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The Legitimacy of ADHD

When I was younger, I used to hear about a child being ADHD and think it was just an excuse for the child being hyper and not listening. Boy was I wrong! I never realized until I began working with kids in the schools who had ADHD that it was a legitimate diagnosis. And then after having a child of my own with ADHD, I learned even more about the intensity of the disorder.

Attention-Deficit/Hyperactivity Disorder, are more commonly known as ADHD, is a brain disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. But it’s not quite as black-and-white as the definition sounds. For many years, research showed there were clear structural differences in the ADHD brain. The largest review ever of ADHD patient brain scans was carried out at Radboud University Nijmegen Medical Centre and published in 2018. Researchers reported that people with ADHD had smaller brain volume in five subcortical areas, and their total brain size was smaller, too. These differences were greater in children and less in adults. Another interesting finding was that the amygdala and hippocampus are smaller in the brains of people with ADHD. These areas are responsible for emotional processing and impulsivity and had previously not been definitively connected to ADHD. Parts of the ADHD brain mature at a slower pace (approximately one to three years) and never reach the maturity of a person who does not have ADHD.

The brain is a busy communication network where messages are relayed from one neuron (brain cell) to the next. There is a gap between neurons, which is called a synapse. Imagine 2 people talking into an empty, hallow can connected by a string. In order for the message to be passed along, the synapse needs to be filled with a neurotransmitter. Neurotransmitters are chemical messengers, and each one is responsible for different functions.

tin-can-telephone

The key neurotransmitters for ADHD are dopamine and noradrenaline. In the ADHD brain, there is dysregulation of the dopamine system. For example, there is either too little dopamine, not enough receptors for it, or the dopamine is not being used efficiently. Stimulant medications help ADHD because they encourage more dopamine to be produced or keep dopamine in the synapses longer. This is why people with ADHD can become calm and relaxed by drinking coffee.

There are several types of brain imaging techniques such as single-photon emission computer tomography (SPECT), positron emission tomography (PET), and functional magnetic resonance imaging (fMRI) that allow researchers to study how the ADHD brain operates and functions.

adhd-brain

There are variations in blood flow to multiple areas of the brains in people with ADHD compared to people who do not have ADHD, including decreased blood flow to certain prefrontal areas. Decreased blood flow indicates decreased brain activity. The prefrontal area of the brain houses the executive functions and they are responsible for many tasks including planning, organizing, paying attention, remembering, and emotional reactions.

One study published in 2010 found that children with ADHD do not have the same connections between the frontal cortex of the brain and visual processing area. This means that the ADHD brain processes information differently than a neurotypical brain.

So, if you can easily see the difference in an ADHD brain vs a neurotypical brain, then why is ADHD not diagnosed via a brain scan? Well, as Dr. Thomas E. Brown explains in his book, “A New Understanding of ADHD in Children and Adults: Executive Function Impairments,” tests such as PET and fMRI scans give an insight into how the brain is functioning at the moment the test was performed. Like a photo, they capture one moment in time. However, they do not take into account how the brain operates in different situations, in the way a clinical test can during a detailed interview.

There is no objective test to diagnose ADHD. Instead, a detailed evaluation is carried out by a clinician. It includes an in-depth interview with the patient, a review of school reports and medical history, and possibly tests to measure attention, distractibility, and memory. With that information, the clinician can determine if the diagnostic guideline for ADHD set by the Diagnostic and Statistical Manual of Mental Disorders (DSM) is met.

Now in it’s fith edition and known as the DSM-5 (this is the first edition that does not use a Roman numeral), the publication doesn’t offer treatment or medication advice for the 157 disorders described in it’s pages. Instead, it was designed to help healthcare professionals better identify and diagnose mental disorders that impact personality, cognitive functioning, mood, and identity. The manual also provides uniform diagnostic codes for each issue which are used for medical billing and data collection. Without the proper coding listed in the DSM-5, US health insurance companies will not cover treatments and/or medication costs.

The DSM-5 is primarily used in the USA where as most of the rest of the world turns to the World Health Organization’s (WHO) International Classification of Disease (ICD) which covers all diseases, not just those that are phychiatric in nature. American Psychological Association (APA) encourages healthcare professionals to consider DSM-5 and ICD as, “companion publications,” designed to be compatible with each other.

I recently did a course on International Open Academy on ADHD (thank you Groupon) and learned that there are gender specifications of how ADHD presents itself. According to the APA in 2013, 5% of school-aged children are affected by ADHD and the ration from boys vs girls is 2:1. Historically, ADHD was thought to be a disorder that mostly affected boys since boys tend to be diagnosed at a much higher rate. Checklists, rating scales and treatment protocols tend to focus on the typical male presentation of ADHD. Research suggests that ADHD may occur almost as frequently in girls as in boys but may be underdiagnosed in girls. The discrepancy in diagnosis is thought to be due in part to the way the symptoms manifest in girls and biases in perception and referral. Boys tend to display symptoms of hyperactivity/impulsivity, the kinds of behaviors that draw attention. Girls are much more likely to present with inattentiveness/forgetfulness and be seen as more distracted or day dreamers.

Even girls with ADHD-hyperactive type tend to display less physical energy than boys. Girls are more likely to display behaviors such as chewing on their clothes or hair, being overly talkative or being more emotionally reactive. Girls also tend to try and cope with their symptoms by immersing themselves in tasks that they can do well. This outward appearance of success can be deceiving and mask problem behaviors. As a result, their struggles don’t immediately garner attention.

Unfortunatly, due to the way ADHD symptoms are presented in girls, they are often time misdiagnosed and 3 times more likely to have been previously treated with antidepressants and were reported as having difficulty with school work and having a strenuous relationship with their parents.

When a child receives a diagnosis such as ADHD, treatment is a family process. Every family member is impacted in some way and it takes every family member working together to manage it successfully.

Create Structure

Structure means establishing and maintaining a daily routine. Knowing what is coming up helps to keep anxiety in check and creates consistency. Establish simple routines for mealtimes, playtime, homework, bedtime, etc. Give your child specific tasks such as setting the table or laying out her clothes for the next day.

Have a Set Bedtime

Sleep is sometimes difficult for children with ADHD. Poor sleep can exacerbate their symptoms. Establish an evening bedtime ritual such as a bath or story and a firm ‘lights out’ time.

Break Things Down

Children with ADHD can easily become overwhelmed with too many instructions or tasks. Be specific in what you say. Break instructions or information down into smaller pieces. Instead of saying, “Go brush your teeth, put your shoes on, grab your book bag and meet me at the door”, you may have to break the steps down to one or two at a time.

Make It Visual

Consider using a big, colorful calendar, cute checklists or behavior charts to help your child remember to do things. Even young children can benefit from visual cues such as pictures or symbols.

Create Quiet Spaces

Children with ADHD are often quite distractible. Create quiet spaces for homework, reading or just relaxing. Ideally, this is an electronics-free zone as electronics can overstimulate and exacerbate impulsivity.

Practice ‘Stop, Think and Go’ Style Activities

Learning to control impulses is a key skill for some children with ADHD. Children’s games such as pick-up-sticks, Simon Says, Red Light-Green Light, and Jenga rely on those skills to be successful. Do homework with your child. Ask questions that require a thoughtful response.

 

Help Your Child Be Organized

Organization is key for children with ADHD. Use a homework planner. Pack her book bag together the night before. Have a designated pace for homework and establish a routine for picking up and putting away personal belongings.

Manage Behavior

Learn effective behavior management strategies. Ideally, you want to encourage positive behaviors. Reward with praise such as “I like how you put your books away when you finished.” Sometimes your child will break the rules. Be flexible but consistent in holding them accountable. Mistakes are often perfect teachable moments.

If your child has the diagnosis of ADHD, they have the right to be on a 504 Plan and accommodations in the school. Examples of some accommodations for a child with ADHD would be to sit at the front of the class, space between the child’s desk and the desks of the other students, written daily schedule or picture schedule, extra set of textbooks to keep at home, and breaking lessons down into sections, etc.

Knowing how to best help your child succeed in the classroom and at home will help them be able to become a successful adult. Adults who struggle with ADHD who were not properly guided or went undiagnosed as a child will struggle with a multitude of challenges. These challenges are, but not limited to:

  • Lack of focus
  • Hyperfocus
  • Time management skills
  • Disorganization
  • Forgetfulness
  • Impulsivity
  • Poor self-esteem
  • Emotional regulation
  • Lack of motivation
  • Anxiety and restlessness
  • Fatigue
  • Poor relationships

If you suspect your child may struggle with ADHD, bring your concerns to their doctor and request a DSM-5 be done. If your child does indeed have ADHD, help them learn essential life skills to become the best and most successful version of themselves that they can be. It will also require a little extra patience on your end as they find their new normal.

-The Lazy Mama

 

 

Naming My Trauma

*****TRIGGER WARNING AND EXPLICIT CONTENT: SEXUAL TRAUMA*****

 

 

This post is very personal and has been something I have been wanting to discuss for a long time but was too afraid to do so. However, I have decided to take back the power and choose to protect others.

I will not be naming this individual. Not because I am protecting HIM, but because I am protecting the loved ones who he has left behind. I do not wish to ruin the good memories that those people have of this man, nor do I wish to cause them any pain by realizing a man they once loved and looked up to was capable of doing something so awful.

With that being said, I will be referring to this individual as Mr. RF.

Mr. RF was an older man in my life with strong ties to my family. He was trusted and loved as an elder to my parents. He was someone who I loved and trusted. He was not someone who anyone would expect to be a red flag person.

Before I go into what happened to me, I want to first explain WHY I am choosing to share my experience.

With the recent #MeToo movement, more and more sexual assault survivors have come forward to share their experiences and call out those who have done them wrong. According to childtrauma.org, 1 out of 3 females in the US, and 1 out of 5 males, have been victims of sexual abuse before the age of 18. And according to the American Academy of Experts in Traumatic Stress (AAETS), 30% of all male children are molested in some way, compared to 40% of females.

Sexual Abuse Statistics

Based off of statistics of the criminal justice system, only 230 out of 1,000 sexual abusers get reported. That means that a staggering 770 offenders go without consequences, allowed to be able to go on and continue hurting others.  My guess as to why this is happening is because either:

  1. The victims are scared of what the abuser will do to them or someone they love,
  2. The victim is afraid no one will believe them, or
  3. The victim has already told an adult but the adult did not believe it was true.

A friend of mine introduced me to the terminology of Red Flag and Green Flag people based off of the book, I Said No! A Kid-to-kid Guide to Keeping Private Parts Private by Kimberly King. I immediately went to our local library and rented this book. I sat down with my son, who was 4 at the time, and we read all about what it means to be a Red Flag person and a Green Flag person.

A Red Flag person is someone who is dangerous and means you harm. Someone who asks to see your private parts, shows you their private parts, or touches you in a manner that is inexcusable.

A Green Flag person is a safe person. Someone who protects you and who you can trust to tell if something or someone has hurt you. People like a parent, family member, doctor, therapist, or teacher.

The book also goes into how some people who are supposed to be Green Flag people, are actually Red Flag people. Unfortunately, that was the case with me and is, sadly, also true for most children.

I Said No! covers a variety of topics, including:

  • What’s appropriate and with whom.
  • How to deal with inappropriate behavior, bribes and threats.
  • When and where to go for help, and what to do if the people you’re turning to for help don’t listen.
  • Dealing with feelings of guilt and shame.

Making sure that your kids, and every child you know, understand that if anything ever happens to them, that they can come forward and tell you, knowing that you WILL believe them, is the most crucial thing you can do for the health and safety for your child(ren).

When I was an adult and told my mother about my experience, she believed me and felt awful. But what made it worse for her, was that she had absolutely NO memory of the fact I had told her right after it had happened.

Mom, I love you dearly and I by no means hold any anger or negative feelings about that. So, please forgive yourself. It was not your fault, just like it was not my fault.

I remember exactly what happened to me. I remember the exact house (we moved around a lot), the exact part of the house, the way the house was set up, and what my mom was cooking at the time that I was assaulted.

I have very few memories of my childhood, though I am told that it was a good childhood. Often, that fact makes my father sad. But I remember that day vividly.

And I was only 7.

My dad was sitting opposite of Mr. RF with my brother in his lap. I was sitting on the armrest of the couch, leaning on Mr. RF who was sitting to my left. My mom was in the kitchen with Mr. RF’s wife talking while she was cooking minestrone soup in a large stock pot on the stove.

Mr. RF had his arm on my right hip. He eventually moved his hand over the small of my back, then he had his hand inside of my pants, rubbing my bottom. I didn’t think much of it at the time because this person was supposed to be a Green Flag person. Yes, it was weird, but again, he was a “Green Flag.”

That is until I felt his fingers slide down and get closer to my vagina. I squirmed to try to get his fingers away from there but he then forced them through my labia and up my vagina.

I immediately got up and ran to the kitchen to tell me my mom who, if you remember, was in the kitchen with his wife. She gasped in shock, looked embarrassingly over to Mr. RF’s wife,then back to me and said, “Alyssa! That is not funny! Never say something like that again!”

So, I never did.

At 7 years old, I learned to never put myself in a situation where I was alone with him, never to sit near him, nor did I ever go out of my way to have any form of communication with him as to prevent anything from ever happening to me again.

It wasn’t until after I had had my first c-section that I had voiced my trauma again. Having been partially strapped down to a table, having no feeling and no control over my body, and a stranger touching my vagina to insert the catheter, I was having a lot of anxiety and flashback emotions of not having control of my body enough to protect myself that day when I was 7 years old.

You may wonder why I am choosing to come forward so publicly, and to answer you, is because I don’t want to be another statistic. And I most certainly do not want my children to become one as well.

While my attacker has long since died, I have only now been able to start my emotional healing. All because of having an older man from my son’s bus stop, last school year, grab my ass and try to kiss me. My anxiety attacks started up again and I once again felt the crippling fear of my childhood coming forth every night I closed my eyes. It was what forced me to seek help from a Sexual Abuse Therapist. As a result of starting therapy, I began to heal from my trauma.

I have only recently opened up to my father about what Mr. RF had done to me and how that has affected my relationship with him. He had no idea and was very angry and pained by my revelations. Only now, he understands why I have a difficult time with showing and receiving affection from him. That it has nothing to do with him, but everything to do with who my attacker was in relation to him.

As stated before, Mr. RF has passed, but the ones he loved have not. And since they loved him in return, I chose to protect those individuals and allow them to keep their positive memories, untainted by the evil that I have endured.

The most important thing we can do is listen and trust our children, or anyone’s child, when they come to you for protection. Make sure that they know you can ALWAYS be trusted and that you will ALWAYS keep them safe.

Even if it’s from someone you love.

-The Lazy Mama

When The Dust Settles

Often times when we are so busy focusing on others, we neglect ourselves. Our own problems fall to the wayside as we put all of our thought and energy into helping someone else. After all, it is Mandy Hale who said, “There is nothing more beautiful than someone who goes out of their way to make life beautiful for others.”  But what about putting the plane’s oxygen mask on yourself before helping put it on the person(s) beside you? I don’t know about you, but I definitely struggle with taking care of myself. I prefer to be the care taker and help those around me, especially those whom I love. And that is exactly what I did.

Now, this will be a two-part post. I will briefly touch on what the second half will be about, but it is a sensitive topic and I am still working through how I will be handling the subject in a way that will not hurt others who are still unaware of my experience. However, I feel that both of these topics are vital in not only my own mental health, but hopefully in one of your’s as well.

With that being said, I have a childhood trauma that I never dealt with. I pushed it to the back of my mind and never thought of it again. I did my best to never think about it and I had done pretty well at succeeding in doing so. The few times it would present itself, I would focus on other people or events in my life. It didn’t start coming back to me until I had Killian. But then I had my HBC trauma and a newborn to put all of my focus on. So, yet again, I continued to ignore my childhood trauma.

When it started to come back again, I had just had Oliver and that happened to be the same time when Killian’s Autism began presenting in full force. Fighting with Dr. D-Bag and learning how to advocate for my son took lead. And that fight lasted a year and a half. I put my entire self, everything I had, into getting the answers I knew were there and pioneered to get the therapies, doctors, and tests needed to get to where we are today.

It wasn’t until March or April of this year (2019) when something happened to me that caused all of it to come flooding back. I couldn’t even pick up Killian from the bus stop without having a massive anxiety attack every time. One of the other bus stop moms was great at staying by my side after I had opened up to her about what had caused my trauma to come flooding back. It had gotten so bad that I could not sleep at night (more-so than normal), and I would often cry every night as images flashed through my mind as I lay in bed reliving my nightmare over and over again.

I wasn’t able to push it away anymore. Our medical life had begun to calm down. Results had come back, therapies were in place, medications were being figured out, and support surrounding Killian’s Autism diagnosis were established. Things were finally, “calm.” I didn’t have anything else to pull my attention away from myself. I was essentially being forced to put on my own oxygen mask. I was suffocating and I needed to do something about it.

I decided it was time to open up to one of my cousins and ask her if she had experienced the same thing I had. Thankfully, her answer was no. She encouraged me to seek help when I had mentioned that I was going to look for a therapist. I had talked to Killian’s behavioral therapist about it during one of my parent sessions and she recommended her office-neighbor, Pamela.

I was going to meet Pamela once every 2 weeks but after doing a wellness check with my primary doctor and, for the first time, opening up to her about what had happened to me, she told me she wanted me to see my therapist once a week instead. Pamela agreed and thought that once a week sessions would be more beneficial.

In each of our meetings we talked about how I had opened up to my mom after having Killian and told her about what had happened to me but that my dad did not know. I was too afraid of my dad finding out and hurting him. I didn’t want him to feel guilty that he was unable to protect me when I was little or cause him any anger over what had happened. But as my sessions continued, I felt that it was imperative for my healing process to open up and trust my dad with my pain.

I had only seen Pamela 6 times before I sat down with him and had a very emotional conversation about my experience. As you can imagine, it was very hard. I cried, but ultimately it brought us closer and allowed him to see why I behave the way I do in certain situations.

A friend of mine recently had her son tested and he came back positive for Autism Spectrum Disorder. This was not news to any of us as we knew he would be, but what did come as a surprise was the severity of his Autism. A couple weeks after receiving his diagnosis, the shock had worn off and she reached out to me asking if I had been hit with the grief of the “what could have been’s” and I answered her with my story. Because Killian has high functioning Autism like I had suspected, I didn’t have the grief but more of the “haha I told you so” feelings directed at Dr. D-Bag. But I did have the memories of my past rearing its ugly head at me that I could no longer ignore. She shared with me that she had a similar experience in the fact that her mother had been an alcoholic and even though she thought she had put those feelings of pain and hurt to rest, experiencing those same memories as a mother ripped open old wounds. She realized that she too was at a point in her life where she was needing to put on her oxygen mask and put herself first.

Caring for others is great, as long as we are caring for ourselves in turn. Finding the balance between the two can be difficult. I firmly believe in the fact that every person, young and old, should be in talk therapy. We all have issues that we need a neutral person to help us work through. Whether it be from our past or something that we are currently going through, intense trauma, or disputes among colleagues, family, or friends, we all need someone who can help us put things into perspective and help us heal.

So, when all is said and done, be cautious of the dust that settles. Once you no longer have someone or something else taking up your undivided attention, it may be the time that your mind decides to perk up and remind you that it is needing some attention. Call around and find a trained therapist who can help you work through it. (I personally like to reach out to my local moms groups on Facebook to get recommendations for doctors and therapists) And if you don’t have any past or present traumas? Good for you! Still call and find a therapist. If anything else, it will be a mandatory self care hour. Something that we are all in desperate need of.

-The Lazy Mama