Elizabeth Ahmann's Blog

It's November, and as Thanksgiving approaches, thoughts may turn to family and ... turkey (with stuffing)!



But, think about it ... Thanksgiving is also a time that we are reminded to give thanks.



It's easy in the busyness of life to only notice what isn't working, what's getting in the way,  or what's annoying or uncomfortable. We often take the positive things (red and yellow fall leaves, the smile of a loved-one, an easy drive to work) for granted.

Research in positive psychology suggests that people who experience gratitude for the small as well as the large things in life are generally happier and healthier. Expressing gratitude to others also strengthens relationships.

Fortunately, research also shows that - for those of us who do not already see life through the lens of gratitude - developing a conscious, purposeful focus on the good things that happen lead to the experience of gratitude. Happiness - both more positive moods and improved optimism - follows!

To cultivate gratitude, it can help to keep a "gratitude journal" in which you regularly record details of positive experiences. Some tips:
A focus on positive experiences with other people can help with relationship building.Write about pleasant surprises or unexpected positive events.Notice and record negative outcomes that you avoided or prevented! Use detail to flesh out your observations - rather than just making lists - to help you savor the experiences.Commit to a regular time for your "gratitude journaling" - ideally several times a week. Keeping a gratitude journal often helps shift perspective, and you may find, as you do it, that you begin to noticing more positive things happening around and to you.

A gratitude journal often focuses on immediate experiences, but it can also be useful to look at larger patterns or more general trends. In fact, Thanksgiving is a great time to consider the big picture:
As you think back over the past year, what are you most grateful for?

Graphic courtesy of: watiporn at freedigitalimages.net

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. . .</span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-size: 14.0pt; mso-bidi-font-size: 10.0pt;">I’ve worked with high school students who have found that they’ll be in class and find </span><span style="font-size: 14.0pt; mso-bidi-font-size: 10.0pt;">that </span><span style="font-size: 14.0pt; mso-bidi-font-size: 10.0pt;">all of a sudden the teacher calls their name and they have no idea where the class is in the discussion – they’ve been daydreaming. It can be a stressful and embarrassing experience! </span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-size: 14.0pt; mso-bidi-font-size: 10.0pt;">I’ve worked with college students who have found that class has ended and they suddenly realize that they weren’t paying attention. If they're responsible to know the material from the lecture, this can be very stressful; it can also impact grades. </span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-size: 14.0pt; mso-bidi-font-size: 10.0pt;">A similar experience can occur with adults in meetings at work or in conference presentations. Oops! That can really be a problem.</span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-size: 14.0pt; mso-bidi-font-size: 10.0pt;">Sometimes daydreaming is helpful to escape boredom, but in times that we want or need to be paying attention, participating and learning, daydreaming can be very frustrating. </span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-size: 14.0pt; mso-bidi-font-size: 10.0pt;"><b>Try this! </b></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-size: 14.0pt; mso-bidi-font-size: 10.0pt;">In her book <i><a href="http://www.amazon.com/Mindfulness-Pre..." target="_blank">The Mindfulness Prescription for Adult ADHD</a></i>, Psychiatrist Lidia Zylowska suggests that a simple approach to curbing daydreaming is to develop a habit of matching your attention with previously set intention. </span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-size: 14.0pt; mso-bidi-font-size: 10.0pt;">You can do this by first setting the intention, such as "I want to be focused on this lecture." Then, during the lecture, periodically ask yourself two questions: </span></div><ul><li><span style="font-size: 14.0pt; mso-bidi-font-size: 10.0pt;">"Where is my attention right now?"</span> </li></ul><ul><li><span style="font-family: "symbol"; font-size: 14.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";"></span></span></span><span style="font-size: 14.0pt; mso-bidi-font-size: 10.0pt;">"Is this matching my previously set intention?" </span></li></ul><div class="MsoListParagraphCxSpLast" style="margin-left: .75in; mso-add-space: auto;"><br /></div><span style="font-size: 14.0pt; mso-bidi-font-size: 10.0pt;">This strategy can be particularly useful when engaging in tasks in which your mind is likely to wander. For students, this might be studying. For adults, it can be any number of tasks that are somewhat routine or perhaps tedious. </span><br /><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-size: 14.0pt; mso-bidi-font-size: 10.0pt;">Try it out! It may take some practice to build the skill, but hang in there and give it a chance! </span><br /><br /><span style="font-size: 14.0pt; mso-bidi-font-size: 10.0pt;">  </span><br /><span style="font-size: 14.0pt; mso-bidi-font-size: 10.0pt;">Photo credit: chokphoto at freedigitalphotos.net </span></div>

October is ADHD Awareness Month - an international movement to educate the public and create greater awareness and understanding about attention deficit disorder.

The ADHD Awareness Month Coalition has put together a rich array of resources to use in getting the word out. These include a press kit, posters, fact sheets, a calendar listing 31 ways to spread the word... and more! 

Among their wonderful resources are some marvelous brief essays about living with ADHD: Strong, funny, vulnerable, determined, successful, or maybe still struggling!

Eleven essays by people with attention deficit explore the experiences and diversity of ADHD.

You can find them here!

Why not share these with friends, family, and others to help raise awareness of what life is like with ADHD?

Thank you for participating in raising ADHD Awareness this month ...  and any time you do!

October is ADHD Awareness Month. One way we spread awareness about ADHD is to share our stories. 

Everyone living with or loving someone with ADHD has stories to tell.

I could share stories of my own family members, managing ADHD at various life stages.

I could share the story of discovering, after 30 years of marriage, that my spouse has ADHD too!

I could share the story of how parenting children with ADHD led me to become an ADHD coach to help smooth the road for others with ADHD ... so each of my client's gifts can shine.

And you likely have your own stories to tell!

At the ADHD Awareness Month website, you can read the stories of 31 individuals with ADHD  - and submit your own story too: http://www.adhdawarenessmonth.org/category/stories/

The more we share, the more we learn!

For most people, productivity is about meeting deadlines and experiencing forward momentum on projects or to-do lists. It can also be about feeling efficient and ... most importantly ... about feeling effective.

With ADHD, developing a toolbox of skills and strategies that support time management and task management, including prioritization approaches, are critical. With the more relaxed pace of the summer behind you, the fall is a good time to evaluate your needs in this regard. You might want to consider:How well am I managing time?How effective is my use of a calendar or planner?How is my to-do list approach working for me?How well am I keeping track of longer-range as well as short-term goals?What's my relationship to getting started with tasks? How about following through?Here's a link to a blog post I wrote that addresses the critical, yet sometimes challenging, skill of initiation, offering eight strategies to help you with this foundational piece of managing productivity:  8 strategies to support improved task initiation!

Here's a link to another post addressing a common source of failing to move forward with tasks and priorities - self-defeating beliefs - offering a creative and effective strategy for addressing thoughts that get in the way of forward momentum: When self-defeating beliefs interfere with productivity.Another post I wrote addresses one aspect of difficulty with follow-through: monitoring and regulating one's actions to support follow-through with tasks.
But productivity is more than just planners, to-do lists, getting started, and checking things off ... fundamentally it is about feeling effective at what matters to you. It's about knowing your values and building your goals based on those values. It is about what matters most to you and about living a meaningful life.

Wow! ... sounds heavy!? But, yet, knowing what matters most to you is critical to prioritizing, and to feeling fulfilled and effective, and, yes - productive - in life.

I invite you to consider coaching as a way to achieve more clarity as well as to sign up for the fall session of my tele-course on mindfulness for ADHD starting in October, based on Lydia Zylowska's research-backed book, The Mindfulness Prescription for ADHD. Coaching can help you clarify your values. Developing a mindfulness practice can support attention,  self-regulation, efficiency, and the self-awareness that can help you live out your values. All of which lead to improved productivity and satisfaction with life.

Here's to a productive fall! And a meaningful life!

"My son often just rushes through his homework and never stops to check his work."

"I have trouble in social settings - it's just hard to be in a group."

"The teacher complains that my daughter just blurts out answers."

These may seem like quite disparate concerns, but ADHD expert Thomas E. Brown considers them to both stem from the ability to monitor and regulate self-action. This "action" ability is considered one of the brain's "executive" or management functions.

Monitoring and Regulating Action

Here's how Brown describes the executive function of monitoring and regulating action:

"Many persons with ADHD, even those without problems of hyperactive behavior, report chronic problems in regulating their actions. They often are too impulsive in what they say or do, and in the way they think, jumping too quickly to inaccurate conclusions. Persons with ADHD also report problems in monitoring the context in which they are interacting. They fail to notice when other people are puzzled, or hurt or annoyed by what they have just said or done and thus fail to modify their behavior in response to specific circumstances. Often they also report chronic difficulty in regulating the pace of their actions, in slowing self and/or speeding up as needed for specific tasks."

Evidence from both behavioral and neuro-physiological research suggests that monitoring action and processing errors are related to ADHD at the brain level. These functions both occur in the part of the brain called the anterior cingulate cortex. This area of the brain is part of the frontal lobes, often affected in ADHD, and impacts a number of cognitive functions, including decision-making,  impulse control, empathy, and emotion. Monitoring action appears to be modulated in the brain by the neuro-transmitter dopamine (brain chemical that transmits messages between nerve cells in the brain) which is often a factor in ADHD.

Impact: 

Here are some ways monitoring and regulating actions can impact students both academically and socially/behaviorally. Adults can experience similar work- and relationship-related impacts.

Academically:
rushing through assignmentsfailing to read directions carefully taking longer than may be necessary for homeworkhaving difficulty planning how long an assignment or project will take, due to erratic regulation of actionSocially/behaviorally
interruptionaggressionpoor reading of social cues
Supporting Success:

What can help with challenges in monitoring and regulating action?

Some general approaches include: 
MedicationCognitive-behavioral therapySocial skills groupsCoaching Self-management can be improved with self-awareness and self-control developed through use of:
Regular exerciseRelaxation techniquesMindfulness and meditation trainingAcademic and work-related strategies include the following: 
Focus on most difficult concepts or assignments earlier in the dayWork on assignments and projects in small "chunks"Vary the type and pace of activity to promote attentionHighlight key words in directions for homework, syllabi, or work assignments  Choose classroom seating and homework areas - or workplace seating -to minimize distractionTake frequent movement breaksDevelop routines to promote consistency Behavioral strategies for young people include:
Employ student suggestions for strategies to manage impulsivityReward self-control in classroom and play settingsTeach social skills, including recognition of facial expressions and other social cues Encourage one-on one interactions if group interactions are stressfulUse mindfulness training to improve self-regulation A key behavioral strategies for adults:
Mindfulness training and practice, as with young people,  has been shown to improve self-awareness and self-regulation.
Additional resources:  A New Understanding of ADHD in Children and Adults: Executive Function Impairments
How Does ADHD Impact School Performance?
ADHD and Social Interactions
Building Social Skills for ADHD Children
How to Jumpstart Friendships for your ADHD Teen
Social Skills in Adults with ADHD

For mindfulness training for adults and teens with ADHD, see:  http://www.lizahmann.com/mindfulness.html


photo credit: stockimages, freedigitalimages.net

Having trouble staying on track when you set out to get something done?

Distraction is common for individuals with ADHD, in fact, it's one of the hallmarks of the diagnosis! But, you can start training your mind to reduce the impact of distractors and, as a result, over time become increasingly efficient at whatever you're doing.

Here's an exercise that will help:

1) When you set out to do a task of any sort - maybe it's doing a homework assignment, reading a chapter in a book, or cleaning off your desk - take a moment to verbalize your intention: "I am doing my math homework now," "I am reading chapter three now," "I am cleaning off my desktop now."

2) Start the task!

3) If you notice yourself getting off-task, no worries. Just ask yourself, "Do I want to be off-task or return to my intention?" Make a choice.

4) If you decide to return to your original intention, state it again: "I am doing my homework."

5) Start again.

6) Then, repeat steps 3-5 as often as necessary!

It doesn't matter how many times you get distracted and have to repeat the process. Each time you do it, you are training your brain to come back to a task after it's distracted.

Just as physical exercise requires repetition to gradually increase strength, this exercise gradually increases your ability to return to the intended task more easily.

With physical exercise, you build muscle. With this exercise, you build new neural pathways in the brain.

You won't become a world class sprinter or weight lifter in a day. Similarly, training your brain to recover more quickly and easily from distraction takes time.  But, each time you do the workout, you are building the skill.


Photo: stockimages, freedigitalphotos.net

Among the books that I most often recommend about ADHD is Thomas E. Brown's Attention Deficit Disorder: The Unfocused Mind in Children and Adults.  In this book, Brown introduces his view of ADHD as a disorder of executive functions, a view increasingly shared by most ADHD experts. A more recent book of his is titled A New Understanding of ADHD in Children and Adults: Executive Function Impairments . If you haven't read either of these books, I heartily recommend you read at least one!


Recently, however, Brown's newest book Smart but Stuck: Emotions in Teens and Adults with ADHD has become one of my must read suggestions, even though I have only read the first three of its 13 chapters!

Why am I so excited about this book? Brown's newest book examines in detail one of the least recognized, yet critically important, impairments of ADHD: emotional regulation, or the ability to self-regulation one's emotions.

As Brown says,

"[E]motional struggles play an especially large role in the daily life of people with attention deficit disorders. The same chronic impairments that interfere with other aspects of ... cognitive functioning also tend to interfere with [the] ... ability to manage and be adequately guided by ... emotions" (p.7).

Brown adds a further important point:  "People with ADHD often suffer chronic difficulties in responding to and sustaining emotions that motivate them for important tasks" (p. 7).

Discussing ADHD and the emotional brain in the first chapter of his book, Brown argues that emotions are not separate from, but, rather, an integral part of brain function. He makes the following key points:

Interest:
Interest is a critically important motivating emotion. Individuals with ADHD have fewer brain receptors for the chemicals activating the brain's reward-recognizing system, making it difficult to both initiate tasks of limited interest and sustain motivation when rewards are not immediate.Perception of a task impacts the level of interest or disinterest.Memory: 
The brain's reactions to emotions is impacted by memory, and working memory impairment associated with ADHD makes it difficult to rely on past experience as a guide. Working memory impairment contributes to difficulty keeping the "larger picture" in mind, impacting motivation and decision-making. Managing emotions: 
Managing contradictory emotions is more challenging for individuals with ADHD, often leading to extreme reactions.Living with ADHD contributes to chronic stress, family stress, and can be associated with anxiety and depression. Following this fascinating, and confirming, overview of emotions and ADHD, Brown offers nine chapters, each a story of a person whose ADHD and emotional regulation difficulties posed significant challenges to accomplishing goals and living a satisfying life.

If you have ADHD, or have a loved on with ADHD, I guarantee that you will recognize your own situation in aspects of these stories. In fact, it's likely that the stories will shed light on experiences that have been difficult for you to understand, and harder to address.

The "ah-ha"s and increased understanding readers will have of the role emotions play in ADHD make  this book extremely valuable and validating. Additionally, through each of these stories, as well as a brief final chapter, Brown offers guidance on awareness, interventions, structures, and support that can help individuals with ADHD get "unstuck."


Photo credit: http://all-free-download.com/free-pho...

If you are very reactive, and have difficulty managing frustration and modulating your emotions, you are not alone.  Everyone experiences this from time to time, especially when tired or stressed, but for some people with ADHD this reactivity is neurologically based and occurs more frequently, regardless of fatigue or stress.

How is emotional reactivity related to ADHD?

Emotional regulation is one of the "executive functions" of the brain, functions that manage and coordinate our mental efforts. Recent understanding is that one or more executive functions are commonly impaired with ADHD. In fact, researchers have found that over half of people with ADHD have trouble regulating their emotions.

According to ADHD expert Dr. Thomas E. Brown,  although the formal diagnostic criteria for ADHD "does not recognize any symptoms related to the management of emotion as an aspect of ADHD, many with this disorder describe chronic difficulties managing frustration, anger, worry, disappointment, desire, and other emotions." This can lead to "quick bursts of anger, frustration, impatience, or excitability in response to everyday events."

What are the signs of emotional reactivity?

Emotional regulation challenges are different from depression or anxiety, which can also accompany ADHD, and can show up in a number of ways:
emotional "hypersensitivity" starting early in life emotions that zoom from zero to 100 in no time at allfeelings that are more intense than normalfeelings that take one over, making it difficult to pay attention to other thingsdifficulty putting emotional reactions into perspectivedifficulty managing strong emotional reactions difficulty inhibiting inappropriate behavior related to strong emotionsa long refractory time, with difficulty coming down from, or relaxing after strong emotions
What helps in managing emotional reactivity?

While emotional reactivity is neurologically based, there are some strategies that can help in managing and modulating your emotions:

1) Recognize and accept the fact that you are emotionally reactive, that it has a neurological basis, and - most importantly - that nothing is "wrong" with you.

2) Accept the emotions you feel, and don't fight against or ignore them - that just makes the pressure worse.

3) Learn to identify and label/name your emotions - that gives you a feeling of more control over them. Here's a link to a large list of feeling words you can look at when emotions flare : Feelings inventory.  When you have a strong feeling, take the time to inventory even the nuances of what you feel - this also helps put your in your rational, calmer, brain.

3) Know that you do not have to act on emotions, even they are strong. In fact, sometimes acting on the emotion makes things worse. Most emotions will peak, and then slowly reduce in intensity. Try to remain calm, perhaps by detaching just a bit, and watch the emotion peak and wane over time, waiting out the intensity. Practicing mindfulness can help you develop this detachment.

4) To manage an intense emotion, remove yourself from the triggering situation, then try using deep breathing and/or distraction until the intensity subsides.

5)  Notice your triggers. If the same situation repeatedly triggers intense emotions, you may want to explore the circumstances to see if you can understand why it is so triggering for you and what you can do to avoid or modify the triggering situation in the future.

6) Develop some regular habits that will decrease your baseline for reactivity. These include:
 getting plenty of sleep  maintaining a healthy diet, including adequate protein  getting regular exercise  developing a daily mindfulness or meditation practice  taking some alone time every day to decompress7) Talk with your psychiatrist about your medications to make sure you are on the best medications and dosages for your needs.

8) Talk things through regularly with a loved one, coach and/or therapist so you don't let emotions build up, triggering stronger reactions. A coach or therapist can also help you learn some strategies to regulate your emotions, such as those above.

You don't have to let your emotions sun your life! Use these tips so that you can learn to manage your emotions and live with more ease. 

"I hate school!"
"I'm no good at writing!"
"I am the worst friend!"


These statements, and others like them, express a lot of emotion!

Many children and adults with ADHD do have strong feelings and reactions. That's because emotional regulation is often a challenge for individuals with ADHD. Feelings can flare quickly and intensely and can sometimes take a while to subside.

As a parent or loved one of an individual with ADHD, this emotional reactivity can be tricky to respond to. Many typical responses backfire, leading to more explosive expressions or to internalized self-judgment. Take a look:
If you try to provide reassurance - for example, "It's not really that bad." - you minimize the feelings of the person, essentially invalidating their own strong feeling. If you try to interject your view of reality - "You do well at school!" or "But you wrote a great paper last month!" - you are also invalidating their point of view.  "You're over-reacting" is a judgment of your loved one.Labeling - "You're too sensitive," for example - is also a judgement and is invalidating. Trying to fix the feelings - for example, "Come on, it'll be OK - let's get a snack"- also invalidates and fails to respond to a heartfelt communication. Offering solutions prematurely - "We can get a tutor."- fails to acknowledge the feeling(s) expressed. At the same time, you don't necessarily want to agree with your loved one who is having such strong feelings in these circumstances, adding flames to the emotionally reactive fire.  It's not helpful, for example, to say things like, "I know what you mean, that school is terrible!"

So what is effective?

Are you familiar with the term "validation"? Validation is a particularly useful communication approach that lets you accept the feelings of another person as a valid expression of thoughts and feelings in a particular circumstance, without at the same time having to agree with them.

Validation, according to Dr. Karyn Hall, means describes "[t]aking another person’s thoughts and feelings seriously, both recognizing and acknowledging." She adds that using validation "leads to a more increased sense of well-being and calm for everyone. Additionally, any request made of someone is more effective if it begins with a statement acknowledging the other person’s needs and concerns."

Validation can take many forms, according to Hall:
providing complete attention, setting down your work and tuning in, even if the feelings you are hearing make you uncomfortablereflecting the other person's statements - "Sounds like you really hate school!"identifying possible unexpressed emotions - "Are you also feeling disappointed about how your test went today?"expressing understanding of the whole person - "I can see why you'd hate school when you keep getting poor grades on your tests."normalization - "Lots of kids feel that way when they have a difficult experience at school."a genuine sense of connection - "I hated school in sixth grade too !"While invalidating responses can lead to increased emotional upset, validating has many benefits:

1) Validation assists in emotional regulation and calming someone who is upset.
2) Someone who feels validated is more likely to open up in conversation.
3) Validation contributes to self-respect and the development of a stronger identity.
4) Problem-solving abilities and resilience improve with validation.
5) Validation builds connection and strengthens relationships.
6) Practicing validation improves ease and happiness in family life.

Validating is easier to understand than to do, but practice makes it come more naturally - so experiment with it as often as you can, and gradually you'll build your skills! You'll feel better about your communication, and your relationship(s) will benefit from your much needed understanding.

(Note: if you are emotionally reactive yourself, try self-validation too.)

Resources: 

For more information on how to use validation, see:
Hall, K. (2012, April 26). Understanding validation: A way to communicate acceptance. Harvey, P.,  and Penzo, J. (2009). Parenting a child who has intense emotions.
Oakland CA: New Harbinger Publications.The following book/workbook for teens includes material on self-validation, among other useful strategies for managing emotions:
VanDijk, S. (2011). Don't Let Emotions Run Your Life for Teens. Oakland, CA:  Instant Help Books. A type of therapy - being used in some places in Europe as a treatment approach for ADHD - that emphasizes validation and other skills for managing strong emotions is Dialectical Behavior Therapy  (DBT). (See also this article on DBT and ADHD.)

For skills groups and individual coaching for parents on using validation and other skills of Dialectical Behavior Therapy (which includes validation and other approaches to working with strong emotions):
Pat Harvey, ACSW, LCSW-C
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