Edge Foundation Blog

Over the years we’ve written a lot of great posts about ADHD.  We thought you might find it helpful to get a quick index to all of the topical posts.  When you scan down the list it seems like there are few topics regarding high school and college students with ADHD that we haven’t covered!  If there is something we’ve missed, please don’t hesitate to let us know.

Okay, we noticed, we don’t have a “Z” topic.  What is the Z of ADHD?

By Robert Tudisco, Edge Foundation Executive Director

I wish I knew back in college what I know now about living with ADHD.  I had to learn ways to cope the hard way because I wasn’t diagnosed until many years after I completed school.  Since my diagnosis I’ve developed many skills that have made a huge difference in my life.  Here are four survival skills I’ve discovered that any college student with ADHD can use to make college more productive and stress free.

READING COMPREHENSION

Many of my prelaw classes had heavy reading requirements that pushed my ADHD brain to its limit.  I tried everything I could think of to stay focused, but my mind always wandered and I struggled with comprehension and staying on task.

Then in senior year, a friend of mine who worked in an accounting firm mentioned that her firm routinely handed out foam earplugs for reading tax code.  The text was very boring and she said that it helped her stay focused.  I immediately went to the store and bought some.

When I inserted the earplugs into my ears, it was like shutting off the world so I could actually climb into what I was reading.  The effect was amazing.  Those small inexpensive foam earplugs got me through the rest of college, law school and the bar exam.

After law school, an office setting presented a new challenge:  I couldn’t just shut it off.  Phones were ringing, people asked questions and my earplugs were of little use.  I experimented with sound machines and music to filter out distractions.  After much trial and error, I determined that classical and guitar music struck the balance that I was looking for.

The important thing to note is that I didn’t give up.  I thought about my focus challenge.  I tried – failed – and tried again.  My thought process and commitment made all the difference.

OUTLINING

Another useful tool I use that also helps with procrastination is outlining.  If, like me, you’ve tried and given up on lists because they are long and intimidating, give outlining a try.  Outlines help me understand how each task is connected and provides me with a map for getting there.  I outline everything that I do, from articles to case briefs to scheduling my day.

• An outline provides the structure my ADHD craves for whatever project or time frame that I need to plan.
• An outline provides a hierarchy of concepts and shows how they are related to each other.
• An outline breaks down projects to smaller subprojects and thereby makes them less intimidating.  Often the hardest part of task is getting started.  Breaking the project into the smallest components makes this much easier.

EXERCISE

After my diagnosis with ADHD, I went back and looked at my school transcripts and tried to correlate the times that I got the best grades with what was going on outside of school.  I quickly saw a pattern.  During the times when my grades were highest in college and law school, I was running to relieve my stress.

After this realization I embraced running and made it a part of my life.  I regularly run 4 to 5 days per week for approximately an hour.  My running helps me organize my thoughts and plan out how I am going to approach situations.

In recent years, research has shown that exercise can help reduce the symptoms of ADHD, anxiety, depression and other disorders.  Integrate exercise into your daily life.  If you keep at it, you’ll find it centers you, reduces your stress and brings you the clarity you need to move forward.

COACHING

One of the most important things that I have discovered in my journey to work with my ADHD is I need help to establish the structure, support and accountability that my ADHD mind so desperately needs.  That’s why I have worked with many different ADHD coaches since my diagnosis.

ADHD coaches offer an objective perspective on the challenges of ADHD.  They help us recognize and develop our talents, and learn where and why we struggle.  Each of my coaches has made a huge difference in how I approach obstacles while building my confidence about the specific talents that I have.

College is a key time to learn skills to work with your ADHD because it is much less structured than high school – especially for those students living away from home for the first time.  You may not have even realized all of the daily support your parents were providing until you are in over your head freshman year.  Even students who are extremely intelligent are at high risk because college requires new levels of self imposed structure and accountability.

An ADHD coach who specializes in the needs of high school and college students can provide the structure, support and accountability you need, not just to survive in college, but to reach your full potential throughout your life.

YOU CAN OVERCOME THE OBSTACLES OF ADHD

As someone with ADHD who has struggled all of his life with the challenges it has provided, I am living proof that there are ways to successfully address these obstacles.  The key is to understand yourself, be willing to try new things, reflect about how you respond to situations and don’t be afraid to ask for help.

Keep that perspective and you will learn to gravitate toward your strengths and to avoid your weaknesses.  And always remember you are not alone.  There are a lot of us out there just like you.  Good luck!

Last August, Edge interviewed Dr. Patricia Quinn regarding her work with girls and ADHD.  Dr. Quinn, an Edge Foundation board member, has published four books about the special ADHD challenges that women and girls face that are different men and boys.  Some of those challenges include:

• Under diagnosis due to symptoms that don’t echo the male standard for ADHD
• Hyperactivity presenting as talkativeness and emotional behavior instead of the classic “propelled by a motor.”
• Greater disorganization, depression and anxiety than boys.

This fall Dr. Quinn will publish a new book, 100 Questions and Answers about ADHD in Women and Girls.  We thought this would be a good time to ask her a few questions of our own.

Edge: Is there anything about the challenges ADHD girls and women face that has emerged for you since our last interview?

Dr. Quinn: I think we have seen more in the way of confirming the development of eating disorders in girls with ADHD.

Edge: What, if anything, is unique about diagnosing ADHD girls with eating disorders than is different from other girls?

Dr. Quinn: Well first, the symptom of impulsivity seems to be a significant factor in the development of eating disorders in girls with ADHD. Poor self-esteem may also play a role, but one does not see the impaired body image seen in girls with eating disorders in general.  Girls with ADHD may binge and develop bulimia, but not because of a desire for thinness, but rather because of mindless or impulsive eating. Women with ADHD often report that they eat to feel better or for stimulation.

Edge: What should parents do when they suspect their daughter with ADHD has an eating disorder?

Dr. Quinn: Parents of these girls should pursue a complete assessment with an eating disorder specialist trained to realize that ADHD may be part of the picture. Girls will need to be treated for their ADHD symptoms (inattention and impulsivity) in order to be able to follow a program to address their disordered eating. Stimulants not only treat the symptoms of ADHD, but, according to some experts, may actually decrease the urge to binge.

Edge: Is there anything else you want people to know about girls and ADHD?

Dr. Quinn: Girls tend to suffer silently for many years, and as a result develop poor self-esteem early on. In addition, many develop anxiety because of their untreated ADHD symptoms. Their symptoms seem to sneak up and ambush them and they worry that this will happen again. So, they get anxious or develop compensatory strategies. They may worry and begin checking to see if they have a test they have forgotten about, or a book they forgot to bring home from school.

They can even develop obsessive compulsive personality disorders where they try to control one aspect of their life to the exclusion of others.  I have seen girls with ADHD become perfectionists to compensate for their symptoms. They spend a great amount of time and energy trying to compensate until it all gets too much for them and they get depressed or just give up.  It is, therefore, important to treat ADHD in girls even if they seem to be doing well academically and holding it all together because they may be doing so at a great cost.

I also want to send the overall message that the disorder does not remit but continues to cause significant problems and functional impairments particularly in girls with the inattentive type ADD.

Edge: What would you say, then to parents who are hoping their daughter will just “outgrow it?”

Dr. Quinn: ADHD is a chronic, life-long disorder. Symptoms may be less impairing as we learn to live with them and develop strategies and a life style to better cope. However, girls who demonstrate the most success are those that have adopted a multi-pronged approach to treating the disorder including, medication, therapy and appropriate treatment goals early on. ADHD coaching, like the Edge Foundation offers, can be an important component in learning compensatory strategies and behaviors.  Girls who as adolescents continue to have significant functional impairments are those who are usually not taking medication even though they have briefly made use of other services in and outside of school. These, however, may not be enough.

Edge: What are some of the most common questions you are asked about women and girls who have ADHD?

DR. Quinn: I am constantly asked why girls and women aren’t diagnosed as early as boys. I think this is because girls are not identified by teachers or others. Often teachers are comparing girls’ behaviors to those of boys rather than the performance of other girls. Mothers may be more likely to compare their daughter’s behavior to that of other girls thus may be more reliable at referring their daughters for an evaluation.  Girls are less disruptive and don’t call attention to themselves, so they don’t get referred. In addition girls and women work hard to compensate for their symptoms and to not let others know the problems that they are having.

Edge: Do women’s hormones have any impact on how medication levels need to be prescribed over time? For instance, does going through puberty or menopause mean medication levels need to be adjusted during those periods?

Dr. Quinn: When hormone levels decrease in menopause many women report that their ADHD symptoms increase and that their medications don’t seem to be as effective as previously.  It is often necessary to increase the dose of medications at this time. In addition, I find that during puberty symptoms often worsen in girls with ADHD. A medication dose that worked previously may no longer be effective during this time.

Edge: You’ve been a long-standing champion for women and girls who have ADHD, do you see the rest of the medical profession catching up in awareness or is there still a lot of ground to cover until females with ADHD receive equal medical treatment?

Dr. Quinn: I think that overall the medical profession is doing a better job at recognizing and treating girls with ADHD.  The problem seems to be with educating teachers and school systems about the disorder in females.

Readers:  Do you have a question about ADHD in girls?  Let us know in the comments and we’ll do our best to get you an answer.

Editor’s Note:  This month we are pleased to publish a guest post by Kathleen Nadeau, Ph.D.  Nationally recognized psychologist, Kathleen G. Nadeau, Ph.D., has many years helping children, teens and adults to learn better planning and organizational skills.   Dr. Nadeau is the brains behind, Skoach, an integrated online time management and task planning tool.

Figure out why you procrastinate, then match your strategy to motivate accordingly.

Procrastination can be caused by several things. You may procrastinate because you don’t enjoy a task. You may procrastinate because a task is large and challenging to organize. Or, you may procrastinate because you aren’t sure how to accomplish the task.

1. Procrastination due to dislike of an activity

If you procrastinate because you don’t like a task, look for ways to increase task appeal such as:

* Make it into a game, and keep score.
* Make it into a game, competing with others.
* Listen to upbeat music while doing it. Schedule a reward immediately after you complete it.

2. Procrastination due to overwhelm

If you’re avoiding a task because it is lengthy and overwhelming, then “divide and conquer”:

* Break the large task into separate, short-term segments.
* Then check off each segment as an accomplished short-term task.

3. Procrastination due to inertia

If you procrastinate because you have difficulty initiating a task, create something to react to. Tasks that can be reacted to are easier to begin than those that you must initiate yourself.

* Work on the task with others – then you can react to their questions, emails, etc.
* Establish a deadline with your supervisor.

4. Procrastination due to lack of organization

Sometimes we procrastinate on beginning a large project because we haven’t organized the task and don’t know where to start. If you can’t seem to get a project organized:

* Think through the task.
* Talk with your supervisor or collaborators to plan it.
* Break the larger task into do-able segments.
* Create a list of resources and supplies needed to accomplish the task.
* Create a timeline for the task.
* Then schedule the first segment of the task.
* Create an email or text reminder for this segment.

5. Procrastination on difficult tasks

Not all tasks can be made easy, but if you find a task particularly difficult, you must analyze how it can become easier.

* Do you need help?
* More training?
* More practice?
* More assistance from other?
* Analyze what is making the task so difficult, and then get the help you need to succeed.

6. Procrastination at certain times of day

More challenging tasks should be done at whatever time of day you seem to feel more focused and energetic. Take note of your daily rhythms, and then try to schedule the most avoided tasks for the time of day when you’ll have more energy to tackle them.

Problem-solve and apply your solution

To combat patterns of procrastination, select a task that you keep putting off. Then look at the list of possible solutions above and choose one that you think is most likely to be helpful.

Pick one (or more) of these solutions, and keep track over the next few weeks. Are you getting things done on a consistent basis? If so, keep up the good work! Your new solutions will soon become habits that require very little effort to maintain.

Final note for severe or chronic procrastinators
Some people seem to have a generally low level of motivation and tend to put off all tasks that take energy or effort. These people are classic “couch potatoes” that would rather do “nothing” than anything at all. If you fall into the couch potato category, you may actually struggle with chronic, low level depression.

Others are couch potatoes due to chronic sleep deprivation, poor nutrition, or poor physical fitness. If you feel as if everything is too much trouble, then get a medical check-up to see if depression or some other health problem is playing a role in always putting things off.

ADHD, Depression and Why it Matters

ADHD and Depression II: Types of Depression

ADHD Depression Busting Tool Kit

Last year we wrote about the importance of healthy sleep habits and ADHD. A few facts worth repeating:

• A just-published study by researchers at Columbia University shows that teens who stay up later are more prone to depression and suicidal thoughts.
• People with ADHD have twice the rate of insomnia and sleep disturbances as people who don’t have ADHD.
• Irregular sleep habits can actually increase your anxiety symptoms.
  Sleep deprivation is also linked to memory and concentration problems and can actually exacerbate hyperactivity symptoms.

When you consider that people with ADHD have much higher levels of depression than the general population , and shorting yourself on sleep increases depression, it seems like a no-brainer to practice healthy sleep habits. If going to bed on time every night can help reduce depression, why are you still pulling all nighters?
So while you are busy sticking to all of your New Year’s resolutions, why not add one that can boost the likelihood you’ll be able to keep them? Go to bed on time every night! And don’t forget to turn off your computer and phone so you won’t be tempted to text or surf at night. One quick text or tweet can easily turn into a late night.
If you are having trouble sticking to a regular bedtime, even when you intend to go to bed on time, a talking to an ADHD coach can help you reduce the distractions, obstacles and last minute fire drills that rob you of life-giving sleep.

Editor’s Note:
This is the third, and final, installment in a three part series on ADHD and depression. The first post revealed that people with ADHD have a higher incidence of depression than the general population and urged all teens and young adults to be screened for depression as part of their annual physicals. The second part looked at the various types of depression. This post, as promised, shares some things you can do about depression.

ADHD and Depression is Serious Business

It’s important to start this post by saying that depression can be a serious, life-threatening condition. If you are feeling hopeless, worthless, irritated, chronically exhausted or have lost interest in things you once loved, you should start by talking to your physician or a therapist. Look for someone who has experience in diagnosing ADHD and working with the co-occurring conditions that can come along with ADHD. (The last thing you need to do is see someone who doesn’t understand or even believe in ADHD!)

A professional can help you determine what the appropriate course of action  to help you break free of your depression. You don’t have to suffer depression alone. Get some help for yourself, right away.  Talk to your parents, friends or even a crisis hotline.  Don’t suffer alone!

What to Do About ADHD and Depression Starting NOW!

Sure calling a doctor or therapist is a great idea, but you may be wondering what you can do for depression right now. After all, depression is something that can be hard to overcome.   (And it doesn’t take holidays!)   You can use all the help you can get to breaking through to the other side of depression! Why not try what Gayle Wilson, ADHD coach, shares with her clients. She calls it her “Depression Busting Toolkit” or “12 Mental Lifesavers.”

ADHD Depression Busting Toolkit: 12 Mental Lifesavers

1. Talk about it.  Pour out your soul to a sympathetic ear.
2. Go to the dogs (play with your pets).
3. Run away (literally). Do something physical. (Yes, we keep saying this over and over. Exercise is critical to healthy living with ADHD!)
4. Laugh your head off. Watch a funny TV show, ask someone to tickle you, Google “funny” or “hilarious,” check out the comedy channel on hulu.com, or watch an old Road Runner cartoon, etc.
5. Get to work. Lose yourself in work.
6. Compartmentalize. Focus on what you can do right now. The old adage, one day at a time, has stood the test of time because it works! Sometimes getting off the couch and doing something, anything, can make a big difference to feeling better.
7. Write. Right now. Paying attention to what you are thinking. Write it down. Be sure to turn off the critical inner voice and just let your thoughts go.
8. Identify something you care about more than yourself.  Is that a friend? A charity? Your grandparents?  Now do something, anything about it.
9. Bring beauty into your life. Buy some flowers, take some pictures, make a painting, clean your room.
10. Learn the lesson. Explore what there is to learn in what you are experiencing.
11. Be well read. Let fiction carry you away.
12. Have faith. Turn to your spiritual practice
13. Curb self-defeating and negative thoughts with an ANT.

Daniel G. Amen, M.D., author of Healing ADD and Change Your Brain, Change Your life, coined the acronym A.N.T.’s — or automatic negative thoughts. Turns out there is a connection between what we say to ourselves and how we feel. If we control what we think, we can control how we feel.

Gayle Wilson gives each of her clients a little plastic ant and a poem. Print out the poem and put it on your desk. Read it when you need to turn your thoughts away from the dark side. Sure it’s a little dorky, and Gayle’s no poet, but these simple words have helped many other people. So there’s no harm in trying it, huh? You can control what you think and change how you feel about yourself.

A.N.T.s: AUTOMATIC NEGATIVE THOUGHTS

Gayla Wilson 12/07

Place this little Ant on your desk, in your pocket or your purse.
Let it remind you, your thoughts can be adverse.
Listen to what your brain tells you
The next time you get into a jam
and you hear “I’m stupid”; “I always mess up”
“Why can’t I ever just push through?”
Write it down, tell it to scram.

Is this thought a fact?
Or, is it the same old you?
If it’s true…change it.
If it’s a lie, answer back.

These are your thoughts
You write the script
Be they pleasant and pleasing
Or harmful…
They’re your thoughts,
You can answer back

The damage CAN be reversed.
It is up to you
Their weight and importance
Are set by you. You take control.
Kill the ANT!

Do you have tricks that help you beat the blues? Please share them!

Last month we started a three part series on ADHD and depression. The first installment revealed that people with ADHD have a higher incidence of depression than the general population and urged all teens and young adults to be screened for depression as part of their annual physicals. This month we’ll be looking at the types of depression.

Depression comes in many forms

The National Institute for Mental Health outlines three types of depression each come with their own variation of symptoms, severity and persistence.

Major depression (also known as major depressive disorder) comes with a whole host of symptoms that interfere with the ability to function in everyday life.  Symptoms include:

• Persistent sad, anxious, or “empty” mood.
• Feelings of hopelessness or pessimism.
• Feelings of guilt, worthlessness, or helplessness.
• Loss of interest or pleasure in hobbies and activities that were once enjoyable, including sex.
• Decreased energy, fatigue; feeling “slowed down.”
• Difficulty concentrating, remembering, or making decisions.
• Trouble sleeping, early morning awakening, or oversleeping.
• Changes in appetite and/or weight.
• Thoughts of death or suicide, or suicide attempts.
• Restlessness or irritability.
• Persistent physical symptoms, such as headaches, digestive disorders, and chronic pain that do not respond to routine treatment.

A major depressive episode can happen just once. But many people will suffer several episodes over their lives. Some people who suffer this type of depression require treatment indefinitely.

Dysthymia (or dysthymic disorder) is a less severe type of depression. People with dysthymia have long-lasting chronic symptoms that keep them from feeling well but without seriously disabling them. Many people with dysthymia also experience major depressive episodes during their lives.

The third type of depression is bipolor disorder (or manic depressive illness). People who are bipolar swing between extreme highs (also known as mania or being manic) and severe lows (depression.) In the depressed part of the cycle the person exhibits some or all of the symptoms of a major depressive episode listed above. In the manic cycle, people often may be overactive, extremely talkative and exhibit poor judgment. Untreated, bipolar disorder is very dangerous to the long term mental health of a person.

If you think you are suffering from depression, start by talking to your physician or psychiatrist. He or she will be able to help you assess your depression and work out a treatment plan for you.

Next time, we will discuss what to do about depression so it doesn’t get you down.  For more information about the types of depression, visit: http://www.nimh.nih.gov/health/topics/depression/index.shtml.

If you have ideas you’d like to share about how you cope with depression, drop us a line. We’d love to hear from you.

Thank you to Gayla Wilson who contributed to this post.

Earlier this year we did a series on ADHD and anxiety.   You may recall that the rate of anxiety disorders is much higher in folks with ADHD than in the general public.  Are you surprised to hear that there is also a higher rate of depression among people who have ADHD than the general population?   ADHD often comes with a host of other issues such as learning disabilities, anxiety and depression.  Perhaps depression is the most life-threatening condition of all.  This post is the first of a series that explores living with ADHD and depression.

What are the known causes for depression?

There is no single cause of depression.  Depression happens because of a combination of things including:

Genes – some types of depression tend to run in families.  Genes are the “blueprints” for who we are, and we inherit them from our parents.  Scientists are looking for the specific genes that may be involved in depression.

Brain chemistry and structure – when chemicals in the brain are not at the right levels, depression can occur.  These chemicals, called neurotransmitters, help cells in the brain communicate with each other.  By looking at pictures of the brain, scientists can also see that the structure of the brain in people who have depression looks different than in people who do not have depression.  Scientists are working to figure out why these differences occur.

Environmental and psychological factors – trauma, loss of a loved one, a difficult relationship, and other stressors can trigger depression.  Scientists are working to figure out why depression occurs in some people but not in others with the same or similar experiences.  They are also studying why some people recover quickly from depression and others do not.

Why do people with ADHD have depression at higher rates than the general population?

Unfortunately science hasn’t cracked the code of why some people get depressed and others do not.  However, Aaron Beckr (who is known as the father of Cognitive Behavioral Therapy) recently gave us a clue when he said  “brain scans have found that in depressed people the prefrontal cortex, known as the seat of rational thought, tends to be underactive.”  If you’ve read much about ADHD, you’ll know that this  area of the brain that is also underactive in ADHD and executive function disorders.

Research shows that people with ADHD have a higher incidence of depression due to the many obstacles, disappointments, perceived failures, and lack of support and understanding that often comes with living with ADHD.  The typical person with ADHD has an uphill battle facing the many myths and misconceptions surrounding the diagnosis.  The years of hearing “if only you would try harder” can take its toll and low self esteem is common.

All teens — especially those with ADHD — should be tested for depression

Last April the journal of Pediatrics reported that the government-appointed U.S. Preventive Services Task Force recommends that all teens should be tested for depression by their primary care physician.  Nearly 2 million U.S. teens are affected by depression, but most suffer undiagnosed.  When you consider that a higher than average number of those kids have ADHD, it is a compelling reason to be sure your teen is screened for depression at their annual exam.

For more information on depression:

http://www.nimh.nih.gov/health/topics/depression/index.shtml

And watch in coming weeks for Part 2 in the series which will explore types of depression.

Editor:  We are honored to have had Dr. Patricia Quinn involved with the Edge Foundation since our founding.  Dr. Quinn is a leading ADHD expert who has worked with, written about and provided training in the field of ADHD for more than 30 years.  This month we are pleased to be talking with her about one of her primary concerns:  girls with ADHD.

Key ideas:

• Many girls with ADHD are left undiagnosed because their symptoms look different than boys.
• Hyperactivity in girls can appear as being hyper-talkative or hyper-reactive (more emotional).
• ADHD girls have greater problems with disorganization than boys.
• Depression and anxiety are symptoms to watch for in older girls with ADHD.
• ADHD coaching can help girls with ADHD learn what works to be successful in school and in life.

Edge: Thank you for all you’ve done on behalf of people with ADHD over the last 30 years.  What are the ADHD projects you are most excited about these days?

Dr. Patricia Quinn:   I can honestly say that working with young girls with ADHD, helping them understand the disorder and learn to live happy, productive lives is very close to my heart.  My most recent book, Attention, Girls!  A Guide to Learn All about Your ADHD, is special because it focuses on the lives of girls ages 7 to 13 years.

I also feel passionately about my work with college students with ADHD most of whom are newly diagnosed and struggling to stay in school.  When I get a call from someone who has just earned his law degree, and he says that he couldn’t have done it without my help when he was in college, it makes my day!

Edge: Girls have had a history of being under-diagnosed with ADHD in part because their symptoms can look very different from boys who have ADHD.  Can you speak to that a little bit?

Dr. Patricia Quinn: Boys with ADHD are easy to spot in the classroom, and are much more likely to be referred for an evaluation.

• Most questionnaires used to screen children for ADHD emphasize items that describe these boys, items about hyperactivity, impulsivity and defiant behavior.
• Only those few girls who are like these boys with ADHD are sent for assessment.
• The ratio of children referred to clinics for ADHD evaluations continues to be about four or five boys for each girl.

What we are beginning to realize is that there are many girls left undiagnosed because their symptoms look different.  One big difference is that girls are less rebellious, less defiant, and generally less “difficult” than boys.  Sadly, they lose out due to their good behavior.  It’s the squeaky wheel that gets oiled.  When a boy is causing frequent discipline problems, either at home or in the classroom, he will quickly be referred for treatment.  Parents and teachers alike want quick relief from their constant challenges.  Girls with ADHD are more compliant, and are not as easy to spot.  Often they are left to drift along from one school year to the next, never working up to their potential and suffering silently.

Edge: So you are saying girls have the same symptoms as boys, they are just less rebellious?

Dr. Patricia Quinn: Basically there are core symptoms of ADHD that are critical to the diagnosis.  These include problems with attention and hyperactivity/impulsivity.  In general, girls usually have more problems with attention.  However, girls can also have hyperactivity, but it manifests in different ways.  For example, girls with ADHD can be hyper-reactive rather than hyperactive.  They are more emotionally labile with tantrums, slamming doors, etc.  Instead, of running around and being motorically hyperactive and disruptive like boys with ADHD, they can be hyper-talkative.  In addition to problems with attention, girls have problems with disorganization and, after puberty, have greater incidence of coexisting depression and anxiety.

Edge: Is there any advice you can offer to high school or college age young women to help them work with their ADHD to be successful?

Dr. Patricia Quinn: To successfully deal with and manage both ADHD symptoms and their lives, girls with ADHD must accurately assess their strengths, as well as weaknesses, and develop a plan for going forward.  For many girls, this means facing and shouting down the shame, low self-regard and those self-defeating scripts they have in their heads that tell them how terrible they are.  In addition, they need to develop a plan, building on their strengths, to deal with time management, disorganization and the other issues that get in the way of their success.

High school is the perfect time to begin developing strategies to deal with their ADHD symptoms.  However, teens do not need to face these challenges alone.  Family members, teachers, therapists and ADHD coaches are there to help.  By enrolling the aid of a coach early on, the girl with ADHD can learn what works for her and what she needs to do to be successful in college and life beyond.

6/2010 Editor’s Note:  For more about ADHD and Girls, check out the latest interview with Dr. Quinn.

Editor’s note:  Last month we talked about how anxiety occurs more frequently in ADHD community than in the mainstream population.  This month we’ll look a little deeper into 4 types of anxiety most commonly occurring for people with ADHD.

The DSM-IV Defined Anxiety Disorders

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) published by the American Psychiatric Association defines 12 anxiety disorders:

1. Separation Anxiety Disorder
2. Panic Disorder – with and without agoraphobia
3. Agoraphobia –  without history of Panic Disorder
4. Social Phobia – exaggerated fear of embarrassment or humiliation
5. Specific Phobia – e.g. of spiders, elevators, flying, etc.
6. Obsessive-Compulsive Disorder (OCD)
7. Post Traumatic Stress Disorder (PTSD)
8. Acute Stress Disorder – symptoms< 30 days
9. Generalized Anxiety Disorder (GAD)
10. Anxiety Disorder due to a General Medical Condition
11. Substance-induced Anxiety Disorder
12. Anxiety Disorder Not Otherwise Specified

The 4 most common anxiety disorders associated with ADHD

1. Generalized Anxiety Disorder (GAD)
2. Separation Anxiety Disorder
3. Social Phobia
4. Post Traumatic Stress Disorder (PTSD)

The remainder of this article will talk in more depth about the unique characteristics of each of these anxiety disorders.

Generalized Anxiety Disorder (GAD)

General Anxiety Disorder is a serious issue for the ADHD community.  It is far more likely to occur during the lifetimes of children with ADHD than in the general population (25% ADHD versus 2.9 – 4.6% general population).  Half (52%) of adults with ADHD will experience GAD in their lifetimes – opposed to only 5% of adults in the general population.

General Anxiety Disorder is the big anxiety disorder that people tend to miss.  With the others – Post Traumatic Stress Disorder, separation anxiety, and social phobia – it’s more obvious when you have it.  And, since GAD often comes along for the ride with depression, substance abuse, and other anxiety disorders, it may be relegated to a back seat in terms of recognition and treatment.

General Anxiety Disorder is characterized by 6 months or more of chronic, exaggerated worry and tension that is unfounded or much more severe than the normal anxiety most people experience.  People with GAD usually expect the worst.  They worry excessively about money, health, family, or work, even when there are no signs of trouble.  They are unable to relax and often suffer from insomnia.  Sometimes the source of the worry is hard to pinpoint.  Simply the thought of getting through the day can provoke anxiety.  General Anxiety Disorder may also grow worse with stress.  In addition to excessive anxiety and worry, people with GAD have at least 3 of the following symptoms:

• Restlessness or feeling on edge
• Fatigue
• Difficulty concentrating or mind going blank
• Irritability
• Muscle tension
• Difficulty sleeping

Separation Anxiety Disorder

About 10 times as many children with ADHD will have separation anxiety compared with the rate in the general population of 2.4%

Separation Anxiety Disorder develops in childhood and can persist into adulthood.  Basically this means a child is fearful of being separated from his or her safety net (familiar place or person).  The child may develop excessive worrying to the point of being reluctant or refusing to go to school, being alone, or sleeping alone.  The child may also experience repeated nightmares and complaints of physical symptoms such as headaches, stomachaches, nausea, or vomiting.

Social Phobia (a.k.a. Social Anxiety Disorder or SAD)

18% of people with ADHD will have a lifetime occurrence of Social Anxiety Disorder – half again as common as in the general population.

Social Anxiety Disorder is an intense fear of becoming humiliated in social situations, specifically of embarrassing yourself in front of other people.  It includes performance anxiety issues.  It often runs in families and may be accompanied by depression or alcoholism.  Social phobia often begins in early adolescence or even younger.  The person recognizes that the fear is excessive or unreasonable.  About 13% of the general population will experience social anxiety at some point in their lives.  Social Phobia is actually the third most common psychiatric disorder in the United States after depression and substance abuse.

Post Traumatic Stress Disorder or PTSD

Although there isn’t a lot of information on PTSD and ADHD specifically, there is some evidence that people with ADHD are more vulnerable to developing PTSD.  For more information consult Adler LA, Kunz M, Chua HC, Rotrosen J, Resnick SG. (2004). Attention-deficit/hyperactivity disorder in adult patients with posttraumatic stress disorder (PTSD): is ADHD a vulnerability factor?  Journal of Attention Disorders.  Aug; 8(1):11-6.

How to manage your anxiety

Anxiety disorders are highly treatable, but you have to recognize first that they exist.  If you think this might be you, seek the advice of a professional and find out what your options are.

An ADHD coach can also help you learn to identify your anxiety triggers and things you can do to keep your anxiety under control.

Watch for part 3 of our ADHD and Anxiety series where we will talk about some steps you can take to help you manage your anxiety.

Do you have ADHD and anxiety?  What have you done to keep it under control?  We invite you to share your story here and help others learn what you have to keep your edge! You don’t have to live with anxiety, sign up for an Edge Coach and start taking charge of your life today.