Michael O. Flanagan

Cheat Sheet / Updated 02-26-2024

Understanding and diagnosing attention deficit/hyperactivity disorder, or ADHD, begins with knowing the three types of ADHD and recognizing that they can be exhibited through secondary symptoms as well. To cope with ADHD, explore a number of treatment options and how you can approach them for better results.

Article / Updated 03-26-2016

AD/HD has three primary symptoms: inattention/distractibility, impulsivity, and hyperactivity. These symptoms don't all have to be present in order for you to have AD/HD, and if you do have one or more of them, they may not be present all the time. Inattention/distractibility Inattention means you have a hard time focusing on something. Distractibility means your attention is easily pulled from one thing to another. Inattention is at the core of AD/HD. However, inattention isn't as simple as never being able to focus; nothing about this condition is as clear-cut as that. Inattention is more accurately a problem in being able to control or regulate how and when you focus on something. A key thing to know about this symptom is that it can look different in almost everyone, and it can change from day to day in each person. But even with such variability, a few basic characteristics of inattention and distractibility are found in people with AD/HD. These are: Not being able to concentrate: Keeping focused on something is difficult and, at times, impossible. Being able to focus well on some things but not on others: Many people think that just because a person can concentrate on something, she must be able to concentrate on everything if she just tries hard enough. This is not the case for people with AD/HD. Being able to focus sometimes but not other times: Scattered thinking makes it difficult for sufferers to tackle complex projects because they often lose track of what they are doing. Being easily distracted by things happening around you: Many people with AD/HD are unable to filter out all the things going on around them and are easily pulled away from what they want to focus on. Being easily distracted by your own thoughts: "Daydreaming," or having unrelated thoughts flowing through their minds, is commonplace for some AD/HD patients. Losing track of your thoughts (spacing out): An extension of being easily distracted is spacing out. This is common with people with AD/HD — it seems like they have gaps in their awareness. Being forgetful: A lot of people with AD/HD tend to lose their keys, forget appointments, and get lost. Being late: Because many people with AD/HD have trouble organizing their time, they are often late to appointments. Being unable to finish things: People with AD/HD are notorious for starting a project and then moving on to something else before finishing it. Procrastinating: People with AD/HD often fail to even start something. Also, after repeated failures, many people avoid starting projects because of the fear that they'll fail again. Not attending to details: People with AD/HD are often "big picture" people. They can think up new and exciting ideas, but when it comes to actually dealing with the details needed to make those ideas happen, they just can't seem to follow through. As well, when given instructions on how to do something, they often miss important details. Making careless mistakes: Not attending to details leads to careless mistakes. This is a common problem with people who are easily distractible because they drift from one thought to another and lose track of what they've done and what needs to be done next. Impulsivity Impulsivity is the inability to consider the consequences of your actions beforehand — in other words, doing before thinking. When you have this symptom of AD/HD, it's almost as though you have an involuntary response to a stimulus. The response can take the form of actions or words. Like the other symptoms of AD/HD, impulsivity looks different depending on the person. Some people have difficulty considering what they say before saying it, whereas others may act at times without thinking. Here are a few ways that impulsivity can manifest in people with AD/HD: Blurting out answers before a question is finished: Many teachers of children with AD/HD complain that the children shout out answers before questions have been asked. Many AD/HD adults have a habit of finishing other people's sentences. Saying inappropriate things: People with the hyperactive/impulsive type of AD/HD have a difficult time censoring themselves, and they respond to other people without considering the consequences of what they say. Butting into conversations: Because of the inability to keep from saying the first thing that comes to mind, people with impulse problems often butt into conversations. This is partly due to the lack of impulse control but is also due to the difficulty that many people with AD/HD have in being able to pick up on and interpret subtle signals (body language) and the rhythm of a conversation. Intruding on others: AD/HD sufferers often don't know where their bodies are in space, so they tend to be somewhat clumsy. Couple this characteristic with the lack of impulse control, and you often find people with AD/HD intruding on others — bumping into them, grabbing at a toy, and so on. Acting without considering the consequences: Many people with AD/HD act from impulse to impulse. They see something in a store and "have to have it," even though that item may not have any useful purpose for them. Engaging in risky behaviors: Because people with AD/HD often crave stimulus, they may get into situations where they do dangerous things. Pushing life to the limits can really help some people focus and feel more in control. Being impatient: One thing that is particularly difficult for people with AD/HD is waiting in line, which requires someone to stand relatively still. They are more likely to fidget and squirm while waiting. Wanting things immediately: This symptom can take many forms, such as wanting to have your needs met immediately, as in the case of a child who has a tantrum when you don't come running to his aid. Restlessness/hyperactivity Restlessness and hyperactivity are essentially the same thing — the inability to regulate your physical movements. For the person with this symptom of AD/HD, sitting still is difficult (especially at school or work where sitting for extended periods of time is expected), as is doing activities that require minimal physical movement, such as playing quiet games. Keep in mind that most young children exhibit what would be called hyperactivity — frequent movement and activity. This isn't necessarily a sign that your child has AD/HD. Most children outgrow this level of activity by the time they're 4 or 5. And even before then, most kids have periods of time where they're able to sit quietly, such as when reading a book with a parent or older sibling. Restlessness and hyperactivity are so variable in people that in one instance this symptom may be obvious, and in another it may be almost completely disguised. Following are a few of the ways this symptom can present itself: Being unable to sit still for any length of time: This is especially obvious in younger children. As children grow older, they often develop the ability to sit, although they may squirm in their seats or, as they grow older still, just fidget. Being always on the go: The classic descriptor is that people with this symptom of AD/HD seem to be "driven by a motor." As much as they'd like to stop moving sometimes, they can't seem to do so. Feeling edgy: Adults with AD/HD feel the need to move and release the energy that builds up inside them. Restlessness also can show up in other parts of a person's life. People with AD/HD often move or change jobs just because they are restless. Fidgeting constantly: Fidgeting can take on a number of forms, from seemingly repetitive tapping to random movements. Some people fidget to try to focus on a task. Talking nonstop: Rather than move their bodies, some people with AD/HD run their mouths. Constant talking is simply another way to release the energy that seems to build up from AD/HD.

Article / Updated 03-26-2016

Although the exact cause of AD/HD is still unknown, there is no shortage of research into the biology of AD/HD. This research fits into four broad categories: genetic, anatomical, functional, and chemical. Genetic AD/HD runs in families — so much so that when diagnosing the condition, an AD/HD professional's first step may be to look at the person's family to see if anyone else has it. The precise genetic factor has yet to be confirmed, but recent research has identified a couple of genes that may contribute to AD/HD. Many studies have examined AD/HD from a genetic perspective. These include studies that look at adoptive versus biological parents, the prevalence of AD/HD in families, twins' tendency to share AD/HD, and specific genes associated with AD/HD. Here's a short sampling of some of these areas of investigation: A study conducted by Dr. Florence Levy of the University of New South Wales, Australia showed that if one identical twin has AD/HD, 81 percent of the time the other one will as well. By contrast, only 29 percent of paternal twins share AD/HD. Because identical twins share the exact same DNA, this strongly suggests a genetic component to AD/HD. Several studies by Dr. Joseph Biederman and his colleagues at the Massachusetts General Hospital have shown that AD/HD runs in families. In one study, Dr. Biederman and his colleagues found that first-degree relatives (parents or siblings) of someone with AD/HD have a five times greater chance of also having AD/HD than someone who has no close relatives with the condition. Studies by Dr. Dennis Cantwell on adopted children with the hyperactive/impulsive type of AD/HD found that these children resemble their biological parents more than their adoptive parents in their hyperactivity. His studies suggest that the environment in which children grow up has less impact on the development of AD/HD than their genes. In a 1991 study, David Comings and his colleagues suggested that a mutation in the dopamine D2 receptor gene is connected to AD/HD. Research is underway now that is exploring several dopamine genes as possible links to AD/HD. A few researchers have suggested that two genes in particular — DAT1 and DRD4 — are the culprits. In fact, a recent study by researchers at the University of California, Irvine, suggests that the DRD4 7R gene may be associated with several AD/HD traits, such as novelty-seeking, increased aggression, and perseverance. Anatomical Researchers have conducted a few studies into the size and shape of the brains of people with AD/HD compared to people without it. A lot of conflicting data exists in this area, but a couple basic ideas have been suggested: One study suggested that the size of the corpus collosum (a bundle of nerves that ties the hemispheres of the brain together) is different in some people with AD/HD than in some people without it. Other researchers have suggested that this part of the brain operates differently in people with AD/HD than in others, so this observation may have some validity. Some research has indicated that asymmetry in the basal ganglia (a set of nuclei deep in the brain that are involved in regulation and control of the motor system) may be indicative of AD/HD. While anatomical research continues, most of the AD/HD research being done right now focuses on differences in brain activity between the AD/HD and non-AD/HD populations. Functional The brains of people with AD/HD seem to function differently than the brains of people without it. This area of research is buzzing right now, not only because it helps explain the cause of AD/HD, but also because these studies use relatively new technologies for imaging. Here's a sampling: A study by Alan Zemetkin, MD, using PET scans on adults with AD/HD discovered that when the subjects concentrated, the level of activity in the front part of the brain (the frontal lobe) decreased from its level at rest. People without AD/HD have an opposite response — an increase in activity in the frontal lobe when they concentrate. This study is generally credited with showing that AD/HD is a biologically based condition. Dr. Joel Lubar at the University of Tennessee conducted several studies using quantitative electroencephalogram (EEG). The studies showed that when people with AD/HD concentrate, there is an increase in theta activity (slow brainwaves) in the frontal lobe of the brain. This finding corresponds to a lower level of activity in the region. Dr. Daniel G. Amen conducted extensive testing at his clinic using Single Photon Emission Computed Tomography (SPECT) technology. He observed several variations in brain activity in people with AD/HD and has suggested that AD/HD is actually several different conditions, each with a different brain activity signature. According to his research, the areas affected by AD/HD include: • Frontal lobe: Dr. Amen found a decrease in activity in this area when people with AD/HD are asked to concentrate. This corresponds with research done by Drs. Lubar and Zemetkin. • Limbic system: The limbic system is located deep inside the center of the brain and is often involved with the way we feel and express our emotions. Dr. Amen's research found that some people with AD/HD have heightened limbic activity in addition to the decreased frontal lobe activity. This corresponds with a perspective put forth by researcher Paul Wender suggesting that the limbic system is at the center of the problems in AD/HD. • Parietal lobe: Located toward the back of the brain, this section is also referred to as the sensory cortex. Dr. Amen suggests that certain people with AD/HD have more activity in this area than other people. Dr. Robert Chabot and his colleagues at New York University found that 11 different patterns of QEEG (quantitative electroencephalogram — a device that measures surface brain wave activity and compares it to normal measurements found in a database) are associated with people diagnosed with AD/HD. They also found that some of these people could be predicted to respond well to certain medications and poorly to others. Chemical For information to pass from one part of the brain to another requires the action of neurotransmitters — chemicals within the brain. A neurotransmitter is a small chemical messenger that allows one neuron (nerve) to communicate with another. When the upstream neuron gets excited and wants to pass on information to the downstream neuron, it releases the neurotransmitter molecules into a closed connection (like an airlock in a submarine or a space ship) called a synapse. The neurotransmitter then crosses the space to the downstream neuron's membrane and binds to specific receptors that cause an effect inside the receiving nerve. One way to think about AD/HD is that it is a problem of balance between the activities of norepinephrine and dopamine two different neurotransmitters. When you have too much norepinephrine working, you are agitated, and you can pay attention only to things that may be threats or targets of opportunity (the "fight or flight" mechanism is very active). When you have more dopamine dominance, you tend to get stuck on repetitive activities, and you don't get bored doing the same things over and over. AD/HD is associated with having too much norepinephrine.

Article / Updated 03-26-2016

Having AD/HD presents many challenges, especially when you interact with people who don't have the condition. Here are some of the more important issues that people with AD/HD have when they live with people who don't have it. Managing moods One of the main characteristics of AD/HD for most people is extreme, frequent changes in mood. One minute you may feel happy and hopeful, and a minute later you feel angry and frustrated without anything outside of you causing the change. This phenomenon is a product of several different factors, the most important of which are: A biological disposition to react more strongly than other people to the ups and downs of life: This tendency is usually helped to some degree by biological treatments — such as diet, medication, and rebalancing therapies — all of which can change the way the brain works. Past experiences: Most people with AD/HD have come up short on meeting their (and others') expectations, so they tend to have an internal dialogue that is demeaning and negative. That tendency to have a low opinion of oneself can be formed, worsened, or reinforced by . . . Others' words: How many times can a person hear "I'm disappointed in you" or "You could do so much better if only you tried harder" before turning that criticism inward (and often making it even stronger)? Most people with AD/HD bear deep scars from criticism directed at them over and over again. A tendency to jump to conclusions: People with AD/HD have a talent for jumping to conclusions ahead of the evidence. After you've jumped to a conclusion, an attitude isn't far behind. If you have an attitude about every conclusion you jump to, you're probably going to come across as moody. Medication wearing off: If you take medication for your AD/HD, as it wears off you may experience changes in mood. If you notice a mood pattern that seems to coincide with your medication schedule, talk to your physician about adjusting your medication, dosage, or schedule. Here are some suggestions to deal with negative thoughts that can lead to negative moods: Stop the thought and ask yourself if it is based on what's happening at the moment. Most of the time, negative thoughts are simply popping up without relating to your life at the moment. Breathe through it. When you have negative thoughts, your body tenses up, and your breath becomes shallower. Take a few deep breaths, and you'll begin to relax. Cancel that thought. After you acknowledge that the thought isn't based on what's happening and you've had a chance to take a breath, you can let it go. Reframe that thought. Even if you think a negative thought is based on what's really happening, you don't have to let it lead you to a negative feeling. Try to reframe negative perceptions, thoughts, or words into positive ones. If you can see the humor or the benefit in a difficult situation, you can probably feel better about it. Don't take things personally. All of us have internal pressures, reasons, or ideas that make us do the things we do. When someone directs a negative comment or action your way, try to realize that it's not necessarily about you. If you can do so, you may not feel the need to have such a strong reaction. Work on understanding the causes and consequences of your own and other people's actions and reactions. If you succeed, you may be able to let us all off the hooks of blame, resentment, and general bad temper. Extreme moodiness may be a sign of depression or bipolar disorder. Because both of these conditions are common among people with AD/HD, have a professional screen you for these conditions. Taking responsibility AD/HD is an explanation, not an excuse. You must take responsibility for your actions regardless of the fact that AD/HD has a biological cause. If your behavior is causing problems in your life, you need to seek the best possible help in getting it under control. If you hurt someone, create a problem, or make situations more difficult — even unintentionally — don't use your diagnosis of AD/HD as an excuse. You and everyone else will benefit if you can focus on understanding how your actions caused the hurt or contributed to the problem. If you can find a way to express that understanding to the other people involved, all the better; they can then realize that you have not ignored their feelings and rights. The most important thing you can do is to learn from situations in which your AD/HD plays a part in creating bad feelings or less-than-optimal outcomes. That way, you can take responsibility and continue on the road to self-improvement.

Article / Updated 03-26-2016

Acupuncture is an ancient Chinese system (several thousand years old) of balancing the flow of subtle energies through the body. In the last 30 years or so, the practice has been studied quite extensively and has grown in popularity in the Western world. In fact, according to the Food and Drug Administration, people in the United States made 12 million office visits for acupuncture in 1993. Acupuncture is used to support general health, but some people use it to reduce some of the symptoms of AD/HD, as well as many of the co-occurring conditions such as anxiety and depression. Getting some background Acupuncture is part of the Traditional Chinese Medicine (TCM) system, along with herbs, meditation, and a host of other techniques. Acupuncture (and the rest of TCM) is based on the concept that all parts of the body and mind are interconnected — every part influences the function of every other part. The belief is that the various parts of your mind and body are connected by a vital energy called Qi (which is pronounced, and often spelled, Chi in the West). This Qi flows through the body, and any disruptions in this flow affect your health, resulting in illness. The goal of acupuncture is to keep this flow going smoothly, which keeps you healthy; or, if you're already sick, acupuncture frees the blockages that are causing your illness. The Qi flows through channels called meridians, which connect your internal organs with the surface. In TCM, there are 12 primary meridians relating to each of your organ systems and 8 secondary meridians, for a total of 20 meridians. Acupuncture involves placing needles on certain localized points in the skin to direct the flow of Qi through each of these meridians. Many theories are available on how this system works, but two stand out: The meridians lie along main nerve centers in the body, and each acupuncture point stimulates the nervous system in a specific way. The acupuncture points, when stimulated, stimulate the body to produce certain endorphins. Regardless of the mechanism involved in acupuncture, its longevity alone suggests that it must help some people. Exploring the process As many as 2,000 acupuncture points exist, and an acupuncturist must figure out which point(s) to stimulate in order to offer you any benefit. Doing so involves a diagnostic process that usually includes the following: Questions to determine your symptoms and history: These questions may involve asking you about your tolerance to heat or cold, your eating habits, and your sleep patterns. Your answers provide a big picture view of you and your condition. Examination of your tongue: According to TCM, a patient's tongue holds a lot of information, so your acupuncturist will likely want to take a look. A check of your pulse: Again, according to TCM, your pulse tells your provider a lot about your state of health. Unlike in Western medicine, an acupuncturist is interested in more than just the speed of your pulse; she looks for the strength and rhythm of it as well. When the intake exam is complete, you're asked to lie down while your provider puts needles in different parts of your body. These needles don't hurt if they're placed in properly. They are very small, and they go only a little way into your skin. If you feel any significant amount of pain from the needles, they aren't put in properly, and you may want to look around for a different acupuncturist. The most you should feel is a slight pricking sensation when the needle is inserted. After the needles are in, you remain relatively still for up to 30 minutes, at which point the needles are removed and you're free to go. Knowing what to expect Your results from acupuncture are going to depend on your condition. Even though you have AD/HD, your acupuncturist may focus on other areas. Remember that the goal of acupuncture is to correct any disruptions in the flow of Qi in your body, so you should receive a very individualized treatment. Generally speaking, it takes several sessions before you can expect to see any significant changes in your symptoms. Side effects, if any, are minimal. Most often, your acupuncturist is able to give you a clear idea after your initial examination as to the number of sessions you need (and their cost) and whether you'll need to return later for tune-ups. Finding a provider Many acupuncturists are in practice these days, but finding one who has experience working with people with AD/HD may be hard. As with any healthcare professional, your best bet is to get a referral from a family member, a friend, or another healthcare provider. If you can't find any referrals, start with your local phone book or check the bulletin board of your local natural foods market. If all else fails, do an Internet search for an acupuncturist in your area. Check the following Web sites, which also have quite a bit of information about acupuncture and TCM: acupuncture.com acupuncturetoday.com medicalacupuncture.com

Article / Updated 03-26-2016

A variety of ways exist to treat your AD/HD symptoms but treatment has to be addressed from three levels: biological, psychological, and social. This combined, or multimodal treatment approach is the most effective way to deal with AD/HD. Biological Biological treatments change the way your brain works. The change can be accomplished several ways and can be temporary or permanent, depending on the approach you take. The options include: Medication Diet Vitamin supplements and herbal remedies Repatterning therapies, such as neurofeedback, Rhythmic Entrainment Intervention, auditory integration training, and vision therapy Rebalancing therapies, such as homeopathics, acupuncture, sensory integration therapies, and manipulation therapies (osteopathy, chiropractic, and CranioSacral Therapy). Psychological Psychological therapies help you deal with the feelings that come from your symptoms and understand how to change the way you think and act to improve your life. Psychological treatment strategies can include: Counseling and psychotherapy, such as insight-oriented therapy, supportive therapy, play therapy, skills training, psychoeducational counseling, and parent training Behavior management, such as behavior modification, cognitive-behavioral counseling, and awareness training Social Everyone needs certain skills in order to function in the world, but people with AD/HD often struggle with basic life strategies. After you deal with the biological issues associated with AD/HD, you need to start developing your social skills in the following areas: Organization Relationships Communication Lifestyle choices Occupational skills

Article / Updated 03-26-2016

AD/HD is not limited to the classic (or primary) symptoms of inattention, impulsivity, and hyperactivity. Many other (secondary) symptoms exist that can negatively impact your life and can include, but aren’t limited to: Worry Boredom Loss of motivation Frustration Low self-esteem Sleep disturbances Hopelessness Procrastination Difficulty getting along with others Difficulty managing time or money

Article / Updated 03-26-2016

AD/HD looks different in almost everyone. You may have problems regulating yourself if you’re dealing with AD/HD. This can happen in areas of attention, behavior, and motor movements. The term attention deficit/hyperactivity disorder (AD/HD) comes from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and the DSM-IV outlines three basic types of AD/HD: Predominantly inattentive type. Having this type of AD/HD means that you have difficulty focusing but are able to sit still. Classic symptoms include: Making careless mistakes Not seeming to listen as someone else speaks Being disorganized or forgetting things Having trouble focusing on a specific task Predominantly hyperactive/impulsive type. If you have this type of AD/HD, maintaining attention is less of a problem than being able to control your body movements or behaviors. The basic symptoms include: Speaking or acting out of turn Not considering consequences before acting Fidgeting or feeling restless when trying to sit `Being excessively physically or verbally active Combined type. If you have a number of symptoms from both the inattentive and hyperactive/impulsive lists, you may have the combined type of AD/HD. To have AD/HD, your symptoms must meet certain guidelines, including: Existing for at least six months Appearing before you were 7 years old Having a significant impact on your life in more than one setting Not being attributable to a different condition (such as bipolar disorder)