the go” or often acts as if “driven by a motor”.
    • Often talks excessively.
    • Impulsivity
    • Often blurts out answers before questions have been finished.
    • Often has trouble waiting one’s turn.
    • Often interrupts or intrudes on others (e.g., butts into conversations or games).
• Some symptoms that cause impairment were present before age 7 years.
• Some impairment from the symptoms is present in two or more settings (e.g. at school/work and at home).
• There must be clear evidence of clinically significant impairment in social, school, or work functioning.
• The symptoms do not happen only during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder. The symptoms are not better accounted for by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000, via the CDC

ADHD (attention deficit hyperactivity disorder) is characterized by distractibility, impulsivity and restlessness or hyperactivity. Considered a neurological condition, it is genetically transmissible. Symptoms are present from childhood on however some symptoms such as inattentiveness, may be more prominent in girls than in boys. The intensity of symptoms falls on a spectrum. Symptoms can worsen due to a variety of influences like hormonal changes or stress. They can also improve with regular fitness and adequate sleep.

ADHD is considered a disability primarily because of the impact the condition can have on executive functioning which we rely heavily upon to succeed in today’s society. For example, neurons in the prefrontal region of the frontal lobe are involved in processes such as planning, integrating information, modulating behavior and emotional responses and prioritization. People with ADHD CAN focus sometimes to a fault, and a fair number are not hyperactive.

Diagnosis is primarily made by a thorough interview and determining whether specific ADHD symptoms have been present throughout one’s history. In establishing a proper diagnosis, it is also important to address whether other conditions may be present such as depression, anxiety, PTSD and learning disabilities. Sometimes a neuropyschological evaluation can be helpful as a tool to aid in the diagnosis of conditions.

• A sense of underachievement, of not meeting one’s goals (regardless of how much one has actually accomplished).
• Difficulty getting organized.
• Chronic procrastination or trouble getting started.
• Many projects going simultaneously; trouble with follow through.
• A tendency to say what comes to mind without necessarily considering the timing or appropriateness of the remark.
• A frequent search for high stimulation.
• An intolerance of boredom. Easy distractibility; trouble focusing attention, tendency to tune out or drift away in the middle of a page or conversation, often coupled with an inability to focus at times.
• Often creative, intuitive, highly intelligent
• Trouble in going through established channels and following “proper” procedure.
• Impatient; low tolerance of frustration.
• Impulsive, either verbally or in action, as an impulsive spending of money.
• Changing plans, enacting new schemes or career plans and the like; hot-tempered.
• A tendency to worry needlessly, endlessly; a tendency to scan the horizon looking for something to worry about, alternating with attention to or disregard for actual dangers.
• A sense of insecurity.
• Mood swings, mood lability, especially when disengaged from a person or a project.
• Physical or cognitive restlessness.
• A tendency toward addictive behavior.
• Chronic problems with self-esteem.
• Inaccurate self-observation.
• Family history of ADHD or manic depressive illness or depression or substance abuse or other disorders of impulse control or mood.

We like to use the Hallowell Method in formulating a well-rounded ‘treatment’ program. Dr. Hallowell is a leading expert in the field of ADHD and author of landmark books on the topic such as Delivered from Distraction. The Hallowell Method is a positive, strengths based approach which is comprehensive. The program addresses:

1. Obtaining an accurate diagnosis taking into account the likelihood of coexisting problems
2. Education and self-awareness
3. Achieving a healthy lifestyle
4. Creating external structure
5. Counseling of some kind like coaching
6. Non-medicinal therapies such as LENS, a special form of neurofeedback and supplements such as omega 3 fatty acids
7. Pharmaceutical intervention

ADHD is a neurological disorder and research indicates that it may be due to alterations in the brain and the way it functions. The causes of these differences are not entirely known, but family and twin studies reveal ADHD is genetic. Between 10 percent and 35 percent of children with ADHD have a close relative with ADHD, and nearly half of parents who had ADHD as a child also have a child with the disorder. Studies in families of children with ADHD show that relatives are at high risk for ADHD, other psychiatric disorders and learning disabilities.

ADHD affects 3 percent to 5 percent of all American children (approximately two million). While typically diagnosed in children, adults can also have ADHD. Adults with ADHD may be unaware they have the disorder, yet know they have difficulty getting organized and staying focused. Everyday tasks such as waking up, getting dressed, organizing for the day’s work, getting to work on time or being productive on the job can be major challenges for the ADHD adult.