Contents
Disclaimer and Terms of Use Agreement: ................................................ 3
Introduction: ................................................................................................ 4
The Current State of Affairs: ...................................................................... 9
How ADHD Is Currently Defined: ....................................................................................................... 9
ADHD: Childhood or Adult Condition? ............................................................................................. 11
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Introduction:
Hyperactive.
Cant focus.
Lazy.
Not achieving your potential.
These, and many other terms are used to describe people with Attention Deficit/Hyperactivity
Disorder.
If you ask the average person on the street what they think when they hear ADD or ADHD, they
say something along the lines of: a little boy who cant sit still.
And if you talk for longer, youll quickly hear that they dont believe in ADHD; they think its caused by
lazy parents, the school system, or violent video games. And what always surprises me is the
strength of their beliefs they dont just think that ADHD isnt real, they seem to express it with
absolute conviction that theyre right.
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The DSM-V is expected to be published in May 2013, and it will likely have some revisions to the diagnostic criteria for
ADHD.
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Increasing Prevalence of Parent-Reported Attention-Deficit/Hyperactivity Disorder Among Children --- United States, 2003 and 2007
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5944a3.htm?s_cid=mm5944a3_w
8
Kessler et al, Am J Psych 2006:The prevalence and correlates of adult ADHD in the United States: results from the National
Comorbidity Survey Replication.http://www.ncbi.nlm.nih.gov/pubmed/16585449
7
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Children
Adults
Percentage with
ADHD:
Approx. Population:
7%
4.4%
87 million
187 million
Estimated
Individuals with
ADHD:
5.9 million
8.2 million
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http://drkenny.com/book
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www.drhallowell.com
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B2) Behavioral:
The third B refers to Brain. As the medical understanding of ADHD has grown, and technology to
study the brain has improved, we now know that people with ADD/ADHD have differences in their
brain structure and function.
We now know that there is a medical side to this condition, and that it is not just willful misbehavior,
or kids being bad or behavioral. We know that it is a real condition, which has well researched
treatments to help it out and to improve the lives of people living with it.
This step (B3) leads to significant progress for individuals living with ADHD and their families. By
knowing that ADHD is a medical condition, it takes many of the negative aspects of the diagnosis out
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Some of the celebrities who have shared their diagnosis of ADHD include:
Michael Phelps: American swimmer and the Olympian who has won the most Olympic
medals in history
Howie Mandel: Comedian, Actor, Author, and TV Celebrity (host of Deal or No Deal, judge of
Americas Got Talent)
Britney Spears: Singer, Star, and judge on The X Factor
Adam Levine: Lead singer of Maroon 5, and judge on the TV show The Voice
Terry Bradshaw: NFL hall of famer and TV personality
Ty Pennington: High energy host of Extreme Home Makeover and the talk show The
Revolution
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Although there hasnt been any conclusive scientific evidence that people with ADHD are more
creative or are more capable in any way than people without ADD/ADHD, its my belief and my
experience that when we get the negative symptoms of ADD/ADHD out of the way, people with
ADD/ADHD can be incredibly gifted in their areas of strength.
When thinking about B4: ADD EvolvedTM remember that each stage progresses from the previous
one. Im not suggesting that you should ignore the Brain stage i.e. you need to accept the medical
treatments to help ADD, and then you can progress to the Better stage, where you are focusing on
building and improving the strengths.
Of course, I encourage you to continuously focus on strengths, even as youre just getting started
i.e. dont wait until you have all of the treatments in place before you start to focus on strengths.
At the same time, if the ADHD symptoms are severe, untreated and causing significant impairment, it
may sound absurd to suggest that there are great strengths with ADD/ADHD. Thats why its
important to treat ADD/ADHD effectively, and then build on the strengths in the ADHD mind.
You can also use this framework to think about where other people are in their understanding of
ADD/ADHD when you interact with them. If you have someone who is still at the Bad stage (i.e. B1),
do your best to move them up to the Brain stage (i.e. B3). If you can get them up there (and even
skip B2), then youve done extremely well. To accomplish this task, youll need to share the medical
facts about ADHD, the research behind the brain and genetic components of the condition, and more.
If youre talking with someone whos at the Brain stage (i.e. B3), then I encourage you to help to
move them up to the Better stage (i.e. B4). You can talk to them about the great things that people
with ADHD do (even though they have ADHD), and how well your child or you do when you focus on
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Next Steps
When I review the scientific literature, there are two areas of ADHD research which dont often get
discussed in doctors offices, in presentations, and when doctors are talking with their patients
(especially not in often very busy office visits).
And every time I read about these areas of research, I think about how critical these are to how
people actually live and function in everyday life.
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14
15
Leidy NK, Rich M, Geneste B (1999) Recomendations for evaluating the validity of life claims for labeling and promotion. Value Health 2:113127
WHOQOL (1995) World Health Organisation Quality of Life Assessment (WHOQOL): position paper from the World Health Organisation. Soc Sci Med
41:14031409
16
Danckaerts et al. Eur Child Adolesc Psychiatry (2010) 19:83105
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http://www.russellbarkley.org/content/ADHD_EF_and_SR.pdf
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Transitioning between tasks: trouble disengaging from one task and moving onto the next
one (a common issue for parents of ADHD kids who need a lot of warning before a transition)
Time management: trouble with being aware of time, its passage and managing tasks
appropriately for the time available
Goal directed persistence: setting a goal, and being able to persist with it to completion
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Metacognition: this refers to the ability to think about ones own thoughts i.e. insight.
Sometimes its hard for people with ADHD to reflect on their own thoughts and behaviors and
have insight into them
Executive functions research correlates well with brain research in ADD/ADHD. There are several
research studies which show involvement of the frontal lobe in ADHD, which is known to be
implicated in executive functioning.
One particular brain area, the anterior cingulate cortex (ACC), is known to help with executive
functions in normal brain functioning. ADHD brain research shows that in adults with ADHD, the ACC
often doesnt work as well as in controls (i.e. adults who dont have ADHD)18, and other research
shows that with the ADHD medication methylphenidate, the ACC works the same as it does in normal
controls i.e. the medicine improves ACC functioning in adults with ADHD19.
While the best theories behind ADHD incorporate an understanding of executive functions, there are
many researchers who say that executive functions are not always an issue in ADD/ADHD. In fact,
when researchers test the executive functions of individuals with ADHD using neuropsychological
tests, only approximately 30% of people with ADHD show measurable difficulties in executive
functions. The researchers then assert that executive functioning challenges are not always present
in individuals with ADD/ADHD.
In his paper called: Executive Functions and Attention Deficit Hyperactivity Disorder: Implications of
two conflicting views20, Dr. Thomas Brown challenges the way that executive functions are defined
and measured. He suggests that ADHD is in fact a developmental disorder of executive functioning.
18
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21
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Late, Lost and Unprepared by J. Cooper-Kahn Ph.D., and Laurie Dietzel Ph.D.
Mastering Your Adult ADHD A Cognitive Behavioral Treatment Program by S. Safren, MD (and
others): This is a workbook which provides you with cognitive behavioral treatment. Although
this is not specifically an executive functioning workbook, it does help with executive functions,
as well as providing cognitive behavioral therapy strategies for other challenges with Adult
ADD/ADHD.
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While I can handle any attack of ADHD quite easily, I recognize that as a doctor in my 40s, who is
known and respected for my professional work, it makes it pretty easy for me to handle these
challenges. However, handling these attacks makes me much more aware of how hard it is for kids,
teens and adults to deal with these attacks on a regular basis when they dont feel that theyve got the
confidence and stature to readily handle them.
My favorite response to disclosing my diagnosis came from a co-worker and friend named Vicki.
Shes a nurse at a hospital that Ive worked at before. When I discussed it with her, she said, Kenny,
youre ADD in the most delightful way. That made me smile. And now, if I feel that Im having a bad
ADD day, I think of Vickis perspective on my ADD, smile, and get on my way.
I decided right away that I wanted to share my diagnosis publicly, then I realized that Id also need
time. I wanted to take some time to get comfortable with it so Id feel good about sharing it in a way
that is intended to help others.
As it happens, its been about a year, and I feel very good about sharing it publicly.
I hope that my unique perspective of being an expert in ADHD who has dealt with ADD using
strategies before getting diagnosed with adult ADD will be helpful for you.
I hope Im able to share messages of hope and inspiration to you and others. Ill be sharing
information about ADD/ADHD from the inside out. By that I mean, as a doctor on the inside of the
ADD/ADHD treatment world, and as an adult with ADD/ADHD who lives with this condition. And in
case theres any doubt, I do love the unique and creative way that I view the world, and consider my
ADD brain as an asset that gives me many strengths and opportunities.
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Best way: make sure youre on my email newsletter list. If you subscribed when you
downloaded this e-book, then youre already signed up. If you got this from a friend, go to:
www.drkenny.com/rethink-adhd and put in your name and email. Youll get email updates
about ADD/ADHD (and if you decide the emails arent for you, you can always unsubscribe)
Free ADHD Podcast: You can find my free weekly ADHD Podcast here:
www.ADHDPodcast.com, and you can also subscribe to the podcast via iTunes here:
www.drkenny.com/iTunes
Face-book: Like my face-book page at: www.facebook.com/drkennyhandelman
Twitter: Follow me at: www.twitter.com/drkenny
If you prefer these other social networks, Im also on Pinterest, and Google Plus.
Final Thoughts:
Ive written this e-book to help to change the world for the better for people with ADD and ADHD.
There is great science and knowledge around ADD/ADHD, and yet the discussion in our society still
centers on whether ADHD really exists! By providing you with the facts you need, as well as some
forward thinking ideas, I hope that you can help us to change the discussion about ADD/ADHD in
our society.
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The fact that there is too much stigma and ignorance around ADHD in our society
The fact that ADHD is a lifelong condition, and that there are in fact more adults with the
condition than there are children with the condition
The history of ADHD
The Evolution of ADHD (B4: ADD EvolvedTM)
How important it is to use a Strength Based Approach to ADHD
How we need to look beyond the core symptoms of ADHD to focus on functioning
Quality of life is often worse in people with ADHD, and we need to work on treatments to help
this
Understanding Executive Functions is very important for understanding ADD/ADHD, and when
you design treatments to help Executive Functions, things can improve.
To help to Rethink ADHD, and to change the discussion, its very important that you share what
youve learned with other people, and help to raise awareness, and decrease stigma.
Connect with ADD/ADHD resources in your community like support groups, and advocacy groups.
Advocacy can be as small as helping one person to understand better what is going on with
ADD/ADHD, and as large as getting your member of congress to help with legislation to support
people with ADD/ADHD.
Great places to start are:
CHADD: CHADD stands for Children and Adults with ADHD. It is a non-profit which helps to
support kids and adults with ADHD. You may be able to find a local chapter to get involved
with, and you can find many online resources.
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ADDA: ADDA stands for Attention Deficit Disorder Association. It is an international non-profit
whose goal it is to support adults with ADHD. There are many resources available to help you
from ADDA.
CADDAC: CADDAC stands for the Centre for ADHD Awareness Canada. This Canadian
organization helps to advocate for ADHD in Canada. It may also help you to find local
resources and supports for you in your community.
There are many more resources available all over the world. Ask your doctor, find other people in
your community, and see whats available. The benefit of our modern technological world is that if you
dont have a local support/advocacy group, you can get involved via the internet. Research your
options, and find something that suits you.
As societys understanding of ADD/ADHD evolves, I look forward to the day that we can openly
discuss and share about ADHD, and that we can count on the support that we need from everyone,
as has happened with breast cancer. In the meantime, I hope that the ideas shared here help you or
your loved one to live better with ADD or ADHD.
With my heartfelt best wishes,
Dr. Kenny
p.s. if youve found this e-book helpful, please forward this link to your friends so they can sign up to
get a copy too: www.DrKenny.com/rethink-adhd
p.p.s. if youd like to share your comments, thoughts or reflections on this e-book, please do so here:
www.DrKenny.com/rethink-adhd-comments
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