The Four Stages of Adjustment to a New Diagnosis
by Ari Tuckman, PsyD, MBA

Receiving a diagnosis of ADHD can be a life changing event. Everyone reacts in their own way, but I've noticed some general trends that people tend to follow. I've broken it into four stages. Don't get too hung up on exactly what stage you're in, so much as use it as a way to understand how this process may unfold for you. Some people feel more comfortable knowing where they've come from and where they're going.

1. Getting Excited
By the time they're finally diagnosed, many people react excitedly with, "This explains everything!" They finally have an explanation that isn't pejorative, that they don't have see as an indictment of their character. They now have an explanation that ties together all sorts of things in their life, from getting in trouble on the school bus to feeling bored during long movies. This clarity can be pretty exciting.

Others, however, feel like the diagnosis confirms their feelings of being defective. It's just further proof that there's something wrong with them-and now it's official.

Regardless of their initial reaction, some people may also experience intense feelings of anger, sadness, and regret for all the wasted time, lost opportunities, and unnecessary struggle. This can be a time of mixed and rollercoaster emotions, all of which make sense, even when you feel completely crazy.

This is the time when people gather their treatment team, buy too many books (which they don't finish), join support groups, and get involved.

2. Getting Down to Business
After the initial rush fades, they get down to work. The motto during this stage is, "Okay, now I know what I can do to make my life better." The rush of discovery is replaced by a more sober attitude of responsibility. They start trying some of the tips and tricks they've learned, work to get their medications adjusted right, and explore the psychological manifestations generated by a life of ADHD. Pieces continue to fall into place. Although this can be a very positive time, this can also be the calm before the storm once they start hitting some road blocks and that initial enthusiasm starts to burn off.

3. Getting Overwhelmed
As with many big habit changes, the real challenge comes after that initial enthusiasm but before consistent effort has yielded some tangible results to maintain motivation. It's this middle time that's the hardest. Adults with ADHD often run into the hard reality that, even with a good medication regimen, it still takes a great deal of hard work to make and maintain the desired changes. The motto here is, "Damn, there sure is a lot to do. Maybe life was better without the diagnosis." They may feel frustrated that everything doesn't magically fall into place. They got their hopes up once again, only to be disappointed. In some ways it's worse now since they know so much better what their problems are, including perhaps some problems that before they didn't know they had. At this point, they will have more problems than solutions.

In an effort to counteract hopelessness, I often remind clients that they've already solved all the easy problems in their lives so, by default, they're left with the harder problems that take more time and effort. So really remind yourself of that when you're tempted to abandon your new good habits and give in to pessimism. Rome wasn't built in a day and neither will your new, successful life be.

4. Getting on Top of It
Over time, hopefully most people will settle into a fuller understanding of their ADHD and how it fits into their life as a whole-it's a part of their life, but not their whole life. The motto for this stage is, "Okay, I can do this. It's hard work but there are real rewards for it." They understand that they will have more work to do in some areas than most people, but they also know that that work will pay off in reasonable ways. They have become automatic with some of the good habits that are especially helpful to them, making those habits less consciously driven. They recognize their imperfections and know that sometimes they will fall short. They can accept that it's difficult to live in an information age when one has information-processing deficits. They may not be happy about this, but they can accept it.

Wilens, T., Bellner, S., Lopez, F., Turnbow, J., Wigal, S., Childress, A., et al. (2008)

Varying the Wear Time of the Methylphenidate Transdermal System in Children with Atteniton Deficit/Hyperactivity Disorder.

Journal of the American Academy of Child and Adolescent Psychiatry, 47, 700-708.

This study used a sophisticated double-blind placebo crossover design in which the duration of application of a variety of transdermal methylphenidate patches (10, 15, 10, 30 mg strengths) were worn for either 4 or 6 hours by children with ADHD ages 6-12. The study used an analog classroom and concluded that positive outcomes associated with the use of the patch are time dependent and remit between two and four hours after patch removal. Authors conclude that duration of therapeutic effect of the transdermal application is related to the time of application of the patch and suggest that clinicians can vary patch duration to meet patient needs.

Adler, L. A., Spencer, T., Williams, D. W., Morre, R. J., & Michelson, D. (2008)

Long-Term, Open-Label Safety and Efficacy of Atomoxetine in Adults with ADHD: Final Report of a 4-Year Study.

Journal of Attention Disorders, 20 (4), 1-6.

Previously, data from 97 weeks of open-label atomoxetine treatment of adults with attention-deficit/hyperactivity disorder (ADHD) were reported. This final report of that study presents results from over 4 years of treatment. Results were derived from the study of 384 patients (125 patients remaining in the open-label trial since the interim report), receiving up to 221 weeks of treatment. Primary efficacy measure was the Conners' Adult ADHD Rating Scale-Investigator Rated; Screening Version (CAARS-Inv:SV) Total ADHD Symptom score. Adverse events and vital signs were assesed. Results indicated that the CAARS-Inv: SV Total ADHD Symptom scores decreased 30.2% (p<.001) during treatment. Similar, significant decreases were noted for the secondary efficacy measures, including the Sheehan Disability Scale Total score, which improved 25.3% p<.001). Adverse events consisted primarily of pharmacologically (noradrenergic) expected effects. The conclusion was the results of this open-label study support the long-term efficacy, safety, and tolerability of atomoxetine for the treatment of adult ADHD.

Below are some interesting articles on ADHD and related topics:

• Three Effective Treatments For Childhood Anxiety Disorders Identified By Study
• ADHD adults have time at work and home
• ADHD Appears To Increase Level Of Nicotine Dependence In Smokers
• Couples With Children With ADHD At Risk Of Higher Divorce Rates, Shorter Marriage

Visit myADHD.com and use the follow tools this month to help children with ADHD establish household routines and to promote responsibility:

• My Daily Jobs
• My Morning Jobs List
• My Bedtime Jobs List
• Using a Home Token Economy Worksheet