ADHD Reality—The focus and distraction dilemma
Practical choices for surviving and thriving
A call about ADHD and life difficulties
A distressed family member and colleague recently called me. They complained they were very nervous and worried as they were failing and falling behind in their part-time university studies and felt hopeless about ever completing their coursework for their degree. Their full-time jobs and careers also seemed at risk from lack of focus and concentration, interfering with their productivity and completing assigned tasks and vital projects. A threatening and contentious work supervisor was applying pressure to get more done. There was a real risk of getting fired. A recently valued relationship was also on "the rocks" and near the breaking point. The unfortunate load of adverse challenges seemed to recur frequently, as has often been a regrettable plight. There was a track record of difficulty with social relationships and problems succeeding in challenging academic and work-related situations.
The person I talked to was very bright and intellectually gifted, read a lot, and appeared attuned to information about things that could cause their problems. The caller knew of various suggested diagnoses like Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) and about all the steps that might alleviate the distress and remedy these recurring difficulties. It was a good time for us to review the larger picture, to bring perspective, and to hone down on alternatives to consider when caught in such a distressing dilemma.
I remember when I was concerned about some of my challenges and perceived shortcomings, wondering whether there was a good diagnosis for my problems. My magical thinking was that a simple solution or cure might be attached to one of those names or labels. I thought there might be an accepted, safe, and effective treatment—especially for such a succinctly defined and labeled difficulty. These trendy or faddish ways of seeing things and the remedies of the day were often popularly espoused by both the medical authorities and the widespread advertising and social media outlets. I was frequently led down blind alleys of false leads, misconceptions, and unhelpful, sometimes costly, hoped-for solutions.
Many of today's popular and accepted descriptive conditions, backed by the authoritative medical consensus publication as the DSM-5 in psychiatry and an array of articles on social media and in the popular press, make it appear that there are discrete entities with proven effective treatments. In fact, or I should say in my humble opinion, there is much overlap between a name or label with closely related conditions or with utterly different contributing factors that might need attention to get any relief or help. Some currently accepted, defined diagnoses or labels might come with just abbreviated letters such as ADHD, ADD, OCD, BPD, PTSD, or have a name such as autism spectrum, dyslexia, bipolar disorders, mood and anxiety disorders, substance use disorders, or traumatic head injury, and so on.
It is currently favored to describe anyone with differences in learning or mental functioning that differs from the typical person in the population as being "neurodiverse"—a positive movement toward destigmatizing the impact of any specific name or labels. There is a holistic, integrative care philosophy towards more open-minded, humanistic approaches and comprehensive assessments as a better alternative than factory-like and less personalized healthcare—that recognizes that individual differences in presentation or functioning don't always represent disease or pathology but just a normative difference that plays an equally valuable role in our diverse society of people.
When seeking relief from persisting or worsening problems, avoid getting pulled into misleading, unhelpful, or sometimes costly traps. Consider consulting someone trusted with specialized expertise and experience in the areas relevant to your difficulties and challenges. Professional guidance can help you manage ADHD issues.
I want to return to the caller to whom I opened this article and discuss some issues raised about ADHD, many of which I wondered about or struggled with on my path to understanding and hopefully some mastery. Learning about ADHD and getting the help you need can empower you, as it puts you in better control of your challenges and equips you with the knowledge to manage yourself more effectively.
People with attention, focus, or ADHD traits, attributes, or difficulties can be disadvantaged in work, academic, and social situations.
Having ADHD can be more problematic when an individual finds themselves in an adverse work or life situation when he feels there are no other choices or options. Ill health can develop from being chronically overextended, not getting adequate sleep, or from continued stress. There can be significant discrimination against people with ADHD in work, academic, and social situations. When diagnosed, allowances can be instituted for workplace or school accommodations under ADA laws (American Disability Act).
When someone with ADHD attributes or traits is in a positive fit with their life situation—operating within their capacity in an accepted and supported environment—they are often creative, talented, and productive. They can become leaders in their fields of interest. ADHD is not an impairment or disabling for many, with less intense presentation or symptoms. It may not be a significant problem or be disabling, even though there often is a struggle to succeed and avoid discrimination, rejection, and disadvantage.
Recognizing ADHD
Many conditions can masquerade and appear to be ADHD. Where there hasn't been a suitable response to initial intervention or self-help, information gathering, getting help, or consultation from someone trusted with specialized expertise and experience in the areas relevant to your difficulties and challenges is encouraged. Professional consultation can help clarify the problem, guide treatment, search for contributing factors, and find beneficial interventions.
A significant percentage of children and adolescents diagnosed with ADHD will continue to have symptoms and problems into adulthood. ADHD presentation often has been present since age seven or younger. After the early teenage years, about half of children will continue with ADHD symptoms into adulthood, usually of the inattentive type—as difficulties with organizing, sustaining attention, distraction, finishing tasks, procrastination, losing things, forgetfulness, and making mistakes. Recognition in adults generally occurs after age forty.
Hyperactivity-impulsivity symptoms commonly seen in children and adolescents are less likely to be seen or appear differently in adults. Children and adolescents with difficulties fidgeting, feeling settled, relaxing quietly, talking excessively, intruding into conversation, blurting out answers, or running and climbing could present in adults as internal restlessness and substance abuse. Other symptoms, such as hyperactivity, difficulties with decision-making, and poor impulse control, could also be present.1 2
Common ADHD attributes, behaviors, and difficulties:
Not getting things done, procrastination, and poor time management
Reduced attention to details, tasks, and activities; easily distractible and makes frequent mistakes
Unable to meet job demands for performance and productivity
Over-focus, especially on special interests, inflexibility, getting overwhelmed with meltdowns
Work inefficiency, failure to complete tasks, poor organization, and experiencing job losses
Inattentiveness and difficulty learning new information
Impulsivity interrupts others, talks excessively, and makes rash decisions
Being discriminated against in the workplace
Difficulty relating to others—effectively and socially
Anxiety and mood swings, poor coping skills, and stress management
Intense emotional reactions in response to feeling rejected by others3
Interference with relationships and family life
Loss of self-esteem
Mental and physical health problems
Substance abuse
Disability
When ADHD-like symptoms occur, studies conclude that:
ADHD occurs in about 4% to 5% of the adult population (varies in different studies but appears more common than has been assumed)
ADHD is highly inheritable, commonly passed from parent to child
Three subtypes are currently described according to dominant symptoms: A. Inattentive, B. Hyperactivity-impulsivity, C. Combination of 1 & 2 (most common in adults).4
There are many natural and safe treatment options.
Conventional treatment for ADHD is often done initially with medication—without first considering safer or less expensive and more natural alternatives. Medications used are psycho-stimulant medications such as Ritalin and Adderall; antidepressants such as Wellbutrin; or less commonly used agents, such as Atomoxetine (Strattera), Clonidine, or Guanfacine. The over-prescribing of these medications can be problematic if there is not an obvious need for the drug and consideration has not been given to the potential adverse long-term effects vs. benefits. Medications can have a positive role in a comprehensive treatment program where other interventions have not worked well. Before trials with medication, an evaluation for contributing factors is essential so treatment can be done if necessary before considering medications are instituted.5 6
Contributing factors often overlooked (essential to find before considering medication) include:
Drug abuse, chemical dependency, or other substance use problems
Medical conditions such as thyroid problems, infections, inflammatory diseases, or nutritional deficiencies
Mood and emotional dysregulation or disorders such as bipolar disorder, depression, and anxiety
Post-Traumatic Stress Disorder (PTSD) or past trauma
Neuro-developmental difficulties, as seen with autism spectrum traits and attributes
Environmental allergies and sensitivities
Family disruption or dysfunction
Significant losses (such as the death of a loved one or the breaking-up of a relationship) or worries about financial problems, job loss, or marital problems
Sleep disturbance (often caused by not getting enough sleep or poor sleep habits).
Other positive steps to consider:
Reduce use-time and distraction from electronics, computers, cell phones, tablets, etc.
Create more work and living space without noise, distraction, and clutter.
Reduce stress and anxiety by adopting a balanced lifestyle with optimal food choices, regular daily exercise, social and recreational activities, and avoiding overcommitment to non-essential activities or over-scheduling career or work-related time. If needed, find a coach or therapist.
Follow a regular, consistent exercise program, such as running, swimming, biking, yoga, dancing, group exercise classes, or walking outside.
Establish a regular sleep routine in a conducive, quiet, electronics-free space and get adequate sleep (7-8 hours).
Improve nutrition with more organic, fresh whole foods (avoid refined sugar and overly processed food)—more healthy plant-based foods including whole grains, lean protein, moderate carbohydrates and healthy fats, green vegetables, beans, fruits, nuts, berries, and some fermented foods as sauerkraut and yogurt—the Mediterranean diet is a healthy choice.
Consider recommended supplements if working with someone knowledgeable, trained, and experienced in healthy nutrition.
Avoid exposure to excessive food additives, commercial and household chemicals, alcohol, and other non-prescribed sedatives or drugs.
Get help with attention, focusing, and organizing from an assistant, ADHD-focused coach, or CBT therapist. Consider using a daily planner, a to-do list, or other time-management tools.
Seek accommodations, when needed, in educational and job settings.
Behavioral, cognitive, family or other therapies can benefit emotional, behavioral, and relational problems. They can help change problematic patterns of interactions and behaviors and enhance self-regulation, mindfulness, and attentional skills.
For anxiety, stress reduction, and focus, consider neurofeedback, photobiomodulation,7 brain games, art, yoga, music therapies, mindfulness, and meditation practices.
It would be best to discuss any of these approaches with a trained and qualified person in the areas you want to pursue.
Tips & Points to Ponder:
Current accepted definitions and labels for medical and mental health issues are usually based on studies by research and academic centers. Labels or diagnoses can help direct research and raise awareness of trends and the need for resources in areas of need. Benefits and guidance are also derived from the applications of new technologies and treatments. However, there are often overlaps when specific symptoms can appear, like those found in another described condition.
In discussing ADHD, some defined attributes and characteristics are found in other described categories or diagnoses. For instance, in autism spectrum disorder (ASD) and ADHD, there is an overlap in behavioral and emotional symptoms, as both appear to be neurodevelopmental and related to family and genetic origins. Both can affect coordination, social interactions, focus, attention, and organization. Deciding whether ASD and ADHD exist together in a person or are distinctly separated may be of importance in how a person values or defines him or herself or may be necessary in determining an approach or treatment intervention if needed. See the article "Diagnosing ADHD and Autism in Adulthood."8
When it is of value, an experienced specialist can often determine the difference or, in many situations, the co-occurrence of the two. Other conditions that may present with similar symptoms are many and include anxiety, bipolar disorder, depression, hearing impairment, post-trauma-related problems as seen in PTSD, sleep disturbances, autism spectrum-related disorders, obsessive-compulsive disorder (OCD), traumatic brain injury, and environmental and toxic exposure illness.
Helpful interventions can focus on specific behaviors or emotions rather than an exact label for the condition. Unfortunately, medical insurers often want a particular diagnosis to pay for the care, which puts pressure on the provider to give a specific named condition. Diagnostic labels are frequently used to sell products, linking the name to a feared consequence and offering a product as a drug or therapy to cure or alleviate a difficulty. So, look for ways to relieve or improve health, physical, and emotional concerns without an over-attachment to names and labels.
Related resources by Ron Parks, MD, MPH, an integrative psychiatrist, holistic medicine consultant, and writer:
MindWise Website: https://parksmd.com/
MindWise Newsletter and Blog: https//:www.inmindwise.com
COVID-19 and Mental Health Crises Book
The current article is an update of two prior articles by Dr. Parks: https://parksmd.com/helping-focus-attention-adhd/ and https://parksmd.com/best-approach-to-adult-adhd/
I appreciate your interest. Please share with others.
Thanks to Shan Parks, writer and editor, for his final edits and suggestions.
Content is created and published for educational purposes only and should not be a substitute for professional or medical services or guidance. Please always look for your healthcare provider's advice and care regarding medical or mental health concerns.
ADDA https://add.org/
Rejection Sensitive Dysphoria https://www.webmd.com/add-adhd/rejection-sensitive-dysphoria
Engineering and research studies suggest that safe transcranial-intranasal brain photobiomodulation (PBM) devices that use non-ionizing light energy can create beneficial changes in cells' responses to light. When mitochondria absorb these light wavelengths, they help produce more cellular energy (ATP), bringing brain stimulation effects that can theoretically improve memory, focus, clarity, and brain energy. If interested in a consultation regarding a PMB, non-medication integrative protocol for ADHD, contact Dr. Parks at info@parksmd.com.
Distinguishing Adult ADHD and Autism Spectrum Disorder (ASD): https://www.webmd.com/add-adhd/adult-adhd-autism