Keith Carman-Chief Administration Coordinator “I don’t want my kid drugged up for the rest of their life.”
“It’s the only way to manage ADHD.” “Doctors are lazy; jump to meds as soon as they hear the term ADHD.” “Big Pharma has the medical industry in its pocket, pushing ADHD pills for profit.” If we here at Artemis had a dime for every time we’ve heard one of these lines when discussing a potential ADHD diagnosis—let alone comforted parents bristling at the thought of the recommendation coming from a doctor—Warren Buffett would be coming to us for financial advice. It happens multiple times every single day. That’s fine, though. We’re here to help, inform and support. We all start our journeys at different points, sharing what we’ve learned along the way. Sometimes, that means steering people to—or even away from—the idea of ADHD medication. More often than not, however, it means clearing up some pretty heavy misconceptions. Here are what I consider to be the Big Four ADHD med mistruths:
Again, there are many more misconceptions and realities regarding this subject, but let’s take a moment to unpack these specifically. DIAGNOSIS: Being diagnosed doesn't mean medication will immediately be recommended. There are various types of ADHD: inattentive, distracted, hyperactive and impulsive. As every person is unique, these can present themselves independently or in any configuration possible. To that extent, there are degrees of severity: mild, moderate and severe. Some people can even slide just between two degrees. There are also comorbidities to ADHD: the things that interact with it, feeding off each other. Stuff like anxiety, depression, executive functioning issues, hyperfocus (yes, ADHD people can be overattentive), psychosomatics…I could go on. Again, those can also be in any configuration and to any degree. Psychologists need to navigate all those tidbits and see what’s presenting in their patients and the extent. Recommending medication to someone with barely even mildly inattentive ADHD and zero comorbidities would be like trying to kill a fly with a nuclear warhead. Who does that? In this case, they’d probably benefit from a few coping strategies such as coaching, reminders and such, not pills, so the psychologist will act accordingly. Also, keep in mind that doctors want to HELP, not HINDER. Why would they dole out medication like it was Halloween if it’s unnecessary? Let alone its negative implications on a doctor’s practice, reputation and self-respect. However, someone with severe hyperactivity, severe anxiety and moderate depression may benefit from pharmaceuticals. It’s a case-by-case situation, not the default starting point for an ADHD diagnosis. HISTORY: These medications have been around for almost a century (some are clearly newer) and have been tested in every conceivable way to ensure their safety and effectiveness. The acknowledgement of ADHD goes back over a century, while the first documented usage of medication was in 1936. This isn’t something brand-spanking-new we’re dealing with. Add in that Health Canada heavily trials/monitors/restricts brands and production as some medications are controlled substances, and it’s easy to see that there’s simply no wanton disregard for exactly what ADHD medication is and how it impacts patients. Compare this against something as new as, say, semaglutide, which was only approved for use in 2017. While it’s also under tight control, it’s more than 80 years younger than Ritalin, yet it is in such high demand that there have been supply issues lately. People clamour for it, using it for reasons that are actually a side-effect of its intended purpose while thumbing their nose at ADHD medication. You may know it via brand names Ozempic or Rybelsus. Check out this Children and Adults with Attention Deficit/Hyperactivity Disorder (ADHD) (CHADD) article for an insightful glimpse into the history of ADHD. EFFICACY: No, ADHD medication doesn’t work for everyone. Sometimes, it’s just not an option. ADHD medication isn’t a one-stop, one-size-fits-all scenario. While it can be the Holy Grail for some ADHD-ers, for others, it must be utilized in conjunction with a host of other practices such as therapy, checklists, coaching and so on. Even then, type and dosage do take dialling in, like a set of old-school rabbit ears on the television: “A little more…a little more…too much! Back it off! Ah. There’s the sweet spot.” Despite all of this, though, it flat-out doesn’t work for everyone. Some of us (my hand juts up) actually feel WORSE from medication, so it’s not an option. Personally speaking, at least I can say I gave it a shot. So, for those parents out there using the old “You don’t know unless you try it” line on your kids with some food or sport they hate, back atcha. CHOICE: It’s just a recommendation, not a life sentence. The old axiom states, “It’s better to have and not need than need and not have.” In the dead of January, you can bet I want mitts and a snow shovel in my car ‘cause I really don’t want to be stuck in some middle-of-nowhere ditch with frozen hands and spinning tires. Odds are you feel the same. Take that idea and transfer it to ADHD medication. If you or your loved one have been diagnosed and given a list of strategies to manage what has been tripping you up for years, but none of it is working, at least you have that recommendation sitting there if you say, “Aww, heck with it. Let’s see what happens.” That’s a lot easier than the rigamarole of phone calls, appointments, tests and possibly even further assessment (read: time/money) to obtain what could have already been waiting for you. Moreover, these psychologists—doctors—suggest this course of action. To this day, I find it strange that a parent will be so obstinate about ADHD medication that could potentially improve their child’s life, writing it off as any of those aforementioned misconceptions. At the same time, if ANY other GP or specialist said, “Jimmy has a heart condition. He should be taking these pills daily,” you’d probably see Roadrunner-style puffs of dust as they made a beeline for the pharmacy. Who wants to see Jimmy stuck in a middle-of-nowhere ditch without his emotional mitts/shovel? To solidify the point, let’s replace “recommendation” with “suggestion.” Sounds a bit…lighter, doesn’t it? It’s there. Use it or ignore it. It’s up to you. The doctor isn’t forcing pills down anyone’s throat, and you are in control of who you share your diagnosis with. The power is and always was yours. A Burnout is prevalent in our daily lives because, well, let’s face it, life can feel overwhelming at times.
Whether that be our full-time job, school, taking care of a family, socializing, prioritizing our health, self-care, or societal expectations… yeah, it’s a lot! These demands often result in high stress, which can lead to burnout. What is burnout? Burnout occurs when we are mentally, physically, and emotionally exhausted. It differs from stress in that it typically results in feeling disengaged and disconnected from activities that we would usually find meaningful. Burnout and ADHD: ADHD burnout happens when mental, physical, and emotional exhaustion occurs because of unmanaged ADHD symptoms. This may be due to deficits in attention, difficulty with concentration, or hyperactivity that can make day-to-day activities more difficult. Some folks with ADHD experience hyper-focus, where they may become entirely focused on a specific topic or project, which can last from hours to days. This often means that self-care comes second, including sleep, hygiene and eating habits. What are some signs that you may be experiencing burnout?
So, what can we do? Identify Are any of your ADHD symptoms contributing to the burnout? These may include an overwhelm in sustained attention daily, ADHD masking, or sensory overload. Knowing what is triggering you can help you take steps to manage the symptoms and make minor adjustments in your daily life to suit you better. Prioritize As much as we sometimes want to, we can’t do it all. It’s okay to practice saying no without the overwhelming feelings of guilt (I know, that’s easier said than done). Burnout can lead us to neglect self-care, including sleep and eating. Focusing on these areas of our lives can help manage stress and prevent burnout. Rest What does rest look like for you? Whether going on a nature walk, spending the day on your couch watching movies or feeling re-energized by social relationships, taking time for yourself is essential. Accommodations Ensure that you have accommodations at work and school to help prevent burnout. Connect Many counsellors and ADHD coaches are skilled at working with folks dealing with burnout and helping to manage their ADHD symptoms. A For more information on ADHD burnout, please email us at [email protected]. Guest Article by Roberto Olivardia, PhDMike (not his real name) is a 27-year-old single male with a thirteen-year history of binge eating disorder. He would eat two gallons of ice cream, a large pizza, a dozen donuts, and two hamburgers two to three times per week until he was sick. He could not stop. He has been to various therapists over the years, some who were eating disorder specialists, and no therapy or antidepressant seemed to help. All the while, his weight was dangerously increasing by the year, and his self-esteem was plummeting to nothing. His last therapist said he was “treatment resistant” and probably did not want to get better.
When I first met Mike, I saw a man who desperately wanted to be free of this eating disorder. Upon further inquiry, I discovered some important details about Mike and his treatment history. He reported that he could not get himself to the appointments on time. He would often sleep through them. He had every intention of filling out a food log but would lose it or simply forget to do it. “I always say I will follow through, but I just can’t.” He often skipped meals because he would be working through lunch, unable to get out of his hyperfocus. Then, he was hit with hunger at dinner and ended up “pigging out.” After much assessment, history taking, and a comprehensive clinical interview, it was absolutely clear that Mike had undiagnosed ADHD. It was when we applied this lens to his eating disorder that Mike made progress for the first time in his thirteen-year battle with food. He is now of normal weight and working day by day at managing his food intake. There is a growing scientific literature regarding ADHD and eating disorders, weight, and obesity. Eating disorders come in many forms. Anorexia nervosa is a disorder characterized by starvation and a fear of fatness. Bulimia nervosa is characterized by binge eating episodes (eating a larger-than-average amount of food in a short period of time to the point of being uncomfortably full). This binge is then compensated for by a method of purging, including self-induced vomiting, excessively exercising, fasting, laxative use, or use of diuretics and diet pills. Binge eating disorder is the binge eating without the purging. However, there are many people who might not fit the above criteria for a clinical eating disorder yet struggle with food. In addition, there is an epidemic of obesity in the United States. Recent research studies have begun to see an association between ADHD and eating problems. A study in 2005 assessed morbidly obese teenage boys and girls at an obesity clinic and found that fifty-eight percent had ADHD, which is significantly higher than what you would see in the general population. What was striking was that sixty percent of the adolescents were undiagnosed prior to the study. A study of obese patients who were getting gastric bypass surgery found that almost one-third had inattentive ADD. For those patients who had a body mass index over 40 (morbidly obese), the rate of ADD was almost half. A recent study found that girls with ADHD are at high risk for bulimia nervosa compared to their non-ADHD peers. A 2004 study of ADHD patients found that ten percent of subjects had an eating disorder sometime in their life, which is higher than what we would expect in the general population. ADHD as a predisposing factor How can ADHD predispose someone to develop an eating disorder or become obese? People with ADHD have difficulty with the executive function of organization. Eating healthy requires a high degree of organization. If you plan on cooking a meal for dinner, you need to start thinking about it hours before. Perhaps you need to defrost the meat. You may need to run to the market to get ingredients you don’t have at home. Or, you might have to pick up your child from soccer practice and make sure that the meal is made before you go. People with ADHD often think about meals at the time they are due to eat. This leads to relying on fast foods, microwaveable meals, or takeout food, most of which are high in sodium, sugar, and fat. Self-regulation is also a challenge for those with ADHD. In order to eat healthy, you need to be attentive to physical cues of hunger and fullness. Many with ADHD skip meals if they are hyperfocused on a task. Once a meal is skipped, metabolism decreases and cravings for fat, carbohydrates, and sugar increase. Many with ADHD report not getting enough sleep because it is too hard to shut their minds off at night. When we are sleep deprived, a hormone in our body called leptin decreases, which then results in storage of body fat, as well as cravings for fat. It is harder to lose weight if you are not sleeping properly. It is common for people with ADHD to eat while doing another activity, like watching television. This can lead to overeating since one’s ability to be mindful is compromised. Many report feeling grounded and focused by the sensory aspects (smell, taste, texture, touch, visual) of eating. Eating can be a means of quelling the stress, anger, and/or sadness that can arise from the challenges of having ADHD. The most common emotion I hear my patients with ADHD reporting that trigger their binge eating is boredom. When they feel little stimulation, they gravitate to food as the surefire, accessible form of stimulation. After all, food is always available, is legal, and is sensory-stimulating. Eating can also be a relief from racing thoughts and distractibility. College students with ADHD might binge before writing a paper as a way to help them focus. Patients who self-induce vomiting report a euphoric stimulation that comes along with purging. They report an intense ability to focus immediately after vomiting. The problem, of course, is that bulimia is associated with several serious health problems, notably cardiac problems that can lead to death. ADHD brains tend to have low levels of dopamine, a neurotransmitter that is involved in reward systems and thrill-seeking behavior. When there are low levels of dopamine in the brain, people tend to seek out activities that will elevate these levels and produce a reward. Eating is one such activity. Treating both disorders Although there are many factors that make people with ADHD at risk for eating disorders or obesity, the encouraging news is that these issues can be treated, provided that the relationship between the ADHD and the eating disorder is fully understood. Clinicians too quickly dismiss ADHD as an important factor in this problem, and it comes at a cost. A therapist with knowledge in both areas is essential. If you cannot find a therapist who specializes in both, find a therapist who specializes in eating disorders and add an ADHD therapist or coach to your treatment so that the two professionals can work in conjunction in wholly treating the eating problem. Eating disorders are serious and need to be carefully treated and monitored, as they can lead to serious medical consequences. Traditional modes of treatment might need to be creatively adjusted in order to work with the ADHD symptoms. Develop an ADHD-friendly list of alternative forms of stimulation. Meditation might work for some people to reduce stress, but some with ADHD would find it impossible to quiet their minds that much. Don’t waste your time on strategies that you intuitively know won’t work for your ADHD. It can feel defeating for people with ADHD to hear that something “should” work since it works for the majority of people. It comes down to whether it works for you. Time management strategies and scheduling your meals out is essential. Sleep more. Not only will your body like it, but sleeping will mean that you are not up late at night eating. Breakfast really is the most important meal of the day. Start your day with protein. Impulse control tips are important. Something simple, like putting your fork down while you are chewing, can go a long way. Using small plates so that you put less food on the plate is also helpful. Those with ADHD respond well to external cues. For individuals with ADHD and bulimia nervosa or binge eating disorder, stimulant medication can be incredibly helpful in managing their eating disorder, mainly because it is managing the ADHD symptoms that can give rise to the eating disorder. Most importantly, if you struggle with an eating disorder, know that you are not alone. This is especially true for males. Contrary to popular belief, eating disorders affect millions of males as well. Both eating disorders and ADHD can negatively affect one’s self-esteem. People who have either an eating disorder or ADHD struggle with feelings of shame, ineffectiveness, and being perceived by others as being lazy or lacking “willpower.” These negative feelings are exponentially increased when people struggle with both ADHD and an eating disorder. Treatment does work and can free people of the painful experience of an eating disorder. It is important, however, to have the right lens through which you are seeing the problem and therefore using the most appropriate interventions. A Roberto Olivardia, PhD, is a clinical psychologist and clinical instructor in the department of psychiatry at Harvard Medical School in Boston, Massachusetts. He is coauthor of The Adonis Complex: The Secret Crisis of Male Body Obsession (Free Press, 2000), a book about body image and eating disorders in boys and men. He has a private therapy practice where he specializes in the treatment of ADHD, eating disorders, obsessive-compulsive disorder, and body dysmorphic disorder. Access his original article here. |
Tara Carman-FrenchDirector, Certified ADHD & LD Coach Archives
October 2024
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