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Mindfulness for ADHD

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Mindfulness Meditation


Close your eyes. Now focus on your breathing. Focus on the steadiness of breathing in and out, in and out. Let this be the anchor for your attention. In this exercise, become aware of your current thoughts.

Let your thoughts come in and be aware of them in the present moment. Do not judge your thoughts, do not attach negative feelings towards your thoughts, accept these thoughts.

Become aware of the distracting thoughts and accept them. Then focus back to your anchor point.

What is Mindfulness?

Mindfulness as a practice was taken from buddhist tradition and has been increasingly used in western society from the 1970s’. The goal of mindfulness based meditations is to reduce stress, anxiety, depression and improve self regulatory skills. For people with ADHD who want to try out non-pharmacological methods for their symptoms, mindfulness is a great way to start.

As you can tell from the example above, mindfulness involves removing distractions and focusing on the present. The goal is to pay attention to the present moment and your current thoughts but with a non judgmental attitude. During this intervention, people focus on their breathing, increase their awareness and remain present in the current experience.

Mindfulness for ADHD

ADHD, a behavioral disorder, can impact interpersonal relationships, academic performance and work related tasks. Mindfulness mediation can improve self regulatory skills which can help people with ADHD decrease their arousal and focus their attention. People with ADHD can feel overwhelmed easily and experience rapid thoughts. Mindfulness for ADHD works to reduce these symptoms and increase control over attention.

Mindfulness techniques you can try on  your own:

6 Mindfulness Exercises You Can Try Today

Mindfulness for ADHD in adults

In one study using mindfulness mediation training with adults with ADHD, about 78% of them had an improvement in their symptoms. Mindfulness practices with adults focus on moment to moment experiences, visual imagery, and expressing loving and kindness towards ones’ thoughts. Rather than became angry at oneself for their ADHD symptoms, mindfulness focuses on accepting these behaviors.

Mindfulness works to let a person recognize when they become distracted and to not just react automatically. After consistently training your brain, a person can be able to stop when they are distracted and refocus their attention. Also, impulsive actions are a strong effect of ADHD, and mindfulness helps reduce these automatic reactions and impulses.

Mindfulness can be an incredibly effective tool for adults as it costs no money, has no side effects and targets the core aspects of ADHD: impulsivity and inattention. Mindfulness for ADHD focuses on helping people become less impulsive and manage their stress better.

Mindfulness for ADHD in children

Mindfulness techniques can also be used for children. About 5% of children and adolescents are diagnosed with ADHD and many are put on medications. Children with ADHD can be easily distracted, get bored quickly and have difficulty redirecting their attention.

Mindfulness can help them be aware of when they are distracted and help them focus their attention on the present task at hand. Mindfulness practices for children tend to be shorter, more interactive and use props like teddy bears or other toys. One example of a mindfulness practice for a child is to pick a super hero like spiderman and focus on keeping a spider man pose and using “spidey senses” to be aware of surroundings.

Examples of mindfulness techniques  for children: https://positivepsychologyprogram.com/mindfulness-for-children-kids-activities/

Work Cited

Househam, A. M., & Solanto, M. V. (2016). Mindfulness as an Intervention for ADHD. The ADHD Report, 24(2), 1-9.
de Bruin, E. I., & Bögels, S. M. (2016). Mindfulness training for childhood ADHD.
 http://mindfullyadd.com/adhd-mindfulness-craze/
https://www.psychologytoday.com/blog/here-there-and-everywhere/201206/adhd-mindfulness-interview-lidia-zylowska-md

ADHD and Learning Disabilities

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ADHD and School Performance

ADHD, a brain disorder, is not considered to be a learning disability but ADHD has been shown to impair academic performance.  Children with ADHD, if it impacts their performance at school, can quality for an Individualized Education Program (IEP). Students with ADHD have a harder time focusing, following directions and learning information compared to their peers.

The main components  of ADHD- inattention, hyperactivity and impulsivity- cause students to be distracted easily and day dream during lessons.
Studies have found that students with ADHD, compared to their peers, score lower on tests, are more likely to drop out of school and are less likely to complete college. Children who have ADHD are at a higher risk for having a learning disability (LD) compared to children with out ADHD. Students with ADHD can succeed academically especially if parents and teachers work together to address their needs.

ADHD and Learning Disabilities (LD)

While ADHD can cause impairments in school and home settings, ADHD is not a learning disability. ADHD and LD are highly co morbid with up to 20-30% of people with ADHD having a learning disability.

Examples of learning disabilities include
1. Dyslexia- reading disability
2. Dyscalculia- difficulties in understanding math
3. Dysgraphia- difficulties in writing
4. Duditory/ visual processing- sensory disabilities (language)
5. Non verbal- difficulty with spatial relations/ organization

ADHD is typically co morbid with dyslexia (reading). The academic impairments that someone with ADHD experiences, is significantly greater when a student has both ADHD and a learning disability together. However, children with LD are more likely to get extra help in school while children with ADHD are less likely too. This can be due to the fact that some students with ADHD do not realize the effect ADHD can have on their ability to learn.

College Students with ADHD and LD

College students who have ADHD are more likely to fail, withdraw from courses or not even complete their degrees. Studies have shown that this pattern starts in high school with teachers rating that the student with ADHD turned in assignments less, had lower GPAs’ and were more likely to be late. College students with both ADHD and LD (co morbid) have lower self concepts where they do not believe they have the ability to complete difficult assignments.

Moreover, college students with ADHD (on its own) spend less time studying and doing their homework. College students with ADHD are less likely to seek assistance for academic help compared to college students with a learning disorder. Those students with an LD are more likely to go over to their professors and seek assistance or work harder on their own.

How to help students with ADHD

  1. Educate  teachers, parents and children on the effects ADHD has on learning abilities
  2. Focus on creating a trusting relationship between the teacher and student. The teacher needs to create structured and predictable environment and establish an emotional connection with the student
  3. Children with ADHD need to build friendships and learn how to interact socially. This will help them concentrate in certain school environments instead of being frustrated due to negative peer interactions.
  4. The parents and teachers need to collaborate to create behavioral plans that are stable across both settings!
  5. Children with ADHD should not be seated near doors and windows where they can easily be distracted.
    Work Cited

    1. https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/add-adhd/is-adhd-a-learning-disability
    2.  http://www.everydayhealth.com/hs/adhd-and-your-child/adhd-children-and-learning-disabilities/
    3. DuPaul, G. J., Pinho, T. D., Pollack, B. L., Gormley, M. J., & Laracy, S. D. (2015). First-Year College Students With ADHD and/or LD: Differences in Engagement, Positive Core Self-Evaluation, School Preparation, and College Expectations. Journal of learning disabilities, 0022219415617164.
    4. Toplak, M. (2015). ADHD: MAKING A DIFFERENCE FOR CHILDREN AND YOUTH IN THE SCHOOLS. Perspectives on Language and Literacy, 41(1), 7.
    5. https://www2.ed.gov/rschstat/research/pubs/adhd/adhd-identifying_pg4.html

Diagnosing ADHD in children

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Diagnostic  process for ADHD in children

There is no singular test to diagnose ADHD; rather, an ADHD diagnosis is made after a series of subjective evaluations by a primary care physician or clinician.
The process includes:
1. Medical exam (physical health history)
2. Interviews/ questionnaires with teachers and parents
3. DSM criteria of ADHD
4. ADHD rating scales
ADHD symptoms have to be present in all settings (home and school). Also, ADHD has to cause severe impairment.  ADHD is chronic and for most children, it continues into adulthood. Since the diagnosis of ADHD is subjective, it also depends on the culture and environment a child is growing up in. For example, certain teachers or parents may not know to look out for certain behaviors or may see certain behaviors as “normal”.

Symptoms of ADHD in Children

The main symptoms of ADHD include: inattention, impulsivity and hyperactivity. Some children with ADHD are hyperactive and impulsive and are more likely to get noticed by their teachers.  On the other hand, children who suffer from inattention, are less likely to be on their teachers’ radar because they are less disruptive.
Examples of ADHD behaviors in children:
1. Inattention: trouble paying attention in boring tasks, appear to be not listening, lose things
2. Hyperactivity: fidgeting, squirming, overly talkative
3. Impulsivity: no self control, intrusive, interrupts others

While ADHD has its challenges, there are also positive qualities associated with children who have ADHD such as: creativity, flexibility and great enthusiasm and energy. When treated with the right therapy and/or medication, children with ADHD can greatly improve their ability to achieve in school.

Can you diagnose a preschool  child with ADHD?

The difficulty when diagnosing younger children with ADHD is due to the fact that it is hard to differentiate between age appropriate behavior and ADHD symptoms. When diagnosing a child in preschool or younger, there must be extra evaluations put in place before a clinician can confirm it’s ADHD.

Sometimes younger children can be experiencing language or developmental delays which can falsely be attributed to ADHD. By age four or five, ADHD becomes easier to diagnose because at this point, the children with ADHD are  more impulsive and disruptive than their classmates. At the younger ages, more of the children are engaging in impulsive actions and can have trouble listening to directions.

Is ADHD being over diagnosed?

About 1 in 5 high school boys in the US  are diagnosed with ADHD and around 6.3 million children ( ages 4 to 17) have had an ADHD diagnosis at one point in their lives. In recent years, there has been a sharp increase in the amount of ADHD diagnoses being made. Majority of those diagnosed then receive stimulants like Ritalin or adderall to control their symptoms.

The problem with an ADHD diagnosis is that there are no objective tests and many people worry that it is being over diagnosed. For example, some clinicians think too many children are being put on medication or that medication is being used to curb mild symptoms. Some parents may be giving their children pills, which improve their focus and allow them to do better in school, but this may not be necessary.

Treatment Plans

Treatment plans should be implemented by both parents and teachers to manage ADHD both at home and at school. Parents should implement structure in their child’s lives, give clear expectations, teach social skills and create a proper sleeping and eating schedule. At school, teachers can seat children with ADHD away from doors and windows, have written behavior plans, allow for movement breaks and teach the lessons in a dynamic way.

Treatment for the different age groups:

1. Preschoolers: Parent and teacher administered behavior therapy ! This should be the first line of treatment and then medication can be applied if there is no improvement (especially in such a young age group)

2. Elementary school (ages 6 to 11): FDA approved medication (stimulant) and/or behavioral therapy

3. Adolescents (ages 12 to 18): Medication and behavioral therapy (preferably both).

Adolescents with ADHD are more likely to be in car crashes, engage in substance abuse and drop out of school so early intervention and treatment is extremely beneficial. With medication and therapy, children who have ADHD can succeed in school and secure a higher quality of life.

Work Cited

https://www.helpguide.org/articles/add-adhd/attention-deficit-disorder-adhd-in-children.htm
http://www.mayoclinic.org/diseases-conditions/adhd/diagnosis-treatment/diagnosis/dxc-20196188
http://www.chadd.org/understanding-adhd/for-parents-caregivers/preschoolers-and-adhd.aspx
Schwarz, A., & Cohen, S. (2013). ADHD seen in 11% of US children as diagnoses rise. New York Times, 331.
http://www.aafp.org/afp/2014/1001/p456.html

Neurofeedback for ADHD

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Training your Brain

Imagine you are watching your favorite movie. Right now the character on screen is getting coffee with her friend and they are discussing their nightly plans. Your mind begins to wander away from the movie, your concentration dwindles and you began to space out. At this moment, all of a sudden, the movie on screen becomes blurry and the sound stops playing as loud.

This is just the reminder you need to concentrate again and to focus your efforts on paying attention to the movie. As the movie progresses, this continues to happen: when your brain is under stimulated and your mind wanders, the movie stops and when you pay attention again, the movie starts. This reward system, over time, slowly trains people with ADHD to sharpen their concentration and sustain attentiveness.  What I have just described is an example of Neurofeedback: Training your brain to reduce the symptoms of ADHD.

How does Neurofeedback work?

In a  Neurofeedback session, a practitioner “maps” out a patients brain. Before a session begins, a patient puts on a cap and has electrodes attached to his or head.  In Neurofeedback sessions, participants can be playing a video game, watching a movie or listening to  song. The game, song or movie only continues when the participant is utilizing the correct portion of their brain to focus or else the task stops.

During the task, a color coded map appears on the computer screen and shows  the practitioner where there is too much or to little brain wave activity. The goal of Neurofeedback is to use this brain training exercise to reduce the ADHD symptoms of impulsively and inattentiveness.  The feedback provided during the treatment session can be lowering the volume  or providing poorer picture resolution of the onscreen task.

Only a healthy brain wave pattern can make the picture resolution clearer and the volume louder. Over the course of the program, the brain learns this feed back system. The computer program compares the EEG reading of the ADHD participants brain waves with the database of typical human brain wave patterns (matching for age and sex).

What if I am already taking medication and see a therapist? Could Neurofeedback back help me?

Neurofeedback therapy can reduce the amount of medication a person with ADHD needs. Some clinicians say that Neurofeedback needs to be used in combination with medication because it has not been tested as much as medication has been. However, there are those who propose to utilize Neurofeedback instead of medication because of the side effects associated with medication (loss of appetite, sleep issues etc.).

How many sessions of Neurofeedback are necessary?

A typical session of Neurofeedback ranges between 10- 30 minutes.  A typical range of sessions is about 20-40 sessions with 2-3 sessions per week. Before participants engage in Neurofeedback they first need a medical evaluation, neuropsychological testing, to fill out their symptom questionnaire and then have an EEG measure their brain wave/ strength.

Neurofeedback at the Sachs Center!

Neurofeedback works directly with the problem as ADHD is a brain problem first and foremost. A the Sachs Center, participants will be able to “train” their brain to focus more, be less impulsive and they will be able to take control of their behavior.  Also, Neurofeedback is an enjoyable treatment option especially for children.

Work Cited:

www.additudemag.com/neurofeedback-adhd-brain-training/

www.aboutneurofeedback.com/conditions/adhd/
http://www.hullinstitute.com/neurofeedback.aspx
https://www.neurocorecenters.com/what-is-neurofeedback/
Arns, M., Heinrich, H., & Strehl, U. (2014). Evaluation of neurofeedback in ADHD: the long and winding road. Biological psychology, 95, 108-115.
http://www.quietmindfdn.org/node/78

Driving with ADHD

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Why is driving with ADHD  dangerous?

Adolescents and Adults with ADHD are at greater risk for driving difficulties due to increased inattention and hyperactivity.

One study found that younger drivers with ADHD were up to 2-4 times more likely to have car accidents than other drivers – of the same age – without ADHD.

One driving instructor who works with people with ADHD discussed how attention plays a role in the driving deficits. First of all, people with ADHD have trouble focusing on both pedestrians and other drivers on the road at the same time and deciding where to shift their attention. Second, due to impulsiveness and hyperactivity, adolescent drivers with ADHD are more likely to speed and engage in risky behaviors which can cause accidents.

Driving is an activity many people in society must take part of to get to work, school or to do errands. At times, it can be easy to forget that driving is something that requires concentration and vigilance.

Especially for people who suffer from attention problems, drivers must take caution.

Adolescent Drivers with ADHD on the Road

1.Impulsive
2.Distracted
3.Clumsy
4.Cannot pay attention (bored easily)

Adult Drivers with ADHD on the Road

1. More likely to exceed the speed limit
2. Less ability to control vehicle (hands off wheel, car in wrong gear)
3. Frustration and anger (at other drivers)
4. Easily distracted

Examples of Driving Issues with ADHD

First hand accounts from adolescents with ADHD learning to drive describe “freak outs at busy intersections” and distraction at red lights. Another adolescent driver described intense aggression (road rage). This person had to learn to control their impulses and remain calm when feeling angered behind the wheel .

Due to inattention, drivers with ADHD tend to make poor judgements and overestimate their driving abilities. They are particularly at-risk for accidents during periods of dull driving (such as long-distance driving or on the highway).

Drivers with ADHD do not necessary commit more intentional driving violations than drivers without ADHD.  When comparing drivers with ADHD to drivers without ADHD, neither group was more likely to break laws intentionally. However, drivers with ADHD were more likely to make accidental mistakes when driving. Not every driver with ADHD makes impulsive decisions and drives over the speed limit but drivers with ADHD must be extra attentive.

Studies which compare drivers with ADHD to drivers without ADHD have found that these differences in their skills are present from when they get their licenses. Examples of driving issues new drivers with ADHD had include trouble with changing speed and lane position (these both require attentiveness). Young adults with ADHD are more likely to engage in driving risks, act impulsively and are more vulnerable to distractions than drivers without ADHD.

Strategies for Drivers with ADHD

1. Adolescents just getting their license should spend more time practicing or get a driving instructor (to get more comfortable behind the wheel). (10)

2. Keep the radio off/ cell phone on silent as to not get distracted  during “dull driving”

3. Breathing in and out when feeling angry towards another driver on the road

4. Don’t overestimate driving skills

5. Remain vigilant when driving with a group of friends

Work Cited

1.https://www.healthcentral.com/article/understanding-brain-fog-in-adults-with-adhd
2. http://www.chadd.org/Understanding-ADHD/For-Adults/Living-with-ADHD-A-Lifespan-Disorder/ADHD-and-Driving.aspx

3. Rosenbloom, T., & Wultz, B. (2011). Thirty-day self-reported risky driving behaviors of ADHD and non-ADHD drivers. Accident Analysis & Prevention, 43(1), 128-133.

4. Barkley, R. A., & Cox, D. (2007). A review of driving risks and impairments associated with attention-deficit/hyperactivity disorder and the effects of stimulant medication on driving performance. Journal of safety research, 38(1), 113-128.

5. Narad, M., Garner, A. A., Brassell, A. A., Saxby, D., Antonini, T. N., O’Brien, K. M., … & Epstein, J. N. (2013). Impact of distraction on the driving performance of adolescents with and without attention-deficit/hyperactivity disorder. JAMA pediatrics, 167(10), 933-938.

6. .Merkel Jr, R. L., Nichols, J. Q., Fellers, J. C., Hidalgo, P., Martinez, L. A., Putziger, I., … & Cox, D. J. (2016). Comparison of on-road driving between young adults with and without ADHD. Journal of attention disorders, 20(3), 260-269.

7.Reimer, B., Mehler, B., D’Ambrosio, L. A., & Fried, R. (2010). The impact of distractions on young adult drivers with attention deficit hyperactivity disorder (ADHD). Accident Analysis & Prevention, 42(3), 842-851.

8. http://www.nytimes.com/2012/03/27/health/add-and-adhd-challenge-those-seeking-drivers-license.html

9.Groom, M. J., Van Loon, E., Daley, D., Chapman, P., & Hollis, C. (2015). Driving behaviour in adults with attention deficit/hyperactivity disorder. BMC psychiatry, 15(1), 175.

10.http://www.cnn.com/2008/HEALTH/conditions/09/15/hm.driving.add/index.html?eref

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