ADHD Answers

How do I know if I have ADHD

Dear Thanos, First of all I want to commend your remarkable insight that led you to seek support here on BetterHelp. As you may know from experiencing issues with attention, ADHD is often co-occurring with anxiety, meaning that individuals with Attention Deficit Hyperactivity Disorder (ADHD) or Attention Deficit Disorder (ADD) are more likely than the general population to experience anxiety.  Unfortunately, BetterHelp therapists aren’t able to provide diagnoses, nor can we prescribe medication. However, here are a few ways your counselor here can help (in addition to your seeking diagnostic and medication support elsewhere – like starting with your primary care provider and seeking referrals to local providers): - Learn more about ADHD and ways to cope and understand how to change your environment to help you be successful at work, school, and in social situations. - Learn about the links between anxiety and cognition. From what you wrote, it sounds like these symptoms are not new for you (but certainly much more problematic right now). A few decades of social science research have helped us understand that our thought patterns and how we consider the world and events lead to specific emotions. Your therapist can teach you more about the cognitive model and describe some practical tools to change the maladaptive thought patterns (in other words, the ways of thinking that keep bringing you down). There are so many practical ways to get started with this work, and it can help strengthen you throughout your life. In the mean time, you can learn more by watching a Groupinar on BetterHelp about Cognitive Behavioral Therapy to start learning about the links between anxiety and cognition. - Learn more about anxiety in general. Physical sensations like increased heart rate, sweating, feeling overwhelmed and panicked are signs of your fight or flight response. This is an evolutionary function of our sympathetic nervous system that helps our bodies prepare for dealing with predators (either to fight or flee). In addition, you may feel your muscles tense up and a surge of energy as glucose and adrenaline are released into your bloodstream. The fight or flight response makes a lot of sense if you are dealing with a physical threat, but it does not help us much when our threat is a work deadline, being late for an appointment, meeting a new person, poor internet connection, or other modern stressors. Indeed, too much of the fight or flight response causes stomach upset, muscle tension, bad mood, trouble sleeping, and eventually even lowered immunity (do you ever notice how college students always get sick right after final exams?). - Disrupt intense fear or the fight or flight response with deep breathing. Learning deep belly breathing (or “diaphragmatic breathing) is a great tool to add to effective stress management. Taking time to breathe deeply for a few minutes is a free and easy to learn method to take you out of the fight or flight zone and into a zone where you can think more clearly and not experience those side effects. You can Google “deep breathing” or “diaphragmatic breathing” to start learning a technique that really helps most people. You can find mobile apps to help (for example the Breathe2Relax or the Virtual Hope Box app – both are free and evidence-based) or watch videos online that can walk you through it. These are skills that not only help you now, but can assist you throughout your entire life (for example, dealing with road rage, poor customer service, annoying family). You can also disrupt the fight or flight response in the moment with just a minute or two of intense exercise (for example, push-ups, jumping jacks or walking up and down a flight of stairs). This helps use some of the adrenalin and glucose that are released into your blood stream when you have encountered a stressor and leaves you thinking a bit more clearly. - Try to identify triggers. We are creatures of habit, and we tend to be afraid of consistent things. Unfortunately, the more we avoid a fear, the stronger that fear gets (avoidance is like fuel for fear). As such, it is important to start learning about the common themes of what makes you anxious. Is it a fear of being judged? A fear of failure? A fear of not being loved or admired? Everyone is different. The best way to do this is to start keeping a log of the times you experienced the fight or flight response. Jot down in a journal or in an app like Google Keep these times, including: -- What was the triggering event? -- How long did it take to calm down? Over time, your therapist will likely recommend that you also track “what was the automatic thought,” or the instant thought that just popped in to your mind that might have made you feel even worse (such as “everyone here is going to hate me.” Or “They all think I’m stupid.” Or “I need to determine my life’s purpose or else I’m a failure.”) Your therapist can help you identify themes and come up with alternative cognitions or thoughts to battle these automatic thoughts. - Learn more about social anxiety. It is completely normal to feel anxiety around new people or people we already know. Often this stems from a worry about being judged or about being disliked. It seems like social anxiety has increased dramatically since the onset of the COVID 19 Pandemic since many of us have had more limited interaction and spending time with strangers was *literally* unsafe prior to vaccines (and even since then for some). As such, it is important to know that you are not alone in this. When you see people walk into a social situation with a smile and a warm handshake, often they are employing the “fake it ‘til you make it” approach. Further, we live in a society that makes us all feel like we need to be extroverts, whereas it is just fine to be a person who only needs a few close friends instead of a large group. Oftentimes when we are in our 20s we start to recognize whether we are the kind of person who feels recharged after spending time with others (extrovert) or who feels recharged after spending time alone (introverts). There is no one right way. - Reducing symptoms of trauma. This may include nightmares, intrusive thoughts, feeling like you are constantly in danger (“hypervigilance”), and other not-so-fun ways that our brains are trying to protect us. Your Better Help counselor will be able to help you understand these symptoms and use evidence-based methods to reduce them. While waiting, you may want to look at the free app made in the VA: PTSD Coach to start learning about the effects of trauma (it’s an app that is free for everyone; not just military combat veterans). You may not have any traumatic events in your past, but I’m noting this one just in case :) - Coping with loneliness and increasing your social network. It’s possible that you have fallen in to a fantastic friend group and that this isn’t a problem for you, but if you are lonely and needing help increasing your social network, this is another great task your therapist can help with. Further, your therapist will be kind and empathic – the kind of person you can tell anything. Sometimes just being able to open up can help us feel so much better (especially if you are having trouble trusting others). Bottom line, there are ways to feel better. Even if you just start with one of these ideas, you and your therapist can collaborate to help you cope and function better. I am wishing all the best for you and hope the next years bring you happiness and joy! Best regards, Julie   Note: If you are in crisis and feeling like hurting yourself, please call 911, go to your closest emergency department, or call the suicide hotline (the National Suicide Prevention Lifeline) immediately at 800-273-8255. You could also go to their website to chat at https://suicidepreventionlifeline.org/.    
Answered on 07/26/2022

What is the recommended ADHD therapy/counseling

Hello RM, thank you for your question. I understand that you have been diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD) as an adult and tried therapy to help manage some of the problems. However, you say that it has not been efficient for you. I understand the struggle and frustration when this happens. When you feel that your treatment is not working the first place to start is to talk to your therapist. He or she may be able to adjust their therapeutic approach, add more homework, teach more skills, change the treatment or refer you to someone else. It's completely ok for you to ask questions and to say that you are not improving. Having this discussion may help you start to see results without having to start over. It’s also important to note that much like a medical condition, often times the first treatment may not work, but you wouldn’t give up trying a different treatment for a medical condition if the first one didn’t work. Most people keep trying until they find the one that works for them. This is the same when it comes to mental health conditions.  It's hard to say what type of therapy is most effective for ADHD because it really depends on each individual person. Studies have shown that Cognitive Behavioral Therapy (CBT) has worked for many individuals with ADHD. Cognitive Behavioral Therapy provides you with skills that teach you to manage a lot of the behavioral problems that ADHD creates for you along with learning to manage thoughts and feelings that create the problems. A good CBT therapist will help you create a plan that targets problematic behaviors that affect your work, relationships, and overall performance. The therapist will consistently check in with you and make adjustments as needed. I also have to mention that for many people, therapy alone is not sufficient in treating ADHD. Many individuals require medication to help them manage the problems. If you are working with a diligent therapist, he or she will know when to refer you to a psychiatrist in order to determine if you would be a good candidate for medication. A combination of therapy and medication have shown to be the most effective treatment when it comes to ADHD.
Answered on 06/01/2021

Where mindfulness falls short

Mindfulness is a wonderful tool that is successful for people of many ages, across many cultures and spaces. Mindfulness is most commonly used in Western society as a non-religious type of meditation and grounding. Still, the roots of “mindfulness” are actually in Eastern religions like Buddhism and Hinduism. Mindfulness entails slowing down your thoughts and focusing entirely on the present, including what is happening in your body and directly around you. As quoted from https://greatergood.berkeley.edu/topic/mindfulness/definition, “ Mindfulness also involves acceptance, meaning that we pay attention to our thoughts and feelings without judging them—without believing, for instance, that there’s a “right” or “wrong” way to think or feel in a given moment. When we practice mindfulness, our thoughts tune into what we’re sensing in the present moment rather than rehashing the past or imagining the future.” This can go wrong because some people really struggle to be in the present and to shut off thoughts and focus on one task. People with difficulty holding attention, such as those diagnosed with ADHD, may struggle to find the benefit of meditation because it might be a hard practice to learn and master. That does not mean it is impossible; mindfulness practice is helpful for most people and can be adapted for individual needs—many mindfulness meditations, including guided meditation or imagery, assist in relaxation and increase focus. People also go wrong thinking that mindfulness practices will work the first time. Many of the skills take repetition and practice to master. It is also not the best coping skill to use when you are already in a full panic attack or a hyperarousal state, as your body is resistant to calming down when it perceives a threat. Mindfulness is best practiced when you are feeling calm and have time to commit to it. That way, when you are starting to get anxious, the skills will be most effective and will be accessible to you. There are many uses of mindfulness that also include a physical component, such as doing deep breathing, stretching or yoga, or progressive muscle relaxation. For some people, particularly those who have experienced traumatic things in their lives, there may be a release of unwanted memories or feelings due to meditation and doing these exercises. The body carries a lot of our stress and repressed memories, and sometimes even the act of making your mind still might cause unwanted memories to flood back or cause tension in your body. If you experience these effects, it is probably a good idea to seek therapy to process what your body has been holding onto and get advice on handling any flooding or intrusive thoughts. 
(M.Ed, LPC)
Answered on 05/03/2021

Can childhood trauma cause adhd?

Childhood trauma, meaning trauma caused before the age of 18, can affect people in many ways.  Trauma shapes the way victims feel, think, and act.  One of the ways some persons who have been traumatized as children acting may see themselves behaving is similar to those who have been diagnosed with Attention deficit hyperactivity disorder, or ADHD.  Some persons who have experienced trauma may be diagnosed with Post Traumatic Stress Disorder or PTSD.  Symptoms that are shared between ADHD and PTSD are difficulty with keeping attention, poor impulse control, lack of focus, insomnia or difficulty sleeping, distractibility, impulsiveness, irritability, inability to concentrate, poor memory, anxiety, sensitivity to sensory stimuli, mood disorders, lack of self-esteem, and heightened likelihood to use or abuse substances.   Since ADHD and PTSD have many symptoms that are alike, it takes a mental health professional who is trained to properly assess if someone has ADHD, PTSD, neither or both.  If a person has both ADHD and PTSD, the question then becomes, which came first?  Unfortunately, there isn’t a large amount of research on this subject.  However, many experts suggest that PTSD, or trauma, causes ADHD in childhood trauma.  This is because if the child had ADHD first, he or she would have presented with these symptoms before the trauma.  However, trauma rewires the brain, affects development, and creates new habits.  Thus, a growing and developing child may cope in new ways after trauma than they had previously and respond differently to stressful stimuli.  Getting Help for Trauma, ADHD or Both If you have experienced trauma, most research suggests that psychotherapy is the most beneficial form of treatment.  There are numerous forms of trauma therapy that are evidence-based and can be discussed with a counselor.  Any counselor who is trained in trauma therapy should present you with all your options for trauma therapy, not just those that he or she is trained in or can provide to you.  If you suspect or have been diagnosed with ADHD, medication, and psychotherapy are considered a winning combination for treatment.  Working with a psychiatrist, your general practitioner, or doctor for medication is 50 percent.  The second half is working with a therapist to help improve coping and behavior skills.
(LPC-S, LCPC-S, MS)
Answered on 04/26/2021

I am looking for a therapy to cope with my compulsive daydreaming.

Hello! Thank you very much for your question.    I think that if you have already been diagnosed with ADHD and GAD then you know how difficult it is to manage those "what if" thoughts that can turn into full-on daydreams with the anixety and then also the distraction-based or impulsive daydreams with ADHD. Most people daydream, maybe even everyday. But, certain individuals possess the ability to daydream so vividly that they can experience their presence in the imaginary environment of their creation. While experiences of such vivid, active day-dreaming may seem odd to some, they’re extremely commonplace for a lot of people — and, in some cases, depending on a number of factors like severity and frequency, may suggest a psychiatric condition called maladaptive daydreaming, or MD. In addition, these individuals also experience constant compulsions to switch to the fantasy several times during the day, which has led experts to believe that it is a behavioral addiction. However, this is still an evolving area of research, and is yet to be formally recognized as a disorder by the American Psychiatric Association (APA). Those who suffer from this condition reportedly spend almost 60 percent of their waking hours in imaginary worlds of their own creation — but, without losing touch with with the real world, and realizing that it is a fantasy they are immersing themselves into.   MD is a form of dissociating oneself from the real world, and getting absorbed into fantasies and mental imagery comprising vivid alternative universes, usually involving elaborate scenarios — that the individual prefers over reality. People suffering from this condition consider it a disorder because it often interferes with the individuals’ social, academic or professional life, especially so, if they begin to replace human interactions with fantasy.   The fifth Diagnostic and Statistical Manual, or DSM-5, does not recognize MD. So, in the absence of DSM-5 criteria for its diagnosis, there is Somer’s Maladaptive Daydreaming Scale (MDS) to help determine whether an individual is experiencing MD — MDS is a 14-point scale that rates five primary characteristics of the condition: Content and quality (detail) of dreams; Individual’s ability to control their dreams and/or the compulsion to dream; Amount of distress caused by daydreaming; Individual’s perceived benefits of daydreaming; Extent of interference of daydreaming with the individual’s ability to carry out their daily activities. In addition to these, people may also be asked to rate how often they experience MD. Interestingly, researchers on the subject have noted that people suffering from MD also report higher rates of attention-deficit and obsessive-compulsive symptoms along with a history of depression and/or anxiety disorders (as is your presented case, I believe)— although experts are still not sure why.   Experts believe that MD is, generally, a coping mechanism in response to trauma, abuse or loneliness that leads the maladaptive daydreamer to conjure a complex imaginary world for them to escape into in times of distress, or loneliness, or maybe, even helplessness in real life. It is an escapist method of avoiding real interactions with families, friends or colleagues. Experts believe that cognitive behavioural therapy, or talk-therapy that helps people manage their day-to-day problems by changing the way they think and behave, can address their compulsive need to slip into their imagination. In terms of medication, one study had found that fluvoxamine, a drug commonly used to treat OCD, can help control MD as well, which tells me that you are on the right path with medication as well as seeking out CBT therapy. Over the years, a number of online communities of self-diagnosed maladaptive daydreamers have also emerged to help each other out. I think seeking out social supports either virtually or in person is a good defense against this daydreaming as well. If you are interacting with someone or doing something actively, there is less potential for your dayrdreams to take over or grow.   When the medical community formally recognizes the disorder, perhaps, there will be more streamlined and nuanced approaches to treating those held hostage by their daydreams — in fact, in 2014, a Texas student named Cyan Reed had even launched a petition on Change.org urging the APA to acknowledge MD as a disorder. As you stated, maladaptive daydreaming still isn’t an officially recognized condition, but it’s clear that people around the world are experiencing the same symptoms: the hypnotic movements, the plots and characters, and the crippling inability to focus on the real world. As a clinician, there is hope to find out much more about this condition and help the medical profession learn to address it.   I think in the meantime however structuring your day with activities, seeking out a CBT therapist on BetterHelp, engaging social supports, and reminding yourself that you are doing the best you can right now in these very trying times can help change your compulsatory daydreaming. I think meditation can also help, as it guides us to generally see the thoughts or images or feelings that pop up but then redirect our focus to something else. It is a difficult process to do--redirecting thoughts--but I think if you were able to practice this technique with meditation it would prove to be easier to access when the daydreams begin to arise and/or build.    I hope this helps! I trust you know that we at BetterHelp are here for you every step of the way. I wish you all the best! Take care :) 
(MA, LMFT)
Answered on 02/15/2021