a map in my own mind

I wrote a while ago about how to get up in the morning. But now I am reminded that it’s particularly hard to get up if you didn’t get enough sleep. I’m not talking about the get-to-bed-earlier issue, but rather what if you really don’t sleep when you think you do?

People with sleep apnea stop breathing while they sleep. According to SleepApnea.org, it could be hundreds of times during the night.

And your body, not wanting to DIE, wakes up a little to kick start the breathing.  You might not notice that little up-from-sleep place, but your day time performance could suffer.

My dad had apnea, although we didn’t know it back then. I just remember the stories about his snoring and then … stopping… So my mother would kick him to start breathing again.  Didn’t get her the best sleep either!

All kinds of things in life are worse with out sleep.

According to a report from the Institute of Medicine (IOM), and posted on the website of the National Sleep Foundation,

Less visible consequences of sleep conditions are far more prevalent, and they take a toll on nearly every key indicator of public health: mortality, morbidity, performance, accidents and injuries, functioning and quality of life, family well-being, and health care utilization.

And besides what you’d expect from not enough sleep–stuff like, oh, tiredness,no energy, irritabity and difficutly concentrating–it might also show up in  higher levels of depressed mood, anxiety, behavior problems, alcohol abuse.  And almost all those things might either look like ADHD when it’s not, or make your symptoms of ADHD much worse.

If you sleep with someone, ask if they think you might stop breating in the night.  If you snore, it might be easier to tell, but you might have apnea even if you don’t snore.

Check out the sleepapnea.org for more information. And ask your doctor if it might be a problem for you.

I love to read about ADHD in the news when the authors are actually interested in some new twist in the reporting.Check out “New World Disorder: Was ADHD an evolutionary asset?” by William Saletan (Posted Thursday, June 12, 2008, at 12:52 PM ET) in Slate.com. He said in part:

The study, led by Dan Eisenberg of Northwestern University and published in BMC Evolutionary Biology, examined a Kenyan tribe called the Ariaal. Part of the tribe has recently settled into an agricultural community. Another part remains nomadic. The tribesmen were tested for DRD4 7R, a genetic variant that, Eisenberg notes, “has been linked to greater food and drug cravings, novelty-seeking, and ADHD symptoms.”

You might be familiar Thom Hartman’s notion of the lives of hunters and the farmers as a explanation of ADHD traits. You can read more about it in his book Attention Deficit Disorder. But in a nut shell: Hunters have to pay attention to everything that’s going on around them–see the rabbit in front AND the bear in the back. Farmers, on the other hand, have to wait a lot. They have to focus and pull weeds and not the food. Wait for the weather.

In this picture the farmers are better suited to sit in school and focus and learn. The hunters are too busy paying attention to the kid in the back row who’s making spit balls. Obviously much more interesting than world history.
Sometimes attention to exactly what you’re supposed to be doing is the right thing. And sometimes seeing the big picture and all the stuff going on around you is the right thing.

I’m thinking small business owners have to be a lot like hunters. You gotta pay attention to everything all the time and make decisions based on as much information as you have. You can’t always wait for more.

Anyway, Thom’s theory is a great way to explain ADHD to kids at the very least. AND it’s really nice to get some scientific study to support it.

Good news, good news.

According to a statement by the DEA:

Today, DEA is unveiling a proposed rule that will make it easier for patients with chronic pain or other chronic conditions, to avoid multiple trips to a physician. It will allow a physician to prescribe up to a 90-day supply of Schedule II controlled substances during a single office visit, where medically appropriate.

What great news for people with ADHD who just plain forget to go to the doctor’s every month, who forget to go to the pharmacy when they know they’re running low. What great news for mothers who wind up paying, on O SO many levels, for kids that run out.

Thank you, DEA. Seems like you’re doing the right thing.

Sometimes, they say, it’s a good idea to let people know what you’re thinking while there’s still time to adjust the plan.

I run a support group for adults with ADHD at St Christopher’s Church in Linthicum, MD, on the third Wednesday of each month. We meet in the church basement so if you come, park on the side and come in through the third door in the back. (Sounds a bit mysterious, doncha think?)

Here’s the back story to the new idea:

We often get a visiting family member of one of the adults - a wife, husband, mother, sister, aunt — someone who thinks the adult with ADHD needs some help. We all understand it’s important to educate the “others” in our lives. The group is always supportive of new people and their “other,” but I don’t like those people to come more than once. The person who does not have ADHD sometimes takes over the meeting with their questions. And that’s not what we’re about.

But last night, someone suggested we might plan one meeting particularly for adults with ADHD and their “other” who ever that may be. This would be one time when we’d be happy to see all those “others” out there and answer what ever questions they have and offer what ever help we might give.

We’ll likely have the meeting on the west side of the Baltimore metropolitan area. But lots of stuff could change.

What I’m curious about is this: What would you like to learn from a meeting like that? Do you think it’s a good idea? Would you come and bring someone?

Drop me a note and let me know what you’re thinking.

I look forward to hearing from you. I like the help of others!

Thanks for thinking.

Kerch

Attention Deficit Disorder: The Unfocused Mind in Children and Adults
by Thomas E Brown, Ph.D.
Yale University Press © 2005
$27.50 384 pp

For years Thomas E. Brown, Ph.D. has been paying attention to the stories of patients with AD/HD. As associate director of the Yale Clinic for Attention and Related Disorders and assistant clinical professor of psychiatry at Yale University School of Medicine, he also knows the science behind the diagnosis. The result is a new book, Attention Deficit Disorder: The Unfocused Mind in Children and Adults. Like Dr. Brown’s very popular talks at annual ADDA conferences, it presents the stories he’s collected during his clinical experience and pairs them with recent research to draw a clear picture of AD/HD.

Dr. Brown’s model of ADD groups significant chronic difficulties which tend to show up together and improve together into six clusters of symptoms which he calls the ADD Syndrome: “a complex disorder that involves impairment in focus, organization, motivation, emotional modulation, memory and other functions of the brain’s management system.”

These executive function impairments are often described as being like a slightly off maestro lacking control of an orchestra. He has trouble managing the starting and stopping of thoughts and actions; his memory and focus are disorganized and undependable.

Executive functions impaired in the ADD syndrome are not simply skills to be learned. ADD Syndrome is not about a lack of will power. Trying harder will not fix it. And medication is not magic — Pills can’t teach skills.

As for any disorder, the most important thing in successful treatment of ADD is education about what it is, what it does, and how it affects the person and his family. The education in this book is clear and comprehensive in its offering. Brown’s references to the problem of emotional modulation for people with ADD is not reflected in the DSM-IV* but it makes sense in my limited experience. I also found some interesting explanations for other problems that I didn’t know were related to AD/HD. For example, I learned that while I may understand all the words my children use to describe their day, my ability to repeat them – word for word — it is out of scale with my understanding of the story. An obscure fact? Perhaps. But I believe knowing that’s common for people with ADD will help me appreciate why a verbal grocery list is less effective than a written one.

The book is heavily cited for clinicians but never in a way that made me feel inferior. In addition, the book includes the clearest explanation I have ever seen of how the brain uses its special proteins to move thoughts around and how different medications affect that process. I particularly appreciate Dr. Brown’s gentle humor and compassion in the construction of metaphors to explain complicated concepts and then his further explanation about why they are not quite the full story. He’ll be making a key note address at the upcoming ADDA conference in Orlando. Do not miss it!

ADD is, if anything, a collection of symptoms – widely varied in those diagnosed with it. For clinicians, this book has the studies to back the premise that ADD Syndrome includes a more complex collection of markers. For parents or adults with ADD, this book lays out the intricacies of the bits and pieces of behaviors that have just not made sense before.

* For a refresher on what the DSM-IV says about AD/HD, check out the very useful website www.helpforadd.com/criteria.htm

Fidget to Focus – Outwit Your Boredom: Sensory Strategies for Living with ADD
Roland Rotz, Ph.D. and Sarah D. Wright, M.S., A.C.T.
IUniverse © 2005
$14.95
126 pp

Do your kids swear that listening to music while they do homework actually helps them concentrate? Can you sit still OR focus, but not both – simultaneously?

If your answer is “yes,” you might already understand the art of effective fidgeting – using simultaneous sensory-motor activities to increase your ability to pay attention.

Based on the collected stories of hundreds of people, authors Roland Rotz, Ph.D. — a licensed child and adult psychologist — and Sarah D. Wright, M.S., A.C.T. – a professional AD/HD coach – propose sifting the paradigm: Give yourself permission to fidget. “Restlessness is not just an expression of trying to ‘get out of the fidgets’ in order to become calm. It is rather an attempt to self-arouse to become focused.”

The beauty of fidgeting in order to focus is that it works for everyone, not just people with ADD. Moving your body is particularly effective. Running, walking or even plain old recess activities help many people attend even after those activities have stopped. Personally, I find knitting to be a great way to keep myself focused while attending mlong meetings. It actuates the sense of touch, and it’s much better than picking at my nails. Color coded file folders are more plesant to look at so they help make the drudgery of filing a bit more interesting.

Key is to identify socially acceptable forms of fidgeting. Whether it’s doodling in a notebook while listening to a lecture, chewing gum while taking a test, or racing against the clock to finish a tedious task like cleaning the kitchen, what makes it work is using different senses for the fidget and for the focus.

This short book is structured with review points at the end of each chapter. It aims to help you identify your own socially acceptable devices to keep one part of your brain busy while allowing greater focus by another part. The strategies suggested in the text and in the “Fidget Strategies Workbook” included with the appendices will likely lead you to think of other techniques that will work for you. You’ll find suggestions for using your senses: sight, sound, touch, taste and smell as well as movement, time awareness, or a companion.

A couple of big points from the book:

“Effective fidgeting uses a second sensory-motor activity, one other than that needed for our primary activity, to help us stay alert and focus the primary activity.” These secondary activities might include listening to loud music while doing housework, racing against the clock to finish a tedious task like cleaning the kitchen, doodling in a notebook while listening to a lecture, or chewing gum while taking a test.

“Some of the strategies we use to simulate ourselves into interest and thus action, e.g. procrastination or emotional conflict, can have undesirable side effects.” The authors warn that if you don’t actually choose your method of fidgeting, you could wind up doing something harmful: perhaps something as simple as picking your cuticles or more problematic smoking or engaging in some other addictive behavior.

ADDitude Magazine asked me to write a review of
When Too Much Isn’t Enough:
Ending the Destructive Cycle of AD/HD and Addictive Behavior
by Wendy Richardson, MA
Piñon Press; $15.99

They chose a different version of the review, so this one isn’t bothered with their copyright issues. Thank you very much.

Let me just say, “I know some people…” who are not technically addicted to food or alcohol or video games. But I do know people who over indulge more often than they should in harmful activities — including just plain ole harmless solitaire.

So Wendy Richardson’s new book, When Too Much Isn’t Enough: Ending the Destructive Cycle of AD/HD and Addictive Behavior, put a great deal of abusive behavior in to a very clear picture for me.

It’s hard to know when you’ve eaten enough, if you don’t notice a full feeling in your stomach. People with AD/HD could find it hard just to remember how much they’ve had to drink — and I’m not talking here because of a drunken stupor. Undiagnosed or untreated AD/HD makes it easier to slide into problems and then more difficult to recover from them.

Richardson’s easily-readable book looks at the many faces of self-medication and why people with AD/HD overindulge or become addicted to drugs, food, alcohol and compulsive behaviors. She makes a strong case for getting a proper and complete diagnosis and treatment. She advocates for finding professionals who understand both AD/HD and addictive behaviors. She also presents many possible avenues for recovery including not only the well known 12-step programs, but also therapy, counseling, coaching and medication. The book’s appendices and end notes include extensive resources available on the Internet, in libraries, and through educational and support organizations.

Obviously, noticing a behavior is key to changing it, but people with AD/HD are notoriously bad at self monitoring. So the chapter “The Less Talked About Traits” is helpful in recognizing how sensory sensitivity, sleep problems and organization issues might affect a person’s abilities to manage his own life effectively.

The chapter “It’s Not Your Fault, But It Is Your Problem” has an excellent explanation of the genetic and biological aspects of AD/HD and addiction. It is written for the general public but comprehensively cited for anyone who wants more in-depth information.

“The Truth about Medication” addresses many concerns that recovering drug addicts and alcoholics have about medication interfering with that recovery.

If you — or someone with whom you live or work — struggles to control problematic behaviors, this book will surely be useful to you. But if you are watching someone who has AD/HD and you are just beginning to notice behaviors that might be crossing some imaginary line — if you’re just not sure what’s going on – this book will be more useful than you can imagine.