Welcome to Our Electronic Book on ADHD

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Martin L. Kutscher, MD
Assistant Clinical Professor of Pediatrics and Neurology,
New York Medical College, Valhalla, New York.
Pediatric Neurological Associates, White Plains, New York.

Introduction

Chapter 1: Full Spectrum of ADHD Problems

Chapter 2: Printable Checklist of ADHD Symptoms

Chapter 3: Home Therapy--Just STOP!

Chapter 4: School Therapy

Chapter 5: Medical Therapy--Ritalin and other Medications

Chapter 6: Cognitive Therapy--How to Talk through a Problem

Chapter 7: Personal Philosophy for Understanding Others

Chapter 8: What Does It Sound Like to Have ADHD: A Simulation

Chapter 9: For Kids to Read.  "What Happened to My Brakes?"

Chapter 10: Summary of ADHD Problems and Treatment

Chapter 11: Pop Quiz on ADHD (Hint: You only need to have read Chapter 10)

Chapter 12: References, Suggested Readings, and Links

[Short on time: read Summary Chapter 10 first, then Chapter 3.]

 

 Disclaimer: This Web site is presented as a resource to patients by Pediatric Neurological AssociatesThere are no commercial sponsors.  This information does not constitute medical advice; nor is it a substitute for discussion between patients and their doctors.  The views of cited references do not necessarily represent  the views of our staff.

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Excerpts from Chapter 9:

"Hey, What Happened to My Brakes?"

                                        

Imagine this:  A kid is on a bicycle speeding downhill. The world is whizzing by.  He needs to avoid holes in the pavement. The road is curving. The wind buzzes in his ear, and makes his eyes tear.

Suddenly, there are rocks in the road. He goes to put on the brakes—but they don’t work!! As the bike speeds downhill, just staying on it seems overwhelming.  Too many obstacles call for the rider’s attention. So much seems out of control. Who has time to pay attention to the huge truck coming up?

That’s the life of someone with Attention Deficit Hyperactivity Disorder (ADHD).  It all comes from difficulty “Putting on the Brakes,” to borrow the title of a book by Patricia Quinn and Judith Stern.

Here’s what’s happening.   Your brain’s “boss” is located just behind your forehead.  These frontal lobes figure out where you want to go, and the individual steps of how to get there.  Like any boss, a large part of their job is saying “no.”  For example, parents are supposed to be the boss in the house.  Think how often their job is to say “no.”  They’re always saying things like, “Susan, do not have a fifth scoop of ice-cream,” or “Bob, stop playing Nintendo so that you can do your homework,” or “Jill, don’t stay out past 10PM.”  Unless something puts brakes on our actions, we would spin out of control.

Well, at least that is how it is supposed to work.  Dr. Russell Barkley explains that for ADHD people, the front part of their brains—the boss—doesn’t do a good job of putting on the brakes. This means that these people may:
bulletHave trouble putting brakes on distractions. Their minds are pulled off the main topic by any competing action.  This leads to the “Attention Deficit” of ADHD.
bulletHave trouble sitting still rather than checking out those distractions. This leads to the “Hyperactivity” of ADHD.
bulletHave trouble putting brakes on any thought that comes into their minds. There is trouble putting brakes on frustrations and over-reactions. This leads to “impulsivity.”

No wonder things go out of control so often!

 

Why Don’t I See Problems Coming?

 

Let’s imagine another scene:   Jack is on a boat, happily fishing.  Reeling in the jiggling fish while still steering the boat captures all of his attention. 

 

This is what Jack sees:                                    This is what everyone else seems to notice:

 

                     

 

Jack is so consumed by the experience of the moment (catching the fish) that he can’t look ahead to see the waterfall coming up. It’s not that he doesn’t care about the cliff. After all, he doesn’t want to fall off a cliff any more than anyone else.  It’s that he never gets the chance to see it. Just like the speeding bicyclist, ADHD kids often are stuck in the present moment. The future comes as a surprise. This is called a lack of “foresight.” So, people with ADHD:
bulletHave trouble stopping long enough to consider what is best for themselves in the future. This often gets misinterpreted as not caring.
bulletHave trouble stopping long enough to consider what is best for other people. This often gets misinterpreted as being selfish or mean.

 

What other Problems Are Common for ADHDers?

Teachers, parents, and friends may notice many other problems for those who have ADHD. Often, these problems are not recognized as just being part of ADHD. These people might also:
bulletBe very disorganized. They often don’t get the right assignments home.  Even more amazing, they may do homework and then forget to hand it in!
bulletFind that other people seem to take forever to eat, shop, or get to the point! Time seems to move so slowly in these settings.
bulletHave trouble with arguing, blaming others, or even lying.
bulletSometimes have “blow ups” over unimportant things.
bulletYell at people who are trying to help them.
bulletHave trouble noticing how other people are reacting to them. After all, who’s got time for that?
bulletHave a sense of always being nervous or worried.
bulletHave trouble with handwriting, or sometimes with other school subjects.

 

What Can We Do About It?

Dozens of books have been written about helping ADHD, including books by Drs. Ross Greene and Thomas Phelan.  Here’s some of the best advice:
bulletJust STOP.  Remember, the problem in ADHD is difficulty putting on the brakes.  First, we need to keep an eye out for the warning signs that our brakes aren’t working—and that we are spinning out of control. The warning signs include getting angry, sensing that we are getting overwhelmed, raising our voice, and tightening our hands.  When we first notice these warning signs of getting “over-heated,” we then need to try extra hard to STOP. Work out a code word or phrase, such as “I need a five-minute time-out” with people you are close to. Go someplace quiet, such as your room. Don’t worry about getting in the last words in the discussion. (You’ll get a chance later.)  Do something calm like reading a book, sorting cards, etc. Once you are calm, then come back for a useful discussion of the problem.  People around you should do the same thing. Sometimes, you may not notice—or may not want to notice—the warning signs. Then please, please, please listen to others when they ask you to STOP and take a five-minute break.
bulletMake decisions when you are calm. You’ll be surprised how much easier it is to reach a good decision when you and everyone else is calm. People cannot think clearly when they are over-excited. Returning to our bicycle example, wait until the bicycle coasts to a stop. Then, look around and calmly consider your options.
bulletRealize that your parents and teachers are usually good at preparing for the future. In the bicycle story above, your parents can be thought of as standing on the sidewalk, watching you speed downhill.  Since they are not overwhelmed just trying to stay on the bike, they have no trouble looking ahead to see the truck coming.  They’re screaming, “Watch out for the truck!” or “Watch out for that cliff,” or “Watch out for that book report due in two weeks.”  A parent’s foresight is typically much better than that of their ADHD child. Listen to them. Please.  If nothing else, it’s probably fair to say that your parents usually try to act in your best interest.
bullet People with ADHD typically need help with organization. Take it. Remember, it is not fair to yell at someone who is trying to help you!
bulletYour doctor may prescribe medication with “stimulants” (such as Ritalin, Concerta, Adderall or Dexedrine). These medications stimulate your frontal lobes, making them perform better. Let’s return to the bicycle story. Medications like Ritalin work by stimulating the stopping power of your brakes.  You find yourself in less trouble because you now have a high performance bike, which is complete with a braking system.  It does not work by making you too tired to move around.
bulletKeep a good attitude about yourself. Remember that ADHDers also have many great traits. They know how to have fun and enjoy the present moment. They are often quite smart, very creative, and have a “why not try it?” attitude that is the envy of many people.  We always need to keep in mind all that is wonderful about you.
bulletGood luck!

 

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Disclaimer: This Web site is presented as a resource to patients.  It does not constitute medical advice; nor is it a substitute for discussion between patients and their doctors.  The views of cited references do not necessarily represent  the views of our staff. This information was last modified 08/31/03.

 

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