Author: Lisa Fernandez

How ADHD Is Diagnosed

This content is excerpted from HealthCentral on How ADHD Is Diagnosed. I am one of the panel experts, along with Russell A. Barkley, Ph.D.Clinical Professor of Psychiatry and Rosemarie Manfredi, Psy.D. Licensed Psychologist and Certified School Psychologist Let’s Talk About How ADHD Is Diagnosed How ADHD Is Diagnosed. There’s no single test that can determine if you or your child has ADHD, but we’ll help you get the answers you’re seeking.   First, What Exactly Is ADHD?

ADHD is one of the most prevalent neurodevelopmental disorders of childhood. It can continue well into the adult years. ADHD is marked by:

  • Inattention (wandering off task, loss of focus, disorganization)
  • Hyperactivity (being in constant motion)
  • Impulsivity (acting or speaking without thinking)

People with ADHD may have one of these signs or symptoms, or a combination. Most kids have the type of ADHD that’s a combo of symptoms. More than 6 million children have been diagnosed with ADHD. Roughly 11 million people, or 5 percent of the adult population, have it, too according to a 2016 report from the Centers for Disease Control and Prevention (CDC).

Who Diagnoses ADHD?

ADHD can’t be diagnosed based on a 15-minute checkup. A proper ADHD diagnosis involves interviews with the person and their parents or other loved ones—and teachers, if applicable. There are checklists, observations, official questionnaires and a medical evaluation, too. Before calling on a trained ADHD expert, know this: Only medical professionals, like physicians and nurse practitioners, can perform a thorough physical evaluation to rule out other possible medical causes of ADHD-like symptoms. As part of a complete check-up, you or your child should get a vision and hearing test. Your physician may also screen for brain injuries, such as a concussion, and look for an underlying seizure or sleep disorder. In rare cases, individuals with ADHD-like symptoms may have thyroid dysfunction. If this is suspected, a blood panel may be ordered. At the same time, other conditions can masquerade as—or coexist with—ADHD. These include:

  • Developmental delays
  • Autistic spectrum disorder
  • Learning disabilities
  • Anxiety
  • Depression
  • Trauma
  • Bipolar disorder
  • Obsessive-compulsive disorder

According to the American Academy of Pediatrics, the majority of children diagnosed with ADHD also meet the diagnostic criteria for another mental health disorder. These types of issues are normally screened for during the next step of the ADHD diagnosis process: The comprehensive evaluation (also called a comprehensive assessment).

Read more in HealthCentral for information on:

Where Can I Get an Evaluation?

What’s a Comprehensive Evaluation for ADHD?

The Diagnostic Interview

Standardized Behavior Rating Scales

Interview With VIPs

DSM-5 Symptom Checklists

Are There Other Tests for ADHD?

What About School Evaluations?

What Are the Chances of a “False Positive” or a Misdiagnosis?

FREQUENTLY ASKED QUESTIONS about ADHD Diagnosis

Read the HealthCentral Article

Additional Resources:

https://drsharonsaline.com/2020/10/02/video-going-back-to-school-w-dr-sharon-saline-debbie-reber/

Message to Tween, Teens and Young Adults During Covid

This can be a tough time for emerging adults.

Seven months into the pandemic, and things are still “far from normal”. You’ve lost so much of what was familiar, valued and fun in your lives–being on campus and attending in-person classes, socializing with peers, working, romantic relationships, etc. It’s natural to feel sad, lonely, anxious, frustrated and disappointed. These are some comments I hear from my clients: “I can’t do anything!” “School is now only Zoom. ,All the good stuff is gone, and all we do now is work.” If your parents or other family members are pressuring you to do more, be happy and act grateful for what you have, it’s really important that you let them know how you feel. You’re struggling a bit. You need empathy not criticism. Consider saying something like: “This has been a hard time for me and most people my age. I’m doing the best I can to shift and accommodate the changes but some days it’s tougher than others.”

Don’t Struggle Alone

Contact your primary care provider or your college’s counseling services to get the names of mental health practitioners if you find that you’re:

  • sad or anxious most days
  • lonely and need someone to talk to
  • your sleep or appetite are disrupted (too much or not enough)
  • have trouble concentrating or taking pleasure in activities that you once enjoyed overusing alcohol or drugs

Ask for Help

Ask your parents if they can assist you in finding someone to talk to which can be intimidating and complicated for many young adults. Try telling them: “I think it would be good for me to find someone to talk to. I don’t want to worry you. I just have some things on my mind that I’d like to sort out.” Since untreated anxiety leads to depression and persistent depression is a debilitating condition, get some help now before things take a more serious turn.

Don’t give up. Something good is around the corner, promise! Learn more about School and Learning  

Socializing in a Pandemic

People who are very engaged in social media must use caution to ensure that they don’t place more value on their virtual friends, or how many or few they have, versus their in-person relationships. We can all get distracted by the online world, believing that things are happening without us (FOMO: Fear of Missing Out) or feeling pressure to respond to posts immediately. This focus means that we may well struggle with interpersonal conversations, especially about difficult subjects, in real time, face-to-face with true friends. I recommend to all my clients, especially those with ADHD who can struggle socially, that sending messages or ‘talking’ online, where you don’t often see another person’s reaction, can possibly make you misinterpret their intentions. In relationship, we have to learn through interpersonal communication and time spent together in the same space to read each other’s emotional weather report and respond appropriately. When people spend more time engaged with each other rather than their screens, they perceive and understand social nuances and learn how to deal with positive and negative feelings with empathy and consideration. This enriches relationships and deepens connections. Read more:

ADHD and Screen Sanity: Why a digital break is good for everybody right now

Millennial Loneliness and Depression

What We Eat is Something We Can Control Now

During this pandemic, we all are experiencing heightened anxiety and there is so much we can’t control. What we eat is luckily something we can control now. Some foods are good for our physical, emotional well-being, and some are not.
Although I am not a medical doctor, I’ve observed that foods do have an impact on us:
Anxiety – Food that is especially sugary or those with a lot of caffeine can increase someone’s agitation and then make them more prone to anxiety. Sometimes ginseng can do this as well.
I think herbal teas such as chamomile or those with other calming properties can be extremely useful.
What amount of food should people eat? – Eating slowly and mindfully can help reduce intake. Often when people eat quickly or standing up, their bodies don’t have a chance to metabolize the food and recognized that they are sated. Often overeating happens with rushing, or when certain moods kick in. Some people eat when they feel anxious; others can’t eat. It’s really an individual response. Whether or not you have an anxiety disorder or ‘just feel anxious sometimes,’ the feeling of anxiety is the same. The difference is one of frequency and intensity.

How to Nurture Yourself When Preparing for Back to School

It’s essential for parents and caregivers to take care of themselves during these times because we’re talking about a marathon, not a sprint. When you listen to the talk on an airplane about oxygen masks, you’re told to put one on yourself first and then on a child. It’s the same principle here. Factoring in self-care to an already full life of work, family and now hybrid learning can be complicated. In fact, it’s usually the first thing to go out the window when people are stressed when it should be one of the last. You have to take care of yourself so you can take care of others. Exercise, nutrition and emotional support are key elements to helping you run this long, arduous race. Here are a few tips:

  1. Get some physical exercise:  Not only will your body and your brain benefit enormously from the endorphins that exercise produces but you will also feel less resentful because you’ve done something good for yourself in the midst of all of the stress in your list. Make a list of two types of activities you could actually do: one at home and one before or after school. For the first list, include taking the stairs or seated/wall yoga poses to do when you need a break. For the second list, identify times and activities of exercise that you ENJOY and want to do. Decide how often you can do something and put it on your calendar with a reminder alarm. The goal is to use your body to help you let go of stress, not to get into the best shape of your life.
  2. Eat well: Many parent are tired of cooking and shopping so you may have limited food selections or they’re not what you desire. You need fuel for this marathon so make a list of healthy snacks to purchase the next time you go to the grocery store. 
  3. Ask your friends for assistance: People who care about you often feel confused about how to help you so they’re happy to do lend an ear, or bring dinner. When I ask a friend how I could help, she asked me to go to Trader Joe’s and buy her a container of dark chocolate pecan candies. I was so happy to do this. For the next six months I bought her a package of the candies. My friend was very appreciative, and even though it was a small thing, I felt like I was easing her burden in some way. 
  4. Meditation: Take some each evening before bed or each morning as you awaken to be with yourself. Guided meditations on Apps such as Headspace, Mindful or Insight Timer can be a great way to start or end your day (or both) with a sense of personal calm, insight and hope. This internal spacial-ness will assist you as you deal with the chaos of caretaking. 

Read more on how to manage life during COVID    

Millennial Loneliness and Depression

Teen looking lonely and depressed on her bed by the window

It can be hard to make friends as adults:

People often feel like it’s hard to make friends as an adult because, quite frankly, it is. When we are in college or technical school, we have a community made for us and we share common goals and interests. We spend time each day or week together. You don’t have to look far for peers because they are all around you. Once young adults have transitioned to living on their and working full-time, the social networks are less obvious. You may have friends at work or you may not. In addition, you may be living in a new place where you lack historical connections to people or a familiar community. Be shy and/or suffering from social anxiety doesn’t help either. Millennial loneliness and depression is real and a challenge to cope with.

Social media increases millennial loneliness:

Women in particular are socialized to develop a sense of themselves based on their relationships. These interpersonal networks help define us and give us purpose. Social media increases loneliness: women have superficial contact with others, often based on short text exchanges, photos or quick responses. Girls and women are developing an inner notion of who they are based on the number of likes they have and how engaged they are online with others. Ultimately, these ways of relating with others are less satisfying than in-person conversations, time spent together and sharing real time experiences.

Aim for Balance:

To build a community, aim for balance between social media and real time interactions. Folks need a few friends, not an entire posse, to feel like they matter and make a difference. Meet up with friends and talk in person more than texting, Snapchat or Instagram conversations. Pursue what interests you and join a club, take a class or volunteer for an organization. By participating in these activities, you’ll make natural relationships, share experiences and build a stronger sense of self to feel less lonely and more fulfilled.

Watch Dr. Saline’s advice on depression, loneliness and teens and millennials.

Learn more:

Help! My Teen is So Unmotivated This Summer!

Teens experience a few types of academic burnout depending on their individual situations. For neurotypical kids, academic burnout usually arises towards the end of the semester when they are burdened with final tests, projects and paper in addition to their other commitments such as sports, music or theater or work. For high-achieving kids who are taking AP classes, preparing for AP tests can add to their stress. For juniors in high school who additionally have to take the SAT’s or ACT’s for college, it can be overwhelming. They can become exhausted with how much they have to do.

Neurotypical Kids:

As a parent of these types of teens, your primary job is helping them maintain balance and perspective in their lives. Work with them to create a study/life schedule that allows for some down time each day. Don’t orchestrate what they should do during that time though. Instead brainstorm some healthy options other than screens such as cooking, walking the dog, going for a run, listening to music or even watching a single show with you. If they want to mess around on their phone a bit to “chill”, keep it (like tv) time limited. Teen brains especially need some non-screen to decompress and integrate all of the information they are learning and processing during the day.

Neurodiverse Kids:

For kids with ADHD, learning disabilities or autism spectrum disorders, burnout  can occur more frequently and more intensely. Working hard to hold it together at school all day takes a lot of effort and concentration for these teens. They spend a lot of their time doing academic tasks that are hard, boring or unpleasant. By mid-semester, their efforts may not be panning out as they had hoped and they become discouraged and uninterested in doing the work.

While the recommendations above for neurotypical kids apply equally to these teens, teens who are outside-the-box thinkers benefit from additional parental support in creating shorter work periods with timed breaks, specific tasks to accomplish in those work periods and acknowledgement of their efforts towards working towards goals, even if they are not fully met. This validation encourages them to keep going. Family work time, when parents and kids work side-by-side on their stuff, also helps teens stay on track because adults can monitor them without being intrusive.

Learn more:

What’s a Normal Level of Anxiety?

Stress and anxiety are connected but also different. Stress is related to feeling overwhelmed and incapable of managing the things that you have to do. Productive stress motivates you to get stuff done; poisonous stress contributes to worry and anxiety. You can’t get things accomplished to feel a sense of satisfaction. Stress can also be related to life circumstances such as poverty, illness and racism that cause you distress but have not clear resolution in sight.

Anxiety is a natural physiological and psychological response related to fears and worries. Panic, irrational thinking, reactivity, increased heart rate, perspiration, shortness of breath or insomnia are all signs of anxiety. Anxiety is about safety and security. Anxiety arises because people want to make uncomfortable feelings and uncertainty go away immediately–whether these concerns are based in reality or distorted and based on negative expectancy. Anxiety disorders often have a negative impact on several areas of someone’s functioning simultaneously.

It’s common for people to experience some type of anxiety seen as worry, dread, fear or distress. Some nervousness in a new situation or worry about chronic stress is expected. If these concerns fail to go away once you’ve learned how to manage the worry or stress and you experience persistent anxiety that is interfering with daily living, healthy choices, mood stability, or functioning at work, anxiety has become problematic and needs treatment. If your anxiety is higher than normal, first consult with your doctor to rule out any medical causes. Then, you’ve got to learn some tools to manage it. Meditation, yoga, daily exercise, therapy and medication can be extremely useful in reducing anxiety. You’ll benefit from learning how to soothe yourself and confront anxious, distorted thoughts to reduce their intensity. Don’t try to remove anxiety from your life: it doesn’t work because we need some anxiety to function, protect and aid us in dangerous or challenging situations. Instead, focus on anxiety reduction so that you feel like you have more control over it. The goal is teaching yourself how to manage the volume button on your anxiety rather than having blast you at full volume with its fears and worries.

Read more about Anxiety, depression and more

Parenting Adult Children is Complicated

When young adults have lived independently, they are accustomed to making their own schedules and sleeping, eating, studying and socializing according to their own rhythm. In general,  they’re not that interested in free advice about what they could be doing better or differently. Instead, they want to be respected for the autonomy that they’ve developed and be seen in their developing maturity.

Coexisting peacefully means realizing that your job is to support them more than guide them. They need collaboration and compassion: their lives have been turned upside down and they’ve likely lost many events, activities and plans which really mattered to them. They want to have a sense of their independence by making whatever choices they can in their newly limited lives. Many young adults right now are both anxious and depressed. As parents, we’ve got to remember that they are more fragile than they’ve been.

It’s reasonable to establish ground rules that reflect creating a civil, honest and safe environment for your home. Take about how to share chores, respect each other’s boundaries and work together to solve issues. Make a list of who’s doing what and post it in the kitchen. Create a plan for what to do when people aren’t following through. By strategizing for success and setting up clear plans for daily living, you’ll reduce the frequency of any conflicts which will naturally arise during this time.

If your adult child is behaving irresponsibly (sleeping all day and up all night, not following social distancing recommendations or abusing substances), talk with them about their stated goals for themselves and their view on how they are progressing towards them. Offer neutral observations about their behaviors, ask them how you can help and consider assisting them with making online appointments with their physician, finding a therapist or following a daily routine that includes exercise. Ask questions and listen to their responses, reflecting back what you hear them say and without judging or dismissing their opinions.

Read more about Parenting and Families

Prepare Now to Transition to In-Person School

Online Schooling has relieved anxiety for some –

Learning from home has been a pleasant relief for many students who struggle socially at school or have extreme anxiety. The various triggers that going to school presents for them have been eliminated. Online school offers limited peer and adult contact with less pressure to perform in casual conversations. Plus, kids are able to regulate their connections with others–who, what, where and how–which further reduces social anxiety.

Transitioning to In-Person School –

When thinking about transitioning to in-person school, parents of kids who have been thriving at home need to consider this issue of control. Many kids who struggle socially feel forced to interact with peers or adults on terms that don’t work for them and at times that are more frequent than they would otherwise choose. They will feel heightened anxiety by the prospect of having to endure or perform in these situations again. As parents, you have to help them remember other times of success in their lives–times when they were able to overcome their nervousness and do something anyway. Anxiety creates amnesia about these successes so we’ve got to bring them into awareness. Brainstorm or review with your son or daughter previous experiences and how they can apply those skills to the current situation. Write these down so you can refer to them in the future.

Role-Play Now –

Practice a few phrases that your child or teen can say in common interactions with peers. Talk about their primary concerns and brainstorm responses. For example, if they are feeling overwhelmed to respond and don’t know how, identify a sentence or two they can use such as “I’m not sure. Let me think about it and get back to you.” Role-plays are very helpful for learning what to say, remembering those words and building confidence. The more general the response, the easier it will be for them to recall and use the phrases. Sometimes kids can overfocus on what to say exactly and when to say it. We want to give them a tool that’s appropriate in several situations so they don’t feel more anxiety about remembering which sentence they need to use.

Read more tips about reducing anxiety