ADHD

ADHD, also called attention-deficit and hyperactivity disorder (and previously known as ADD or attention deficit disorder), is a very common condition experienced by both children and adults. It is characterized by someone who struggles with focus, impulsive behavior, and maybe even hyperactivity. Sometimes these symptoms are present by the age of seven and may be noticed through adulthood. 

Sometimes a more helpful way to look at ADHD is to veer away from mere focus issues, and to understand it as a “hyper-focus disorder.” What this means is that when someone gets in a rhythm, especially with something they might enjoy, it's very hard to transition to another task. Thus, this person may get lost in that project for hours at a time. To others, it can even seem obsessive. This can look like a certain work task, such as excel spreadsheets, or can be a hobby, such as artwork or puzzles.  Thus, the ADHD patient lives in a dual reality: Certain tasks feel nearly impossible to be attentive to,  and other tasks feel impossible to break away from.

The other component to this hyper-focus disorder is that it's very difficult to transition from one type of task to another completely different task, whether or not it's enjoyable. For example a child with ADHD struggles significantly to go from physical activity outside to suddenly sitting down inside and doing homework at the table. In order to be successful at going from task to task, there has to be a time for mental preparation for that change in routine. 

There is often a behavioral component to ADHD that most commonly causes the family to pursue treatment. Behaviors include: attention-seeking behaviors, impulsive or disruptive behaviors, and destructive or even violent behaviors. Sometimes ADHD is mistaken for rebellious or antisocial traits. However, with the proper interventions, relationships, functionality, and focus can improve radically.

Why does someone become attention-deficient? There are many factors that can lead to poor focus and even an outright diagnosis of ADHD.  

1. Genetics - in other words, it "runs in the family". The genes in the family line are predisposed to having risk of ADHD symptoms.  But that's not always a thorough reason.  We are not defined by our genetics, but rather by the way that we live. Lifestyle is a major factor in how our brain and cognition functions. This is not always good news for those who struggle with wanting to modify their lifestyle, but it is positive news because we have the power to choose how we want our brain to function. The following causes are examples of specific lifestyle factors that may impact attention. 

2. Poor Sleep - Sleep cannot be valued enough. Sleep is one of the first things that we cut out or cut back on when we feel pressure to complete tasks, stress, have poor routines in place, or when we have any coexisting mood symptoms (such as anxiety). Sleep is essential to supporting our brain's ability to focus because it is the only time in the day that we have uninterrupted moments for rest. The brain requires complete rest (through sleep) in order to have a proper reset and recharge. If someone is deficient in sleep, the brain will not be at full capacity. This is fairly simple if we imagine a battery that has not been properly charged overnight. We can only expect that whatever technology that battery is powering will have limited capacity for what it needs to do if it did not get recharged. Our brains are not too different! The question is: what symptoms do we typically see if the brain is not fully recharged? Poor focus, increased anxiety, more "over-stimulated", more irritability, increased impulsivity, more drained/fatigued, and decreased motivation… to name a few.

The optimal duration of sleep for adults is between 6 to 9 hours each night. The optimal duration for minors is approximately 8 to 10 hours per night. We should be falling asleep within 20 minutes and should be staying asleep throughout the night.  Is most essential to fall asleep by 10 p.m. in order to obtain all of the important stages of sleep, especially deep and REM sleep!

3. Limited Nutrition - Nutrition speaks to what are we eating, how often, and how much at each meal or snack. 

When it comes to focus and attention, we tend to see that people benefit from eating regular meals that are high in protein and healthy fat content (especially omega-3s). 

Being mindful of what to eat less of it's also important. While we don't want to create too many rules on what is "bad" or "wrong", it is helpful to know what is less helpful for the brain, especially when it comes to focus.  These Foods include high sugar foods (desserts), high processed fat foods (french fries), and foods that contain a lot of preservatives or dyes (candy).  It's always worth taking a look at what we are eating in a day, and assessing if there is enough balance between the guilty pleasure foods and the nutrient-rich foods.  And remember, there's no perfect diet, and you don't need to have a perfect diet in order for your focus to be better.

We have to eat often enough (every 2-4 hours) to keep the brain fed and alert. Typically, those with hyperactivity and higher energy burn through nutrients faster and need to keep up with the demands of the brain and body. We also have to make sure that we are eating at the appropriate time. One of the most important meal times for attention issues is breakfast, because this meal helps with starting your day strong.  Perhaps one of the strongest factors for someone’s focus is whether or not they ate a strong breakfast, or any food at all. Examples of a strong breakfast may include eggs, yogurt with nuts and berries, avocado toast, or peanut butter toast with banana.  The goal when we eat is to feed our body with the building blocks to create the hormones and chemicals that are needed for the brain to function well. It's an extra plus when we enjoy these nutrient-rich foods!

4. Co-existing mood symptoms - A really common concern that patients will want to be evaluated is to target their inability to focus, get good grades, or achieve tasks at work. But there is an ambivalence to how their mood is, or how they're feeling. One of the most telling signs that someone is struggling with depression or anxiety is that their focus is declining.  For example if someone really struggles with social anxiety, fearing that others are judging them or fear that they don't fit in, their focus when they are at work or school will be one of the first things to be affected, because their brain is occupied by their fears.  Or, when someone is struggling with hopelessness, sadness, or even suicidal ideation, the mind lacks motivation to stay engaged with life tasks. This can't be ignored, because most primary treatments for ADHD or focus issues can actually make anxiety, irritability, anger, or sleep  worse if they are not first addressed.

Another emotion that may be  a component in the inattentiveness is anger... which can lead to defiance.  This is a common emotion that we see especially in minors, but is not absent in adults.  Anger is a high energy of motion that takes up a lot of space in our mind. It is very difficult to remain engaged in any other activity or task when anger is present. Anger is known for being distracting and overstimulating to the mind. If someone is struggling with anger and a secondary emotion that drives the anger, it is going to be nearly impossible to focus until those things are addressed.

5. Too Much Screen Time - This is a more pressing issue as our world becomes more technologically advanced. Our younger generations are becoming exposed  to screens at even younger ages for longer periods of time. Screens surround us at work, school, and at home. Screen time has a direct impact on the brain, especially when it is still developing. Specifically, screens cause atrophy or shrinkage on the frontal lobe, which is the key area in the brain responsible for impulse control, focus, higher level thinking, and regulation of emotions.  Our society as a whole is becoming more attention deficit and  fitting into the ADHD category simply as a result of excessive screen time. It’s important to be mindful of and to limit screen time (especially for social or leisure use) to less than 2 hours per day. Spend time outdoors and with shared time together to replace this unhelpful habit and it will be very healing for the brain!

6. Lack of Skills - This is not frequently talked about in a medical setting when someone is struggling with focus. The truth of the matter is that someone who struggles with transition, staying engaged, focusing when anxious or overwhelmed, etc. is that there is a lack of skills to self regulate, communicate needs, or to simply learn how to transition. When someone struggles with impulsivity or defiance, there is a lack of skill to pause, think through decisions, cope with or communicate their emotions. These skills are one of the most important aspects to focus on in treatment as it will help the patient become equipped for life’s challenges.

Screening for ADHD is a multi-step process involving behavioral and psychological assessment, a history and physical and questionnaires. Family, parents, friends or teachers will be interviewed and asked to provide valuable information about the individual’s tendencies toward inattention, hyperactivity and impulsivity, like how often they lose their temper, argue, bully/threaten others or, are easily distracted by noises or other external stimuli. Behavior in everyday situations can provide a lot of insight about attention deficits and underlying needs.

ADD or ADHD can be easily confused with other disorders. Just because it looks like ADD or ADHD, doesn’t mean it is. For example, if the individual self-medicates, it can be confusing to the individual’s medical presentation and general health. Thorough evaluations by a medical provider and a therapist is necessary to get a proper diagnosis and a comprehensive treatment plan.

When approaching treatment for focus or attention, it is important to  first address the lifestyle  factors (especially sleep) in addition to any co-existing mood disorder. This is essential because many of the medications used to treat ADHD can actually worsen anxiety, anger, irritability, or even impulsivity. Other  times, when the mood disorder is treated first, the attention symptoms are much less overwhelming and more manageable and don’t require additional medication to treat.

Stimulants, like Adderall or Ritalin, are not commonly used in our clinic. While a certain population can find them helpful, there is definitely risk involved in taking these medications. These include: Addiction potential, worsening of mood disorder symptoms (especially if there is any underlying bipolar disorder), dependence (worsened focus over time without  the medication), or tolerance (needing higher doses due to getting used to the medication). In adults, when a stimulant is started, it’s harder to get off. Children tend to have an easier time getting off stimulants once starting as their brain develops.

Our treatment team takes into account various options to target focus, mood, behavior, and functionality. This can include holistic supplements, lifestyle management, mood-supporting medications, psychotherapy, case management, parenting/family coaching, and MeRT. 

Family care is probably the most important part of the treatment for ADHD to support skill building and long-term tools to support basic functioning. 

Psychotherapy is often used in cases of ADHD. The disorder can cause a lot of stress within a support system, with family, friends or co-workers and feelings of frustration, blame and even anger can arise. Family therapy will educate friends, spouses, parents or caregivers about ADHD and address any negative emotions that may have developed while caring for a loved one. Behavioral therapy helps individuals adjust their behavior and teaches them to be aware of their behavior. Regardless of age, the individual can be proud when they act in a positive way, such as controlling anger, pausing before a reply, taking the time to think before acting out. Positive reinforcement can further support the success in staying with a care plan. In the classroom, teachers can carry out rewards systems for good behavior to encourage children to behave appropriately. Similarly, in the workforce, the employee with ADHD might want to communicate to their supervisor or a coworker how much incentives mean to their closure or stamina across a task, assignment and thought process. 

MeRT (Magnetic e Resonance Therapy) is an especially helpful tool is helping support brain waves at the source. MeRT has been studied to help with anxiety, racing thoughts, thought clarity and organization, impulse control, and focus.

At Solstice Pacific, you will have a treatment team that will monitor the process of finding medication and a larger neurological treatment plan that works for the person. Everyone is affected differently and neurobiology is unique at all times, always changing based on factors like environment, genetics, biology, trauma, chemistry and comorbid conditions. Finding and following integrative care options will take some patience and experimenting to get it right with time in a supportive interdisciplinary clinic.

Learning how to deal with frustration is a large part of managing ADD or ADHD. When individuals know how to control their emotions and behavior, they are able to manage stress and feel more at peace within themselves.

Life after a diagnosis has as much life in it as we train ourselves for; ADHD can be a benefit because the diagnosis may challenge the individual to be aware of their needs and learning style. 

At Solstice Pacific, care means creating comfort and safety for you. While there is no cure yet developed for this condition, it is entirely possible to gain control over the symptoms and live a full and productive life.