ADHD
attention deficit hyperactivity disorderWhat is ADHD?
ADHD is a neurodevelopmental disorder that impacts a persons’ entire self. Not only does if effect attention and impulsivity, but it can lead to mood disorders, low self esteem, chronic stress, addictive behaviours, along with a number of other conditions. There are 3 types: Inattentive /Distractible Type, Impulsive/Hyperactive Type, and Combined type.
Studies show that it is a chronic condition, and often affects one through adulthood and across a person’s lifespan. ADHD affects ones work life, social life, emotional functioning, school and academic performance, mental and physical health, relationships and family, marriage and parenting.
ADHD has many different presentations and can look different in how it manifests person to person. However, most folks with ADHD have difficulty with regulating attention, focus, and concentration and many struggle to regulate emotions. If you have ADHD, you may have problems with time management or difficulty with organization, completing or initiating tasks, or struggle with restlessness and impulsivity. ADHD is recognized as a disability by major government institutions and health authorities in Canada and the US.
Treatment for ADHD
ADHD can be fairly easy to treat when using a multimodal approach. It has a number of different presentations making it imperative to encompass an Integrative, Individualized, Holistic approach designed to meet each person’s specific needs. Some people respond well to ADHD medications while others do not.
Research shows that using a combination of interventions gives the most effective results. This can include ADHD coaching, Psychotherapy, Cognitive Behaviour Therapy, Dialectical Behaviour Therapy, Acceptance and Commitment Therapy, Supportive Counselling, Lifestyle Coaching, Stress Management, Self Compassion, Holistic Nutrition, Mindfulness, Psychoeducation about ADHD and related conditions, and Vocational/Educational Accommodations.
If you already have a diagnosis, we will start with an Intake/Discovery Session where we will begin to get to know you, your strengths, your challenges, and how we can support you in achieving your goals. The next step is followed by individual sessions where we work together to set goals and create the treatment plan. We will build on your strengths, skills, and abilities while offering new tools and interventions to support any impairments or areas that need improvement.
And finally, if you do not have a diagnosis and feel that you would like to address symptoms and challenges without getting a formal diagnosis, we can start with the Intake/Discovery Session and begin creating a treatment plan together.
Treatment Approaches
Cognitive Behaviour Therapy (CBT)
CBT’s primary aim is support behaviour change by addressing negative thought patterns and core beliefs
Dialectical Behaviour Therapy (DBT)
DBT treats ADHD symptoms in the areas of emotion regulation, distress tolerance, mindfulness, and interpersonal effectiveness
Acceptance and Commitment Therapy (ACT)
Values based therapy aimed at using 6 primary processes to facilitate change
Executive Function Coaching (EF)
Take the test to see where you strengths and weakness lie. Time management? Working memory? Planning and Organization? Starting / completing tasks? Self -Regulation? Coaching will support you in discovering and building on strengths, developing skills and strategies to help with weaknesses, and to provide a safe and caring space to support you in living your ADHD friendly lifestyle.
Lifestyle and Wellness Coaching
ADHD impacts a person on every level and in all domains of life. Secondary conditions often occur along side ADHD such as anxiety, depression, sleep problems, chronic stress, and poor dietary habits. Coaching can support you in creating exercise plans, healthy eating habits and nutrition, supplements for brain health, stress management, mindfulness and self- compassion exercises, and relaxation techniques.
Client Education
We provide information and education about ADHD and how to manage symptoms in order to empower you to find ways to optimize skills and function. Topics may include the ADHD brain, executive functions, organization and planning strategies, working memory, time management, skills and strategies, and nutrition for optimal brain health functioning.
Group Coaching- Living an ADHD Friendly Lifestyle
Learn all about ADHD, how to manage symptoms, develop skills and strategies, and do it within a supportive group so that you feel less alone, and more connected to a community of people who have similar struggles. This 8-week group meets weekly and is followed by an Alumni group so you can stay in contact with other ADHD participants.
ADHD Symptoms
Impaired Attention Regulation
- Difficulty with remaining focused on tasks when the task feels boring such as paperwork, reading, or tasks that are repetitive.
- Challenges with stopping or changing focus when the task is rewarding and of high interest
- Struggles with switching from task to task when doing something that is stimulating or of high interest (hyper focus)
- Difficulty with initiating and focusing on important tasks that are priority (at work, school, or home) instead of the stimulating task.
- High distractibility to sounds, sights, or internal thoughts and feelings
- Struggling to pay attention to details resulting in numerous and ongoing mistakes (at work, home, or school)
- Losing belongings like keys, wallet, phone, jacket, etc.
- Forgetting to complete tasks at work, school, or home even if they are daily or regular occurrences
- Problems with listening skills
- Zoning out while being spoken to-being distracted
- Problems with reading-unable to focus on reading material
- Lost in thought or daydreaming during work, school, or task time
Difficulty with Hyperactivity
- Internal sense of restlessness
- Difficulty relaxing
- Excessive mind activity or racing thoughts
- Difficulty with staying on topic- mind rapidly switches focus from topic to topic
- Verbose- talking excessively too fast or too much
- Desire for excitement and high risk situations
- Attempting to do too many tasks or activities at the same time
- Acts as if driven by a motor-cant sit still
- Fidgety, foot tapping, hand drumming on table, unable to stay still
Difficulty with Impulsivity
- Acting in impulse or reacting without thinking first
- Decision making without thinking things through
- Spending on a whim- or without thoughtful planning
- Interrupting while others are speaking
- Blurting things out thoughtlessly that others find rude, offensive, or inappropriate
- Speaking ones mind without thinking first- No filter on what is shared with others
- High level of emotional reactivity
- Ending/switching jobs or relationships abruptly and suddenly and often
Difficulty Regulating Emotions
- Mood problems-feeling happy and elated one minute and down and depressed the next
- Feeling overwhelmed and flooded unable to come back to a balanced state
- Outbursts and emotional reactivity
- Irritability, impatience, lack of frustration tolerance
- Highly sensitive to real or perceived criticism
- Heightened sensitivity to stimuli
- Difficulty calming down when upset
ADHD
Executive Function Skills
In order to complete tasks of daily living and to execute plans and reach our goals, our brain needs to develop and use a set of skills called executive functions. These include things like working memory, organization, planning, prioritizing, time management, task initiation and focus. If your executive function skills are working well, you will find ease with completing tasks and managing thoughts and feelings at work, home, school, and in relationships. If your skills are weak, you will most likely struggle with the demands of daily living in all domains. Everyone has particular strengths and weaknesses in executive functions; however, people with ADHD tend to have more weaknesses than those with neuro -typical brains. Understanding your particular brain, its strengths and weaknesses and learning how to improve them is one of the cornerstones to ADHD treatment. The use of evidenced based interventions, skills and strategies makes it possible for the brain to change, develop and strengthen at any age. Through skill development, coaching, and therapy, one can not only improve weakness but also tap into innate strength and potential.
Studies show there are more than 40 executive function skills that can be chunked together into 12 categories. Peg Dawson and Richard Guare, authors of the book Smart but Scattered named the following 12 Executive Function Skill Categories.
Executive Functions
Response Inhibition/Impulse Control
The ability to pause and think things through before speaking or taking action
Time Management
The ability to consistently know what time it is, to estimate how long tasks take to complete, and arrive on time for appointments and scheduled activities
Working Memory
The ability to remember dates, details, information, and commitments without needing reminders
Sustained Attention
The ability to stay on task until completion even when interrupted or bored
Planning /Prioritizing
The ability to create and follow a daily plan at work, home, and school, and to focus on the important tasks
Stress Management
The ability to function well in high stress situations without resorting to maladaptive coping mechanisms in order to self regulate
Emotion Control
The ability to stay calm when dealing with problems and upsets and to come back to baseline quickly when under stress and emotional activation
Task Initiation
The Ability to begin a task on time without leaving it to the last minute
Flexibility
The ability to adapt to unexpected change and to switch from one to another effortlessly
Metacognition
The ability to “think about thinking” or to plan, monitor, and evaluate ones thought and/ or learning process
Goal Directed persistence
The ability to set goals and to refrain from acting on desires for short-term pleasure or impulses that may get in the way of completing the goal
Organization
The ability to create and maintain systems for organizing in the home, work, school, etc.
Red Flags for Executive Functions
- Do you regularly forget appointments; lose your keys, wallet, or phone? (working memory)
- Do you tend to forget important dates like birthdays or forget to look at your planner? (working memory)
- Are you regularly late for work or meetings? (Time management)
- Do you lose track of time causing you to hand in assignments late at work or school? (time management)
- Is it difficult for you to switch from one task to another? (flexibility)
- Do you procrastinate leaving things to the last minute? (task initiation)
- Do you tell yourself you will “do it later”, due to overwhelm or perfectionism? (task initiation)
- Do you feel overwhelmed by projects at work? (planning/prioritizing)
- Is it difficult for you to break down large tasks into smaller steps? (planning)
- Does clutter seem to accumulate at home and in the work place? (Organization)
- Do find it difficult to create or maintain systems of order for your emails, files, paperwork, desk, cupboards, etc.? (Organization)
- Do sounds, sights, visuals, people walking near your desk, make it difficult for you to stay focussed on the task at hand? (Sustained attention)
- Does a sudden change in plans create distress? (Flexibility)
- Is it difficult for you self monitor and to have insight into your thoughts? (Metacognition)
- Do you find it difficult to complete a project all the way to completion? (Goal directed persistence)
- Do you find it difficult to regulate emotions and manage moods? (Emotion regulation)
- Is it hard for you to come back to baseline once you have an emotional upset? (Emotion regulation)
- Do you find it difficult to stay on task until completion? (Sustained attention)
- Do you find yourself bouncing between multiple tasks and feeling scattered between them? (Sustained attention)
- Do you make quick decisions and later regret it such as impulse buys, making plans with friends or work commitments that you wished you had taken time to think through? (Response inhibition/impulse control)
- Do you frequently interrupt people when they are talking or blurt out things you later regret? (Response inhibition/impulse control)
- Do you start projects but can’t seem to complete what your start? (Goal directed persistence)
Accommodations-Vocational / Education
Adults with ADHD can also have challenges at work, school, and home life in the following areas:
- Starting tasks that are mundane, repetitive, or not stimulating
- Completing projects
- Mind wandering and being distracted by noises or internal stimuli
- Planning and breaking down large projects into smaller tasks
- Deadlines and getting work done on time
- Being late for work and appointments
- Becoming overwhelmed with work and school responsibilities
- Losing items such as documents, materials, keys, phone
- Forgetting due dates, schedules, appointments, tasks
- Putting off tasks until they are due
- Avoiding mundane tasks
- Keeping up with workload
- Talking excessively, interrupting, and blurting out blunt comments
There are many accommodations that can be implemented in the work place, school, or at home that will support the person with ADHD in being successful. The following is a list of common accommodations:
College and University Accommodations include:
- A reduced course load while having this count as a full time course load
- Extended time for taking tests
- Using a note taker in class who will share their notes (this is done anonymously)
- Priority and early registration for courses. Many people with ADHD need smaller class sizes and later start times due to sleep issues
- Permission to write tests separately and in a quiet room where there are no distractions
- Recording of lectures
- Altered test formats if you also have a learning disability
Work Accommodations
- Moving your workspace or desk to quieter area
- Using noise cancelling headphones
- Changing your work hours so you can start later if sleep is an issue
- Use of office dividers
- Uninterrupted work time schedule
- Working remotely
- Shorter meetings and walking meetings for those with hyperactivity
- Regular breaks for stretching and movement
- Extra time to complete tasks
Conditions that often accompany ADHD
- Anxiety
- Depression
- Substance use
- Alcohol use
- Autism
- Learning Disorders
