Stranded Mental healthiness is sweet to the soul. It’s also pretty good for the other parts of life!But, bumping around in school, relationships, work, or daily life management can create the feeling that everyone else knows how to manage, but you don’t. It’s like living on an island without a boat, looking at the mainland where there are lights, and homes, and a future for “those other people.” Those “other people” have what is called neuro-typical brains, and the islanders have what is called ADHD. It’s a different type of brain. Neuro-imaging finds that the islanders have “smaller brains by 3-10%, have less brain activity (10-25%+) and delayed development by 2-3 years.”1 This difference describes the fractionated Executive networks located primarily behind the forehead. So, let’s clothe the islander with a cap and a jacket and a new name better suited and research-based; Executive Function Deficit Disorder (EFDD).
Replace the Leaky BoatThere are many unproven and disproven “treatments” for EFDD (ADHD). Disproven are; elimination diets, Sensory Integration Training, Chiropractic skull manipulation, the removal of sugar and additives, megavitamins, mega-anti-oxidants, and minerals. For children, Play therapy, Self-control (CBT), and psycho-therapy has been disproved as a treatment. Children need in-the-moment, during-life intervention. Games like mybraintrainer.com, emindfitness.com, happyneuron.com, positscience.com are only effective at making the player good at playing the game.
Aiming for the Lighthouse - Advances in the Management of EFDD Children and AdultsThe ideal treatment suite for EFDD (ADHD) is education and the treatment of medications, modifications, accommodations, compassion, and forgiveness. Why medicate? EFDD (ADHD) meds have a sizeable, well-established evidence base. They improve 70-90% of clinical cases, normalizing 50-60% of such cases. Stimulants are found to be the most effective with a response rate of 75-80%.2
What type of modifications and accommodations? Classroom behavior management is effective. Work modifications; an enclosed office, noise cancelling EarPods, written training manuals, plenty of alarms/clocks for time blindness and regular calendar checks are helpful. Routine physical exercise is helpful for coping. Improving duration of sleep impacts daytime attention. Cognitive behavioral training for social skills, time management, organization training and being present in-the-moment training.3
Rowing towards the MainlandCompassion and Forgiveness are essential for any relationship; to oneself and with others. When we understand the deficits, we can have productive discussions. Honesty, lack of shame, developing skills, and adjusting expectations are the basis of a good working foundation. I’m thankful for people gifting me with compassion and forgiveness, aren’t you?
Bringing the Islander Home There are seven reasons for early childhood intervention, these include; Reduction of symptom severity and associated executive/self-regulatory deficits. Decreasing family stress and parent-child conflict. Reduction of impairments at home, school, with peers, and the community. Decreasing the risks for health-related problems. Lessening the risks for other disorders, such as oppositional, conduct, anxiety, and depression. Lessening the economic burden to family and society. And there is evidence that there is perhaps accelerated brain growth due to early intervention. For adults, continuing stimulant medication significantly enhances the brain’s frontal lobe.4
Landing!ADHD, or EFDD, is best viewed as a disorder of self-regulation and executive functioning. Several advances in medication delivery systems and in new medication options have occurred in the past decade. Given the evidence, it can be concluded that it is among the most treatable of psychiatric disorders. The greatest problems are access to evidence-based treatments, cost, and getting patients to remain in treatment through the critical adolescent years. And for adults, to accept the diagnosis, take the medication, change, and adapt to new methods to establish a rich and rewarding life.
1 Arain M, Haque M, Johal L, Mathur P, Nel W, Rais A, Sandhu R, Sharma S. Maturation of the adolescent brain. Neuropsychiatry Dis Treat. 2013; 9:449-61. doi: 10.2147/NDT.S39776. Epub 2013 Apr 3. PMID: 23579318; PMCID: PMC3621648.2 Chang Z, Ghirardi L, Quinn PD, Asherson P, D'Onofrio BM, Larsson H. Risks and Benefits of Attention-Deficit/Hyperactivity Disorder Medication on Behavioral and Neuropsychiatric Outcomes: A Qualitative Review of Pharmacoepidemiology Studies Using Linked Prescription Databases. Biol Psychiatry. 2019 Sep 1;86(5):335-343. doi: 10.1016/j.biopsych.2019.04.009. Epub 2019 Apr 17. PMID: 31155139; PMCID: PMC6697582.3 Solanto, M. V., & Marks, D. J., Mitchell, K. J., & Wasserstein, J. (Collaborators). (2011). Cognitive-behavioral therapy for adult ADHD: Targeting executive dysfunction. Guilford Press.4 Moreno-Alcazar, A. et al. (2016). Psychiatry Research: Neuro-imaging, 254, 41-47.