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Thanks!
David

What's an ADHD Coach?

Its a question that pops up frequently at my ADHD/Processing Disorders workshops. And I answered the question for myself when I took part in the recent annual conference of the ADHD Coaches Organization in Chicago.

My "take-home" was this: ADHD coaches are knowledgeable, creative, energetic, warm, and enthusiastic.

Now here's the thing: at conferences and weekend events I'm sometimes the guy that slinks away mid-afternoon to go to the gym or return to my hotel room to work on some project. But not this time. I learned as much from the informal between-session conversations as I did from the workshops themselves.

And you know how you exchange business cards and false promises to "stay in touch" at weekend events like this? Well I actually have stayed in touch - by phone, email, twitter, and facebook - with several coaches I met at the ACO event. And am in the process of cooking up some joint ventures. Stay tuned!

And if you or someone you love struggles with inattention and disorganization, consider coaching supports here.

Activity Resources for Students with Sensory Processing Issues

At my ADHD/Processing Disorder Workshops I'm often asked about recommendations for further reading. This morning I stumbled upon a figure skating website (of all places!) with parents' comments about sensory processing/integration issues. One mom had posted her list of favorite books on the topic. Looks like a good place to start. Would like to hear your recommendtions as well, if you're an occupational therapist or parent.

The Out-of-Sync Child Has Fun, Revised Edition: Activities for Kids with Sensory Processing Disorder


101 Games and Activities for Children With Autism, Asperger’s and Sensory Processing Disorders

Attention Games: 101 Fun, Easy Games That Help Kids Learn To Focus


Early Intervention Games: Fun, Joyful Ways to Develop Social and Motor Skills in Children with Autism Spectrum or Sensory Processing Disorders





photo: Nailia Schwarz

J.O.E. - A Quick Test for Purpose

I had a chance to speak to a group a vocational rehabilitation counselors a couple of days ago and wanted to share something that Denise R. of Springfield offered to me. She explained that when she works with clients around the issues of values and core purpose, she asks three questions. Here they are:

J - Will this bring me joy? Real, deep down, happiness? A sense of what Denise calls "well-being"?

O - Will this bring me opportunities? Will this course of action increase or decrease my freedom? Will it open doors, or burn bridges?

E - This path I am considering here...will it edify other people? In addition to my own joy, will this expand others' happiness? Will it help and encourage others? If you do this, can you imagine the people closest to you being thankful that you did that?

Thanks to Denise for sharing JOE with me. Thanks also to Alex and the others there in the Springfield office making efforts to increase joy and opportunities for your consumers. We're mighty edified because of your work!




photo: eye spot shoot

Saved by the Dragon Lady

There are a number of great technologies out there to assist students and adults with attentional and learning challenges. One of these is speech recognition software. I've been struggling with Dragon on my laptop for a year now. Could have read the manual, I guess. I wanted a "plug and play" experience and this software is just not that simple.

Everything was illuminated yesterday after my consultation with Patty Vaillancourt. I think I get it now, and have some good ideas about how to better implement speech recognition software in my practice.

Patty ("The Dragon Lady") is a training consultant from Manchester, NH. After my time with her I determined that the next time I recommend Dragon software for individuals with ADHD, I'll also recommend some 1:1 time with a really good trainer like Patty!

A Neurological Blueprint for Happiness

What's happiness for?

For over a decade now, one of the central themes of positive psychology has been the nature of happiness. At first blush it can seem trivial to focus on frivolous emotions. What is the value of happiness?

It may be that good feelings are a worthwhile end goal in themselves. But there are also practical and pragmatic reasons to boost happiness. Barbara Fredrickson’s “Broaden and Build” model of positive emotion suggests that when we are happier we are better problem solvers. We do better thinking when we’re happy. Which leads to better decisions. And better outcomes increase our future happiness. Which leads to better problem solving. And so on.

But what is happiness, really? You can’t show me a cubic yard of it, and I can’t point to it on an MRI of the brain. Sure, it’s a feeling, but what – exactly – does it feel like?

What does dopamine feel like?

Various neurotransmitters are involved in the brain-based phenomena behind “feelings.” Dopamine is one of these. Increasingly, we are coming to understand that dopamine is the neurotransmitter not only of reward but also of motivation. And the phenomenology – the felt experience - of motivation is person - specific. Your feelings of engagement, "flow," and passion are unique to your history, your body, and your neurology.

Typically, if we ask what someone why they persisted with a difficult task, they will identify an end-goal. They wanted the extra money, for example, so they worked an extra shift. Or they wanted to see their partner's expression of delight after they had spent a Saturday morning waxing her car. But behind that in the goal is, in fact, the actual reason that any of us do anything: a feeling, or state.

Nobody wants a hunk of red metal

Nobody wants a red sports car, really. If someone is passionate, driven, or "crazy" about having a particular car, it's because he or she wants what they think they'll feel when they get that car, when they are driving it, or when a specific person or type of person sees them in that car. Some type of feeling state is the actual goal.

No one wants to spend a week on a mound of sand dotted by palm trees. They want what they think they will feel on a Caribbean vacation.

And nobody wants to wrap a measuring tape around his or her waist and come up with a particular number. Rather, we want what we think we will feel in our bodies when we are svelte, healthy, lean, or athletic.

Three of us had a great experience at the Grand Canyon

Imagine that three of us are chatting in the elevator, and one of us brings up the topic of a fantastic experience he had at the Grand Canyon.

It turns out the all three of us have visited the Canyon and, for that reason, we feel that we can say "I know exactly what you mean, I know exactly the experience you had at the Grand Canyon." In fact, we have absolutely no idea what any other person experienced at the Grand Canyon. We don't know what was so great about that, for that person. What made it a reward or motivating or "good."

For one of us, the really great part of the Grand Canyon was the IMAX film at the visitors center several miles south of the canyon itself.

For the second person, the best part of a trip to the Grand Canyon was reconnecting with a romantic partner after a protracted dry dull period in the relationship. In fact, the couple spent so much of the vacation "reconnecting" at the national park lodge that they actually forgot to take a look at the canyon itself.

For the third person in our conversation, the really special feature of her trip to the Grand Canyon was approaching the edge of the canyon and taking in the view for the first time. This experience happened at just the right time for her because some philosophical or spiritual questions had begun to emerge. And something about looking at the vastness of that space seemed to answer some of those essential questions .

For all of us, there was pleasure in our trips to the Grand Canyon. And you could imagine that a similar future trip would be "motivating" for each of us. But the nature of that motivation would be as different as each of our histories, bodies, and neurology.

What’s the one thing you need to do now?

The thing you know you should do but have been putting off. It's that thing you would do if only you had the resources -- the time and money and support. Or it's the commitment our obligation he would take on if you could just find the courage.

When you think about this one important thing, what's the end-goal? How will you feel when you’ve done that?

Beyond rat pellets

When we talk about motivation here, were talking about the common theme of reward or reinforcement. And the types of reinforcers that adults, teenagers, and even children are able to appreciate can be subtle and nuanced.

We are not, then, speaking only of pellets of rat food, or "good job" stickers, or bland verbal praise. We're speaking specifically to that which makes life juicy for you, and for me.

For some of us, there is real reward in being number one, the top of the class. For others, there is real satisfaction in surveying the social landscape and seeing a level playing field, feeling that everyone is equal here.

Motivation can "feel like" comfort, predictability, and sameness for some people. While for others, the feeling-in-the-body of motivation is one of adventure, "wind in my hair," living on the edge.

Behavior modification is hard work

None of this is easy. Whether it is our own behavior, or the behavior of students and clients and loved ones, that we seek to change, this is hard and courageous work.

Our hero in this regard is Odysseus. Knowing in advance what he wanted for himself, and knowing what would be his temptations, he lashed himself to the mast of a ship, so that he would not be tempted by the call of the sirens. It is as though Odysseus were protecting himself from Odysseus.

Likewise, knowing that I'm sluggish and uninspired in the morning, I might place my gym bag near the front door, to protect me from myself. And knowing that what you really want for yourself is a lean and healthy body, you might choose to keep your pantry free of junk food. To protect yourself from yourself.

Lend me your brain

Finally, if you parent or teach or coach young people, you will frequently be in a position to protect them from themselves. The best of that protection is in advance, like Odysseus.

We are, temporarily, the guardians of young people who are not yet cognitively and emotionally capable of making these types of choices. Essentially, we "lend them our brains" until they emerge into neurological, cognitive, and social maturity and begin to take on the Odyssean task themselves.

photo: New Mexico

(85 - X) x 365

"The best defense against the manipulation of our attention is to determine for ourselves – in advance - how we want to invest it." – Elkhonon Goldberg


What neuropsychologist Goldberg is saying here is that our social and physical environments are full of distractions. Things that distract us from our core tasks. Pull us away from what we know to be the best next thing to do.

There’s a seductive sweetness to not doing that next thing we know is best. But effective time- and self-managers are able to stay in the saddle.

Do, Be, and Have

Some of us are convinced that we are here on the planet to have some set of experiences, or to manifest some fine quality, or to have a particular type of relationship. Here to do and be and have something specific.

And the key that unlocks our motivation – our burning, passionate, nothing-can-stop-me motivation – is to consistently take actions and pursue relationships and make commitments that connect to those core do/be/have’s. And to say no to anything, even very good things, that do not.

As you’ve probably already noticed, time is a limited resource. Whatever it is that I'm here to do and be and have will need to take place in this pretty narrow window of opportunity. World Bank data suggest that life expectancy for children born in the US in 2008 is about 78 years. But if you're reading this I'm guessing that you've got such excellent health habits and are surrounding yourself with such positive people that you've got 85 years in you. That’s 85 years to do what you’re here to do, to experience what is exactly most important. Eighty five years at 365 days each year. Not a lot, really.

But you don’t have 85 anymore. If you’re reading this when you’re 30, for example, we might say you’ve got 55 years still on the clock. So there’s a formula that you might keep tattooed in your memory the next time someone invites you into a 3-year dead-end relationship. Or asks you to exchange a valuable evening for overtime at work when in fact you might need the time more than the money. The formula is this:

(85 – X) x 365

In the formula, “X” equals your current age. Check my math here, but I think that if you’re 40 right now you’ve got about 16,425 days left to do/be/have whatever it is you need to do. And if you’re 28 you’re right at 20,805 days still on the clock.

So if you’re 52 (12,045 days left) how much of that will you allocate to commuting in and out of the city? Watching television shows about people who have too many cats? Talking about how you really ought to join a gym?

The question here is not “what are people in my zip code doing and being and having?” And it’s not “what are my siblings doing”? The core question here is how do I want to inhabit and embody these 12,045 days?

“I’m going to eat all the gum and candy I want!”

When an 8 year old says that when they grow up they’re going to eat all the candy they want, I chirp something like “Oh boy, you betcha! Being an adult is awesome.” What I don’t tell them, because it would be soul-killing, is that being an adult is really hard work.

I do eat all the gum and candy I want. And when I overdo it, I pay for it in my body. One of my fondest dreams as a boy was to be grown up so that I could decide how late I’d stay up at night. And now that I’m an adult, I do. And if I stay up too late I pay for it my emotional and cognitive experience. I don’t feel quite well, and my concentration is off. And my clinical presence with clients suffers.

And there’s no Mom to tell me to go to bed now. Or to stop eating that. Or to turn that off or stop reading that.

Eating just the right amount of gum and candy is hard work. And having just the right amount of small talk at work is a tough call. It bears repeating:

"The best defense against the manipulation of our attention is to determine for ourselves – in advance - how we want to invest it."

Isn't it a Bit Late for Me to Be Thinking about Life Purpose?

Honestly I’ve heard 70 year olds and 35 year olds and 23 year olds express their belief that the best part of their life is behind them. Do you really think high school is as good as it’s gonna get? If you’re old enough to remember the 1980s do you really think that was the high mark?

The best part of your life may be in the part of (85 – X) that still lies ahead.

Ted Williams and Susan Boyle

When we think of individuals who later in life moved squarely into the center of their life mission, the examples frequently offered are Colonel Sanders and Grandma Moses. Sanders was at the front end of fully exploiting the concept of the food franchise. But not until he’d tried lots of other less phenomenal business ideas. And Anna Mary Robertson Moses didn't take up painting, the medium for which she became beloved, until her 70s.

But we’ve got a couple of more recent examples of mid-life moving into something really important or meaningful. As everyone with internet access knows at this point, Susan Boyle was a 47-year old hopeful on Britain's Got Talent when she wowed the judges and the world with her amazing voice.

Ted Williams was a 53 years old, homeless, and unemployed when a YouTube video went viral and helped him re-connect with one of his real gifts, his "golden" announcer's voice.

Like most of us, Susan and Ted haven't enjoyed entirely smooth sailing since their "discoveries." Just like real life, there hasn't been a happy -ever-after for either of them. But both have indicated a commitment to working through their obstacles and sticking with their do/be/have.

Tools for "Determining in Advance"

So how, specifically, do we “defend ourselves” against the activities and entanglements that would distract us from our core tasks? What specifically does it mean to “decide in advance”?

For me that means setting aside some at the end of each year to consider how I’m doing. Am I doing what I’m really here to do? Do my relationships and commitments reflect my core purpose? Is my mission evident from a review of how I’m stewarding my time?

And before the week starts, it could be valuable to spend some time “determining in advance” how my day to day scheduling is consistent with my do/be/have core tasks.

Finally (and this may be the most important part) we do well to invest some time each morning reviewing our hour by hour tasks and obligations. How exactly does each of these connect to what you most want to express and experience?

So our tools here are:

• 
  
  real clarity about our core goals and values


• 
  
  a good daily planner or smartphone app


• 
  
  a regular commitment to review - hour by hour - our activities in the light of what we know to be most important
  

Everybody Benefits

Doing this “deciding in advance” work is not just for you, by the way. When you’re really on-purpose, living squarely in the center of your do/be/have, others will benefit as well. If you’ve been around people who are living this type of life you know what I mean, you know how you’ve benefitted from being around that person. There are people in your circle that only you can inspire and affirm. And living your best life is part of that.



photo: beach sand waves

To Test or Not to Test

From time to time I will hear that an individual "is being tested for ADHD" as though there were some objective diagnostic tool which allows certain identification of the underlying condition, in the sense that one may be "tested" for Lyme's disease.

In fact, there is no "test" for attention deficit hyperactivity disorder. Rather, ADHD is a clinical diagnosis made on the basis of

• an interview,


• history,


• behavior observations,


• review of pertinent medical records, and


• collateral report (interview with a roommate, spouse, parent, or teacher).

Would that we had some objective "test"! Such wishful thinking was displayed several months ago, in an article in the New York Times which described a souped-up continuous performance test as a "biomarker for ADHD." An example of a true biomarker would be, for example, specific cerebrospinal fluid protein abnormalities in Alzheimer's disease. Or a positive dexamethasone suppression test in the case of clinical depression. The concept has been extended, in psychiatry, to include cognitive phenotypes in addition to "substances" like proteins.

In the case of, ADHD, however there is in fact no "biomarker." In fact, as a clinical entity ADHD is heterogeneous, with multiple genetic risk factors, multiple environmental risk factors, and a variable clinical presentation.

But how might a continuous performance test, or some other type of neuropsychological indicator, improve upon the interview and clinical history for determining the presence and functional impact of ADHD? Is it recommended to have a complete neuropsychological assessment?

One consideration is the patient's and family’s time. A neuropsychological evaluation requires a greater commitment of time than a briefer office consultation. A second consideration is the considerable expense of neuropsychological evaluation. We want to direct our resources -- time and money -- in the most helpful direction.

There are times when I've committed 8 or 10 hours to a formal neuropsychological evaluation, only to confirm what the client herself, or the client's parents, already know. And in retrospect I wondered if we might have spent those 8 to 10 billable hours in a different way? For example, patient education, spouse education and support, specific parent training, or ADHD coaching supports?

So how do we make this determination, To Test or Not to Test?

My perspective as a clinician who conducts this type of evaluation is threefold:

First, consider the complexity of the clinical presentation. If in addition to attention/focus/impulsivity are there are other clinical concerns? Such as depression or substance abuse or trauma related anxiety, or attachment disorder, or questions about general intellectual functioning? If so, then a complete neuropsychological evaluation may help "tease out" these factors so that we may speak to the specific functional impact of ADHD versus some of these other concerns.

A second consideration comes to mind when I think of the unsavory, but unforgettable, advice of a graduate program supervisor. When it comes to performing psychological testing, there's always the option of yet more evaluation. One more personality test, for example, or one more approach to verbal learning.

My supervisor’s advice was this: "It's like picking your nose - if you find something, where you going to do with it?" And likewise when we are considering a neuropsychological evaluation, we ask ourselves "what will we do with this information?" Practically speaking, how will these test scores facilitate services or treatment or predict success in an academic or vocational setting? What will you do with these data?

In my own practice, I do frequently conduct an abbreviated neuropsychological battery when the referral question is related to ADHD. This battery might include intellectual assessment, academic testing, evaluation of various aspects of memory and learning, as well as targeted evaluation of attention and concentration and focus.

The diagnostic impression of ADHD will not, however, be based on this testing. The diagnosis is offered, again, on the basis of history, clinical interview, and mental status exam.

And what test scores might provide me, over and above that clinical history, is a context. A way of understanding the client and his/her ADHD symptoms as it impacts academic or vocational settings. After confirming an ADHD diagnosis, I am sometimes asked whether or not this 17-year-old will be able to manage the demands of college or university. And I will make use of my test scores to better answer that question. Can a 17-year-old with ADHD reasonably expect college success? If the full scale IQ score is 100 or 110, my response might be “yes.” He can likely manage college coursework if he has a good academic and study skills supports, starts out with one or two college course is to "ease into" the demands of college coursework, lives at home with supportive family for a semester or so before making the transition to dormitory life and campus social life, and if he/she is really motivated and inspired by the particular course of study.

On the other hand, the 17-year-old with ADHD whose IQ score is 85 might find college coursework unmanageable. And the 17-year-old with full scale IQ score of 110, but reading achievement score in the low 80s may find college coursework overly demanding.

So, the additional neuropsychological data provides a context for understanding an individual client and making some useful recommendations her predictions.

A final concern, when it comes to the Test or Not question, is the extent to which a client actually needs my consultative input. Many parents, or adult patients, come to me fairly certain, they have some of the attentional and executive challenges associated with ADHD. And what they need from me is not a confirmation of this diagnostic label but, rather, some specific advice or direction or coaching type support.

In summary, the decision to pursue this type of evaluation will depend on:

• the client's time and financial resources and how best to allocate those,


• the complexity of the clinical presentation,


• the practical "what will you do with this information" consideration, and


• the extent to which you actually need diagnostic confirmation, or on the other hand could benefit from direction and advice.

To test or not to test? What's certain is that there's no need to to suffer the slings and arrows of outrageous fortune. Talk to your doctor or healthcare advisor about your concerns, and decide your next step. You can also contact me at David@DrNowell.com

Gift Ideas for the Distracted Person in Your Life

An attendee at a Lansing area workshop a couple of months ago told me about the Smartpen. I tweeted about it without actually having had a chance to look at it myself. So I was psyched to meet someone who was actually using the Smartpen to take notes at a recnet Lend Me Your Brain workshop!

There are a number of time/project management tools for distracted students and adults. One that's caught my eye recently is Skoach. Anybody have experience with this one?

The Pomodoro Technique is a sweet way (it's a plastic timer shaped like a tomato!) to take advantage of "chunking." The idea is to commit to a period of uninterrupted work and then commit to a break.

I was first sold on "chunking" a few years ago after reading Dave Lakhani's The Power of an Hour, and use something a bit simpler - a plain kitchen timer.

photo: i love you

Positive Psychology in Australia

I'll be working with TATRA Training in May 2011 to highlight what we've learned from a decade of Positive Psychology research.

8 workshops are scheduled across Australia!





photo: australia

New Journal - Developmental Cognitive Neuroscience

A new scientific journal on brain development launched in November.

Here's a podcast that summarizes that issue.

The Dangers of "Mental Retirement" -- Our Brains Need to Solve Problems!

Freelance writer Sara Rowe recently posed some questions about dementia for an upcoming project. Here are some of my responses on that topic:

Q: What causes memory loss (both in the form of diseases such as dementia and in simple situations such as where you forget where you put your keys)?

A: Some decline in memory functioning is normal over the lifespan. A neuropsychologist can identify "normal age-related changes" beginning in the seventh decade (patients who are over 60). But these should be slight changes and not the sort of forgetfulness that has real functional impact. Frank forgetfulness is not normal in older patients and should not be dismissed. Among older patients, memory complaints may be related to reversible causes or more serious and progressive decline (dementia). Common reversible causes of forgetfulness among older adults include poor B vitamin absorption, sodium imbalance, and sluggish clearing of medications. Progressive memory decline is typically related to two common types of pathology: vascular changes (tiny strokes or insufficient blood and oxygen supply to brain tissue) and abnormal protein plaques and tangles. When the plaque-and-tangle changes are significant, doctors call that Alzheimer's disease.

And even among healthy older (and not so old) adults, transient forgetfulness may be a red flag of stress, depression, or overwork. Some people notice that after a poor night's sleep, or a night of drinking too heavily, they experience memory lapses and word-finding problems.

Just over 70% of the human brain is dedicated to "what is." We take note of the room temperature, what people around us are wearing, the nature of things as they are. The rest of our brain - the prefrontal cortex - is all about "what could be." I could end an unsatisfying relationship. I could move to Phoenix. I could move the piano over there so the door could open more easily into the room. The prefrontal cortex is the home of all that is magic about human cognition. And when our lives fall into a rut of predictability - when we're not solving problems and asking "what could be" questions, we run the risk of declining cognitive efficiency.

Q: What exercises/activities do you recommend to patients to sharpen memory and prevent or delay the onset of dementia etc.?

A: Several lines of research are coming together to suggest that complex mental activity is associated with reduced dementia risk. Cognitive Training refers to prescribed sets of mental activities directed at sharpening memory skills, reasoning, and speed of processing. Informally, many clinicians have encouraged their older patients to “stay active” by keeping their brain busy with crossword puzzles or Sudoku.

But in a recent study, Susann Rohwedder and Robert J. Willis discuss what they call "mental retirement." In the winter 2010 issue of Journal of Economic Perspectives (Abstract here and NY Times article here), Rohwedder and Willis suggest that retirement from vocational activity is associated with measurable decline in cognitive ability. There may be something about work that stimulates and protects the brain against age-related decline. And that may be something that crossword puzzles and Sudoku can't approximate. Vocational activity is an excellent cognitive workout. Work presents the brain - the whole brain - with sensory demand and motor planning challenge and time management and nuanced social problems.

My advice to anyone concerned about his/her memory is first talk with your doctor. She may ask questions and chart changes over time, or may refer you to specialists for further evaluation. You and your doctor will also try to stay on top of risk factors for memory decline: monitor and regulate blood sugar, maintain normal blood pressure, and keep cholesterol in check.

Meanwhile, the type of "brain exercise" I recommend is activity which is as organic and real-life as possible. If your life is not busy enough to require an alarm clock and a planner, then you are not busy enough to maintain brain functioning. At least 5 days a week, you should have a specific reason to be out of bed, dressed, and out the door. You should have enough going on that you need to keep a calendar to keep it all straight. You should be interacting with people who are a lot like you as well as people who are so different that you have to struggle a bit to figure them out. You should be solving problems every day. We need to avoid drifting into nostalgia and reminiscence; we need to keep imagining "what could be." That's what keeps our prefrontal cortex tap-dancing. Social problems, traffic logistics, travel planning, meal preparation....all of these give your brain the workout it needs to stay healthy.

The emerging concept of neuroplasticity recognizes that experience shapes our brain. Literally, at the level of the cell and synapse and brain structure itself, our daily learnings are shaping our brains. And although our brains don't regenerate as quickly and thoroughly as skin or even bone tissue, we do now recognize that the brain makes effort to heal itself and adapt to ongoing changes. At the risk of sounding trite, "use it or lose it."

Here's a real life story that illustrates the point (with identifying information changed of course!) Marion was surprised to find how dull retirement was. After looking forward to early retirement for several years, she found herself physically healthy but, at age 58, not as busy and engaged as she'd been while working a clerical position at a community college. She began to notice minor aches and pains and checked in with her doctor about these. She'd had checkups but had never had many complaints before, and her doctor questioned clinical depression. Marion complained of some amotivation and malaise but no real sadness. She did confide with her doctor, though, that she'd begun to worry about her memory. She slipped up with words that “I ought to know” and misplaced items in her apartment. She later recalled that she had started to see herself as “old,” and didn’t put much effort into grooming or maintaining her wardrobe. She’d been dedicated to her work at a local college and without that piece of her life, she realized she didn’t have many social outlets.

Marion responded to an ad in a local weekly paper to volunteer as a “baby cuddler” in a neonatal unit. The hospital was about a half hour drive from her home which she didn’t mind if she left early enough in the morning. She loved holding the newborn babies and felt relieved that, because this was volunteer work, there was no pressure to perform. But there were other mental challenges. She now describes her surprise at the cultural diversity and the different personality types among the staff and other volunteers at the hospital. Her coworkers at the college had all been “pretty much like me.” In her volunteer work, Marion found herself navigating social challenges, avoiding “putting my foot in my mouth,” and trying to coordinate her schedule to avoid working with one particularly bossy and overbearing nurse. Most of the staff was younger and Marion loved hearing their take on movies and politics and popular culture. They teased her about dressing “frumpy” and she began to take their advice and tips. To save money, Marion packed a lunch. And this meant planning ahead, prepping the night before, and coordinating grocery shopping around her volunteer work. She began to take delight in the little day by day prizes – finding a secret parking spot near the hospital back entrance, finding the coldest soda machine in the building, and picking up a few words of Portuguese in her conversations with one of the hospital staff members. Within weeks, Marion reported that her memory seemed “back to normal,” and she even felt less focused on physical aches and pains.

For folks who are approaching retirement, then, I'd recommend considering how to keep up the kind of mental workout that vocational activity involves. For example:

Volunteering
Active involvement in caring for grandchildren
Traveling

We need a specific reason - and deadline - to get out of bed in the morning. We need the challenge of having clean and pressed clothes ready. We need to interact with easy as well as difficult people. Our brains need problems to solve!

Regional Variability of ADHD Diagnosis

I'm meeting clinicians in North Carolina this week and was interested to learn that is the state with the highest rates of ADHD diagnosis.


An expert in a recent article attributes this statistic suggests that heightened awareness among families, and better diagnosis by professionals.


And that's almost certainly part of the story here. But when we consider the state-by-state variability of ADHD diagnosis, or of stimulant therapy, there are likely other factors at play here. We notice, for example, an Eastern bias towards making the diagnosis.

This regional variability is an issue we touch on briefly in the workshop but I'm interested to hear the thoughts of my colleagues in North Carolina next week.

photo: psychiatric news

The Best Part of My Morning

My favorite moment of the day is my morning journaling practice. Three or four days out of the week I'm able to get to it. I have coffee, read a couple of newspapers, then open my journal. My practice is based on themes in the Positive Psychology literature.

I clarify some specific gratefulness, I remind myself of what I like most, and I commit to some specific way of being kind to myself and another person that day.

And my favorite moment is usually five or ten minutes into the practice when I feel a shift, like I'm settling down a bit more deeply into myself. Kind of a "oh yeh, that's why I'm here!"

This practice is, I think, part of my ongoing challenge to maintain a spiritual life. I got an early start, growing up in a minister's family. But the "pull" or the gravity of my life is to the dry and dusty details of daily commitments and tasks. I want to keep it juicy and alive. To feel the pulse of it all running just under the surface of the visible and quotidian.

Here's a link to my journaling template if you'd like to try it.


photo: january first

Intrinsic Motivation! Magical Unicorns! Serial killers!

Elizabeth Báthory was a Hungarian countess who tortured and killed over 600 girls and women in the early 17th century. Clearly this was an individual with some disordered motivations. Ideally we'd like to see her develop empathy and other pro-social intrinsic reasons for not serially brutalizing others, but if the best we could do were keeping her behavior in check with extrinsic reward, well I'd settle for that. I really wish her parents had offered her music downloads or candy corns or 20 minutes past-bedtime play for every day she could go without hurting someone.

...read more at my Psychology Today blog

The Body Double

ADHD Coach Linda Anderson discusses the role of the Body Double here.

And there's a very helpful discussion of the Body Double concept in a BlogTalkRadio show from earlier this year right here

I've got a theory about how this works....it's the same way stimulant meds work. They "increase the saliency" of difficult or dull tasks. That is, at the brain level, one is more "in touch" with the medium- or long-term payoff of the activity.

Which is exactly what a good teacher or ADHD coach does! You know how organized and efficient you are the day before vacation? That deadline "increases the saliency" of work activities - even those which are dull or hard.

And you know how students tend to "tighten up" their behavior as the teacher moves physically closer to the student? As entertaining and rewarding it is to misbehave, there are rewards that I want even more than that....and the proximity of the teacher puts me in touch with those rewards (avoiding detention hall, or being seen as a "good kid"). That proximity "increases the saliency" of sticking-to-the-ground-rules in the classroom.

So my theory here is that the presence of the body double functions like that looming deadline or that nearby teacher...the Body Double increases the saliency of at-hand tasks.

I'm going to be kicking this around with clinicians who work with ADHD clients. And I'd love to hear from ADHD coaches out there!


photo: astronaut twins

Q & A: Homework Challenges

Here's a question from a recent participant in the ADHD and Processing Disorders workshop.

Q: Any suggestions for parents who struggle with homework issues with their ADHD children?

A: Our first piece of work is to determine where the student is breaking down. To ask "what's the kid's deal"? And to encourage parents to direct support to those points of performance.

In order for homework to get "done," a number of things have to happen. So when homework is not done reliably and painlessly, there are a number of common points where the project goes awry. The student might, for example:

Fail to write down assignments

Forget the assignment book

Forget necessary materials

Have trouble with the "getting started"

Take hours to do minutes of homework

Hassle parents about when and where to do homework

Lie about having done homework

Need constant supervision with homework

Forget to bring homework back to school

Our intervention will depend upon the student's specific way of not getting the homework done. The student with problems "getting started" might need strong incentives up front. And once he's actually dived into the task he might be more independent.

The student who gets the homework done (usually with good parental supervision) but who fails to get the material turned in the next day needs support with that piece. Faxing the homework to the school office in advance might help, or attaching the work to an email which can be opened, and printed at the school computer lab might be a fun way of getting the material to the teacher.

The student who lies to parents about assignments (I actually hear this complaint fairly frequently) is in a tough situation. She's doing something fun, or at least benign. And Dad asks whether she has homework. Now if she says yes to that question she will have to stop doing something fun and do something less fun, possibly even something hard. It's almost a set-up to tell a fib. I'd rather encourage teacher-parent communication. Some schools have websites for just this type of daily communication about assignments. So parents can maintain an overview of schoolwork there rather than using the student as the primary source of pure truth about necessary assignments which might be dull or hard.

Practical Tips

Ongoing school / parent communication regarding assignments and due dates.

Regular predictable routine regarding where and when homework takes place.

Limit distractions. If your student claims she performs homework better with simultaneous chat/IM or texting, you can definitely inform that in fact multitaskers perform worse on tasks than individuals who perform one task at a time.

Chunk cognitive activities. Commit to working on one single thing for a specified period (length of focused activity will depend on the age of the student). If you like cute, the Pomodoro Technique is a cute way to think about chunking.

Support the “getting started.” If your student has difficulty engaging with even moderate cognitive challenge - they drag their feet, use stall tactics, and so forth, you might consider rewards and incentives which are front-loaded. "I'll give you 4 iTunes downloads if you finish your math homework. And I'll give you 3 downloads just for opening your math text and taking out a pencil." For some students, this strong push to get started might be all it takes. Then, they're moving.

Each of has a specific recipe for success. Likewise we have a specific recipe for not getting things done. Mess with my recipe and you change the outcome. The goal here is find where exactly the homework isn't happening and direct support to that point of performance.

Brain: The Inside Story

I can say this to you because you're, well...you're reading a blog called The Neuropsychology of Happiness. But some of my friends think my excitement about the brain exhibit at the American Museum of Natural History is overexuberant. I cannot wait to see this.

In NYC through August 15, and the perfect excuse to plan a trip there.

Deep Happiness by Design - at Kripalu Center

One of my great pleasures is facilitating a workshop called "Deep Happiness by Design."

The core experience of the workshop is identifying our preferred states - what we need to feel in our body to be motivated and engaged. Each of us has a brain/body blueprint that is our unique recipe for feeling on-task.

And my approach to time management flows from that. In the workshop, we journal to recall great moments and memories. We then identify the "Kodak moment" in these memories and then drill down to the feeling: how it felt in our body to be in the middle of all that. With that self-knowledge we take an honest look at our schedule. Our commitments, obligations, and relationships need to flow directly from our unique motivational blueprint.

During the holidays there are more opportunities than there is time. And we say yes to the right experiences based on this self knowledge of what our bodies most want to feel.

I'll be offering the workshop in 2011 at Infinity Foundation in Chicago, and through the Alternatives program at St James Church in London.

And in just a week or so the program will be offered at Kripalu Center in the Berkshires of Western Massachusetts. There's still time to sign up right here!

Also,the journaling exercises that we use in the workshop are available (and 25% off right now) right here.

What Kind of Holiday Experience Do You Want this Year?

Think about your overall holiday experience last year. Give it a rating on a 10-point scale, with 1 being miserable and 10 being the best possible holiday experience. Got a number in mind? Now, a challenge for you: What would it take to make this year's holiday experience just one point better?

There may be a part of this that's actually within your control. You might be able to make some changes this year. The commitments and relationships and obligations you pursue over the next several weeks will in part determine whether the holidays will a better experience for you this time around.

Here's a journaling exercise to help you take control of Holidays 2010:
Find a quiet place before you're already in the "thick" of holiday activities. In the morning is good, while the house is still quiet and before the day has started. Take out a journal or other blank paper and make a list of great holiday memories. These could be from last year or 20 years ago. We're talking here about the big memories as well as the tiny little things that made the holidays great for you. See how many memories you can come up with in 15 minutes or so.

Now, identify the one single moment that captures that holiday memory for you. The "click," the sound of a camera shutter catching what was the best about that experience. Try to drill down to the one moment in each of your holiday memories on that list.

Next, identify what you were feeling in that single moment - really try to identify where you were feeling that in your body. If you try to recreate that feeling now, can you "find it" in your belly or chest or around your eyes? What exactly does it feel like?

If you've done this with a list of 15-20 holiday memories then you've identified a number of really great feelings that you have associated with the holidays over the years. And you want more of those feelings, and less of the stress or obligation or whatever might be the negatives that have become attached to the holidays for you. As you consider activities and invitations and commitments over the next month or so you might ask yourself "with which of my core preferred feelings does this connect?"

You might need to be firm and decisive to manage the universe of holiday possibilities and carve out just those experiences that make the holidays great for you.

Hope you feel great this holiday season!