New hope for ADHD in children and adults: A practical guide

NEW HOPE FOR

ADHD

in children and adults: A practical guide

Helena Bester

Tafelberg

We have knowledge

Beyond the scope of words

Once we turn inward

And reach beyond the mind

It is love alone that gives worth to all things. – Teresa van Ávila

This book is dedicated to you, the reader.

Foreword

Ms Bester has written an easy to understand practical guide in her latest book, New Hope for ADHD in Children and Adults, offering sound advice for parents, teachers, therapists, and those who experience ADHD symptoms. She provides the reader with a variety of solutions in the areas of diagnosis, related conditions, parenting tips, daily exercises, school tips, medication, dietary tips and neurofeedback. The neurofeedback chapter has been updated to reflect the latest research findings, which have increased immensely in the past decade. The reader is given the sense of travelling on the same clinical journey that Ms Bester has over decades of experience. It is obvious that she has a passion for helping those with ADHD and anyone who knows someone with ADHD. Whether you have ADHD, or are a parent, teacher or therapist working with ADHD individuals, I highly recommend this accessible book for your library.

Roger de Beus, PhD

Licensed Psychologist

ISNR Fellow

Assistant Research Professor

University of North Carolina at Asheville, USA

Introduction

For decades I worked almost exclusively with children with ADHD and their parents. ADHD, or attention deficit hyperactivity disorder, or attention deficiency, is characterised by one or more of the following main symptoms: inattention, hyperactivity and impulsivity. I conducted extensive research with a view to finding alternatives to the mainstream treatment, which was based mainly on prescribing stimulant medication.

Perhaps over time one develops a sixth sense pertaining to the subject to which one is dedicated. A veterinarian friend of mine who has performed thousands of sterilisations on animals, once told me she believes one perfects an action after ten thousand repetitions. Well, I may not have evaluated quite ten thousand ADHD cases, but I have consulted with and evaluated many over a period of many years. And yes, from the moment I set eyes on a client during a first consultation, my brain subconsciously begins to scan my extensive data base of stored facts for any of the subtle, often immeasurable hints in behaviour associated with ADHD. During the preliminary interview I have with the parents before I evaluate the child, I often recognise some signature ADHD-related signs or hints in one or even both parents.

The poem at the front of this book is about that immeasurable something that lies beyond reason and facts, and that encompasses the uniqueness of each individual. Even though I generalise a great deal in this book, I do realise with my entire heart, soul and understanding that you and your child are unique. I never reduce the person I am working with to the condition that brought them to me. But measurable or not, we must be able to clearly identify the signs, symptoms and tendencies in order to tackle the problem effectively, especially if it is hindering the person’s functioning.

Readers who have perhaps read one of my previous books or attended one of my talks or heard me on the radio, will know that I readily sing the praises of people with ADHD. They are usually very honest; they see only the good in others; they are extremely enthusiastic; and the hyperactive group provides the energy that drives progress. So why is it necessary to cure those with ADHD? Hasn’t it simply become fashionable to diagnose and treat every second person with attention deficit disorder – with or without hyperactivity? Are we focusing too much attention on this condition, which can potentially result in overdiagnosis? Shouldn’t we rather accept that people are different without labelling them? Aren’t we using our diagnoses and therapies to make people conform to the safe known? These are just a few of the valid questions that are examined in this book.

One of the new alternative treatments that we will look at in detail, is neurofeedback therapy. It is used for all forms of ADHD and, although less commonly, is also used very successfully in the treatment of anxiety disorders, insomnia, depression, epilepsy, brain injuries, autism, intermittent explosive disorder, and addiction. In fact, in October 2012 the American Academy of Pediatrics indicated the therapy as a level-1 treatment (that is, a preferred option in the proposed treatment protocol) and the best supporting therapy for attention-related problems. We will return to this later.

Since offering neurotherapy in my practice as a supplementary therapy, I am no longer focusing exclusively on the treatment of attention-related problems, but also on treating the conditions mentioned above. The difference this therapy makes to the lives of people, is something I am privileged to witness and one of the reasons for writing this book. I have included quotes from these people throughout the book – whether they themselves or their child has received the therapy.

It used to be believed that one outgrew ADHD. We now know that this is usually not the case. Some people develop the ability to manage the symptoms better, but this is not true for everyone. ADHD with or without hyperactivity in adults, another focus of this book, has a huge impact on one’s performance and relationships. Most sufferers over the age of thirty have never been diagnosed. Twenty years ago, the symptoms that teachers and parents now recognise as those of ADHD, were interpreted differently. The child was written off as naughty or lazy or stubborn. Often it is only years later, when the person’s own child is diagnosed with ADHD, that he realises he has the same problem.

Managing the symptoms associated with ADHD, whether in the case of an adult or a child, remains a source of concern eight years after publication of my previous book. Whatever treatment is followed, the sufferer must learn skills to prevent the symptoms taking over his life. At the same time, the parent must learn skills to support the child and the teacher, to make the necessary adjustments within the learning environment. Tips on how to do this are provided in this book.

I still firmly believe, as I wrote in the introduction to my previous book, that we are not defined by other people’s judgements or by a diagnosis. Our own fears are our only limitation. I also know that when we face our fears, the terror of those fears vanishes. Perhaps you have been struggling for years to hide or suppress the symptoms of attention deficit disorder or some other problem. I invite you to join me with an open mind on a journey to a possible solution.

The children and families referred to in this book are based on actual cases. Names and details have, however, been changed and some cases combined to ensure confidentiality.

1

A typical case history of a person with ADHD

A typical picture – Pete’s story

I meet almost as many dads with ADHD as I do children with ADHD. Obviously there are also many mothers with ADHD, but three times as many boys as girls are diagnosed with attention deficit hyperactivity disorder.

Many parents, usually fathers, have their own stories to tell when they realise that they have been struggling their wholes lives with the problems that have now been identified or diagnosed in their child. For many of them there is the profound realisation that they too have ADHD, and they feel relieved that the monster that has turned their world upside down for so long, finally has a name. But there are those who are extremely impatient with their child because they feel they are being forced to revisit what they have conquered all over again. They endured years of punishment for being forgetful, impulsive, unreliable and impatient. They had to learn how to cope with the muddle in their head. And the last thing they want is to be landed with the same problems again.

Pete’s wife called me. She, Sue, was at her wits’ end. It seems like there are five children in the house, not just four. We’re reaching a crisis point here, she said. Sue had heard about the new treatment for ADHD that was available at my practice.

Sue does not have children of her own. She met Pete two years after the death of his first wife and they were married shortly afterwards. Pete can be so wonderful and funny, Sue explains. But after a few months of married life I began to feel I was living in a nightmare.

Their life together was chaotic. The children had no routine and there were no proper rules. They wanted to watch television until they fell asleep at night and were very unwilling to eat balanced meals at regular times. Complaints from the school were a regular occurrence. Sue faithfully checked the children’s homework books, but their homework was often not done simply because it was not written down. Sue tackled the problems one by one, like a vegetable patch or flowerbed that you systematically clean and till. Soon the basic structures were in place: There were homework times, mealtimes, bedtimes and time for friends. There were fewer complaints from the school and Sue felt more in control.

Initially, Sue was not too concerned about the tantrums and other childish behaviour that Pete sometimes displayed. She was too overwhelmed by the adjustments that the children demanded of her. It was only with the benefit of hindsight that she realised that Pete’s unpredictability had been apparent from the beginning of their relationship.

As a child, Pete had hated school. He was always in trouble, being labelled naughty. He did not do his homework and got poor marks. He fell in with a bad crowd and even tried to burn down the school at one point. Pete explains that he now realises he simply accepted dares from his friends without considering the consequences. He feels as if he sometimes has tunnel vision and cannot see the bigger picture. He regularly finds himself overreacting and it makes no difference how unreasonable his actions are, he feels he cannot free himself from them. He feels powerless and trapped. It sometimes feels as if he is outside, looking in on himself and his behaviour.

The same thing happened on the day he tried to set the school alight. He broke into a classroom, egged on by his friends. He became caught up in the attention and the intensity of the emotions. That was the day they were going to teach their teacher a lesson. It was only after he had poured the petrol over the crumpled-up newspaper and put a match to it that he realised the seriousness of what he was doing and how bad the consequences could be. He desperately tried to put out the flames while his friends made a run for it. He says that it was never his intention to burn down the school. It was just that he got carried away. Fortunately Pete was able to quench the flames that day, but metaphorical flames that are lit by thoughtless actions can sometimes be much more difficult to extinguish.

Sue explains that Pete sometimes gets home when their youngest son is already in bed, storming into the bedroom while Sue is reading a bedtime story. He picks up the little boy and starts play wrestling him, after which the child is wide awake again. It often seems to Sue that Pete is only aware of his own needs and has no sense of responsibility. For instance, he might be in high sprits and start a game with the children at the dinner table that ends in tears because he fails to set boundaries or cry halt when things start getting out of hand. It has got to a point where she does not even feel comfortable leaving the children in his care when her attention is required elsewhere.

Pete runs his own business, which was often close to bankruptcy as a result of ill-considered decisions. Here too Sue has had to come to the rescue. The business is viable and has great potential. In the past, Pete has often tried to start up a second or even a third business while failing to give proper attention to his existing one.

After leaving school, Pete worked for a string of firms. Things usually started off well, but after a while he would become unreliable or get into a disagreement with another employee. Fortunately he inherited his father’s business. It flourished at times, but he was unable to apply sound principles consistently. For instance, sometimes he was very friendly to clients while at other times he was abrupt and even rude. Sue took over some of Pete’s responsibilities herself and delegated others in an effort to limit the inconsistency in their level of service.

Sue has reached the point where she is no longer prepared to assume all Pete’s responsibilities and do constant crisis management. She wanted a marriage in which responsibilities were shared and where she could rely on her husband’s guidance sometimes.

As a child, Pete was diagnosed with attention deficit disorder, specifically the type with hyperactivity. In his case the hyperactivity was associated with oppositional behaviour.

In some children and adults certain symptoms are more pronounced than in others. All people with ADHD do not necessarily present with all the symptoms of the condition. The behaviour patterns, weaknesses, strengths, personalities and abilities of people with ADHD differ. The typical cases that I describe are not intended to undermine anyone’s individuality in any way. I want to enable you to identify emotionally with the information in this book, and that is why I’m not merely providing you with factual information.

The initial interview

Various disciplines can shed light on the questions a therapist might ask at an initial interview. Through experience and personal preference the therapist will refine or change those questions until they become accurate searchlights that light up the relevant dark corners.

On page 32 there is an example of questions that might be asked in an introductory interview. I encourage you to go through the list and try to answer the questions as they pertain to your child or yourself as a child (if you have the relevant information). Teachers, therapists and students can use the questions as guidelines to help them sift through the relevant background information more easily.

I have included high-frequency responses, that is, answers that I hear most often from parents. I have not (yet) been able to determine response patterns when it comes to certain questions, although those questions do relate to certain aspects of ADHD. For example, one often hears that sleep disorders or problems are common among those with ADHD. But of the thousands of children with ADHD with whom I have worked intensively over the past twenty-three years, those with sleeping problems are in the minority. I have indicated the places where, according to my own observations and experience, there is no clear pattern of responses.

Questions are a vehicle of immeasurable importance to the therapist. But even more important is the therapist’s ability to listen. Regardless of how effective the questions we ask are, there is always the possibility that we might be overlooking an important component. The other danger is that a specific set of questions may shed light on a particular issue from one angle only. This can lead to prejudice on the part of the therapist. It is like when you begin focusing on red cars on the road: It will eventually seem to you that there has been a sudden increase in the number of red cars. And the longer, figuratively speaking, you look at someone through a particular lens or set of questions, the clearer certain aspects of that person become while others fade into the background, which could influence the type of intervention you decide on. That is why my opening statement is usually: Tell me, I’m listening. This important open question can offer you, the therapist, a perspective that your limiting lens or questions cannot.

As the reader, I ask that you do as follows: In your own words, state the problem as it is in your experience with your child (or with you or a child in your classroom). Awareness is an important step in treatment, and also in the decision-making that could lead to a positive change.

Professor Rudoph E. Tanzi of the department of neurology at Harvard University’s medical school says in Super Brain (2012), a book he co-wrote with medical doctor and author Deepak Chopra, that in every task we perform we are either unaware or aware or self-aware (aware of our own role in the situation rather than shy). When we are unaware, we are driven by our emotions and lower brain functions. The brain is then in an unbalanced state of functioning. Our decision-making functions are impaired and our behaviour is controlled by fear and anger, among others.

When we act consciously or are in an aware state, we can express how we feel about something. The emotions are then put in perspective by the higher brain functions, including judgement. The brain is therefore in a more integrated state, with both the higher and lower brain functions playing a part. Emotional as well as cognitive brain functions are involved. We do not feel as overwhelmed by our emotions and as if we have no control over the situation. The ADHD sufferer often feels overwhelmed by an emotion he is caught up in, so much so that his powers of judgement and decision-making functions are crowded out.

When we are aware of our own involvement in a situation – in other words, when we are self-aware – we are able to think about it properly. Once we have that awareness, we can evaluate our own behaviour and make the right choices. In this way alone lies positive change. Emotions are not the opposite of a state of awareness, but are in fact an important searchlight to highlight what questions we should ask to bring about insight and growth.

I believe awareness to be essential not only for those with ADHD in managing their symptoms, but for every one of us as we grow as human beings. We will discuss this further in the chapter on neurotherapy. Neurotherapy generally improves self-awareness.

Back to the initial interview: You need to start at a specific point when describing the problem as you experience it, to the therapist. Some people’s thought process is more analytical whereas others think in a more systemic way. Some mothers arrive with a list of ten points, with pregnancy as point one. Others start with an incident that occurred the day before the interview and others sum up the problem in a single sentence.

It disturbs me greatly that many test conductors allocate only a ten-minute time slot for the first interview. Time is a factor, but I do not understand how one can get to the essence of the problem after just a few questions. You may perhaps leave a consultation clutching a prescription, but plagued with doubts, questions and fears.

Once the parent has responded to my initial statement – tell me, I’m listening, I ask questions about those aspects that may be relevant and which the parent has not yet addressed. It is primarily in response to the first question that I start to discern synchronicities and patterns hidden behind the general symptoms that I would not necessarily have noticed at first. A large percentage of children with ADHD, for example, had high fevers or fever convulsions at a very young age. Most are also emotionally very sensitive, though it often seems that they are not at all aware of other people’s needs. They are also often creative thinkers. In adults in particular, it is clear that people with ADHD do not like problems. They appear to need their environment to be under control because of the often chaotic state of their own thoughts.

The following questions are useful not only in setting up an intervention programme but also in other practical aspects of managing the condition. They may perhaps make you as a mother smile as you realise that there are many other moms walking the same path as yours. As already mentioned, I have also included general answers and comments and indicated where there is no clear pattern. Questions that are more appropriate in an initial interview with adult ADHD sufferers are covered later in this book.

Please bear in mind that the answers are