Articles
What is Social Communication Disorder?
BY EILEEN BAILEY
The symptoms of Social Communication Disorder previously fell under the umbrella of Autism Spectrum Disorder. Now, they merit their own diagnosis and fine-tuned therapy plan. Here, learn SCD’s hallmark symptoms, diagnostic criteria, and treatment options.
Exercise and the ADH D Brain: The Neuroscience of Movement
Research shows that physical activity sparks real, positive changes in the brain that increase attention and improve mood. What's more, exercise is an inexpensive, self-prescribed, and accessible supplemental treatment option for adults and children with ADHD.
"Think of exercise as medication," says John Ratey, M.D., an associate clinical professor of psychiatry at Harvard Medical School. "For a very small handful of people with attention deficit disorder (ADHD or ADD), it may actually be a replacement for stimulants, but, for most, it's complementary — something they should absolutely do, along with taking meds, to help increase attention and improve mood."
While most of us focus on exercise as a way to trim our waistlines, the better news is that routine physical activity firms up the brain — making it a simple, alternative ADHD treatment. “Exercise turns on the attention system, the so-called executive functions — sequencing, working memory, prioritizing, inhibiting, and sustaining attention,” says Ratey, author of Spark: The Revolutionary New Science of Exercise and the Brain (Little, Brown). “On a practical level, it causes kids to be less impulsive, which makes them more primed to learn.”
The latest news about exercise and ADHD is that it helps kids with the condition push through past failures and attack things they didn't succeed at before. "The refrain of many kids with ADHD is, 'No matter what I do, I'm going to fail,'" says Ratey. "Rat studies show that exercise reduces learned helplessness. In fact, if you're aerobically fit, the less likely you are to learn helplessness."
So how, exactly, does exercise deliver these benefits to the ADHD brain? When you walk, run, or do a set of jumping jacks or pushups, your brain releases several important chemicals.
Endorphins, for one, hormone-like compounds that regulate mood, pleasure, and pain. That same burst of activity also elevates the brain's dopamine, norepinephrine, and serotonin levels. These brain chemicals affect focus and attention, which are in short supply in those with ADHD. "When you increase dopamine levels, you increase the attention system's ability to be regular and consistent, which has many good effects," explains Ratey, like reducing the craving for new stimuli and increasing alertness.
Source:
https://www.additudemag.com/exercise-and-the-adhd-brain
Learning Disabilities: What They Are (And What They’re Not)
The most common learning disabilities are dyslexia (language learning disabilities), attention deficit disorders (ADHD), nonverbal learning disabilities (NLD), and executive function disorder (EFD) • Contrary to what some people think, children with LD are smart, talented, and resourceful; they just learn differently.
The term learning disabilities (LD) refers to an array of problems that cause bright and capable children to have difficulty learning using teaching methods found in most traditional classrooms.
While the underlying cause of LD remains a mystery, experts agree that it is neurologically based, meaning it results from differences in the way the brain is wired and processes information.
Although LD cannot be outgrown or “cured,” it can be compensated for and remediated. The better you understand the nature of your child’s learning difficulties, the greater your chances are of helping him succeed academically and socially.
Below is an introduction to the most common learning disabilities; these may exist alone or in combination.
Dyslexia
Many learning disabilities involve language. These language-based learning disabilities, also referred to as dyslexia, or reading disabilities, may show up as problems with reading, writing (dysgraphia), spelling, speaking, listening, and/or math (dyscalculia). Additional specific learning disabilities (SLD) include perceptual disabilities, or brain injury.
It’s important to understand that children with LD may be highly intelligent and have considerable strengths upon which to build.
Nonverbal Learning Disabilities
In contrast to language learning disabilities, children with nonverbal learning disabilities (NLD) have difficulties with visual and spatial relations, which impact their ability to learn from nonverbal information. Kids with NLD often have trouble understanding the “big picture,” and because social interaction relies heavily on the exchange of nonverbal cues (e.g. body language, facial cues), children with NLD may be socially awkward.
ADHD
Although it is not included in the term specific learning disabilities, ADHD involves problems regulating attention, which occurs often among children with learning disabilities. If not treated, ADHD interferes significantly with a child’s ability to learn and function in school, on the playground, and at home. ADHD is usually classified under the heading “other health impairment” (OHI) on an IEP.
Executive Function Disorder
Executive Function Disorder (EFD) refers to difficulties carrying out the tasks that are a part of daily life—the ability to plan, organize, set goals, solve problems, regulate emotions, and monitor behavior. Because these skills are fundamental to what goes on in the classroom as well as in other settings, children with EFD often have significant problems in school and, as they grow older, in life.
The Adult ADHD Mind: Executive Function Connections
A chef who can't find her ingredients. An orchestra trying to play without a conductor. Thomas Brown, Ph.D. uses these metaphors - as well as a strong dose of hard-hitting science - to break down what's really going on in the mind of an adult with ADHD. Read on for clarity.
BY THOMAS E. BROWN, PH.D.
A woman with executive function problems looks into the distance.
For decades, the syndrome now known as attention deficit hyperactivity disorder (ADHD or ADD) was seen simply as a childhood behavior characterized by chronic restlessness, impulsivity, and an inability to sit still. Not much more was known about ADHD or how it affected the brain.
In the 1970s, the number of ADHD diagnoses rose when doctors recognized that hyperactive children also had significant problems paying attention to tasks or listening to their teachers.
This discovery paved the way for changing the name of the disorder in 1980 from "hyperkinetic disorder" to "attention deficit disorder" and to recognizing that some children suffer from chronic inattention problems without significant hyperactivity.
That change - from an exclusive focus on hyperactivity and impulsive behavior to a focus on inattention as the principal problem of the disorder - was the first major paradigm shift in understanding this syndrome.
In recent years, there's been another major shift in our understanding of ADHD. Increasingly, researchers are recognizing that ADHD symptoms overlap with impairments in what neuropsychologists call executive dysfunction. The term refers not to the activities of corporate executives, but to the brain's cognitive management functions. The term is used to refer to brain circuits that prioritize, integrate, and regulate other cognitive functions.
Inconsistent Inattention
Everyone I've ever evaluated for ADHD has some domains of activity where they can pay attention without difficulty. Some are artistic, and they sketch intently. Others are childhood engineers, constructing marvels with Lego blocks and, in later years, repairing engines or designing computer networks. Others are musicians who push themselves for hours at a time to learn a new song or to compose a new piece of music.
How can someone who is good at paying attention to some activities be unable to pay attention to other tasks that they know are important? When I pose this question to patients with ADHD, most say something like: "It's easy! If it's something I'm really interested in, I can pay attention. If it's not interesting to me, I can't, regardless of how much I might want to."
Most people without ADHD respond to this answer with skepticism. "That's true for anyone," they say. "Anybody's going to pay better attention to something they're interested in than to something they're not." But when faced with something boring that they know they have to do, those without ADHD can make themselves focus on the task at hand. People with ADHD lack this ability unless they know that the consequences of not paying attention will be immediate and severe.
Metaphors for Executive Functions
Imagine a symphony orchestra in which each musician plays his or her instrument very well. If there is no conductor to organize the orchestra, to signal the introduction of the woodwinds or the fading out of the strings, or to convey an overall interpretation of the music to all players, the orchestra will not produce good music.
Symptoms of ADHD can be compared to impairments, not in the musicians but in the conductor. Typically, people with ADHD are able to pay attention, to start and stop their actions, to keep up their alertness and effort, and to use their short-term memory effectively when engaged in certain favorite activities. This indicates that these people are not totally unable to exercise attention, alertness, or effort. They can play their instruments very well - but only sometimes. The problem lies in their chronic inability to activate and manage these functions in the right way at the right time.
One way to consider this broader view of attention as executive functions is to observe situations where tasks are not dealt with effectively. Martha Bridge Denckla, M.D., professor of neurology, pediatrics, and psychiatry at Johns Hopkins University School of Medicine, in Baltimore, has written about intelligent patients with no specific learning disabilities who have chronic difficulties in dealing effectively with tasks. In Attention, Memory, and Executive Function (#CommissionsEarned), she compares these people to a disorganized cook trying to get a meal on the table.
"Imagine a cook who sets out to cook a certain dish, who has a well-equipped kitchen, including shelves stocked with all the necessary ingredients, and who can even read the recipe in the cookbook. Now imagine, however, that this individual does not take from the shelves all the relevant ingredients, does not turn on the oven in a timely fashion so as to have it at the proper heat when called for in the recipe, and has not defrosted the central ingredient. This individual can be observed dashing to the shelves, searching for the next spice mentioned in the recipe, hurrying to defrost the meat and heat the oven out of sequence. Despite possessing all the equipment, ingredients, and instructions, this motivated but disheveled cook is unlikely to get dinner on the table at the appointed hour."
The "motivated but disheveled cook" sounds very much like a person with severe ADHD who tries to accomplish a task but is unable to "get it together." Individuals with ADHD often describe themselves as intensely wanting to accomplish various duties for which they are unable to activate, deploy, and sustain the needed executive functions.
Executive Functions and Awareness
A 43-year-old man came to my office with his wife to be evaluated for attentional problems. Both of the couple's children had recently received an ADHD diagnosis and had benefited from treatment. When I explained that most children with ADHD have a parent or other close relative with ADHD, both parents laughingly responded, "Those apples haven't fallen far from the tree." Both agreed that the father had more ADHD symptoms than either of the children. Here's how the wife described her husband:
"Most of the time he's totally spaced out. Last Saturday he set out to fix a screen upstairs. He went to the basement to get some nails. Downstairs he saw that the workbench was a mess, so he started organizing the workbench. Then he decided he needed some pegboard to hang up the tools. So he jumped into the car and went to buy the pegboard. At the lumber yard he saw a sale on spray paint, so he bought a can to paint the porch railing and came home totally unaware that he hadn't gotten the pegboard, that he had never finished sorting out the workbench, and that he had started out to fix the broken screen that we really needed fixed. What he needs is a lot more awareness of what he is doing. Maybe that medicine our kids are taking can give him that."
From this wife's description, one might conclude that the central problem of ADHD is essentially a lack of sufficient self-awareness. She seems to believe that if only her husband were more steadily aware of what he is doing, he would not be so disorganized, jumping from one task to another without completing any single one. But most people do not require constant self-awareness to complete routine tasks. For most people, most of the time, operations of executive functions occur automatically, outside the realm of conscious awareness.
For example, while driving a car to the local supermarket, experienced drivers do not talk themselves through each step of the process. They do not have to say to themselves: "Now I put the key in the ignition, now I turn on the engine, now I check my mirrors and prepare to back out of my driveway," and so on. Experienced drivers move effortlessly through the steps involved in starting the car, negotiating traffic, navigating the route, observing traffic regulations, finding a parking place, and parking the car. In fact, while doing these complex tasks, they may be tuning their radio, listening to the news, thinking about what they intend to prepare for supper, and carrying on a conversation.
Even the simpler example of keyboarding on a computer illustrates the point. If one can type fluently without stopping to consciously select and press each individual key, one's mind is left free to formulate ideas and to convert these into words, sentences, and paragraphs that convey ideas to a reader. Interrupting one's writing to focus on and press keys one at a time costs too much time and effort; it cannot be done very often if one is to write productively.
Many other routine tasks of daily life - for example, preparing a meal, shopping for groceries, doing homework, or participating in a meeting - involve similar self-management in order to plan, sequence, monitor, and execute the complex sequences of behavior required. Yet for most actions, most of the time, this self-management operates without full awareness or deliberate choice.
The problem of the "unaware" husband is not that he fails to think enough about what he is doing. The problem is that the cognitive mechanisms that should help him stay on task, without constantly and consciously weighing alternatives, are not working effectively.
The Brain's Signaling System
Some might take my orchestra metaphor literally and assume that there is a special consciousness in the brain that coordinates other cognitive functions. One might picture a little man, a central executive somewhere behind one's forehead, exercising conscious control over cognition like a miniature Wizard of Oz. Thus, if there is a problem with the orchestra's playing, one might attempt to "speak" to the conductor, requesting - or demanding - needed improvements in performance.
Indeed, this presumed "conductor," or controlling consciousness, is often the target of encouragement, pleas, and demands by parents, teachers, and others as they attempt to help those who suffer from ADHD. "You just need to make yourself focus and pay attention to your schoolwork the way you focus on those video games!" they say. "You've got to wake up and put the same effort into your studies that you put into playing hockey!"
Alternatively, they may impose punishments on people with ADHD or shame them for their failure to "make themselves" do consistently what they ought to do. These critics seem to assume that the person with ADHD needs only to speak emphatically to the "conductor" of his own mental operations to get the desired results.
In reality, there is no conscious conductor within the human brain. There are networks of neurons that prioritize and integrate all of our cognitive functions. If these networks are impaired, as they are in ADHD, then that individual is likely to be impaired in the management of a wide range of cognitive functions, regardless of how much he or she may wish otherwise.
How Medication Helps
There is now considerable evidence that executive functions of the brain impaired in ADHD depend primarily, though not exclusively, on two particular neurotransmitter chemicals: dopamine and norepinephrine.
The most persuasive evidence for the importance of these two transmitter chemicals in ADHD impairments comes from medication treatment studies. Over 200 well-controlled studies have demonstrated the effectiveness of stimulants in alleviating symptoms of ADHD. These medications work effectively to alleviate ADHD symptoms for 70 to 80 percent of those diagnosed with this disorder.
The primary action of medications used for ADHD is to facilitate release and to inhibit reuptake of dopamine and norepinephrine at neural synapses of crucially important executive functions. Improvement produced by stimulants generally can be seen within 30 to 60 minutes after an effective dose is administered. When the medication has worn off, ADHD symptoms generally reappear at their former level.
Stimulants do not cure ADHD; they only alleviate symptoms while each dose of medication is active. In this sense, taking stimulants is not like taking doses of an antibiotic to wipe out an infection. It is more like wearing eyeglasses that correct one's vision while the glasses are being worn.
Given the often-dramatic alleviation of symptoms experienced by people with ADHD when they take stimulant medications, it is very difficult to sustain the notion that ADHD impairments amount to a lack of willpower.
Much more remains to be learned about how the brain's complicated neural networks operate to sustain the broad range of functions encompassed in "attention." Yet it is clear that impairments of executive functions, those brain processes that organize and activate what we generally think of as attention, are not the result of insufficient willpower. Neural-chemical impairments of the brain's executive functions cause some individuals who are good at paying attention to specific activities that interest them to have chronic impairment in focusing for many other tasks, despite their wish and intention to do otherwise.
This article is from Attention Deficit Disorder: The Unfocused Mind in Children and Adults (#CommissionsEarned) by Thomas E. Brown, Ph.D., and published by Yale University Press. Reproduced by permission. He is a member of ADDitude's ADHD Medical Review Panel.
The Truth About ADHD: It's Not Black and White
ADHD is not black and white, where one either does or does not have the characteristics, where there is no "almost" or "a little bit." ADHD is more like a mood disorder, which occurs along a continuum of severity. Everyone occasionally has symptoms of a low mood. But it is only when symptoms of a mood disorder significantly interfere with an individual's activities over a longer time that he is eligible for such a diagnosis.
The Gaslighting Risk: Why Adults with ADHD Are Particularly Vulnerable to Manipulation
Gaslighters often target women and men with ADHD. Here’s how to recognize when you are being psychologically or emotionally manipulated, and how to shut down the abuse.
By Stephanie Sarkis, Ph.D.
What Is Gaslighting?
Gaslighting is a form of psychological or emotional abuse — a series of manipulative techniques designed to gain control of another person. By blatantly and repeatedly lying or challenging reality, the gaslighters keep their victims off-kilter and make them question themselves. Many times, a person’s diagnosis of ADHD is used against him or her by the gaslighter. I have been a therapist for 20 years, and lately I have seen more and more clients with ADHD reporting being gaslighted in their relationships and at their jobs.
One of the best defenses against gaslighting is to educate yourself about this kind of emotional abuse. Adults with ADHD may be more vulnerable to gaslighting due to issues with self-esteem, difficulty with past relationships, and feelings of guilt and shame. Know that there is hope, and you can rebuild your life after living with gaslighting for months or even years.
Gaslighting Behaviors
Gaslighters sometimes hide their partners’ belongings and blame their partners for being “irresponsible,” “lazy,” or “so ADHD” when they can’t find the items. A gaslighter may also tell their partner that they don’t need to take medication for ADHD because “I know what you need better than some doctor does.”
Gaslighting behaviors include:
Telling you that you didn’t see or hear something
Cheating often, but obsessively accusing you of cheating
Saying that other people think you are crazy
Pitting you against people (this is known as “triangulating”)
Idealizing you, then devaluing you, and finally discarding the relationship
[Take This Self-Test: Emotional Hyperarousal in Adults]
Why and How Gaslighters Target People with ADHD
Gaslighters sense vulnerabilities in a person. They specifically target people who are grieving a loss or who feel inadequate or isolated. If you have ADHD, you probably grew up with the feeling that you were “less than.” You may have had difficulties maintaining friendships or relationships. You may have been dismissed by others who said you were “difficult.”
When you meet a gaslighter for the first time, he or she will do something called “love bombing.” They will tell you everything you have wanted to hear from someone, especially after a lifetime of rejection. The purpose of the behavior is to hook you. Once you are committed to the relationship, the gaslighter begins abusive behavior.
Early on, the gaslighter asks you about your fears and inadequacies. It feels good to have someone listening to you and caring about what you have to say. However, the gaslighter is gathering data to be used as ammunition against you later. You may eventually hear, “No wonder your sister doesn’t talk to you anymore. She knows you’re crazy, too.”
If you leave the relationship, the gaslighter will “hoover” — drawing you back. They will send messages through friends and family that they miss you. They will promise you the world, but will never apologize. They don’t think they did anything wrong. The threat of losing their ability to manipulate you motivates a gaslighter to get you back in their clutches. But once you return, everything promised to you disappears, and your relationship becomes more abusive than before.
How to Escape Gaslighting In a Relationship
For most people, leaving a gaslighting relationship means “no contact — at all.” Block phone numbers and email addresses. Tell friends and family that you will not listen to any messages sent through them. You should also meet with a licensed mental health professional; having ADHD makes you vulnerable to anxiety and mood disorders. Set up and follow through with an ADHD treatment plan, and re-establish connections with the healthy people in your life. If you have children with a gaslighter, meet with an attorney to establish a detailed parenting plan.
https://www.additudemag.com/gaslighting-adhd-adults-women-risk
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