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Over the last few years the health care community has been forced to take a hard look at the prescription medications that providers have been putting out into the community.  The rampant misuse of doctor prescribed opiates, stimulants, and benzos has compelled clinicians to re-evaluate their methods for treating patients.   But as encouraging as this trend has been, it is still important for us as patients and consumers to take an active role in our treatment.  A balance must be struck between relying on the expertise of providers and being conscious of what we choose to consume.

I want to preface this by saying that the correct medication can do wonders for your mental health.  The difficulty stems from (1) thinking that ONLY medications can help and (2) not taking the time to figure out the true nature of the problem before deciding on treatment.

Rule out other causes

It may be tempting to want to get your child on an ADHD medication at the first sign of problems in the home or school.  The presence of inattention, difficulty concentrating, irritability, excessive activity or aggression can all be disruptive to your child’s academic success and relationships with family or friends.  But, like most endeavors, mental wellness must be built on a solid foundation that cannot be rushed.  And the best place to start, is with a proper diagnosis.

This is often easier said than done.  For example irritability, increased sensitivity, sleeplessness, temper tantrums, and difficulty concentrating can all be seen by your clinician as signs of ADHD.  However, these symptoms are also what you might expect to see with DEPRESSION, as it presents in children.   Taking the time to ensure a thorough diagnosis may save you years of chasing your tale with minimal benefit (not to mention money).

Who should I have diagnose?

First and foremost, a diagnosis of ADHD has to come from a health care professional.  Resist the urge to self-diagnose!  While no one would argue that you aren’t the expert on your child (you almost certainly are) there are clinicians out there who are experts in mental illness, which is what you need.  If your child’s school is lucky enough to have a school psychologist, try reaching out to them to discuss options.  In the community, the primary clinicians diagnosing ADHD are psychiatrist.  These are medical doctors, with expertise in treating mental illness, and they are the only providers (at least in Kansas and Missouri) that can prescribe medication.  A Licensed Psychologist may also be a good person to reach out to for an initial diagnosis.  Although they cannot prescribe, they can help you create an optimal treatment plan for your child.

With all respect to teachers out there, teachers should not be diagnosing.  A well-reasoned recommendation from your child’s teacher may be worth taking into consideration, as they do spend a significant amount of time with your child in a structured environment.  But teachers should never diagnose.  I would also strongly encourage against letting your primary care physician prescribe psychopharmaceuticals to your child.  While they may have had some training in the past on mental illness, that does not mean they’re still well versed in the subject (you likely wouldn’t let your pediatrician perform an operation on you right?).  It’s far if your PCP suspects your child may be suffering from a mental illness, to just ask them for a recommendation to a good psychiatrist or psychologist.

What goes into a GOOD diagnosis?

As I previously stated, there is no definitive test for ADHD.  I am fond of saying things like, there’s no thermometer for depression or blood test for inattention,.  but that does not mean we should be taking shots in the dark hoping to hit something; especially when it comes to prescribing medications to a developing brain.  There are some ways for you to know that your child is receiving a good, well thought out diagnosis.  A thorough evaluation should include the following:

• Extensive history.  Any thorough diagnostic intervention is going to include a detailed history going back to infancy or earlier.  You never know where important diagnostic information may pop up, so having as much information as possible is a plus.
• Multiple settings. An often overlooked aspect of ADHD is that it appears in multiple settings. You would normally expect impairment to be fairly global, with signs of hyperactivity/inattention appearing in multiple areas of life. If you only see symptoms in one area (at school, at home, out with friends, etc.) then it would be a good idea to explore other diagnoses.*this can be accomplished through testing discussed below*
• Areas of strength, aside from the difficulties, children with ADHD almost always have tasks or topics for them that are considered strengths and aren’t impaired by symptoms of hyperactivity or inattention. When interviewing parents of children with ADHD, you almost always hear, Little Johnny just can’t focus on anything, except when it comes to ______ . With that he’s focused in. It’s important to focus on these areas (reading, video games, sports, etc.) and take them into consideration during diagnosing.
• Psychological testing. I know, I know, I said there’s no DEFINITIVE test for ADHD. But there are assessments that can lend some measure of objectivity to the diagnosing process and help rule out other issues besides ADHD. These tests include the Conners 3, BASC-3, or Brown ADD Scales and should be administered and interpreted only by a qualified professional. A good psychological assessment should include 1) a developmental history, (2) a parent rating scale, (3) a teacher rating scale, (4) a self-report, and (5) observation.

Now, clinicians certainly don’t HAVE to go through all of these steps before giving an ADHD diagnosis.  In fact, there are plenty out there that will give your child a diagnosis and prescription after one, 50 minute interview.  But like any treatment, you want to be sure your provider is treating the correct thing.  Just like you would want testing done to confirm lung cancer, rather than asthma for example, before starting chemotherapy.  Before your provider prescribes your child stimulants, it’s worth taking the time to rule out other causes; like depression.

Take away

There are plenty of good and effective medications and treatments available to help manage ADHD symptoms in your child.  But, there are ZERO shortcuts.  Before you invest the time, energy, and money into your child’s treatment, it’s crucial that you insist your clinician take the time to ensure an accurate diagnosis.

Thank you for reading.  Feel free to reach out with any questions or topics of interest.  In Part 2 we will be discussing treatments available, what the latest research is saying, and self-care.

Take a moment to reflect on this morning. What was your first thought when you awoke? If you are like many people, it was, I did not get enough sleep last night. It is also likely that your last thought as you prepare to go to sleep each night is, I did not accomplish enough today. If you are frequently beginning and ending most days with these not enough thoughts, you might have difficulty engaging in positive thinking throughout each day. Your thoughts about all the things in your life that are not enough may lead to feeling that you are not enough.

Our culture is filled with messages that feed this not enough mindset. There are expectations that in order to be enough, you have to be the best, work the hardest, and achieve the most. This idea that the ordinary is not enough cultivates dissatisfaction and unhappiness.

Replacing your not enough thinking with positive thinking will improve your satisfaction and feelings of happiness. This process starts with a shift in perspective.

Circumstances have a lot less control over your emotions than you might realize. Your emotions, including feelings of happiness, are closely connected to your thoughts. Positive thinking leads to positive emotions. A key to increasing positive thinking about yourself and your experiences is gratitude.

I don’t have to chase extraordinary moments to find happiness it’s right in front of me if I’m paying attention and practicing gratitude. Bren Brown

Gratitude is more than saying, thank you, to a stranger for holding the door open. Gratitude is a state of being a lifestyle. Living in a state of gratitude means recognizing that you do have control of your thoughts and choosing to trade in your, not enough thinking, for enough thinking. Gratitude is choosing to say, this is good, because or, I am doing well, because

Mindfully choosing to practice gratitude will increase contentment, reducing not enough thinking which traps people in shame and feelings of inadequacy. Gratitude provides freedom from feelings of shame and inadequacy and allows you to begin thinking positively about yourself and your circumstances.

There is an old proverb, Confession is good for the soul. But is it really?

It sounds odd but can talking with somebody make you feel better? It can and it does. But why does it work? Why can just something as simple as talking about something that you are worried about, or feel guilty about make you feel better and less stressed?

To understand that question you have to understand how memory storage in our brains work. Doctors as far back as the 1890’s have recognized some memories fade into nothing and some memories resist that fading away. Mostly the memories that won’t fade are ones that are charged with emotions.

Simply, there is a part of us that feels and there is a part of us that thinks. Generally, we want to keep these things in balance. However, in life when we are scared, worried, guilty or sad we feel those emotions strongly. When your feelings are strong it diminishes your capacity to think; especially, your ability to say what you are feeling.

Have you ever seen a parent tell their screaming child to “use your words.” The parent instinctively recognizes that a child has to calm down and talk before they can stop being hysterical. That is because when the part of your brain that feels gets overwhelmed your body will actually shut down parts of itself in order to conserve fuel. When the “fight or flight” part of your mind is triggered, energy is diverted from other parts of your brain-systems in order to give you energy to fight of run. One area that is impacted is your ability to think rationally. 

So, let’s say you got in an argument that escalated. Or that you made a mistake at work and are scared you will be fired for it. So, in that moment you are feeling strong emotions instead of thinking. If you do not communicate with anyone about it, after your emotions have calmed down, you will be putting that memory into the bookshelf of your mind with an emotional charge.

So what does an emotionally charged memory do? An emotionally charged memory is one that when you think about that memory you feel that emotion all over again. So you could be lying in your bed after having had a great day but start thinking about something from your past and BAM! Right there in your bed you feel what you felt then. Despite the fact that you just a moment ago felt at peace with the world. That is an emotionally charged memory.

Going back to the initial question, why does talking help you feel better? Because in order to take the charge out of a memory you have add thought to that memory. Remember that you both think and feel. A memory that is all feeling and no thinking will remain a charged memory. But when you talk about the past, especially when you think about what you were feeling and why, it helps add thought to that memory . A memory that has thought and feeling in it a memory that can be put on the bookshelf of your mind and just fade into the thousands of other memories there.

When you talk to someone who influences you to think about why you felt what you felt it can make that emotional charge go away which feels wonderful. This is why the whole practice of counseling even exists. To help people remember their past without feeling what they felt in the past.

Do you feel that you are haunted by your past? Do you feel that there are things in your past that you will never get over? Let’s get together. I can help you move forward. Contact me today!