Q: I need a suggestion for how to find a good doctor for ADHD issues. I have a long list of "acceptable" docs from my insurance company but don't know how to tell them apart.

A: Here are some ideas that will help you narrow your search:

• If you think you might need medications, find a psychiatrist rather than a psychologist. The latter can't prescribe for you.
• Contact your local ADDA and CHADD chapters to find out if they have recommendations about people versed in ADD in the area
• Local schools can often recommend someone, particularly for diagnosing children.
• Contact any potential doctor's office and ask some questions: What percent of your patients have ADHD? How long have you been treating people with ADHD? What's your approach to treating ADHD? How often do you see your ADHD patients?

The Hallowell approach, if you are trying to replicate it, is a strengths-based approach, with frequent check-ins to tweak treatments and help patients find strategies which help them in their daily lives. We think this is more effective than a "disease-based" approach, which focuses on "what's wrong".

Q: What can I do when my (undiagnosed, but likely ADD) husband lashes out with a sudden hurtful comment, and thinks nothing of it? It bothers me for the whole day (or week) and I don't know how to cope with it.

A: Impulsiveness is one of the hallmarks of ADD and it is common that they "think nothing of it". While impulsiveness can be a very positive trait - for example allowing fearlessness in difficult situations - impulsive words can often hurt others.

Impulsiveness, however, isn't quite the same thing as making hurtful comments - so chances are that there is something else going on, too - perhaps a building resentment around something in your relationship.

It makes sense to talk about impulsiveness at a neutral time (not when it happens). Say something like "You have a tendency to say things that hurt me without realizing it. I'm not sure why this happens, but I am requesting that you notice it and try to stop. If there is an underlying problem, perhaps we can talk about it."

If the impulsive person doesn't "see" these impulsive comments as hurtful, consider saying "Since you are having trouble seeing these comments as they happen, I would like to make an agreement with you that for the next week when you say something that hurts me I will tell you in a nice voice "that hurt me". I don't want to have a big conversation about it at the time, I just want you to note the frequency. Then, when we're ready -maybe at the end of the week - we can talk more about what's going on. I'm not trying to make you defensive...I'm only trying to point out the frequency you are saying hurtful things to me without realizing it."

As this conversation unfolds, it's good to have some coping strategies on hand that have worked for others with ADD. People with ADD report curbing impulsive remarks by:

• Learning to count to three before interupting
• Teaching themselves to take a deep breath before saying something - to give time to "check it"
• Creating a system for important conversations where one person talks/other listens, then the roles are reversed. This gives time for "thought" around big issues.
• Developing a "cue" where if one person starts to get into negative territory the other can alert him before damage is done.
• Calling a "time out" with each other to lessen the sting of hurtful or impulsive comments
• And, most importantly, starting treatment for untreated ADD symptoms. Treatment can provide tools that help a person develop restraint

If the spouse or child still does not agree to start working to curb their impulsive comments, it's time to step out of your established patterns and start new ones. For example, you can leave the room if confronted with particularly nasty words to stop the escalation of a fight (make sure to tell your child or spouse why you are doing so in a calm voice); you can circle back to "higher level" ideas (rather than disagreeing over details); you can deflect the specific comment and start to probe for underlying issues and bring them out at the time of the comment (To a teen "I know you say you want me to get lost, but I'm wondering if that comment stems from how much pressure you are under with your exams right now. Is there something that is particularly bothering you or that I can help with?")

In the short term, rather than thinking about specific, impulsive comments all week, consider saying to yourself "this is going to get fixed...and in the meantime I'm not going to injure myself with the stress of worrying about what he said". You may have been focused on it for a long time because you didn't have a plan in place to make things better over the long haul. Now that you do have a plan you can let go of any specific infraction in favor of your personal well being - as long as you don't leave the problem unresolved over the long-term. Respectful interactions are critical for any healthy relationship.

We don't often think about the team of people who support us in school or at work, but when in transition to college or a new job it's very smart to do so. Thinking through "how" you get things done and "who" helps you do it can save you headaches, problems and (in the case of college) some Fs.

A conversation with a college sophomore recently illustrates why this is so important. Here is his story - you'll find that the ideas can easily be translated to the business world.

Though this student managed to stay in college, his freshman year was a disaster. He couldn't understand it - it seemed to him that he was replicating his approach to high school where he had been very successful - cramming for exams and enjoying himself. That was until he started looking deeper, and talking about his "team" at the boarding school he had attended. Without his even knowing it, a team of people had helped him avoid some of the ADD traits (distraction, procrastination, lack of motivation) that were bringing him down in college.

His old team consisted of:

• The friends who got him out of bed to eat breakfast and to start his work and who formed study groups with him
• His teachers, who required class attendance, checked homework, and gave him quizzes to make sure he was keeping up with the material in a timely way
• Peer tutors who helped him when he got behind
• An advisor who checked in with him (and other advisees) once a week to see "how things were going"
• His parents, whose periodic visits and emails reminded him to push himself
• His coaches, who encouraged him to exercise (adding to his focus and fitness)

In other words, though his academic accomplishment was his own, his "team" helped him move forward in a way that created a well-structured environment in which he could succeed.

Compare this with his freshman year at college. There, his team consisted of:

• An advisor, who checked in with him to select courses once a term

His parents had fallen off as an influence, he was not required to go to class, he had only mid-term and final exams to test his knowledge (so no way to check his knowledge over the semester and no "need" to see a tutor since he didn't know he was behind). He wasn't on a sports team, and didn't get up for breakfast. His friends frequently distracted him by asking him to join them for videogames at times he should have been in class. Problem sets were "optional" and he "didn't like" the computer system used to give out assignments, thus avoided it.

When laid out like this, it may seem obvious that this boy's transition to college was not successful because he didn't put the support mechanisms in place to help himself. But, really, when was the last time you thought carefully about who is on your team, and how they support you?

This year, this student is thinking about adding the following members to his team:

• Friends, whom he will invite to join him for breakfast (and help him get going). He may also use them to clarify the computer assignment system.
• Classmates in study groups.
• An advisor with whom he can meet weekly, not once a term
• His parents (he will send home a copy of his agenda for each day with each thing he's done checked off so they can help make sure he is utilizing his team and completing his problem sets. Eventually, they will back away.)
• Tutors as needed when problem sets are too hard
• An administrator in the learning disabilities office who will check in with him regularly.

His chances for success are greatly increased now that he knows that putting a team in place can help him fight against his ADD traits of distractibility, procrastination and lack of motivation.

Next time you are facing a transition, make sure to ask yourself these questions: Who's on your team and how do they help you? and How can you replicate or improve the effectiveness of your team in your new position?

Robin Roman Wright, career coach at the Hallowell Center, dispels several misconceptions about finding a fulfilling career if you have ADHD or learning disabilities in her recent article, "Finding a Career That Suits You: Play to Your Strengths".

In the same article, she also outlines in detail a specific seven step process you can use if you are just entering the workforce or thinking about changing jobs. This process will help you optimize your thinking and your search.

As she points out, finding a rewarding career is a journey. To find out more about this journey, go to this link.

Children and adults who suffer from behavioral and cognitive concerns related to specific disorders (listed later in this article) can benefit from getting a neurobehavioral assessment to determine if specific types of treatment might help them.

Common behavioral issues worthy of evaluation include heightened irritability, anger outbursts, problems with lethargy and motivation, safety and judgment issues and impulsive behaviors. These behaviors can be important to treat because they can lead to tension within social, family and work relationships.

Cognitive issues can include memory decline (including word finding), and poor organization, focus and concentration skills. Patients may become stressed or frustrated when changes occur in household management or work effectiveness.

Both behavioral and cognitive problems can impact family dynamics, work, household management skills and ultimately self-esteem.

These types of issues can be impairments related to specific neurological disorders including:

• Traumatic Brain Injury
• Cerebral Palsy
• Stroke and Vascular Disease
• Lyme disease
• Toxic Exposure (e.g., lead, drugs, toxins)
• Anoxia/hypoxia
• Aneurysm
• Dementias
• Autistic Disorders
• Seizure disorders
• Multiple Sclerosis
• Tumor
• ADHD

People often don't realize that these impairments can be treated through traditional, complementary treatments and support services, thus they never get the evaluation to determine what types of treatments could make their lives easier. Some neurological conditions produce behaviors that are resistant to treatment, so an evaluation helps patients and their families understand if this is the case and learn how to work around the behavior. So, if you or someone in your family has behavioral or cognitive issues, the Hallowell Center in Sudbury suggests that you call to determine if an evaluation there might make sense. Christine Sorgi can answer your questions, at 978- 287- 0810 x 101.

The neurobehavioral assessment and treatment program at the Hallowell Center in Sudbury is expertly run by Dr. Carol Montgomery.

Research Confirms Low Dopamine in Motivation and Reward System an Issue with ADHD - The National Institute on Drug Abuse and the DOE Brookhave National Lab released research results that confirms that people with ADHD have lower dopamine levels in key areas of the brain related to motivation and reward than people with ADHD.

Researcher Nora Volkow says "These deficits may help explain the clinical symptoms of ADHD, including inattention and reduced motivation, as well as the propensity for complications such as drug abuse and obesity." She also said that the results "support the continued use of stimulant medications which have been shown to increase attention by elevating brain dopamine."

For more details about the study, go to this link.

Multitasking Research shows multitaskers perform suboptimally because they can't filter out irrelevant information. For more details, go to this link.

WSJ Highlights New Home Sleep Monitor - If you are having great difficulty sleeping, you may benefit from a new home sleep monitoring system called a Zeo, says the Wall Street Journal. For details from this article, go to this link.

Link Between Late Bedtimes and Depression in Teens Research presented at the 2009 Associated Professional Sleep Conference suggests that teens with bedtimes at midnight or later are 20% more likely to have suicidal thoughts than teens with parentally mandated bedtimes of 10pm or earlier. Researchers concluded that parents should "sell teenagers on the importance of getting enough sleep".

5 Steps to Prevent Depression Relapse - a very useful blog post by Elisha Goldstein, Ph.D. outlines how to understand depression "relapse signatures" and pre-empt returning to depression at this link.

Sept. 17 - Lincroft, NJ - Dr. Hallowell speaks on CrazyBusy. Call 908-276-1319 for more info.

Sept. 24, Sudbury Hallowell Center - Free open house for MySensorySolutions, Learning Breakthrough and Reading Plus. Email olga@mysensorysolutions.com to register.

Late September, Sudbury Center - "Managing Your Short Fuse" starts. 8 group sessions on Thursday evenings 7- 8:30pm. Learn about anger and aggravation and how to manage it. Call Carol Montgomery at 978-287-0810 x 130 for info or to register.

October 1 - New York City - Dr. Hallowell will discuss new ideas in the field of ADHD at CHADD. 6-7:30pm. Call Hal Meyer at 646-205-8080 for more info.

Oct. 5 - Virtual - Dr. Hallowell speaks about Married to Distraction at the Virtual ADHD Conference

Oct. 6 - Grosse Pointe Farms, MI - Dr. Hallowell speaks about CrazyBusy Coping Strategies for Children. Call 313-866-1221 x255

Oct 8-10 - St. Louis, MO - Dr. Hallowell speaks on a broad range of topics. Call Mary Brotherton at 314-997-4343

Oct. 13 - Nantucket, MA - Connecting to decrease youth risk behavior. Call Dr. Pellicone at 508-228-7825 x 1150.

Oct. 14 - New York City - Dr. Hallowell speaks on Preserving Intimacy in an Age of Interuption. St. James Church, 865 Madison (71st) 11:30-1:30 pm.

Oct 27 - Lexington, MA - Dr. Hallowell speaks on Finding Buried Treasure in ADHD @ Clarke Middle School, 17 Steadman Rd. 7:30pm

FOR MORE DETAILS ABOUT ANY OF DR. HALLOWELL'S SPEAKING ENGAGEMENTS, GO TO THIS LINK.

email: morlov@hallowellconnections.com

phone: 508-545-2250 Hallowell Connections or 978-287-0810 Hallowell Center (medical)

web: http://www.drhallowell.com