ADHD treatment for Adults

The 3 Essential Components

The 2020 International Conference on ADHD just wrapped up and boy, what a year! Just like previous years, there was a wealth of information, a whole lot of laughter and support, and tons of tips, tricks and strategies shared. Unlike previous years it was all virtual.

Now, let’s be honest- 3 days of all-day zoom sessions is pretty exhausting. But, the cool thing about this conference is that the heart, the personality and the laughter could be felt, full-force even online.

I know not everyone got to go this year (though- really guys- this is one event you don’t want to miss next year) so I thought I would share a piece of my talk this year. I presented to the professional part of the conference but you don’t have to be a professional or be in any type of professional treatment to be thinking about these things. The treatment triad is true for any ADHD management- what you are doing for yourself at home or what your support team is helping you do as well.

So, check it out and ask yourself- how’s my balance these days? What do I need to add in to make sure I’m addressing each corner of my triangle?

Transcript: 

ADHD treatment for Adults: The balanced ADHD treatment model. We're going to talk about what it looks like, what it is, why it's important, and we're going to talk about how to tell when treatments out of balance. We're going to go in-depth into some client stories and really talk about some strategies for finding balance and ways to create that balance when it when it falls out of whack. So I love this quotation from Dana Kingsford, because I really do think that it's so true, you know, that balance is something that we're often all striving for, particularly when it comes to balancing work and and and life or the rest of our life as a workplace and also a part of life.

And it is easy to feel like it's something to go out and find or that it's something that just kind of fall on us from the heavens. But it's really not that way. Right. In order to create balance, we need to actively work at it. We need to set the boundaries, set the intention and then follow through on it. And the same thing is true in treatment. That balance isn't something that we magically stumble upon, that we had something that we actually have to create very intentionally and very actively in our work with clients.

So let's talk about what we're balancing.

I like to think of there being three main components to ADHD, the presentation. So the first is regulation. This is a basic neurobiological aspect of ADHD. And when I talk to clients about the regulation issues inherent in ADHD, I talk about it as being a lack of dimmer switches. So if you imagine one of those giant soundboards that they have in fancy recording studios, your is a huge table of all these different dimmer switches. And so you can have a little bit of this and a little bit of that. You can go much higher on this one and totally nonexistent on something else. And that's really what a neurotypical brain would look like in terms of regulation.

You can have a little bit of tension over here and you can have a lot of activation energy over here. You can you can be modulating things for various various situations and various actions that you need to be taking.

But the ADC brain doesn't have that. The brain has a whole bunch of on-off switch is right. And so this is going to cause issues with all of the executive functions, initiation focus, activation attention. They're either on or off or hyperfocus or they're not focused at all. Right. They're either going all in or they're avoiding and not doing anything altogether. And so there's this on-off quality that causes some serious issues when we need something to be just a little right. And so that's that's the regulation component of this. In addition to the emotional causes, practical issues, these are the expression of ADHD that we see in everyday life. We're talking about issues with time management and procrastination and activation and avoidance and all of those everyday manifestations of that basic neurobiological disorder that is made up of these regular regulation issues. And then finally, we have the emotional component. And I think five or 10 years ago, we didn't even really talk about the emotional component of ADHD. It wasn't research, it wasn't studied, it wasn't discussed. I'm really, really grateful that as a part of the discussion now that it's really a much larger part that we can really explore, because I think so many of our clients have struggled with this aspect for so long. And is both the emotional flooding that happens with ADHD, the sensitivity that can happen with ADHD, as well as the baggage that comes along with a lifetime of struggling with ADHD struggles, particularly if somebody had a diagnosis late in life.

So these three components really interplay quite a lot, and you can't really have one or target one without targeting the others because each one impacts the other in turn.

And I think is important to notice here that the arrows in the symptom triad, really, they go in both directions. And we're going to talk more about that, because while it is easy to talk about some of those directions, we don't always think about it going in the opposite way. And so we're going to really dive into that and explore the way each each corner of the triangle impacts the other.

So we're going to start with this practical and regulation connection, this one side of the triangle, and I think this is one place where we often think about ADT when we think about the symptoms of ADHD and exactly how it plays out. We think about this side. We think about the regulation issues caused by by the neurobiological aspects of the disorder and how they play out in practical ways in people's lives. And we do a lot of work there. Right? We treat the regulation with medication primarily. But there are lots of other treatments that are going to talk about and we provide coaching and strategies on the practical. Do we spend a lot of time in this domain because it's very clear that the regulation issues, the on-off switches then cause difficulties in terms of regulating all the aspects of the practical parts of our life. So a difficulty with maintaining a appropriate level of attention or concentration will then cause miss details. And it's going to cause people to forget things, is going to cause people to not grasp every detail of conversation. And now we're going to have practical issues. Right now. We're going to have missed details. We're going to have things that didn't get processed and therefore things that somebody can't act on. And so oftentimes as clinicians will dive in there and that's great. That's the necessary thing. But, you know, the other thing to remember is that the practical impacts of regulation, too. So when we think about the things that that feed our regulatory system, we're really talking about four things.

We're talking about sleep. We're talking about nutrition. We're talking about exercise. We're talking about medication and we're talking about meditation. And those four things really will feed and fuel our regulatory system. Right. And the problem is oftentimes with ADT, the cruel irony is that the symptoms get in the way of the treatment, right. So the practical aspects of ADHD get in the way of treating the regulatory system and keeping it as high functioning as possible. So somebody who doesn't notice that their pills are running low or notices but then forgets to says, oh, I'll call the doctor later, but forgets to do so, then ends up not having the medication that they need and going for days or even weeks without medication. Right. So the practical implication, implications of ADHD are then are then making the regulatory aspects of ADHD harder to manage. This also happens with exercise, right? When when when you can't figure out how to schedule your day in order to create enough time to exercise, then it's going to be a lot harder to use that really beneficial strategy to help fuel that regulatory system. So this side of the triangle really does go both ways. The next side, the regulation and emotional connection also goes both ways, again, pretty easy to see the way regulation impacts the emotional components that when we have on-off switches, that means we also have on-off switches for emotions.

Right? We have we feel all angry or not angry at all. People are going to have to be flooded by the emotion or on the flip side, have the alexithymia where they're kind of not feeling much at all or at least not being able to name them. Right. And and so there's this on-off quality that's happening with the emotions and then it goes the other way. When flooded by emotions, it's really hard to manage the regulation of other other aspects of our functioning. Right. So when we're feeling really overwhelmed, really scared, really anxious, really, really angry, it's going to be really hard to focus and attend to other aspects. People are going to really hone in on those feelings. Also, when you're feeling really sad, is hard to strap on your running shoes and go for a run. When you're feeling really anxious, it's hard to sit down and meditate. So the emotional implications are really and then they make the regulation harder to be make the fueling of the regulatory system harder as well. So that final side, the practical and the emotional, is where a lot of the treatment work is in terms of ADHD therapy, it's really managing these two components. We also talk about regulation. It's really all three. But but you'll see that kind of balances a lot in kind of volley between practical and emotional, because then what often happens is people come into treatment for these practical concerns. And as you start to address them, the emotional stuff comes up.

And and so then you kind of work with that and then you bounce back and forth. So the way that the practical impacts the emotional is a lot in the history. The people with ADHD struggle with the logistics of life. They struggle to show up on time. They struggle to organize their material as they struggle to follow through on commitments. And this then makes them feel bad because about themselves, because they're not able to show up in the way that they want to show up and that they probably are capable of showing up. And it also means that they get a lot of criticism from the outside. And so this fuels the low self-esteem and sometimes a hatred and shame that then gets triggered every time they come up with an idea of doing something, anything, any time that there's the potential for failure, their emotional history really gets triggered. And so the practical issues are going to impact. The emotional in that way is also a whole lot harder to feel good about yourself when you're having a hard time following through. Right. When you know that you have the the intellectual capabilities, let's say, to do really great things, but you can't execute because of issues with initiation and procrastination and and follow through. And so it is going to be hard to develop that sense of self efficacy, the sense of self esteem that allows you to feel good throughout the day when you're having these practical and logistical concerns all day, every day.

And and then, you know, as as it has happened on every side of this triangle, it goes both ways. So is extra hard to follow through to get moving on something when you're feeling anxious, when you're feeling sad, when you're feeling really bad about yourself. Right. It's going to be super hard to get cracking on that paper when you feel like a failure, when you feel like, why bother? I've never been able to do it well before. I'm not going to be able to do it well this time either. Those emotional hurdles make the practical application really, really challenging. So this whole triangle really interrelates going both ways and every single corner is connected to each other.

Optimal ADHD treatment is going to address all sides of the symptom triangle. It's going to get involved in the regulation, involved in the practical and involved of the emotional. And the reason for that is that if you only address one, the other two that aren't being addressed are going to bring it down. The other one that has been addressed down. Right, that you might be able to get away with it for a little while. You might be able to give somebody some really great strategies and they can work so well in their life and really make them make them work for a period of time. But eventually those emotional hurdles are going to start to get in their way or some regulation issues. They're going to have a period of time where they're not sleeping well or they change their meds or some kind of regulation issue is going to pull them down. If we're not addressing all three of those corners of the triangle, then that treatment can't stay for very long. It's not going to stay effective for very long. So when we talk about how to do each one with regulation, as I said, there five things. We're talking about medication. We're talking about exercise. We're talking about nutrition, meditation and sleep. Those are the five things that really best fuel our regulatory systems and give people the best shot.

We're not talking about fully treating it right, but giving them as many resources within that regulatory system as possible. Practical strategies, our strategies, skills, coaching, organizational help, all of that concrete hands-on stuff. Those are going to be practical treatments. And then the emotional is going to be best treated by therapy, CBT, CBT, ACT, and exercise, and some medication. And those are all going to help deal with the emotional issues, creativity and. So we want to maintain this balance, we have to create the balance, we have to make sure that throughout a treatment, not necessarily throughout a session, but throughout a treatment, we are our managing and talking about and working with each corner of this triangle. We want to make sure that we're giving people skills, language ability, processing for each corner so that they can all support each other, because, again, if we have one, that is an address is going to pull the other two down. If we only treat one, it's going to get pulled down by the other two eventually. Even if it doesn't in the beginning, while you're working with them, it will eventually.

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