Category: Adults

Baseball and ADHD?

Watch Dr. Pentz discuss ADHD, baseball, and Andres Torres. 

Do baseball players have ADHD?

You bet they do.

The story of one such player, Andres Torres, the NY Mets talented centerfielder and lead-off hitter, is so inspirational that a documentary movie is being made about his life. Due for completion this summer, “Gigante” is the story of a poor kid growing up in Puerto Rico, determined to make it to the major leagues.  Andres starts the minor leagues at age 20, but despite a world of talent and determination, he flounders there. Making matters worse, he genuinely seems to be a really good guy.  As one of the owners of the Giants (and a major force behind making the movie) put it, “Andres was one of the most charismatic and caring individuals I’d come across.”  His frustration and lack of success were all the more disheartening.  He would struggle this way for nearly ten years, an eternity for an aspiring major leaguer and usually the sign of a player who will never get to the “bigs”.

There was some hope five years into his minor league career, after he was diagnosed with ADHD.  He finally understood the reason for the inconsistencies that held him back.  While this must have been a relief to him and his coaches, his effort to try medication did not succeed and, perhaps not fully accepting the diagnosis, he continued to struggle.  Five more years of futility followed, and another baseball official (from his fourth minor league organization) suggested he should try medication again.  Now he was more accepting of it and this time, thankfully, the medication worked. The next season he hit over 300 and shortly thereafter got his big break: a major league call up to the San Francisco Giants. A rookie at 30 years old!  He ended up playing there for three successful seasons, including being an integral part of the World Champion Giants in 2010, before his trade to the Mets last year.

Andres Torres is a wonderful and inspiring example, not only of successfully overcoming the effects of ADHD, but also of how persistence, dedication and overcoming obstacles can help to achieve a dream.  He also appears to be as much a hero for his willingness to go public about his ADHD as he is for his long struggle to get to the majors.

As he told the NY Times (in an article by Andrew Keh, December 17, 2011): “A lot of people who have this condition, they don’t want to talk about it, and that’s fine, and I respect that,” said Torres, who hopes his candor about ADHD will help remove its stigma.  “But I am who I am, and I don’t feel bad about it.  That’s why I’m doing this.”

I think the term “hero” is used much too loosely when it comes to athletes these days, but in this case, Andres Torres is a hero in more ways than one

Major League Baseball deserves a lot of credit too.  In that same NY Times article there was a remarkable statistic. Given the controversy over performance enhancing drugs in the past, it would not be surprising to learn that Major League Baseball bans the use of stimulant medication (and drugs, of course, like steroids) and randomly tests for them. Last year, there were 111 major league players who were granted a “therapeutic use exemption” to take otherwise banned substances.  One hundred and five of those exemptions were for players getting medication for ADHD.  Yes, one hundred and five! By our calculation, that would represent between 7% and 8% of all major leaguers. In other words, if you look closely into any major league dugout, two or three of the players on the average (out of 25 at any given time on a major league roster) will be using stimulant medication to treat their ADHD. That’s about what you would predict based on a conservative estimate of the percentage of people in the general population who likely have ADHD.

Major League Baseball, perhaps more than many other organizations, seems to have moved past the fears and prejudice many in our culture have about ADHD and taking medication for it (please see previous blogs on this page citing several media articles this year alone railing against the use of medication).  Baseball should be as proud as Andres Torres for its’ support and understanding.

Doug Pentz, PhD
Affinity Center Co-director
dpentz@theaffinitycenter.com

Categories: Adults Parents

Medication

At the Affinity Center we are committed to helping people using a combination of interventions within a holistic approach. Medications are often suggested as part of an individualized treatment plan. The information contained here is intended to provide an overview of the different medications used at The Affinity Center. Direct discussion with your physician and therapist will help you fully understand the role of medication in the treatment plan the Affinity Center team has recommended for you.

ADHD is a neurobiological disorder that affects the portion of the brain responsible for our “Executive Functions”. Executive Functions help us stay alert, sustain and shift our attention appropriately, plan, organize, store and recall information, modulate emotional responses and inhibit inappropriate behavior. When this part of the brain is affected, the person often appears “under-aroused”, inattentive and/or hyperactive or impulsive. Medications have been shown to very helpful for these problems.

There has always been controversy about the role of medication in the treatment of ADHD. Some of it justified, most of it not. It is true that many children and adults have not had good experiences with medication and there are contentions that it is being overprescribed and perhaps not always used for justifiable reasons. This is not for a lack of scientific support and clear guidelines for when and how medication should be used, however. The truth is that medications for the treatment of ADHD have been extensively studied for the past four decades. There are well over 220 well designed studies demonstrating their safety and effectiveness, more than any other class of psychoactive drugs, and more than most of the medications in your medicine cabinet, including aspirin. When prescribed appropriately and monitored systematically, medications can be the single most effective component of a comprehensive treatment plan. The most important questions that should be asked when considering medication options are: Do you want to and is it appropriate for you to try medication, and will you be followed carefully to insure you are on the right type, the right dose, and the right schedule of medication to insure maximum benefits and safety?

At The Affinity Center we regularly review the medical literature and meet with professionals around the country who have extensive experience with ADHD and these medications. Those resources allow us to offer safe, helpful and state-of-the art medication treatments when they are indicated.

The most important resource to determine the most helpful medication regimen for you, is you. We really want to listen to your experience and work closely with you to monitor and evaluate your response to medication.

STIMULANTS
Research and experience tell us that stimulant medication is still considered the first choice in the treatment of ADHD. Stimulant medications are either amphetamine or amphetamine-like medications that stimulate brain activity to increase attention and decrease impulsivity and/or hyperactivity. They are called “stimulants” because they produce a temporary increase (usually for about 4 to 12 hours) of the functional activity or efficiency of areas within the brain responsible for alertness, attention, memory, organization, the self-monitoring and control of behavior and the other “executive functions” that are core problems for people with the disorder. Unlike most of the rest of the medications described here, we list stimulants by their trade names rather than their generic names. That is because we more often than not prescribe the brand name version in the beginning whenever possible and use generic versions later once we have established an appropriate medication regimen. Many people taking these medications have noticed problems with generics, feeling they are generally not as consistent or as helpful for reducing the symptoms of ADHD and are often more likely to have side effects.

Brand name stimulant medications prescribed at the Affinity Center include (organized by their generic name category):

Mixed Dextroamphetamine/Amphetamine Salts: Adderall, Adderall XR

Dextroamphetamines: Dexedrine, Dextrostat, Dexedrine CR, Vyvnase

Methylphenidates: Ritalin, Ritalin LA, Focalin, Focalin XR, Metadate, Metadate CD and ER, Concerta, Daytrana (patch)

(XR, ER = Extended Release CR = Continuous Release LA = Long Acting CD = Continuous Dosing)

Non-Stimulant Medications to Treat ADHD

Other types of medication may also be used in your treatment here at The Affinity Center. These medications may have originally been developed and used for other diagnoses (not necessarily ADHD) but have been shown to be helpful in reducing ADHD symptoms and are approved for its use. These include: Intuniv, Kapvay and Strattera. Other medications have shown to be effective to treat other symptoms often present when people have ADHD like anxiety, depression, tics and mood related problems. The following categories of medication may be used in combination with stimulants or alone:

ANTIDEPRESSANTS
Although antidepressants get their name from their original use indications, over time they have been shown to be effective for many other problems as well. Medications in this category are used for depression, anxiety, sleeplessness, rage reactions, hyperactivity, impulsivity, and obsessive-compulsive disorders. Unlike the fast action of stimulants, antidepressants generally require a cumulative effect over several days or weeks, so patience while initiating therapy is needed. The antidepressants used at The Affinity Center include (with brand names in parentheses):

Tricyclics (called this because of their chemical structure): amitriptyline (Elavil); clomipramine (Anafranil); desyrel (Trazadone); imipramine (Tofranil); desipramine (Norpramin)

SSRIs (called this because they are Selective Serotonin Reuptake Inhibitors, meaning the chemical that they specifically target is serotonin): citalopram (Celexa); fluvoxetine (Prozac); escitalopram (Lexapro); fluvoxamine (Luvox); nefazodone (Serzone); paroxetine (Paxil); sertraline (Zoloft)

Other(less “selective”) antidepressants: atomoxetine (Strattera)**; venlafaxine (Effexor/Effexor XR); duloxetine (Cymbalta); vilazodone (Viibryd); buproprion (Wellbutrin/Wellbutrin XL/Wellbutrin SR/Zyban); mirtazapine (Remeron); desvenlafaxine (Pristiq)

*Straterra has a unique role in the treatment of ADHD. Originally developed as an antidepressant it was not particularly effective for depression. It has since been specifically approved by the FDA for treatment of ADHD and we find it a very helpful medication, often in combination with stimulants, particularly when anxiety is present along with ADHD symptoms.

ANTI-HYPERTENSIVES
Anti-hypertensive medications were originally designed to treat high blood pressure. We have used these medications for years, often in combination with stimulants. These medications can improve frustration tolerance, reduce impulsivity, decrease anxiety, improve task-oriented behavior, help with sleep and decrease tic behaviors for those with tic disorders. Over the past two years the FDA has approved Intuniv and Kapvay for treating ADHD. These medications often require sustained use to determine effectiveness.

atenolol (Tenormin); labetolol (Lopressor); clonidine (Catapres/Kapvay); guanfacine (Tenex/Intuniv)

MOOD STABILIZERS
The mood stabilizers listed below were found helpful for managing mood swings while they were being used for other reasons. Tegretol and Depakote, for example, were used to treat seizure disorders. These medications usually do require a cumulative effect over several days or weeks to determine their impact.. These drugs also require periodic blood tests to determine the medication’s presence in your body.

carbamazepine (Tegretol); lamotrigine (Lamictal); Lithium; valproic acid (Depakote)

ANXIOLYTICS (ANTI-ANXIETY MEDICATIONS)
Anti-anxiety medications help to lessen anxiety. Sometimes very useful and appropriate these medications are also potentially addictive so we use them with caution and monitor them closely.

alprazolam (Xanax); lorazepam (Ativan); buspirone (Buspar); Clonazepam (Klonopin)

SEDATIVES/HYPNOTICS
Hypnotics are used to help establish healthful sleep patterns. In general, they are used for a limited time as other strategies are implemented to help with sleep.

temazepam (Restoril); zolpidem (Ambien); eszopiclone (Lunesta)

ANTIPSYCHOTICS
These medications are given this name because they were originally developed to help people with psychosis (symptoms such as disorganized thoughts or hallucinations). At the Affinity Center we mainly use them for treatment of tics, aggressive behavior, anxiety and mood disorder. The medications listed below are called Atypical Antipsychotics, which are newer and have fewer side effects than their predecessors.

olanzapine (Zyprexa); quetiapine (Seroquel); risperidone (Risperdal);aripiprazole (Abilify); ziprasidone (Geodon)

 

The Affinity Center Approach to Medication:

The Affinity Center team will use the information gathered in the evaluation process to work with you in developing a treatment program. Many factors including temperament, family history, your own medical history and other issues will be considered in determining the most appropriate medication for you.

Research and our experience has shown that finding the right type of medication, taking the right dose and using it consistently and at optimal times of the day are the keys to positive outcomes.

It is extremely important during medication trials to stay in close contact with us at the Affinity Center. A medication diary can help you monitor progress at home or at work. In follow-up visits we will evaluate the effectiveness of medication based on target indicators that were determined during the evaluation. There is no “cookbook recipe” that works for everyone. The process of finding the right “therapeutic window”, or the optimal dose and type of medication to produce the most improvement with the least side effects, is individualized for every client. Sometimes you have to try several different doses and types, or a combination of medications, to get the best results. It may take time, but we will follow you closely and work hard to find a safe and effective medication that works for you.

 

Additional Information about Stimulant Medication:

And now the warnings…

1. Until you know how these medications affect you, be cautious when operating machinery, driving a car, riding a bicycle, etc.
2. Keep these and all medications out of the reach of children and use containers that small children cannot open.
3. If mistakenly swallowed, call the local poison Control Center (Cincinnati is 558-5111).
4. Do not use these medications if you are pregnant, trying to get pregnant (practicing unprotected sex or no birth control) or are breastfeeding.
5. It is a federal crime to transfer stimulant medication to any person other than the patient for whom the medication was prescribed. Do not share this medication with anyone else.
6. Remember, there are no medications that are completely “safe”. Do not attempt to change the pattern of taking medication without first talking with your Affinity therapist or physician. The same is also true for restarting a medication program after an interval of not taking it.

Categories: Adults Parents Students

How Can Coaching Help with ADHD?

“If opportunity doesn’t knock, build a door.” ~Milton Berle

Coaching helps you open doors to the possiblities you want in your life. At The Affinity Center, we offer coaching to provide individual support that helps you stay on track to define and attain those goals you have for your life. Our coaching takes place in person, by email, and by phone–whatever works best for your busy life. We want to empower you to improve your performance and reach your goals by gaining knowledge and developing structures, strategies, and supports that work for you and the way you live.

Our coaching works with your strengths in a collaborative process. Coaching focuses on how well a particular area in your life is working for you (and the people around you). It works because you suddenly are not alone but become part of a team that is set up to help ask the tough questions that have to be examined if you are going to see the changes you want so badly. And YOU are the team’s director because you set the goals! We help you brainstorm and look at what-if scenarios, developing–right beside you–possible solutions and strategies. You provide your strengths and critical observations of yourself and your life to the process; The Affinity Center brings its team of professionals who understand behavior and regularly meet to problem-solve an array of issues to this effort. We’ll plan, discuss, re-evaluate, and adjust strategies and supports with you, testing the team’s ideas, because an untested “solution” really isn’t a solution. During this collaborative process, you’ll be gaining self-awareness abou the choices you’ve been making and their impact on your life and all the people whose lives you touch–friends, family, and perhaps your business associates. You’ll gain experience making better-informed decisions. You’ll feel how these decisions empower you, making you more effective, more efficient, and, we believe, even more inspired and energized to open new doors on a world of fresh possibilities.

Our coaching focuses on a variety of areas, including, but not limited to:

• managing time
• setting priorities
• organizing–from drawers and backpacks to rooms and households
• succeeding academically–for all ages and levels
• handling procrastination
• balancing life
• identifying and exploring various avenues for personal growth
• developing interpersonal skills

Categories: Adults Teachers

What is Adult ADHD?

ADHD is an inherited, neurological disorder that affects approximately 3-7% of children. But what happens when those kids grow up? Do they ever “grow out” of their distractibility, impulsive behavior, and restlessness? Many people develop successful strategies to cope with their symptoms over time, which allows them to live free from the impairments that result from an attention deficit. However, research shows that as many as 7% of adults still meet criteria for the diagnosis of ADHD.

There are a few ways in which ADHD differs in adulthood, most of which are related to way the symptoms impact daily life for adults. Specifically, adults with ADHD may struggle to properly manage their time, commitments, or important documents. Conversations can be difficult, especially in larger groups. These symptoms lead to conflict in interpersonal or intimate relationships, which often exacerbates the symptoms of attention deficit.

Adults with ADHD may also struggle with sitting still and working for long periods of time without breaks. They often experience trouble at work as a result of these symptoms and may often change jobs or feel unhappy in their current job.

Learn more about managing ADHD in your work environment.

Sources: DSM-IV, Nat’l Resource Center for ADHD

Categories: Adults

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ADHD and the Workplace

Busy Businessman

Adults with ADHD often run into problems at their jobs related to the symptoms of ADHD. Commonly reported difficulties include being distracted, running late, missing deadlines, procrastinating, being bored, or disagreeing with coworkers. Individuals with ADHD are protected by the Americans with Disabilities Act (ADA) in most situations. This means that, should someone choose to disclose their diagnosis of ADHD to their employer, it is illegal for that person to be discriminated against on the basis of their disability alone.

The decision to disclose one’s disability at work is complicated, but can be beneficial if an employer can offer reasonable accommodations to improve the individual’s performance. However, adults with ADHD can make accommodations on their own that can help troubleshoot problems in the workplace that result from ADHD. The following are some suggestions to consider if you are struggling at work as a result of ADHD:

  1. Reduce distractions. Emails, phone calls, and visits from coworkers are disruptive and interfere with one’s ability to complete the task at hand. Try to reduce distractions by sending phone calls directly to voicemail, turning off email alerts, and working in a place where coworkers are less likely to interrupt. If possible, change work hours to include some time in the office when others may not be around or work from home when possible.
  2. Keep lists. Keep a blank notebook on hand to jot down ideas that are unrelated to the current task or that come up during meetings. This way, the ideas are not forgotten, but can be addressed at the appropriate time instead of interrupting the current job. Lists are also useful as reminders of long-term projects, deadlines, and important meetings.
  3. Take breaks. Sitting still for long periods of time is difficult for people who have ADHD, so schedule breaks in the day to satisfy the need to move and refresh the ability to focus on the task at hand.
  4. Reward yourself. Take note of small accomplishments throughout the day and track progress on long-term projects. The strategies outlined above are most effective when reinforced, so setting specific goals and recognizing when they have been met is an important part of managing ADHD.
  5. Ask for and accept feedback. Ask a trusted coworker to help monitor progress towards the goals that are related to improving performance on the job. Being accountable to another person helps individuals with ADHD stay on track and focus on meeting their goals.
  6. Consider your career choice. Individuals are more likely to succeed in careers that utilize one’s strengths and assets while capturing the interest of the employee. For individuals who suffer from ADHD, the wrong job/employee fit can exacerbate symptoms and magnify problems in the workplace. In contrast, the right fit can provide a more enjoyable and fulfilling work experience and improve performance overall.

Sources: Nat’l Resource Center for ADHD/CHADD

Categories: Adults

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