rethink adhd

Copyright © 2012 Medical Integrity Inc. & Dr. Kenny Handelman All Rights Reserved. PAGE | 2

Rethink ADHD: Changing The Discussion

Contents Disclaimer and Terms of Use Agreement: ................................................ 3

Introduction: ................................................................................................ 4

The Current State of Affairs: ...................................................................... 9

How ADHD Is Currently Defined: ....................................................................................................... 9

ADHD: Childhood or Adult Condition? ............................................................................................. 11

The Evolution of ADHD: ............................................................................ 13

“B4: ADD EvolvedTM” ................................................................................ 17

Where The Discussion Needs To Go: ..................................................... 25

Next Steps… .............................................................................................. 25

Quality of Life in ADHD: ............................................................................ 27

Executive Functioning and ADHD: .......................................................... 30

My Personal Story: From Doctor to Patient ............................................ 39

Final Thoughts: ......................................................................................... 44



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Introduction: “Hyperactive.”

“Can’t focus.”

“Lazy.”

“Not achieving your potential.”

These, and many other terms are used to describe people with Attention Deficit/Hyperactivity Disorder.

If you ask the average person on the street what they think when they hear “ADD” or “ADHD”, they say something along the lines of: “a little boy who can’t sit still”.

And if you talk for longer, you’ll quickly hear that they don’t believe in ADHD; they think it’s caused by lazy parents, the school system, or violent video games. And what always surprises me is the strength of their beliefs – they don’t just think that ADHD isn’t real, they seem to express it with absolute conviction that they’re right.



They seem to know that their opinion is absolute fact because they heard the news report that pesticides cause ADHD1, or general anesthetics cause ADHD2, or they just know that the parents of those kids don’t know what they’re doing.

There’s little understanding, compassion or support for the condition and the challenges that it gives those who have it, their families and their communities.

There’s little regard for the significant research behind the existence of the condition, the medical side of it, the psychosocial side of it, and the treatments that work. And this lack of understanding completely misses the way people’s lives are transformed when they have the right diagnosis and treatment for ADD/ADHD.

Imagine, if you will, asking the same ‘average person’ on the street what they think when they hear the term: “breast cancer”.

Invariably, you’ll hear about the challenges that women go through, how they’ve donated to a fund raising event, and how they know someone who has gone through treatment, and they may even be aware of the significant impact that this cancer has on the person who is fighting it and their family and loved ones.

When discussing breast cancer, it’s highly unlikely that this ‘average person’ would tell you that breast cancer isn’t real, or that it’s caused by therapeutic abortions3, or by toxins in the environment4. And 1 http://abcnews.go.com/GMA/OnCall/pesticides-contribute-attention-deficit-hyperactivity-disorder/story?id=10662790#.T700vUVYvh4 Accessed May 23, 2012 2 http://www.cnn.com/2012/02/02/health/anesthesia-infants-adhd/index.html Accessed May 23, 2012 3 http://en.wikipedia.org/wiki/Abortion%E2%80%93breast_cancer_hypothesis Accessed May 23, 2012 4 http://envirocancer.cornell.edu/factsheet/general/fs45.chemical.cfm Accessed May 23, 2012



even if this person actually believed in some less common theories (or even “fringe theories”) around the cause of breast cancer, or its treatment, they wouldn’t minimize the disorder, or take away from the people who are suffering with this real condition.

It wasn’t long ago that breast cancer: “was considered by many to be a taboo subject and many of its sufferers often felt ashamed or embarrassed to openly discuss the disease.”5 Contrast that with the current state of affairs – the ‘pink ribbon’ is so well recognized that everyone knows that it represents breast cancer, and survivors and women with breast cancer are celebrated at fund raising events, and supported in their families, churches and communities.

The stigma around breast cancer has dropped dramatically in the past few decades. This has helped to support those who are diagnosed with breast cancer, as well as their families. It helps to raise money for research, and most importantly, it helps to raise understanding, compassion and caring for the condition. We haven’t gotten there yet with ADHD, as well as mental health disorders in general.

While I am well aware of the fact that the medical consequences of breast cancer are very different from the medical consequences of ADHD, the fact that it is a real medical condition which has gone from being a stigmatized disorder to one which is understood and supported makes it an important example when thinking about the challenges with the stigma of ADHD.

The general discussion in our society about ADHD is focusing on the wrong things. It focuses on whether ADHD is real, whether it’s caused by lazy parents, kids who don’t try hard enough, or social causes.

5 http://www.randomhistory.com/1-50/029cancer.html From “A History of Breast Cancer” Accessed May 23, 2012



And then of course, there is a huge debate about medication for ADHD. Despite a large research base that medication can be helpful for ADHD (as part of a comprehensive treatment plan), many people are so vehemently opposed to medication for ADHD, that they don’t ‘believe in it’ (as if it’s a religion or cult).

The real issues affecting kids, teens and adults with ADHD are very different than the discussions which are going on right now in the community and in the press.

This e-book, Rethink ADHD is intended to help us to take control of the discussion around ADHD. Let’s focus the discussion on the issues that matter to us. Let’s focus the discussion on the issues that will help healthcare professionals, educators, parents, therapists, community members, family members, soccer coaches, spiritual leaders, and everyone else to help to recognize people who have ADHD, and help to support them to get the right help.

And if that’s too much to ask for, we’d simply ask for understanding from the public, and to not be judged for having ADHD.

It may take many more years for the stigma and ignorance around ADHD (and other mental health conditions) to go away, but I’d like to encourage you to do your best to help to change the discussion on this topic to one that builds people up and supports them, rather than breaking them down and making them feel guilt or shame.

When someone is struggling with a mental health condition like ADHD, they need understanding, support and compassion. And, they need proper assessment and treatment. With these things, their lives can be transformed. Without them, they can get worse, and they develop shame and guilt, which takes away their drive, desire or willingness to work toward improvement.



Let’s get rid of judgment and stigma. It doesn’t help, and it is based on ignorance.

This e-book is for you if you are impacted in any way by ADD or ADHD (i.e. you’re a parent of a child or teen, you’re an adult with ADD/ADHD, it’s in your family, or you work with clients with ADD/ADHD as a teacher, therapist or even a doctor). I’ve written this e-book because I’m concerned about what is going on in the world today with ADD/ADHD. It seems that every month or two, the media come forward with new reports which question the legitimacy of ADD/ADHD, or challenge the accepted treatments for ADD/ADHD. This creates a discussion and dialogue in our society which questions the validity of ADD/ADHD, and challenges everyone who is dealing with it. People end up spending time and emotional energy defending the existence of the condition, rather than using their precious time and energy to develop the strategies they need. They end up fighting with people to justify why they are using the treatments they use, rather than being supported by others. This is in contrast to other medical conditions like Breast Cancer. Can you imagine in the 21st century having to defend the existence of Breast Cancer? Can you imagine a woman having to use her physical and emotional energy to have to defend that her disease is real and that she’s justified to take medical treatment? If this were going on right now, people would be up in arms that we weren’t supporting people in their time of



need… This book is intended to help to change the discussion for ADD/ADHD. We need to move away from discussions which undermine the condition and those people who have it, and move toward discussing the best way to understand ADD/ADHD and to help people living with it.

The Current State of Affairs: How ADHD Is Currently Defined:

AD/HD is officially called: “Attention-Deficit/Hyperactivity Disorder”. It’s diagnosed using the American Psychiatric Association’s DSM-IV-TR (The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision; published in 2000)6. One can be diagnosed with one of three variations of ADHD:

1. AD/HD: Predominantly Inattentive Type a. When there are clinically relevant symptoms of Inattention

2. AD/HD: Predominantly Hyperactive-Impulsive Type

6 The DSM-V is expected to be published in May 2013, and it will likely have some revisions to the diagnostic criteria for ADHD.



a. When there are clinically relevant symptoms of Hyperactivity-Impulsivity

3. AD/HD: Combined Type a. When there are clinically relevant symptoms of both Inattentive and

Hyperactive/Impulsive symptoms

While the official term for the condition is AD/HD (irrespective of whether there is hyperactivity), people so commonly use the terms ADD or ADHD, that they are often used interchangeably.

The DSM-IV TR states that 3-7% of school aged children have ADHD. Recent reports from the Centre for Disease Control report that in 2007, approximately 9.5% of children aged 4-17 have been diagnosed with ADHD7. This study also reported that this was a 21.8% increase from 2004 to 2007. This same report showed that 2.7 million children (66.3% of those diagnosed) were taking medication for ADHD.

To look at the prevalence of Adult ADHD, we can turn to research by Dr. Kessler, published in the American Journal of Psychiatry. It estimates the rate of Adult ADHD in the American population at 4.4%8.

Using the 2012 American population of over 313 million, with the adult population (between 20 and 65 years old) making up 59.9% of the population, this would yield approximately 8.2 million American

7 Increasing Prevalence of Parent-Reported Attention-Deficit/Hyperactivity Disorder Among Children --- United States, 2003 and 2007 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5944a3.htm?s_cid=mm5944a3_w 8 Kessler et al, Am J Psych 2006:The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication.http://www.ncbi.nlm.nih.gov/pubmed/16585449



adults who have ADHD. Dr. Kessler is quoted as saying that adults with ADHD often receive treatment for co-existing conditions they may have (like anxiety or depression), though the rate of treatment of adult ADHD is actually very low9.

ADHD: Childhood or Adult Condition? ADHD is a condition which is more commonly recognized in childhood and adolescence (remember most people think of a person with ADHD being a boy who is hyperactive). As a society, we think of it as a pediatric disorder. If we take into account the demographics of the US (and most Western countries), we need to remember the population bubble called the ‘baby boom’. Our population is heavily weighted toward adults who were born between 1946 and 1964, and are in the ‘baby boom’. If we look at the raw numbers for ADHD, using approximate population estimates in the US, we would have the following:

Percentage with ADHD:

Approx. Population: Estimated Individuals with ADHD:

Children 7% 87 million 5.9 million Adults 4.4% 187 million 8.2 million Table 1: Estimates of the Number of People in the USA with ADHD

Demographic information was taken from http://en.wikipedia.org/wiki/Demographics_of_the_United_States The population in the US was found to be 313 million The childhood population was used as 0-19 year olds = 27.9% (27.9% of 313 million = 87.3 million) The adult population was used as 20-65 year olds = 59.9% (59.9% of 313 million = 187.4 million) The estimates for the rate of ADHD are listed above, and were chosen to be reasonable representations of different research

studies

9 http://sciencewatch.com/dr/fmf/2010/10mayfmf/10mayfmfKess/ Accessed May 2, 2012



Looking at Table 1, you can see that there are more adults with ADHD than there are children with ADHD. While some may try to challenge the data and rates chosen, the logic is simple: if we have 7% of children who have ADHD and children make up a small percentage of the population compared to adults; and we have 4.4% of adults and adults make up a bigger percentage of the population, 7% of a smaller number is less than 4% of a bigger number. We can say that there are estimated to be over 8 million American adults who have ADHD, and over 5 million American kids who have ADHD.



The Evolution of ADHD: While many people think of ADHD as a new condition, particularly related to the new fast paced electronic world that we live in, the reality is that ADHD has been described for a very long time. One of the first published accounts of ADHD was thought to be Dr. Heinrich Hoffman’s story: Fidgety Phil, which was published in German in 1844 and in English in 1848. It was published in the book: Struwwelpeter Merry Stories and Funny Pictures. In it, Dr. Hoffman writes:

"Let me see if Philip can Be a little gentleman; Let me see if he is able To sit still for once at table": “Thus Papa bade Phil behave; And Mamma looked very grave. But fidgety Phil, He won't sit still”

(To see the full story as written by Dr. Hoffman, including the pictures from his original book, please visit this page on our website: http://drkenny.com/fidgety-phil). Although this was thought to be the first reference to ADHD in the literature (although it wasn’t an actual medical publication), a medical textbook published in 1798 by Dr. Alexander Crichton discussed cases of ‘mental restlessness’ in otherwise healthy individuals. Dr. Crichton’s description is



very close to the DSM criteria for inattentive ADHD10. The discovery of this text brought the earliest report of ADHD from 1854 to 1798. More recently, a chapter was found in a medical textbook from 1775 by German physician Melchior Adam Weikard. This chapter was about ‘Attention Disorders’, and it described the same syndrome as our modern ADHD11. This is now considered to be the earliest medical reference to the condition we now call ADHD. Other history includes the fact that Dr. Still spoke of patients with attention issues in 1902 when delivering medical lectures. Dr. Bradley was the first to use stimulant medication to treat ADHD in 1937. Interestingly, the boys who took the stimulant medication called it their ‘arithmetic pills’ because they were better able to do their math work after they had taken the medication. ADHD has been thought of and described in different ways during the 20th century. What we now call ADHD has been called:

Minimal Brain Damage Minimal Brain Dysfunction Hyperkinetic Disorder ADD ADD+H ADHD

It was 1980 when the concept of ‘attention deficit’ became the new standard for ADHD (rather than hyperactivity). It was thought that a deficit of attention was the critical issue in the condition. While it has still undergone some variation in its name (i.e. Attention Deficit Disorder vs. Attention Deficit

10 http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=83919 Accessed August 12, 2012 11 http://jad.sagepub.com/content/early/2012/02/05/1087054711432309 Accessed August 12, 2012



Hyperactivity Disorder), it is very likely that the name will stay very close to ADHD for the foreseeable future. This relates to the gains which have been made in advocacy i.e. legislation to support people with ADHD in school or the workplace, insurance coverage etc. If the name were changed, it could interfere with the progress which has been made.

In my 2011 book Attention Difference Disorder®12, I discuss the fact that when someone has ADHD, there isn’t always a deficit in attention, rather there is always a difference in attention. My thinking on this came from the numerous discussions I had with families in my office when I would say: “Your child meets the criteria for a diagnosis of Attention Deficit Hyperactivity Disorder”. And the parent would reply something like this: “How can you say he has an attention deficit when he can play X-box for 12 hours if I let him?”

The reality for most people with ADHD is that many people can focus on different things, even though they have an ‘attention deficit’. It is just extremely hard to focus on the routine, mundane, boring and challenging things. Critics of ADHD will often criticize this by saying that it seems ‘fishy’ to say that the condition only affects people when they are doing something which is harder for them to do. To this, I always respond with the fact that there are many medical conditions which change based on the circumstances, like heart disease and asthma. If someone has blockage of the heart arteries, they often don’t have trouble with chest pain until they do physical exercise. This is so well established that doctors will order a ‘stress test’, which means that they will ask their patient to exercise (in a controlled setting) to see if the symptoms of chest pain

12 http://drkenny.com/book



may occur because of the stress of exercise. And of course we all know people with asthma who get asthma attacks when they go near something that triggers their asthma, like a dog, or a musty, cold, damp basement. The concept of an Attention Difference Disorder® is to underline that it is not completely a deficit of attention, rather a difference. It is also intended to help people to view ADHD differently – to focus on strengths. I discuss changing deficits into differences and differences into strengths. The common approach in our society is to focus on weaknesses, and to work on them. For example, if a student in school is great at language arts, and does poorly in math, parents and teachers often tell the student to work harder at math i.e. to build up his weakness. And, if a child, teen or adult is struggling with ADD/ADHD, the doctor, therapists and loved ones tend to focus on improving the weaknesses, i.e. let’s help you to focus better, get more organized and control your impulsivity. This approach is very important, but it doesn’t go far enough. People with ADD/ADHD have fast brains with bad brakes. Their brains are quick, creative, energetic and more. When the ADHD symptoms are well controlled, the positive aspects of ADD/ADHD brains can come out. And that’s why it’s important to focus on strengths. By helping people who are great at languages, or arts, or business, or music to build on those strengths, it does wonders for their self-esteem, confidence, social life, and functioning. I encourage parents, kids/teens and adults with ADHD and other doctors to make sure to focus on the strengths that each individual has, and to build those up as much as possible. A phrase to describe this would be: a “strength based approach to ADHD”. Although people may feel down when getting a diagnosis of ADD/ADHD, it is actually a good news diagnosis, because it helps people to realize that there is an explanation for their challenges, and



there are strategies to help. And if one gets good treatment for ADHD, then one can tap into the greatness of the ADD/ADHD mind – which can include fast thinking, creativity, ‘out of the box’ thinking, increased energy and drive, and much more. Dr. Edward Hallowell13 is a leading psychiatrist, author and speaker in the field of ADHD. He has been a pioneer in the concept of strength based ADHD. Adapting from Dr. Hallowell’s work, I suggest the following framework to help you to understand the evolution of ADD/ADHD:

“B4: ADD EvolvedTM” The concept of “B4: ADD EvolvedTM” is to discuss the evolution of ADD/ADHD over history. B4 refers to four B’s which help us to understand the progression of ADD/ADHD. Above, you find a description of the generally accepted view of the history of ADHD. Here is how I believe it should go from here. B1) Bad: The first B refers to the fact that historically, people with ADHD would be considered ‘bad’. They were not thought of as having a disorder, or needing help, rather they were thought of as ‘bad people’. They didn’t listen, they misbehaved, and they didn’t live up to their potential. They did well sometimes, and didn’t do well other times (proving that they were being bad when not succeeding, rather than just being inconsistent as many people with ADHD are), and I could go on. Dr. Hallowell has referred to this as the ‘moral diagnosis’ for ADHD. 13 www.drhallowell.com



B2) Behavioral: The second B refers to ‘Behavioral’. This refers to the fact that there was more recognition of the behavioral components of ADD/ADHD. Kids were thought to be ‘hyperkinetic’ (i.e. high energy). They weren’t necessarily ‘bad’, but their behavior was bad. If we could just find the right behavioral treatment or help for them, they would be much better. This step is mildly better than the first, because people would consider the behavior bad, rather than the individual as bad. Though, in practical application, most kids, teens or adults who were being told that their behavior was bad felt like they were being called bad anyway. B3) Brain: The third B refers to ‘Brain’. As the medical understanding of ADHD has grown, and technology to study the brain has improved, we now know that people with ADD/ADHD have differences in their brain structure and function. We now know that there is a medical side to this condition, and that it is not just ‘willful misbehavior’, or kids being ‘bad’ or ‘behavioral’. We know that it is a real condition, which has well researched treatments to help it out and to improve the lives of people living with it. This step (B3) leads to significant progress for individuals living with ADHD and their families. By knowing that ADHD is a medical condition, it takes many of the negative aspects of the diagnosis out



of the equation. Instead of blaming the child, their parents, the school system, video games, etc., people begin to realize that we need to find the right treatments to help to treat the condition. Research has been funded showing that there are many different treatments which can help people with ADHD to function and live better. These treatments include: behavioral treatments, parenting strategies, school strategies, medication and even alternative treatments. Although medication for ADHD often causes the most discussion and debate, the medical analogy with asthma or heart disease applies here as well: with asthma, the doctor suggests medicines for asthma, as well as strategies to help to limit the risks (i.e. getting rid of carpets, dealing with allergies, etc.); with heart disease, the doctor doesn’t just do an operation, he/she also recommends medication, exercise, quitting smoking, eating better, etc. If one wants to be healthy with asthma, heart disease or ADHD, one has to use all of the treatments available, not just the medications. In ADHD, the use of all of the available treatments is often called ‘multi-modal treatment’, referring to research that shows that the ideal treatment is using medication in combination with the non-medication treatments as well. The 3rd B – ‘Brain’ has led to a lot of progress for people living with ADHD. By recognizing the medical side of the condition, there has been more research, more support, more understanding, and more treatments developed. But is there a negative side to viewing ADHD as a brain condition?



B4) Better: The fourth B in the evolution of ADD/ADHD is ‘Better’. This refers to the strength based approach to ADD/ADHD. While the medical side of ADHD has led to many benefits for people with ADHD, throughout my medical practice, I have been very uncomfortable telling kids/teens and adults that when they have ADHD that they are ‘disordered’ or ‘diseased’. If someone is diagnosed with asthma, heart disease or arthritis, the diagnosis can be helpful to them (i.e. they weren’t sure what was happening), and it may also be upsetting (i.e. “I can’t believe that I have this, what now?”). While someone’s reaction to a diagnosis of ADHD is somewhat similar to the diagnosis of a medical condition (i.e. it can be helpful or upsetting), there is another layer to it because it is a psychiatric or mental disorder. Being diagnosed with a psychiatric or mental disorder becomes much more personal and difficult because the disorder is in the brain, and affects mood, personality and actions in day to day life. We don’t necessarily identify ourselves (i.e. who we believe we are) by our joints, so if we are diagnosed with arthritis, it doesn’t necessarily change how we view ourselves. However, we do define ourselves by our personalities, and our minds. When diagnosed with ADHD, this can change how we see ourselves, because our mind is ‘disordered’. Although I don’t dispute the medical side of ADHD, and I in fact support it, I don’t stop there. I progress to the fourth B, the ‘Better’ approach – which is strength based.



When people with ADD/ADHD get the negative symptoms of their condition out of the way (by using good, proven treatment for ADHD), and they focus on and build their strengths, great things can happen. People with ADD/ADHD can have incredible minds which can make wonderful contributions to our families, communities and the world. This can be lost if someone with ADD/ADHD goes through life believing that they are disordered and their brain is broken. We don’t need to hide the facts that there are differences in their brains, we just have to make sure to emphasize that once well treated, they can unleash the tremendous energy and creativity that can come along with an ADD/ADHD brain. In recent years, a number of famous celebrities have come forward to share that they have ADD/ADHD. This is very helpful because it can help to inspire people to realize that even if they are struggling with math work at school, or struggle with managing money as an adult, that greatness is still possible, even with ADHD. Some of the celebrities who have shared their diagnosis of ADHD include:

Michael Phelps: American swimmer and the Olympian who has won the most Olympic medals in history

Howie Mandel: Comedian, Actor, Author, and TV Celebrity (host of “Deal or No Deal”, judge of “America’s Got Talent”)

Britney Spears: Singer, Star, and judge on “The X Factor” Adam Levine: Lead singer of Maroon 5, and judge on the TV show “The Voice” Terry Bradshaw: NFL hall of famer and TV personality Ty Pennington: High energy host of “Extreme Home Makeover” and the talk show “The

Revolution”



And many more…

Although there hasn’t been any conclusive scientific evidence that people with ADHD are more creative or are more capable in any way than people without ADD/ADHD, it’s my belief and my experience that when we get the negative symptoms of ADD/ADHD out of the way, people with ADD/ADHD can be incredibly gifted in their areas of strength. When thinking about “B4: ADD EvolvedTM” remember that each stage progresses from the previous one. I’m not suggesting that you should ignore the ‘Brain’ stage – i.e. you need to accept the medical treatments to help ADD, and then you can progress to the ‘Better’ stage, where you are focusing on building and improving the strengths. Of course, I encourage you to continuously focus on strengths, even as you’re just getting started – i.e. don’t wait until you have all of the treatments in place before you start to focus on strengths. At the same time, if the ADHD symptoms are severe, untreated and causing significant impairment, it may sound absurd to suggest that there are great strengths with ADD/ADHD. That’s why it’s important to treat ADD/ADHD effectively, and then build on the strengths in the ADHD mind. You can also use this framework to think about where other people are in their understanding of ADD/ADHD when you interact with them. If you have someone who is still at the ‘Bad’ stage (i.e. B1), do your best to move them up to the ‘Brain’ stage (i.e. B3). If you can get them up there (and even skip B2), then you’ve done extremely well. To accomplish this task, you’ll need to share the medical facts about ADHD, the research behind the brain and genetic components of the condition, and more. If you’re talking with someone who’s at the ‘Brain’ stage (i.e. B3), then I encourage you to help to move them up to the ‘Better’ stage (i.e. B4). You can talk to them about the great things that people with ADHD do (even though they have ADHD), and how well your child or you do when you focus on



your strengths and use that powerful dogged determination that many people with ADD/ADHD have. You can tell them about some of the celebrities who have ADHD, and you can also refer them to download a copy of this report for themselves, at http://DrKenny.com/rethink-adhd. As one who is reading this report, you’ll no doubt be ‘called upon’ to advocate for people with ADD/ADHD. You’ll need to educate others, help to decrease stigma, and help to get services and support for people with ADD/ADHD. I hope that this concept (B4: ADD EvolvedTM) helps you to recognize where people are at, and helps you to move them up the ladder in their understanding of ADD/ADHD (until they hopefully get to ‘Better’, i.e. B4).



Where The Discussion Needs To Go: This e-book started with the fact that we need to ‘change the discussion’ about ADD and ADHD. So far, we have discussed:

The fact that there is too much stigma and ignorance around ADHD in our society The fact that ADHD is a lifelong condition, and that there are in fact more adults with the

condition than there are children with the condition The history of ADHD The evolution of ADHD

In this document, we have discussed the strength based approach to ADHD, and how important this can be to people living with the condition. And if we stopped there, then we could still help many people to live better with ADHD, and to feel better about themselves, and achieve more in life. But we can go further...

Next Steps… When I review the scientific literature, there are two areas of ADHD research which don’t often get discussed in doctor’s offices, in presentations, and when doctors are talking with their patients (especially not in often very busy office visits). And every time I read about these areas of research, I think about how critical these are to how people actually live and function in everyday life.



To help you to live better with ADD/ADHD, and to help you to change the discussion with ADD/ADHD, we are going to discuss these two areas of research which are so incredibly important. They are:

Quality of Life Executive Functioning

When I teach many doctors around the world about ADHD, during most presentations, I need to emphasize the importance of identifying the core symptoms of ADHD (inattention, hyperactivity and impulsivity), and monitoring treatment response and progress with the core symptoms. I often cover strategies to help doctors in practice to implement these strategies in their busy offices, so that they can have a high standard of care for their ADHD patients. If we could get all doctors to do this, it would improve the care that people with ADHD receive. And it’s still not the whole story... Before we get to the rest of the story, let’s discuss research which was published in 1993 by two Canadian Psychiatrists – Dr. Weiss and Dr. Hechtman. They found that parents of school aged children with ADHD were not most concerned with the core symptoms of ADHD (inattention, hyperactivity and impulsivity), rather the following issues:

1. Poor school work 2. Social difficulties with peers 3. Problems related to authority (particularly at school) 4. Low self-esteem

In other words, the parents of school aged kids were more concerned with how their kids were functioning, rather than worrying specifically about hyperactivity or inattention. This is critically



important – because as I mentioned, doctors are often focusing on the improvement that medication and other treatments provide for the core symptoms of ADHD (i.e. inattention, hyperactivity and impulsivity), when the real issues are the actual functioning and impairment in day to day functioning. This leads directly into the areas of Quality of Life (QoL) and Executive Functioning (EF’s). Sometimes, when I’m presenting to a more advanced audience, we take more time on Quality of Life, and Executive Functioning. While the average doctor may not think much about a strength based approach, the ideas of Quality of Life (QoL) and Executive Functioning (EF’s) are so well researched, that they are becoming the standard of understanding for ADHD (EF’s) and the standard for comprehensive treatment of ADHD (QoL). So even though many practicing doctors may not be aware of these factors, they are gradually becoming the standard of care in ADHD. And I’m introducing these ideas to you so that you can help to progress the discussion about ADHD – with teachers, community members, your family, and even health care providers. Most importantly, I hope that understanding these ideas will help you with managing ADHD for yourself or your loved one. Because you deserve to know, and you need to know the newest and best research that is out there.

Quality of Life in ADHD: Quality of life is a very important concept, and one that has been defined slightly differently by different researchers and organizations. Here are two definitions to help you to grasp the concepts intended by Health Related Quality of Life (QoL):



Leidy defined QoL as follows:

‘‘an individual’s subjective perception of the impact of health status, including disease and treatment, on physical, psychological, and social functioning.’’14

The World Health Organization’s group on QoL defines it as:

“the individuals perception of their position in life, in the context of culture and value systems in which they live, and in relation to their goals, expectations, standards and concerns.’’15

As you can see, looking at Health Related Quality of Life in ADHD encompasses much more than just assessing how the inattentive or hyperactive symptoms are doing. It encompasses how one is feeling, functioning and progressing in life in relation to one’s own goals, desires, culture and interests. It is a much broader net, and it is very important in ADHD assessment and treatment. Numerous studies have shown that ADHD impacts QoL significantly. It is generally found to impact QoL in the same amount as severe physical illnesses, as well as other psychiatric disorders. In other words, the impact of ADHD on an individual and his/her family can be as much as if that child/teen or adult had a severe physical illness. Studies have shown that higher levels of ADHD symptoms and impairment can lead to worsened QoL.16 A limited number of studies have shown that effective treatment of ADHD can improve QoL as well, but more research is needed.

14 Leidy NK, Rich M, Geneste B (1999) Recomendations for evaluating the validity of life claims for labeling and promotion. Value Health 2:113–127 15 WHOQOL (1995) World Health Organisation Quality of Life Assessment (WHOQOL): position paper from the World Health Organisation. Soc Sci Med 41:1403–1409 16 Danckaerts et al. Eur Child Adolesc Psychiatry (2010) 19:83–105



How This Relates To You: Many people who are dealing with ADHD themselves or in their families are struggling with the issues which we have already covered: stigma, ignorance, fighting to get the right support and treatment, and much more. And many people have doctors with insufficient experience with ADHD. Even doctors with experience in ADHD may focus only on the core symptoms of ADHD. It is imperative that you broaden your understanding of ADHD, and how it impacts you and/or the one you love. The impact of ADHD goes far beyond the core symptoms of ADHD. It impacts one’s functioning in so many different ways, such as:

Social life, friendships Family life Connection to a community/religious group Academic challenges, and their impact on future prospects Work issues – which can lead to lower earning, not getting promoted, etc. And ultimately, and most importantly, a drop in self-esteem – so that the individual with ADHD

feels that it’s not even worth trying, because he/she believes there’s no point... I am not listing these impairments and challenges to make this seem depressing for you (and of course, not everybody gets all of these consequences), rather to clearly identify how far reaching ADHD’s impact can be for you, or others with ADHD. And because of the current state of the discussion on ADHD (as described earlier in this report), hardly anyone realizes that ADHD is real, that it can be debilitating, and how hard it can be on adults who have it, as well as kids and teens who are dealing with it. People also don’t realize that we need



to increase understanding, decrease stigma and improve supports, treatments and understanding for people with ADHD, and their families. When you’re thinking about your ADHD (or your loved one’s ADHD), it’s critically important to think about Quality of Life. Think about all of the different areas that ADHD is impacting, and then work toward treatments that can help these areas. Treatment of the core symptoms of ADHD is critical, but it’s only the start. You need to move beyond the core symptoms to include the much broader concepts of Quality of Life.

Executive Functioning and ADHD: While the DSM-IV-TR describes the diagnostic criteria for ADHD by describing the symptoms that are often found in individuals with the condition, it does not talk about what causes ADHD. While there



are different theories which have come forward over the years, the best cognitive and psychological theories are the ones which discuss executive functions. There’s no consensus definition of executive functions, meaning that there have been many different definitions used by different researchers at different times. In an online PDF, Dr. Russell Barkley, a leading researcher and author on ADHD defines executive functions this way: “those neuropsychological processes needed to sustain problem-solving toward a goal.”17 Executive Functions have been defined in many different ways, and the mental processes which EF’s refer to have been described differently as well. Here is a list of EF’s as Dr. Barkley defines them:

Inhibition Resistance to distraction Self-awareness Working memory Emotional self-control and even self-motivation

In other words, executive functions are the highest level thinking skills that we use to help us to achieve complex goals. In my book Attention Difference Disorder, I give an analogy of the board room table in the movie “Air Force One.” If you recall the movie, Harrison Ford is the president of the United States, and his airplane, Air Force One, has been hijacked by terrorists. Back at the White House, Glen Close is the Vice-President, and she is sitting at a board room table with the heads of the different parts of the military and advisors. As these people are talking around the board room table, 17 http://www.russellbarkley.org/content/ADHD_EF_and_SR.pdf

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they’re working together to find a solution to a very complex task – to save the president’s life (and the lives of the other people on board the plane). Each branch of the military is expert at what it does, and even so, if they aren’t coordinated in their efforts, they may not achieve their complex goal. This board room table, and the work going on there, is like the frontal lobe of the brain, and it is using executive functions – i.e. thinking, planning and trying to use each expert skill in the brain in a coordinated fashion to achieve complex goals. To explore executive functions further, let’s discuss some specific ones:

1) Inhibition: This is a very important executive function, and in fact in some theories, it is considered to be the key executive function in the cause of ADHD. This refers to the ability of the brain to inhibit its responses. For example, if someone has an urge to say something (even if it is ill-advised, or harmful), one doesn’t stop to think of the consequences, and just blurts it out. One doesn’t inhibit the impulse and control it. Or if one is focused on an important task, one doesn’t inhibit the urge to check email, or look at that thing over there that seems interesting. This is the executive function which is referred to when people say that “ADHD brains are very fast, but have bad brakes.”

2) Working Memory: Working memory refers to the ability to hold a bit of information in your mind to problem solve. It often doesn’t work as well in people with ADHD. This is not short term memory, but it can often impact it. For example, if you’re talking to someone with ADHD, and you tell them something important – if that person has trouble holding it in their working memory for long enough to either use a strategy to help them remember (i.e. write it down), or ‘code’ it into short term memory, then the person doesn’t register what you’ve said and doesn’t



recall it at all. This difficultly can impact many areas of someone’s life and day-to-day functioning.

3) Emotional Self Control: This refers to one’s ability to handle emotions as they come up,

particularly challenging ones. To handle emotions appropriately, one has to be able to keep an emotional reaction in check, and to continue to use some thinking and logic to problem solve. Sometimes, people with ADHD can immediately ‘see red’, or over-react, and then struggle with problem solving in the moment because of poor emotional self-control.

Some other executive functions which are discussed by different authors/researchers include:

Initiating tasks: trouble starting a task when one needs to

Transitioning between tasks: trouble disengaging from one task and moving onto the next one (a common issue for parents of ADHD kids who need a lot of warning before a transition)

Time management: trouble with being aware of time, its passage and managing tasks

appropriately for the time available

Goal directed persistence: setting a goal, and being able to persist with it to completion

Organization: the ability to organize oneself appropriately

Planning/Prioritization: planning appropriately and prioritizing tasks to achieve the goals desired



Metacognition: this refers to the ability to think about one’s own thoughts – i.e. insight. Sometimes it’s hard for people with ADHD to reflect on their own thoughts and behaviors and have insight into them

Executive functions research correlates well with brain research in ADD/ADHD. There are several research studies which show involvement of the frontal lobe in ADHD, which is known to be implicated in executive functioning. One particular brain area, the anterior cingulate cortex (ACC), is known to help with executive functions in normal brain functioning. ADHD brain research shows that in adults with ADHD, the ACC often doesn’t work as well as in controls (i.e. adults who don’t have ADHD)18, and other research shows that with the ADHD medication methylphenidate, the ACC works the same as it does in normal controls – i.e. the medicine improves ACC functioning in adults with ADHD19. While the best theories behind ADHD incorporate an understanding of executive functions, there are many researchers who say that executive functions are not always an issue in ADD/ADHD. In fact, when researchers test the executive functions of individuals with ADHD using neuropsychological tests, only approximately 30% of people with ADHD show measurable difficulties in executive functions. The researchers then assert that executive functioning challenges are not always present in individuals with ADD/ADHD. In his paper called: Executive Functions and Attention Deficit Hyperactivity Disorder: Implications of two conflicting views20, Dr. Thomas Brown challenges the way that executive functions are defined and measured. He suggests that ADHD is in fact a developmental disorder of executive functioning. 18 Bush G et al. Biol Psychiatry. 1999 Jun 15;45(12):1542-52. 19 Bush G et al. Arch Gen Psychiatry. 2008:65:102-14 20 You can read the full article here. Be forewarned, it is from the medical literature and presents detailed & complex arguments: http://drthomasebrown.com/pdfs/ef-conflict.pdf



By his argument, all individuals with ADHD have poor executive functions, and the fact that the neuropsychological tests don’t measure that relates more to problems with the tests used, rather than an absence of these symptoms. He suggests that clinicians need to ask careful questions about the day to day functioning challenges of people with ADD/ADHD, and this will help to identify the executive functioning challenges which people experience with achieving complex goals in our modern, complicated world. Why is it important to you to understand executive functions? When we think of ADD/ADHD as purely a disorder of trouble with focus, hyperactivity and impulsivity, we are often left with questions as to why day to day life can be so challenging. Things like: a parent of a child with ADHD may wonder, “Why is it so hard to get my son to start his homework?” or for an adult with ADHD, “Why is it so hard for me to start working on my taxes?” While inattention may contribute to these challenges, understanding the concept of the executive function of ‘task initiation’ helps you to understand far better what’s going on. And most importantly, when you have a better explanation of what’s going on, you can start to develop better strategies to help to improve the identified challenge. Do ADHD Medications Help With Executive Functioning? There have been some studies which look at the impact of treatment of ADHD with medication on executive functioning. The results have been mixed, i.e. some studies show significant improvement in executive functioning, and some studies don’t. This likely relates to issues with measurement and study design. When I prescribe medicine for ADHD, at the follow up visits, I monitor for improvement in the core symptoms of ADHD (i.e. inattention, hyperactivity and impulsivity). I also ask about areas of regular



day to day functioning, to develop an understanding of how my patient is doing with executive functions and challenges which may be associated with them (and of course, I’m also checking on on Quality of Life, and how we can improve it). In my experience, improvement in the core ADHD symptoms with medication does not always lead to improvements in executive functioning challenges. Sometimes it does, but it doesn’t always. This is another reason why it is so important to look at ADHD treatment which goes beyond just a prescription medication. As many ADHD coaches say: “pills don’t teach skills”. It’s important to work on strategies to function well in day to day life, and to combine medication with non-medication approaches (and if you decide not to use medication for treatment, it becomes even more important to develop the right strategies to help). While going into a more thorough explanation of executive functions and how to develop specific strategies to help with them is beyond the scope of this e-book, I do want to share some resources to help you to explore this area further. ADHD Coaching: ADD/ADHD coaching has progressed and developed a lot in the past several years. It’s now considered a very helpful treatment option for people living with ADD/ADHD. Nancy Ratey writes: “The ADHD coach, who is trained in specific techniques to help those with ADHD, works with clients on tactical, not psychological, issues.”21 Helping with executive functioning challenges, and day to day challenges are ways that coaches can really help people with ADHD. To learn more about ADHD coaching, visit the website of the ACO (ADHD Coaches Organization).

21 http://www.adhdcoaches.org/about-coaches-and-coaching/ accessed September 30, 2012

http://www.adhdcoaches.org/



Books for parents of kids and teens with ADD/ADHD: To understand executive functions even more, and how they may be impacting your child or teen, as well as strategies you can use to improve them, consider these books:

Smart but Scattered by P. Dawson Ed.D., and R. Guare Pd.D.

Late, Lost and Unprepared by J. Cooper-Kahn Ph.D., and Laurie Dietzel Ph.D. Books for adults with ADD/ADHD: To understand executive functions even more, and how they may be impacting you, and to develop strategies to help you out, consider these books:

Understand Your Brain, Get More Done by A. Tuckman, PsyD, MBA: This is a specific resource and workbook on helping you with your executive functioning.

Mastering Your Adult ADHD A Cognitive Behavioral Treatment Program by S. Safren, MD (and others): This is a workbook which provides you with cognitive behavioral treatment. Although this is not specifically an executive functioning workbook, it does help with executive functions, as well as providing cognitive behavioral therapy strategies for other challenges with Adult ADD/ADHD.

http://www.amazon.com/gp/product/1593854455/ref=as_li_ss_tl?ie=UTF8&camp=1789&creative=390957&creativeASIN=1593854455&linkCode=as2&tag=adhdtelesemin-20






My Personal Story: From Doctor to Patient After sharing the ideas and concepts in the digital pages of this e-book, I’d like to give you some insight into who I am, and how my involvement with ADHD has continued to grow and change over time. When I first began medical school, I didn’t start with the intention of becoming a psychiatrist. Initially, I wanted to be a general practitioner/family doctor. As I got further into my studies, I realized that family medicine wasn’t the right fit for me (I have more of a ‘specialist mentality’ i.e. to delve deep into one area rather than remaining more general). As time went on, I started to love many other areas in medicine. For a while, I wanted to be a general surgeon, then a neurologist, then an orthopedic surgeon… Then I clued into the fact that with each medical specialty that I was interested in, I was most interested in the mental, psychological and emotional components of that specialty (i.e. in general surgery, I was most interested in oncology, because I wanted to help people with the emotional and psychological aspects of dealing with cancer). When I did my psychiatry rotation in my last year of medical school, it dawned on me: If I was a psychiatrist, I could spend all of my time helping people with their emotional and psychological issues. This was the best fit for me. At the beginning of my psychiatric training, I liked it a lot. I was happy with my choice, but when I got to train in child psychiatry, I was hooked. It was enjoyable to work with kids and teens, and I realized that if I could help them, it could have a positive impact on the course of their future. That was very meaningful for me. I also liked the fact that I’d be able to help families to get back on track, by helping them to find the right strategies and treatments to improve real challenges that were largely misunderstood in our society.



When I trained in an ADHD clinic, I really clicked with the kids and families there. I “got” them, and they clicked with me too. Helping kids and teens with ADHD (and a other co-existing conditions) and their families to get their lives on track was tremendously rewarding and exciting. I loved encountering the creativity, excitement, and out-of-box thinking of people with ADHD. For me personally, I felt I could resonate with many of the ADD/ADHD traits of the patients I worked with. While I always did well with school, it was because I used a lot of strategies to keep myself on track. While I didn’t think of myself as classically inattentive and distractible, I had always needed to put in lots of energy to stay on track with my studies. I would use a looming deadline and then hyperfocus, which helped me to consume and learn huge amounts of information, because I had been so busy doing so many different things for the weeks leading up to the deadline. And, it always worked. My strategies and determination paid off, and I always did well. In the recent past, I began to find that the strategies that I was using weren’t always working to keep me on top of all that I wanted to do. I keep busy, and get excited about different ideas, projects and goals. And then I demand a lot of myself to meet those goals. In the past few years, I have developed a blog on ADHD which has gotten over 750,000 unique visitors per year, written a book, participated in ADHD clinical research, spoken internationally on ADHD (Hong Kong, Korea, Thailand, Taiwan, Switzerland, Mexico, and many places in Canada), started a podcast, and much more – all while keeping a busy hospital based psychiatric practice, and most importantly, valuing my commitment to and relationships of being a dad and a husband. With all that I was doing, at one point, I found that I was reaching “overwhelm” and the strategies that had previously helped weren’t working well enough. I had always thought that if I wasn’t finishing everything that I set out to do, it was likely because I was too busy! But, with advice from my wife, I decided to go get a professional assessment. I went to a psychologist whom I know and respect, and had an assessment. He did a thorough adult ADHD assessment, including interviewing me, my wife



and my mother (for corroborating history), he did psychological testing (which isn’t necessary for an ADHD assessment, but in my case it was helpful), and then provided feedback. I was diagnosed with mild ADHD - Inattentive type (or “ADD” in older terms). The psychologist noted that I had developed many strategies to compensate for the ADD symptoms over the years that helped me to function well, and it contributed to the delay in getting formally diagnosed. When I got the diagnosis, it made sense in some ways as I always knew that I needed to work with strategies to accomplish what I need to do, and it was also surprising in other ways. Even though I know about ADHD as an expert, plus I know the assessment was thorough, complete and accurate, emotionally, I went through an emotional process to accept my diagnosis. I started with internal questions and thoughts: I first thought that it was just because I was extremely busy thus feeling stressed (i.e. don’t we all get overwhelmed when stressed?)… I thought that the testing couldn’t be accurate… And a whole lot more. I thought of the words by Kate Kelly, Peggy Ramundo, and D. Steven Ledingham from: The ADDed Dimension:

“The life changes you will undergo as a result of an AD/HD diagnosis are monumental. It will take years, not months, to integrate all the new information and make the needed changes in your life. The emotional upheaval that accompanies this work comes in waves, rather than being a once and forever event.”

Understanding these words as an expert in ADHD is very different from experiencing the process myself, as an adult with ADHD.





I have been going through a process of understanding myself as an adult with ADHD for just over a year (I was diagnosed in September 2011). I have worked on different treatments to help myself, including medication, strategies, lifestyle approaches - like incorporating improvements in exercise, diet, supplements and sleep. A year later, I am aware of the positive changes due to the improvements, and my journey still continues...

I have shared my diagnosis with close family, some extended family, as well as some friends, and professional colleagues. I haven’t shared it with all of my social contacts, because it often doesn’t seem appropriate or necessary (i.e. “Hi, I haven’t seen you in a long time. How are your kids? By the way, I got diagnosed with ADD”).

When I have shared my diagnosis, I’ve been interested to hear the different responses and I’ve been interested in my own reactions to the responses. For example, I’ve had some friends say: “That makes complete sense. Of course you have ADD!” I’ve had one professional colleague say: “I’m so sorry to hear about your diagnosis. That must be so hard for you and your family.” I was really surprised by that response. I answered that it’s a good news diagnosis, because it’s very helpful, and it’ll just help me to live better.

My strongest reactions come when someone challenges the existence of ADD after I share it. I have always been a big advocate for ADHD, to support kids, teens and adults with ADD/ADHD and to dispel ignorance and stigma associated with the condition. When I respond to a challenge of the existence of ADD now, I think of the movie: “Jaws 4: The Revenge”, not because the movie was memorable, but because of its tag line: “This time it’s personal”.



While I can handle any attack of ADHD quite easily, I recognize that as a doctor in my 40’s, who is known and respected for my professional work, it makes it pretty easy for me to handle these challenges. However, handling these ‘attacks’ makes me much more aware of how hard it is for kids, teens and adults to deal with these attacks on a regular basis when they don’t feel that they’ve got the confidence and stature to readily handle them.

My favorite response to disclosing my diagnosis came from a co-worker and friend named Vicki. She’s a nurse at a hospital that I’ve worked at before. When I discussed it with her, she said, “Kenny, you’re ADD in the most delightful way”. That made me smile. And now, if I feel that I’m having a bad ‘ADD day’, I think of Vicki’s perspective on my ADD, smile, and get on my way.

I decided right away that I wanted to share my diagnosis publicly, then I realized that I’d also need time. I wanted to take some time to get comfortable with it so I’d feel good about sharing it in a way that is intended to help others.

As it happens, it’s been about a year, and I feel very good about sharing it publicly.

I hope that my unique perspective of being an expert in ADHD who has dealt with ADD using strategies before getting diagnosed with adult ADD will be helpful for you.

I hope I’m able to share messages of hope and inspiration to you and others. I’ll be sharing information about ADD/ADHD from the inside out. By that I mean, as a doctor on the inside of the ADD/ADHD treatment world, and as an adult with ADD/ADHD who lives with this condition. And in case there’s any doubt, I do love the unique and creative way that I view the world, and consider my ADD brain as an asset that gives me many strengths and opportunities.



I will continue to share my reflections, thoughts and perspectives on ADD/ADHD, as both an expert and an adult with ADD via my newsletter, podcast, and future books. To make sure you get my updates, please connect with me:

Best way: make sure you’re on my email newsletter list. If you subscribed when you downloaded this e-book, then you’re already signed up. If you got this from a friend, go to: www.drkenny.com/rethink-adhd and put in your name and email. You’ll get email updates about ADD/ADHD (and if you decide the emails aren’t for you, you can always unsubscribe)

Free ADHD Podcast: You can find my free weekly ADHD Podcast here: www.ADHDPodcast.com, and you can also subscribe to the podcast via iTunes here: www.drkenny.com/iTunes

Face-book: ‘Like’ my face-book page at: www.facebook.com/drkennyhandelman Twitter: Follow me at: www.twitter.com/drkenny If you prefer these other social networks, I’m also on Pinterest, and Google Plus.

Final Thoughts: I’ve written this e-book to help to change the world for the better for people with ADD and ADHD. There is great science and knowledge around ADD/ADHD, and yet the discussion in our society still centers on whether ADHD really exists! By providing you with the facts you need, as well as some forward thinking ideas, I hope that you can help us to ‘change the discussion’ about ADD/ADHD in our society.

http://www.facebook.com/drkennyhandelman

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We’ve covered:

The fact that there is too much stigma and ignorance around ADHD in our society The fact that ADHD is a lifelong condition, and that there are in fact more adults with the

condition than there are children with the condition The history of ADHD The Evolution of ADHD (“B4: ADD Evolved”TM) How important it is to use a Strength Based Approach to ADHD How we need to look beyond the core symptoms of ADHD – to focus on functioning Quality of life is often worse in people with ADHD, and we need to work on treatments to help

this Understanding Executive Functions is very important for understanding ADD/ADHD, and when

you design treatments to help Executive Functions, things can improve. To help to “Rethink ADHD”, and to change the discussion, it’s very important that you share what you’ve learned with other people, and help to raise awareness, and decrease stigma.

Connect with ADD/ADHD resources in your community – like support groups, and advocacy groups. Advocacy can be as small as helping one person to understand better what is going on with ADD/ADHD, and as large as getting your member of congress to help with legislation to support people with ADD/ADHD.

Great places to start are:

CHADD: CHADD stands for Children and Adults with ADHD. It is a non-profit which helps to support kids and adults with ADHD. You may be able to find a local chapter to get involved with, and you can find many online resources.

http://www.chadd.org/



ADDA: ADDA stands for Attention Deficit Disorder Association. It is an international non-profit whose goal it is to support adults with ADHD. There are many resources available to help you from ADDA.

CADDAC: CADDAC stands for the Centre for ADHD Awareness Canada. This Canadian organization helps to advocate for ADHD in Canada. It may also help you to find local resources and supports for you in your community.

There are many more resources available all over the world. Ask your doctor, find other people in your community, and see what’s available. The benefit of our modern technological world is that if you don’t have a local support/advocacy group, you can get involved via the internet. Research your options, and find something that suits you.

As society’s understanding of ADD/ADHD evolves, I look forward to the day that we can openly discuss and share about ADHD, and that we can count on the support that we need from everyone, as has happened with breast cancer. In the meantime, I hope that the ideas shared here help you or your loved one to live better with ADD or ADHD.

With my heartfelt best wishes,

Dr. Kenny

p.s. if you’ve found this e-book helpful, please forward this link to your friends so they can sign up to get a copy too: www.DrKenny.com/rethink-adhd

p.p.s. if you’d like to share your comments, thoughts or reflections on this e-book, please do so here: www.DrKenny.com/rethink-adhd-comments

http://www.add.org/

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About The Author:

Dr. Kenny Handelman is a Child & Adult Psychiatrist who is an expert in ADD/ADHD, and has Adult ADD himself. He is board certified in the USA and Canada, and is an Adjunct Professor of Psychiatry at the University of Western Ontario. Dr. Handelman is the best-selling author of: Attention Difference Disorder: How To Turn Your ADHD Child or Teen’s Differences Into Strengths in 7 Simple Steps, a book for parents of kids and teens with ADHD. Dr. Handelman teaches other doctors, as well as parents, educators and kids about ADD/ADHD. He speaks internationally on the subject and is often interviewed on TV and radio. He conducts clinical research in ADD/ADHD, and his websites on ADD/ADHD get over 750,000 unique visitors per year.

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