Do It Anyway
by Ari Tuckman, PsyD, MBA

It seems like I spend a lot of time helping clients do the things that they know they should, but just can't get themselves to tackle. (Yes, I spend a fair bit of time helping them not do certain things also.) This is especially true among my ADHD clients. They know they should do certain things in order to be happier, calmer, or more successful, but can't get themselves going reliably enough. As Russell Barkley has said, ADHD is not a disorder of knowing what to do; it's a disorder of doing what you know.

ADHD adults face a double whammy when it comes to getting going on certain tasks:

• Neurological ADHD brains have a hard time activating and persisting on boring tasks, unless the pressure is on.
• Psychological After a lifetime of struggle, of letting themselves and others down, many of these folks get a sense of dread at the mere thought of certain types of tasks, so they avoid those tasks to make themselves feel better-in the moment, at least.

Of course, this all makes sense, in a way. The problem is that avoidance has a tendency of making things worse, creating a self-fulfilling prophecy wherein the undesirable task does become rather awful or works out badly if it's done at the last minute.

The challenge is to push yourself through that bad feeling and get going on that task anyway. Yes, you will feel uncomfortable. Yes, you may even hate it. When you find that you're trying to talk yourself out of doing something that you know you should do, do it anyway. When you find yourself avoiding something uncomfortable, do it anyway. When you find yourself dreading something, do it anyway.

When England was getting pounded by the Germans in World War II, Winston Churchill supposedly said, "When you're in the middle of hell, there's nothing to do but keep going." Exactly-rather than sit and suffer, keep moving. At those times, any action may be better than avoiding dealing with it.

Share Your Story!

I am working on a new book for adults with ADHD and would like to include others' experiences-funny ones, poignant ones, successes, failures. If you have a story to share, I would love to read it. Identifying information will be kept private. You can email me at Ari@TuckmanPsych.com.

Last week, the American Heart Association (AHA) announced a recommendation that will affect the way children and teens with ADHD who are either taking stimulant medication or who are thinking of getting started on stimulant medication. The AHA believes that children and teens with ADHD should receive a careful heart evaluation, including an electrocardiogram (ECG), before they begin taking any of the stimulant drugs commonly prescribed to treat ADHD.

Studies have shown that these medications can increase heart rate and blood pressure. While these adverse effects are generally insignificant for most children with ADHD, they become important to consider when a child or teen has a heart condition. In a study done by the AHA, up to 2 percent of healthy school aged children had potentially serious undiagnosed cardiac conditions identified by an ECG. Certain heart conditions increase the risk for sudden cardiac death (SCD), which can occur when the heart rhythm becomes erratic and doesn't pump blood through the body.

Data from the Food and Drug Administration showed that between 1999 and 2004, 19 children taking ADHD medications died suddenly and 26 children experienced cardiovascular events such as strokes, cardiac arrests, and heart palpitations. For the past year, the FDA has required all manufacturers of drug products approved for ADHD treatment to develop Medication Guidelines to alert patients to possible cardiovascular risks.

"After ADHD is diagnosed, but before therapy with a stimulant or other medication is begun, we suggest that an ECG be added to the pre-treatment evaluation to increase the likelihood of identifying cardiac conditions that may place the child at risk for sudden death," said Victoria L. Vetter, M.D., head of the statement writing committee and Professor of Pediatrics at the University of Pennsylvania School of Medicine in Philadelphia.

The medical workup currently done by pediatric and psychiatric practitioners who are prescribing stimulant medications for children and teens with ADHD includes a screen for cardiac disease, although the medical workup is often not as extensive as suggested by the AHA. ECG is not a standard evaluative tool administered by physicians before prescribing stimulant medications. However, the AHA found using ECG screening in this specific population of ADHD children and teens is medically indicated and reasonably priced.

Vetter also said doctors should evaluate children and adolescents already taking these medications if they were not evaluated when they started the treatment. Those with known or suspected heart conditions should be routinely monitored by their physician for side effects related to taking stimulant medication. This can mean a simple, routine blood pressure and heart rate check.

Children who are suspected of having heart problems after the screening evaluation is done by their pediatrician or psychiatrist should be referred to a pediatric cardiologist to get clearance for using a stimulant. Once stimulant treatment begins, these at risk children should have their heart health monitored periodically, with a blood pressure check within one to three months, then again at routine follow-ups every six to 12 months.

"While we feel that an ECG is reasonable and helpful as a tool to identify children with cardiac conditions that can lead to SCD, if, in the view of their physician, a child requires immediate treatment with stimulant medications, this recommendation is not meant to keep them from getting that treatment," said Vetter, who added that some children may not have access to a pediatric cardiologist who can evaluate an ECG or perform a cardiology consultation.

The statement writing committee of the ADHD said its recommendations were not intended to limit the appropriate use of stimulants in children with ADHD. Their intention was to provide the physician with some tools to help identify heart conditions in children with ADHD and help them make decisions about the use of stimulant medicaitons. The goal of the committee was to reduce cardiac risk of stimulant products in susceptible children.

Below are some interesting articles on ADHD and related topics:

• Shire announces FDA approval for Vyvanse for Adults
• Sensory Treatment Reduces Autistic Mannerisms
• Working Memory Study Could Help Those with ADD and Other Attention Difficulties

Visit myADHD.com and use the follow tools this month to understand how cognitive behavior therapy works and how it can help with depression and anxiety:

• 1300 Introduction to Cognitive Therapy
• 1301 CBT for Depression
• 1302 CBT for Anxiety