Archive for ADHD

Guilt and ADHD

guilt 200x300 Guilt and ADHD

When you’re dealing with ADD/ADHD, you often experience guilt.

If you’re a parent dealing with an ADD/ADHD child or teen, you may experience guilt in numerous ways, such as:

  • Guilt that you have somehow caused the ADHD…
  • Guilt that you aren’t handling it well…
  • Guilt about the treatment you are giving your child (i.e. medication)

If you’re an adult dealing with ADD/ADHD, you may experience guilt in numerous ways as well:

  • Guilt over impulsive comments you make
  • Guilt over disorganization, or being late on deadlines
  • Guilt over financial issues

Guilt can be a trap, or like an invisible cage which locks you in. If you, however, learn from the guilt, it can be a great teacher, and help you out.

I’ve just posted a new ADHD Podcast episode which discusses how to Overcome ADHD Guilt in 5 Steps. This free episode will help you to overcome guilt, by understanding it, learning from it, and moving forward.

Enjoy!

Best,

Dr. Kenny

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ADHD Podcast

I’m please to let you know that I’ve launched an ADHD Podcast. It is available on iTunes, Zune and Blackberry. Of course, you can just go to the site and listen to the shows right there.

It is a weekly ADHD Podcast, and I aim to bring you tips, strategies and tools to help you to live better with ADHD.

You can find the show here:

1) ADHD Podcast

2) ADHD Podcast on iTunes

Please listen in – sign up to get new episodes delivered automatically, and please join the discussion by commenting on the episodes – we’d love your input!

Best,

Dr. Kenny

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Is There a Role For Guns in Parenting?

gun 300x222 Is There a Role For Guns in Parenting?In February 2012, this video was uploaded to youtube. It is a video of a dad expressing his upset with his daughter’s insulting rant on Facebook. He then takes out a gun and shoots her laptop (with hollow point exploding bullets, no less…).

This video went viral. At the time of this post (June 27, 2012) there are over 33 million views of this video. You can watch the video below, if you’d like.

While this dad expresses the frustrations that many parents feel with their teens in this electronic/facebook era, the question is: Is there a role for guns in parenting?

During this video, the dad explains that his daughter has so many things given to her, and yet she complains so much. She complains that she is being treated like a slave, when in fact the chores she is responsible for are quite few and very reasonable. Her comments are very disrespectful to her parents.

Teens today have a sense of entitlement that seems far beyond what generations past had. Even kids in families with financial challenges push their parents to get video games, electronics, music downloads, $200 headphones, etc. And there is often a lack of real appreciation and gratitude.

Of course, not all kids act this way – there are many great teens as well… But that’s not the topic for this post.

And when it comes to teens with ADHD, these issues are often more of a challenge, because of oppositional behavior with parents and teachers, which may increase the defiance they show. And because of social challenges that many teens with ADHD have, they may be more likely to post impulsively on Facebook, and that can lead to more trouble for them later on…

Acknowledging that this teen crossed the line in her facebook post, the question is – is the Dad’s response to her reasonable?

Let’s review what her dad did:

  1. He accessed her facebook and found the offending post.
  2. He recorded a video expressing his disappointment and anger with her – and didn’t show it to her – he posted it to Youtube and her Facebook wall. Youtube let the whole world see it, and Facebook let her friends see it.
  3. He pulled out a gun and shot her laptop to teach her a lesson.

Let’s analyze these ‘parenting strategies’:

1) Accessing Your Teen’s Facebook Account to look at their posts:

This parenting strategy gets the thumbs up.

In the unmoderated world of social media, teens can post things which are self degrading, harmful to others and themselves. And their posts create an online reputation that can follow them forever. Can you imagine this young woman applying for a job in 10 years as an early childhood educator? What would they say when they saw her comments about her parents in her Facebook profile? Material posted online can be archived for a very long time.

So, it is important for parents to monitor and help their kids and teens to be thoughtful and careful about what they post on their social media pages and profiles. So, I support this dad’s approach on this one.

2) Recording a Video Response to Your Teen’s Misbehavior and Posting It Online:

This parenting strategy gets a thumbs down from me.

When a parent is disappointed with his teen’s posting of a ‘rant’ against her parents online, and he wants to discipline her for it – why is he using the same offending behavior? i.e. he is saying it is not right to do that, and yet he is doing it himself back to her…

What message will she get from this act?

She’ll learn that her dad won’t take any crap, and that he’ll find her posts online, so she should be careful. She also learns that if she embarrasses her dad on Facebook, he’ll embarrass her more. And she learns that the way to problem solve when someone is publicly rude, is to publicly retaliate.

Huh?

Is that what this dad wants to teach her? That when you are upset with someone, you publicly retaliate and humiliate?

Not the best approach…

3) Finally, Using a Gun to Teach His Daughter a Lesson:

This parenting strategy also gets a thumbs down.

By using a gun to shoot up his daughter’s laptop, he’s using an aggressive way to show that he is in charge. What does that teach her? It teaches her that when you want to get the upper hand in a situation, firearms (or aggression) is the solution.

Not the best parenting message.

This dad does successfully deliver the message that he is in charge, and he’s not going to take it anymore. However, he is humiliating his teen, and solving this issue publicly and with violence (even though he has a seemingly quiet and calm tone when he talks).

My Recommendations:

Here are my recommendations for parents dealing with similar issues (as a Child Psychiatrist and ADHD Expert):

If your child does something like this, and you are very angry – work on finding a parenting approach that gets your message across clearly, and does not use behavior that you don’t want your child using.

If you want your child to learn that it is OK to solve your problems and upsets by publicly humiliating the person who upset you (publicly as in online – or other offline ways of publicly humiliating someone), and using a firearm, then use the approach as demonstrated by this dad.

On the other hand, if you want to use disciplinary approaches which demonstrate behavior that you want to encourage in your child, find approaches that work with your child and model the behavior that you want your child to develop. For example, discussing the issue privately, creating fair but firm consequences and sticking to them, and escalating the punishment for repeat offenses.

If you are struggling to do this effectively, there are many great parenting resources out there. Many people have found the chapter on parenting in my book Attention Difference Disorder helpful to them, and there many other great parenting books out there.

Also, talk to your doctor for help, or access resources from a mental health center, counselling center, or even your church or religious community. There is help out there for parents who are struggling. Remember, even though in our modern western society, we often don’t access our community as much as generations past did, there are people who would be willing to support, help and guide you.

My hope for you is that you find effective parenting strategies that work, and model the behavior that you want your child to learn (so, in 15 years, they don’t parent with a video camera, an internet connection, and a handgun).

What is your reaction to this parenting approach? Do you agree with this dad using a gun to prove his point? Do you agree with me? Please share your thoughts and comments below.

Best,

Dr. Kenny

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The Individuality of People with ADHD

fingerprint 150x150 The Individuality of People with ADHDWhen you ask someone what they think of when they hear the term “ADHD”, they often say that they picture a boy who is hyperactive. And that’s accurate – there are some boys with ADHD who are hyperactive.

But ADD/ADHD can go far beyond boys who are hyperactive.

There are also boys who are inattentive, girls who are daydreamers, young men who get angry easily, young women who are “too emotional”, and a whole range of other different ‘presentations’ of how people seem when they have ADD or ADHD.

In my office, after completing an assessment, I discuss with a family that their child meets criteria for ADHD (if they do) and I explain more about it. It’s quite a common occurrence for the parent to say something like: “I know about ADHD because my other child has it (or my nephew has it; or I’m a teacher and I’ve had kids in my class with it), and I just don’t see my child having the same thing as the other kid(s) that I know with ADHD.”

I then go on to explain how ADHD can ‘look different’ in different people, and I explain how it is manifesting in their child.

While I’ve always known that ADHD can seem different from one person to another, the extent of the individual nature of ADHD really hit home recently when I was reading to prepare for a presentation to teachers. In the book ADHD in the Schools by Dupaul and Stoner, this point was made very clear. Before sharing Dr. Dupaul and Dr. Stoner’s insights, let me just give a brief overview of how ADHD is diagnosed with the DSM criteria.

The DSM-IV-TR (The Diagnostic and Statistical Manual of the American Psychiatric Association) lists 9 symptoms of inattention, and 9 symptoms of hyperactivity/impulsivity. To meet the criteria for ADHD, one has to have at least 6 symptoms on one or both of these two lists (inattention or hyperactivity/impulsivity).

If one has at least 6 symptoms of inattention, and fewer than 6 symptoms of hyperactivity/impulsivity, then one is diagnosed with ADHD- Inattentive Subtype.

If one has at least 6 symptoms of hyperactivity/impulsivity, and fewer than 6 symptoms of inattention, then one is diagonsed with ADHD- Hyperactive Impulsive Subtype.

If one has at least 6 symptoms on BOTH lists, then one has ADHD- Combined Subtype.

So, to meet criteria for ADHD Combined Type, one has to have at least 12 out of 18 symptoms of ADHD. Of course, one could have 13 symptoms, or 14, etc.

In their book ADHD in the Schools, Doctors DuPaul and Stoner write:

“There are at least 7,056 possible combinations of 12 out of 18 symptoms that could result in a diagnosis of ADHD-Combined Type.”

7,056 different combinations of ADHD symptoms!

No wonder there isn’t one stereotype for kids/teens and adults with ADHD.

And this only relates to the combined type of ADHD. There would be more combinations if we added inattentive only, or hyperactive impulsive only.

And this is just based on the combination of symptoms alone. If we go a little deeper, and look at the individual, and take into account things like:

  • Ethnic and cultural background
  • Personal life experiences
  • Likes and dislikes
  • Strengths and skills people have
  • Weaknesses and challenges people struggle with
  • Personality traits
  • The society they’ve grown up in…
  • And a whole lot of other varilables

It’s no wonder that not everyone with ADD/ADHD seems to ‘look’ the same, and appear to have the same type of ADHD.

Are there similarities between individuals with ADHD? Of course there are. To meet criteria for the diagnosis, one has to have a relevant number of symptoms, and there are clinical patterns which can emerge.

However, don’t ever dismiss ADHD as a diagnosis just because that one person doesn’t appear the way you think ADHD should look . That person is just an individual with ADHD (with all of their unique individuality).

I hope that after reading this blog post, you’ll share this message with other people about ADHD. One of the first steps to destigmatize and to improve understanding about ADHD in society at large is for people to have the facts. And if we can help people to realize that not every person with ADHD is a hyperactive boy, and we open people’s minds to the fact that people with ADHD can be either gender, they can have a whole range of different symptoms, life experiences and levels of achievement in life, then we can do a lot of good out there.

And once someone has been diagnosed with ADHD, it is important that we focus on their differences and strengths to help them to achieve their best outcomes.

Please share your thoughts and comments below.

Best,

Dr. Kenny

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Britney Has ADHD

britneyspearscropped Britney Has ADHD

Britney Spears has ADHD (picture from Wikipedia.org)

It has just been reported that Britney Spears has ADHD. The Grammy winning pop star, who holds Guinness World Records, and has her own Star on the Walk of Fame has now shared that she has ADHD.

Britney has taken on the role of a judge on the singing reality show “The X Factor”, and she is now currently filming for the show. During the filming of auditions, Britney reportedly needed to take breaks, and the explanation was that she has ADHD, and that she had to take breaks during the long filming sessions.

The reports also go on to explain that Britney was diagnosed with ADHD when she was young, and used to take medication for it. Her doctors apparently have now forbidden her from taking ADHD medication for reasons related to other mental health concerns. Here is a link to one of the news reports about this story.

Now that Britney has come forward and shared her diagnosis of ADHD, she joins other celebrities like: Howie Mandel, Ty Pennington, Adam Levine, Michael Phelps, Karina Smirnoff and many others.

I personally view this as a brave and helpful admission. Millions of kids and teens get diagnosed with ADHD, and they feel that they are disordered, and they wonder if they will have a positive future because of their “Disorder”. Having celebrities come forward to share their diagnosis helps kids to realize that they can be successful even though they have ADHD.

While I view Britney’s disclosure as a positive, I have come across some comments on social media sites (which I don’t want to support with a link right now…) who say that Britney is “blaming” her behavior on ADHD, and how awful is that. They are suggesting that she is acting like a diva, and using ADHD as an excuse.

Before responding to this, I’d like to share that I have no direct knowledge on Britney’s diagnosis or medical care – I only know what I’ve read online. And saying that – here’s my response: Britney apparently disclosed to her employer (Simon Cowell) before signing on for the show that she has ADHD, cannot take medication for it, and needs to take breaks at times because of it. Simon apparently agreed to this before hiring Britney. Britney can’t take medication for ADHD, and instead she is using strategies to help herself to function well. And let’s remember – although an ‘audition show’ makes it seem like 1 hour for each city (i.e. the LA auditions only seem to take 1 hour), in fact, they are filming for very long days… (and of course there is much more involved – make up, lighting, direction, breaks, etc.) They just edit it to seem short for us – the viewers.

In my understanding of the situation, Britney is acknowledging her challenges, putting strategies and supports in place, and working to function in the best way that she can. I think that is a great model for others to learn from and to emulate. I would not try to tear her down for being a diva and blaming it on ADHD.

The reality is that ADHD medication is helpful for Adult ADHD, and it is not the whole solution. There is some research that shows that most of the time, ADHD medications do not fully treat the symptoms of adult ADHD. So, it is very important to use strategies and to develop skills to improve functioning with ADHD. This is even more important if someone is unable to take medication.

Why can’t Britney take medication for ADHD?

There aren’t any reports that I’ve read which explain this in more detail. One news report said that she can’t take medication for ADHD because of mental health issues. While I don’t know what these are for Britney, it is possible that she has had one of these challenges: intolerable side effects from ADHD medication; mood instability from ADHD medications (i.e. depression or induction of hypomania or mania), sleep disruption, significant decreased appetite, etc. In other words, I’m guessing. I’m sure she has expert and capable doctors.

The take away I encourage you to get from this is: Britney is a talented star, who has ADHD, is using strategies to manage it because she can’t take medication (on doctor’s orders). That’s a great example for all of us.

What impact do you think this admission will have for you, or your kids with ADHD, or the people you work with (if you’re a professional working with people with ADHD)?

Please share your thoughts or comments below.

Best,

Dr. Kenny

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ADHD and Post-Term Births… Don’t Believe Everything You Read

sleep 300x200 ADHD and Post Term Births... Dont Believe Everything You ReadA new study just came out in the International Journal of Epidemiology, called: “Post-term birth and the risk of behavioural and emotional problems in early childhood”. It was published online on May 3, 2012.

The press have widely reported that this study shows that when a pregnancy goes beyond 42 weeks, then a child is more than two times more likely to develop ADHD in early childhood.

You can find many media references to the study, and here is the link to a BBC article entitled: Overdue babies: ‘Risks for those born after 42 weeks’.

I am largely annoyed with the difference between what the study reports, and what the press are saying.

What The Study Reports:

First of all, this study is very interesting from the perspective that we often think about prematurity as a risk factor for ADHD, as well as other medical, learning and emotional issues. However, we don’t really think of a baby being ‘post dates’ as an issue for ADHD or other emotional or learning issues. The researchers point out that as a pregnancy goes beyond 40 weeks, the placenta may not be able to meet all of the needs of the baby, and thus going past dates may cause problems too.

This study followed the pregnancies of 5145 children in a large population-based prospective cohort study in Rotterdam, The Netherlands. Mothers enrolled between 2001 and 2005. Of the births, 382 (7%) were born post term. The researchers had all of the mothers complete the Child Behavior Checklist (CBCL) at the ages of 1.5 and 3 years old. This questionnaire has parents rate a wide range of symptoms in their children, and then the software calculates the scores, and provides a rating (based on parent report) on several different scales of emotional functioning – such as: anxiety, depression, somatic symptoms, ADHD, aggressive behavior, etc.

Please realize that questionnaires do not diagnose ADHD. Questionnaires can provide data, which can help an experienced clinician to conduct a more detailed assessment to see if ADHD (or any other condition) is actually there.

The research report says: “post-term born children had a higher risk for overall problem behaviour [odds ratio (OR)?=?2.10, 95% confidence interval (CI)?=?1.32–3.36] and were almost two and a half times as likely to have attention deficit / hyperactivity problem behaviour (OR?=?2.44, 95% CI?=?1.38–4.32).”

Let me highlight an important point there: “two and a half times as likely to have attention deficit / hyperactivity problem behaviour“. The questionnaire doesn’t diagnose ADHD, rather it points out that these children have more ‘ADHD problem behavior’ compared to babies born at term.

As an experience clinician and expert in ADHD, I know that it can be very difficult to diagnose kids with ADHD at a young age. It certainly can be done at 3 years old, but I am very cautious about a diagnosis at that age, and I certainly put a lot more work into it than just having the parents fill out a questionnaire. Personally, I would find this information more reliable if the researchers were able to provide follow up at school age – i.e. at 6 years old. That would give us a better idea of how the child was doing (of course I do understand that there are big issues with funding, timing, etc., but I still would love to see data at 6 years old).

Furthermore, I am left wondering: “is the relationship between post-term birth and ‘ADHD problem behavior’ truly a causal relationship?”
In other words, if we accept that the behavior ratings at 3 years old are accurate (i.e. there are more ADHD problem behaviors), then do we know for sure that this was caused by post-term birth?

Maybe there was another variable at play here.

In a cohort of over 5000 women, approximately 4% of them would be expected to have ADHD. That works out to about 200 women. It would be much more likely for these women to have children with ADHD problem behaviors irrespective of when their child was born (premature, on time, or post-dates). And what if they were more likely to refuse intervention from the doctor, and wait for nature to take its course? Then we may believe that it is going ‘post dates’ that is causing ADHD type symptoms, when in fact, we are just screening out for moms who have ADHD symptoms. Now, I have no science to back this up, and I do not believe that the mothers were screened themselves for ADHD. So this is complete conjecture. But, I think it’s an interesting theory.

Before I get flaming comments here, I’m not suggesting that women who refuse induction of labor, or who want to let nature take its course all have ADHD. Far from it. I’m just putting forward a theory which may refute the theory that it is a causal relationship between post-dates birth and developing ADHD.

What The Media Is Reporting:

The media is reporting that kids born post-dates (i.e. after 42 weeks) are over 2 times as likely to have ADHD. I read one report which went so far as to suggest that mothers should consider having a C-section before 42 weeks to help to prevent ADHD (I can’t find the exact news report to link to here, but trust me, I read it).

In Summary:
As you can see based on what I wrote above, I believe that these claims are over-simplified. I am not convinced that post-term births increase the risk of ADHD. This study has opened my eyes to the possibility that post-term births may be a risk factor for ADHD, or possibly other learning or behavioral issues, but it is by no means conclusive research. It’s my opinion that the media are over-simplifying this, and it may create more backlash and stigma for ADHD patients and their moms (like the mother-in-law saying: “I told you you should have listened to the doctor and had an induction of your labor at 41 weeks. The fact that you waited too long caused my grandson’s ADHD…”).

What do you think? How do you respond to the research, and the media reporting of it?
Please share your thoughts and comments below.

Best,
Dr. Kenny

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Why I Like NBC’s “The Voice” and Its ADHD Lessons

230px TheVoiceTitleCard Why I Like NBCs The Voice and Its ADHD Lessons

The Voice (picture from wikipedia.org)

In general, I’m not one for reality shows, especially not ones about singing (maybe it’s because I can hardly carry a tune…). But, something about the promos for “The Voice” caught my attention. This season (season 2), I caught a couple of the early shows – with the blind auditions, and I’m now watching the final shows (to see who’s going to win!).

As a doctor who specializes in ADHD, I think “The Voice” has some important lessons for parents of kids and teens with ADHD, as well as Adults with ADHD, and I’ll share them with you here.

If you’re not familiar with “The Voice”, it has some interesting twists on a singing competition show.

Firstly, on this show, the judges aren’t just judges, they’re coaches. The four coaches are: Christina Aguilera, Adam Levine, Ceelo Green and Blake Shelton. While they do ‘judge’ throughout the competition, they each choose contestants, and they coach them. The coaches help to develop their singer’s talents, and help them to do the best they possibly can during the show. Through the course of the show, the contestants get great advice, training and encouragement from their coaches, and viewers can see how close the relationships develop during the course of the show.

ADHD Lesson: getting coaching from people who have been where you are, and can help you to go where you need to go, can be life altering. When it comes to ADHD treatment, there are doctors, therapists and other health professionals, and now there are also expert ADHD Coaches – who can help you in many ways as well. To find out more about coaching, visit the ADHD Coaches Organization.

Secondly, when the contestants audition, the judges are ‘blind’ to what they look like. The judges have their chairs turned backward, and they can only hear the singer’s voice when they’re deciding if they want to choose them for their team. This is a real twist, because the judges have to choose the contestants based solely on their voice, and not on how they look. We all know that certain people look like stars, and many people don’t. In some reality shows, a person’s look has a big impact on whether they’re chosen. In this show, people are chosen based on their own merit. Although the world doesn’t always work that way, it’s great to see it happen.

ADHD Lesson: Many times, kids, teens and even adults with ADHD are judged negatively because of their ADHD symptoms (i.e. they’re too inattentive, or too impulsive in a situation). We need to help people to see ADHDer’s talents and actual abilities. Often, they’re incredibly talented in particular areas. Hopefully, people can look past ADHD to see the talent, and hopefully, good treatment for ADHD will help people to develop their talents, and share them well with others.

Thirdly, I love how many contestants and participants make so many sacrifices to pursue their dream of singing. Early in the season, there were many people who left their jobs, left a semester at college or made other sacrifices to be able to attend the auditions. And not all of them even got chosen for the show! From my perspective, even if they weren’t selected for the show, those participants were hugely successful for choosing to pursue their dreams.
To quote Zachary Scott: “As you grow older, you’ll find the only things you regret are the things you didn’t do.” (source Brainyquote.com)

Fourthly, many of the show’s contestants/singers are singing for reasons which are much bigger than just themselves and their dreams. Many are singing to stay true to themselves and to support their families; to honor and thank those that believed in them; and Erin Willette even stayed in the show and sang when her father passed away in between the auditions and the live battle rounds. Although she was quite emotional about it, she knew she had her father’s love and support, and both of her parents (and her family) wanted her to pursue her dream. What a gift her family gave her, and what a gift she gave her dad – for him to see her pursuing her dream (and succeeding!) in his final days.

ADHD Lesson: Combining points 3 and 4, we learn that it’s important to pursue our dreams, and to work for a reason bigger than ourselves.
For many of us, getting through the day to day and week to week can be challenging (especially when dealing with ADD/ADHD in ourselves or our children). And it may seem selfish, indulgent, or just absurd to take the time to dream again, or to connect with our long lost dreams. And it is still important to do! Why do you get excited when you see an underdog win a gold medal in the Olympics? Why do we love hearing the back-story of someone who goes on to do great things? Because it inspires us. It touches us deep insider – where we have our dreams, goals and our greatness. And when we hear their story, we briefly remember our greatness. Make a decision to pursue your dreams again. You don’t have to quit your job, or move to Los Angeles right now, but if you love music – start playing your guitar again, or start singing again. Maybe there’s a local ‘open mic’ night, and you can enjoy connecting with your creative side again. Or the church choir would love to have your voice join them…

When it comes to helping to motivate kids/teens and adults with ADHD, it’s important to have a great ‘reason why’. People with ADHD don’t pursue goals ‘just because’. The daily, mundane, boring (and seemingly irrelevant tasks) don’t get done just because they should. When there is a great reason why – that motivates ADHDer’s to do great things. So, think about some great reasons why. And if you have a child or teen with ADHD, take the time to help them to find the reason why things are important (like Math homework that they think will never be relevant in their life… try putting a dollar sign in front of the numbers :-)) With a strong ‘reason why’, the contestants in “The Voice” are more compelling, and in real life, if we have a strong ‘reason why’, we work much harder to pursue what’s important to us.

Finally, one of the reasons that I love “The Voice” is the huge respect I have for Adam Levine, the singer from Maroon 5. Not only is Adam a great singer, a great coach on the show, and the coach who won in season 1 of “The Voice”, he is also an adult with ADHD.

Not only is Adam an adult with ADHD, he is one who is sharing it widely, and using his position of celebrity to help others who have adult ADHD. Up to 60-70% of kids/teens with ADHD still have it as adults. However, most believe that they have outgrown it, and don’t need any more help. Adam’s message is simple – you may not have outgrown it, and you should review it with your doctor, and get the help you need. Recently, Adam has worked with Shire to create the “Own It Project” target=”_blank”, which encourages adults with ADHD to ‘own their ADHD’, and if that’s you – you can submit your story to qualify to win a prize.

Adam is doing a great thing to raise awareness of adult ADHD, decrease stigma, and to help others. And for that, I’m grateful.

When it comes down to it, I don’t mind whether you watch “The Voice”, or whether you ever will. Hopefully, these reflections will help you in your life (or your loved one’s life) by taking the messages and applying them to your situation.

Please share your thoughts and comments below.

Best,

Dr. Kenny

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ADHD in Japan: A Personal Perspective

225px Flag of Japan.svg  ADHD in Japan: A Personal PerspectiveThe “Land of the Rising Sun”…
The home of Samurai and Ninja…
The birthplace of Sony, Nintendo, and countless other technology companies which have changed our world…
The originators of Anime and Manga…
The manufacturers of Toyota, Honda and many other cars…

Japan is a country with a rich history, a strong economy, a fascinating culture, and it has a big influence on our modern world. For these reasons and others, I was very excited that I was invited to teach Japanese doctors about ADHD in early March 2012. While I was there, I presented to, and met many Japanese Child Psychiatrists and Pediatric Neurologists. I had many discussions with them about their work with ADHD.

In this blog post, I’ll share some of what I learned while I was there, and I’ll share some of my personal opinions about ADHD in Japan. Please note – this blog post really is my personal opinion. I did not see patients in Japan, I was only there for 6 days, and I did not conduct any research while I was there. Although I’ve gathered information and formed some opinions, I clearly cannot say that I have a strong grasp of Japanese culture, nor the mental health system in Japan, nor all there is to know about ADHD in Japan. That said, I hope that my thoughts can help you to understand more about ADHD in Japan. (And if you read this article, and find that my opinion has some factual inaccuracies, please let me know if the comments, and I’ll do my best to fix them.)

(and after sharing my opinions about ADHD in Japan, I’ll share about my experiences with traveling in Japan, so stay tuned…)

Firstly, you may wonder: Do kids and teens have ADHD in Japan? Do they get diagnosed, and are they prescribed medication?

The answer is: yes and yes.

Kids and teens are diagnosed with ADHD in Japan, and they are prescribed medication when they are diagnosed.

In general, to get a diagnosis of ADHD in Japan, one needs to see a Child Psychiatrist or Pediatric Neurologist. To get an assessment, a family would go directly to the specialist, as there aren’t family doctors or general practitioners in Japan. The specialists use the same assessment and diagnosis process that doctors in North America and Western Europe do.

In many ways, the challenges with getting diagnosed with ADHD are similar in Japan as they are in other parts of the world. By this I mean that there is stigma around mental health issues, and a significant reluctance for parents to give children medication. In addition to the challenges around acceptance of the diagnosis of ADHD and the use of medication which go on all over the developed world, in Japan, there have been significant issues with stimulant abuse and misuse. This has led to even more concerns around the proper use of ADHD medication in Japan. Here is a link to an article published in 1989 about stimulant abuse in Japan. There were renewed concerns about stimulant abuse in 2007, which are summarized below.

I learned about one very interesting cultural difference around ADHD diagnosis and treatment in Japan. In Japanese culture, it is important to respect other people’s personal space. When a child with ADHD has hyperactivity/impulsivity, which includes a symptom like: “interrupts and intrudes on others”, then their parents are often very concerned about this symptom, because it breaks the cultural norm. As such, parents of a child with this symptom may be more inclined to get their child diagnosed with ADHD, and they would be more inclined to give their child medication to help with ADHD. While this may be good to ensure that these children get the help that they need, it can also work against longer term treatment. In other words, when that symptom goes away (and the child is no longer interrupting and intruding on others), the parent is more likely to stop treating their child with medication. And even though that hyperactive/impulsive symptom is resolved, the child may have many other challenges with ADHD (such as inattention, restlessness, social problems, etc.).

While talking with Japanese specialists about their ADHD patients, it seemed to me that parents of kids and teens with ADHD go through issues of frustration and guilt, as they do in North America. Although I didn’t meet parents of kids and teens with ADHD in Japan to discuss this issue with them, I have a suspicion that the frustration and guilt that parents experience may be more in Japanese culture around ADHD than in Western countries.

What About Medication for ADHD in Japan?

When it comes to medication for ADHD in Japan, there are very few options. While Ritalin is available in Japan, it is illegal for it to be used for ADHD (it is currently only approved for narcolepsy). In October 2007, there was a crisis which happened in Japan over Ritalin, and a concern around its abuse. There were articles in a major Japanese newspaper – The Yomiuri (which at this point are not available on their website – and if they are, they aren’t in English). There was a significant tightening of rules around the use of stimulants for ADHD. Although I can’t access any source materials for this story, a user on ADD Forums posted a quote from the news story, when it was happening (you can find the post here). The quote said:

A panel of the Health, Labor and Welfare Ministry on Wednesday decided to remove the psychotropic drug Ritalin from its list of approved medicines to treat depression as it has become widely abused.

Following the decision by the pharmaceutical and food sanitation council, the ministry within this month will restrict the prescription of the highly addictive drug solely for the treatment of narcolepsy.

Ritalin is the brand name of methylphenidate hydrochloride, a central nervous system stimulant.

To prevent a further increase of the abuse of the drug, especially among young people, the ministry ordered Novartis Pharma K.K., the pharmaceutical company that produces and distributes the drug, to develop a system to manage its distribution.

The Minato Ward, Tokyo-based company plans to set up the system by early next year.

Under the new system, which is as strict as that applied for narcotics for medical use, doctors with expertise in diagnosing narcolepsy as well as medical institutions and pharmacies that prescribe the drug will be required to be preregistered.

Also at the panel meeting, Janssen Pharmaceutical K.K. proposed the same management system regarding the distribution of Concerta, a drug used to treat attention-deficit hyperactivity disorder.

(Oct. 19, 2007)

Prior to the release of Concerta in Japan, there were no medications officially approved for the treatment of ADHD. Doctors were treating ADHD with Ritalin, but Ritalin was only approved for the treatment of Depression and Narcolepsy. Because of the issue described above, Ritalin was only approved for Narcolepsy, and doctors are no longer allowed to use it to treat ADHD. Shortly after this issue, Concerta was released, and was approved for the treatment of ADHD.

The medications currently available in Japan for ADHD include: Concerta (OROS Methylphenidate) and Strattera (Atomoxetine).

These medicines are approved to treat ADHD from 6-18 years old.

Doctors are not allowed to prescribe the medication to anyone younger than 6 years old, and they are only allowed to prescribe ADHD medication to anyone over 18 years old if they started the medication prior to their 18th birthday. In other words, at the current time, if someone is diagnosed with Adult ADHD, and did not start medication before their 18th birthday, they would not be allowed to take an ADHD medication. I do understand that at least one of the companies which produces ADHD medication in Japan is applying for an adult indication for ADHD. If and when this is approved, it would make it easier for patients who get diagnosed with adult ADHD to receive medication for their condition.

For a published scientific article looking at the use of medications for ADHD in Japan, please view this article.

Japanese ADHD Specialists:

When I presented in Tokyo, I presented at a national ADHD meeting. There were many Japanese presenters at the meeting (which I could understand thanks to the translators). I was very impressed by the caliber of their presentations, and the wisdom and insight they shared. I have attended ADHD meetings in Canada, USA and Europe, and while all of the presentations in Tokyo were very good, there were a couple of presentations ranked in the top presentations that I’ve seen. The Japanese Psychiatrists and Pediatricians are very well trained, intelligent, they conduct great research, and they care for their patients deeply.

Prevalence of ADHD in Japan:

The prevalence of ADHD in Japan is relatively understudied. Yoshimasu published in 2006 that regarding ADHD in Japan (and Eastern countries): “the epidemiological evidence including data for incidence, prevalence, gender differences, and etiology remain insufficient.”

When it comes to the number of patients diagnosed with ADHD and the number receiving medication, my sense is that there are significantly fewer in Japan (based on population) compared to the United States or Canada. While I have no solid research upon which to base this opinion, here’s how my logic goes (from my Canadian perspective):

  • Japan has a population of approximately 135 million people; Canada has a population of approximately 35 million people
  • Japan has approximately 500 Child Psychiatrists; Canada has approximately 500 Child Psychiatrists
  • Japan has approximately 2500 Pediatricians who treat ADHD; Canada has approximately 2500 Pediatricians who treat ADHD

In other words – for the size of the population, there is an equally sized ‘work force’ of medical specialists who assess and treat ADHD. While I don’t know the budgets of mental health treatment programs (i.e. how much money is invested in psychological treatments), based on my logic above, I suspect that overall fewer patients in Japan (based as a percentage of the population) are identified with ADHD and receive help for it than are in Canada.

Hopefully these insights and opinions are helpful to you. Please share any comments below.

Before wrapping up, I’d like to share some of my personal experiences traveling in Japan.

My Personal Experiences Traveling in Japan:

I had so many great experiences while in Japan, even though it was a very busy trip (I was there for 6 days, and I had 6 presentations in 4 cities). I hardly had time to get accustomed to the time difference, so I was always some variant of tired while I was there (except for when I was presenting, because as the saying goes: “The show must go on!”). Here are a few experiences which I enjoyed:

Grateful for the translators:

I was fortunate while I was in Japan to have two excellent medical translators. They did real time translation during my presentation, so that doctors could listen to my presentation in Japanese on headphones while I presented in English. When participants asked questions, I would listen to the question in English on headphones, while they were asking in Japanese. While most doctors could speak some English, there were few who could talk about medical issues comfortably in English (and their English was always better than my Japanese!).

When traveling between cities, I was fortunate enough to have a guide to get me to the train, or airport. Because I don’t speak or read Japanese, it is very hard to get around without help, because one can’t even read a street sign! And while many people speak some English, it is hard to get around without speaking Japanese.

Excellent Train System:

JapanTrip 4 of 333 150x150 ADHD in Japan: A Personal Perspective

Dr. Kenny and the Bullet Train in Tokyo

Japan has an excellent train system. It runs like clockwork, and the trains are local, express (to an adjacent city), and there are of course the “Bullet Trains”. I did take the Bullet Train from Tokyo to Nagoya. It went approximately 160 km/h, and it was smooth and comfortable. On my last day in Japan, I was supposed to take the Bullet Train from Osaka to Tokyo (so that I could go to Narita Airport to fly home), however there had been an accident earlier, and the bullet train was significantly delayed. The message we were told was that someone had slipped off the platform when the bullet train was passing through a station, so the train was not running. While it was explained as an accident, one of the psychiatrists I had spoken to expressed concerns about the high suicide rate in Japan, and how many people jump in front of trains as their method of committing suicide. While I will never know what happened to that person that day, I was certainly concerned for that person, and their family. In the end, the travel agent found me an alternate way of getting to Tokyo (via a short flight), and I got to Narita airport earlier than I would have otherwise. Interestingly, when I had no ability whatsoever to contribute to the solution of the issue, I had a surprising calm about the fact that I could potentially miss my flight. If I were in the English speaking world, I wouldn’t have had a travel agent with me, and I would have had to figure it out, or get the right help to figure it out – and in that case, I certainly would have worried more.

Expensive Taxi Ride: One of the first things I noticed when I got to Japan was the fact that the airports are quite a distance from the cities. Narita International airport is quite a drive from Tokyo, and when I arrived on a Friday afternoon, it took around 2 hours to get there. The bill for the taxi ride? The equivalent of $300! The message here is this: when you go to visit Tokyo on holidays – make sure to take the train from Narita Airport into Tokyo. It’ll probably be faster, and it will cost a lot less.

JapanTrip 21 of 333 150x150 ADHD in Japan: A Personal Perspective

Fresh Tuna in Tsu City

Amazing Sushi: Need I say more? As a sushi lover, I had fantastic fresh sushi in Japan. I was able to go to two different local restaurants (one in Tokyo and one in Tsu City), and the food was amazing. When I say ‘local restaurants’, I mean restaurants which aren’t tourist locations, but rather restaurants where real Japanese people eat. That’s how I love to get great food when traveling, and I loved it!

Tech Tourism: When I had time to tour in Tokyo, I went to the beautiful Asakusa temple, and then the day was getting late, and things were closing. When I was asking my guide about the different options we had, I chose to go to Ginza (a part of Tokyo), where the Sony showroom is. As a bit of a ‘tech geek’, I really enjoyed seeing the Sony showroom, which included several pieces of technology which aren’t in North America yet. I then went to ‘Bic Camera’, which was like a huge department store, with floors and floors of electronics. Although I loved seeing these great technology stores (and I didn’t spend too much), I must admit that I feel pretty geeky for visiting the tech stores in Tokyo icon smile ADHD in Japan: A Personal Perspective

Wonderful People: While in Japan, I met many smart, educated, warm, caring and humble people. While I was only there a short time, I met some great medical colleagues, and made at least one good friend that I will keep in touch with.

Japan is a fascinating and complex country, and this trip has really piqued my curiosity. I look forward to my next opportunity to go back to the ‘land of the rising sun’, to experience more of what Japan has to offer.

Final Thoughts:

If you are going to travel to Japan, and you take medication for ADHD, please be very mindful of the Japanese rules and laws for stimulant medication. In a future post, I will share the current rules and restrictions (hint – you can’t bring all stimulant medications into Japan…)

Best,

Dr. Kenny

Here are some more of my pictures from Japan:

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Family Meetings For Parenting ADHD Kids

As a parent of a child or teen with ADD/ADHD, you’re likely always looking for parenting strategies that work. If you’re like many parents that I work with, you find some that work, and then after a while, your child (gotta love ‘em :-)) goes and changes, and then you feel like you’re back to the drawing board.

One of the strategies that can be very helpful, and is often not taught – is having family meetings. Family meetings – when they are done well – can be very helpful (and if they are done poorly, they can really back fire!).
That’s why I’ve interviewed ADD Coach Diane O’Reilly for this coaching video for you. She discusses how to run a Family Meeting to help your family to function better. And not only is Diane a trained, expert coach, but as you’ll hear – she has 4 boys – three of whom have ADHD (and one is on the ‘borderline’, she says), and she herself has ADHD. So Diane knows how to use this strategy to make family life run better.

Just click play to watch this video:

Click here for iPhone/iPad compatible video.

If you’ve found this video helpful, and you’d like to join our coaching training call on Monday February 13th at 8 pm Eastern time (or even if you can’t make it live, you can get the recordings), just click here to join the “Insiders” program:
Join ADD/ADHD Insiders

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ADHD & New Year’s Resolutions

Today is January 4, 2012, and I sent an email today to my email subscribers asking them two simple questions:

  1. What is your #1 New Years Resolution this year?
  2. Have you achieved your New Years Resolutions in the past?

I asked people to just hit ‘reply’ and send in an email to let me know the short answers to these questions. On other occasions, I have used ‘survey software’, which makes it easy to tabulate and summarize responses, but this time, I thought if people just had to hit ‘reply’ in their email, then they’d be more likely to respond.
And did you ever respond!
In the first 8 hours after the email was sent – I received 153 email responses!
I am appreciative, honored, and touched by the emails sent. I wanted to summarize some of the comments and issues which came forward.
First, I’d like to give you some background.

The Issue With New Year’s Resolutions:
Every January 1st, many people ‘resolve’ to improve things in their lives. The gyms are full, the diet clinics are doing brisk business, and people plan to change their lives.
And by Valentine’s day (or maybe even by January 7th?), the resolutions are gone, forgotten, and things are back to ‘normal’.

And when it comes to people with ADD/ADHD, it can be very hard to make and keep resolutions. The symptoms of ADD/ADHD include poor focus, distractibility, impulsivity, etc. And, many people with ADD/ADHD have executive functioning difficulties. One executive function is: goal directed persistence! If everyone in society has trouble with keeping resolutions, how easy is it going to be for people who have trouble with ‘goal directed persistence’?!

And when it comes to family members who care for their loved ones with ADD/ADHD, they often get so burned out by their daily support and advocacy that it can be hard to focus on themselves…

So, with all of the odds against us here, why did I want to talk about New Year’s Resolutions?

It is my personal belief that we need to continuously strive for improvement. We need to evaluate where we are, and continuously set goals to reach the next step.
And not everyone agrees with me… BUT on New Year’s – this is a chance when everyone is considering New Year’s Resolutions. Many people are thinking about setting goals, and they want to achieve them.
I view this as a chance to help you – if you want it.

Your Responses To My Email Questions:

154 emails in the first 8 hours!
The first 80 or so got personal responses, and then I had to just read the emails, because I was running out of time.
I did read every email, and let me say this:
I am very touched and appreciative to each and every one of you who wrote in (and if you respond after this post goes live, I will happily read your email as well!)
As I was reading your emails, I realized that when you wrote in, you were letting me in to your hopes, dreams, and sometimes wounds (from previous hopes and dreams which didn’t go well). I was touched and honored that you were kind enough to share this very personal information with me. And I don’t take it lightly.

In my email to you, I wrote the list of the top 10 New Year’s Resolutions according to About.com. They are:
1. Spend More Time with Family & Friends
2. Fit in Fitness
3. Tame the Bulge
4. Quit Smoking
5. Enjoy Life More
6. Quit Drinking
7. Get Out of Debt
8. Learn Something New
9. Help Others
10. Get Organized

But I wanted to know what your top resolutions were.
While this isn’t an official ‘tally’, here are some of the top themes which came up over and over again when you wrote in your #1 New Year’s Resolution:

  1. Have more patience (with my ADHD child, spouse, or with myself)
  2. Declutter, and get organized
  3. Lose weight/gain health
  4. Spend more time with friends/better connection with family
  5. Save more money/spend less/earn more
  6. (I resolve to) Not make any more resolutions because I always let myself down
  7. I don’t make resolutions, I work on year round improvement

When it came to the question of “have you been successful with resolutions in the past?”, the answer was a resounding “No”. Though there was a (powerful) minority who have been partially or fully successful in the past with resolutions.

There were several emails which I’d like to quote:

Regarding question 1: What is your #1 New Years Resolution this year?

John said: For the first time, to set goals for myself.

N. said: This year number one is : Take care of myself FIRST.

A humorous response: Marvin wrote: I’m a 70 year old who was diagnosed with ADHD almost 20 years ago. I have had the same resolution for several years and am one of the few people I know who has consistently been successful in keeping theirs: No new tattoos. (Of course I don’t have any old tattoos).

Regarding Question #2: Have you achieved your new years resolutions in the past?

Suzy said: (I don’t achieve my resolutions because) Like you said…..I don’t persevere. Top resolution should be to be more self disciplined…..that would take care of a lot!!

Kay wrote: No it is the same each year, the list is the same…. same goals, same ending.

Psalm says: Resolutions are rather intimidating to me. I prefer to think of goals, such as small, incremental, attainable goals.

Jennifer: I have not always achieved my resolutions but I have when I am very specific with the goal.

N. wrote: Yes, I achieve them because I type them up and paste them inside my wallet, checkbook, reading material etc and post them where I will see and be reminded of them every day plus I announce them to my inner circle for support.

Of course, as you can see – your wisdom came through in the emails. As you were sharing your comments, many of you revealed the answers to success with setting and achieving goals and New Year’s Resolutions.

And remembering the importance of the fact that we are in the area of mental health, there were some emails which were very personal, and acknowledged how hard things can be for people. Here is one example:

As J. wrote: My New Years resolution is to learn to live with ADD and all it brings, to fight the bully at work who constantly yells at me and to not commit suicide because of my poor self-image. Have I achieved my past new year’s goals? No, of course not.

Of course, I personally emailed J., and encouraged a visit to the doctor and/or therapist to work on J’s issues and challenges. (Our thoughts and prayers are with you, J!)

After reading 154 emails with people’s hopes, dreams, wounds and fears, I reiterate that I was personally touched and honored that you shared all that you did.

In the next few days, I’ll be sharing some thoughts and ideas for your on how to do well with your New Year’s Resolutions this year. Your emails have motivated me a lot to make sure to give you some helpful tips and strategies.

I’ll wrap up with this:

Jamie wrote: “Thanks…just curious…what were yours?”

When it comes to resolutions, I do take the time to review the past year, take stock, and look forward to the new year, and I do set goals. I set specific, measurable goals, with deadlines on them (3 month, 6 month, 9 month, 12 month) – and my goals are written down.

My three main goals (or goal categories) this year are:

  1. Family: Support my family more and increase my connection with them
  2. Health: Improve my health and well-being
  3. Finances: Improve my business and financial well-being

Thanks again, and watch for more updates in the coming days.

Best,

Dr. Kenny

p.s. please share your thoughts and comments below in the comments section…


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