IDEA, IEPs, and Section 504 Plans: ADHD School Accommodations
Both laws apply to ADHD — so which fits your child?
by ADDitude Editors
The Individuals with Disabilities Education Act (IDEA) covers students who qualify for special education. Under IDEA, a student is eligible to receive special education and/or related services if it can be determined that the student has a disability under one of the qualifying conditions.

Each public school child who receives special education and related services must have an Individualized Education Program (IEP), according to the Department of Education. The basic requirements for IEPs are that they must be designed for one student and must be individualized documents.

Students who do not meet the criteria spelled out by IDEA may still qualify for help under SECTION 504 of the Rehabilitation Act of 1973, also known simply as “Section 504” or “a 504 Plan.”

What’s the difference between IEPs and 504 Plans?
While the procedures are different, the goal is the same: to ensure that students with disabilities have access to a free and appropriate public education that is comparable to the education available to their non-disabled peers.

IEPs under IDEA cover students who qualify for Special Education. Section 504 covers students who don’t meet the criteria for special education but who still require some accommodations. Section 504 is actually a civil rights law, designed to protect the rights of individuals with disabilities in programs and activities that receive federal assistance from the Department of Education. A student is eligible as long he/she currently has or has had a physical or mental impairment which substantially limits a major life activity. Students who have ADHD may qualify if their ADHD “substantially limits” their ability to learn.

Instead of having an IEP, students who qualify under Section 504 are required to have a plan that specifies any accommodations that will be made in the classroom. Accommodations for the ADHD student may include allowing extra time to complete assigned work or breaking long assignments into smaller parts.

By JOHN AMODEO, PHD

Plato Bust“Be kind, for everyone you meet is fighting a hard battle.” – Plato

As shock waves resulting from Robin Williams’ suicide begin to settle, we might reflect upon what we might learn from this tragic event.

Viktor Frankl, a concentration camp survivor and author of the classic book, Man’s Search for Meaning, reminds us that we may sink into despair and depression unless we find meaning in tragic circumstances. What meanings and wisdom might we gather as we mourn the loss of one of our great actors and humorists — and by all accounts, kind and generous human being?

We can’t presume to know all the complexities of another person’s heart and mind, and we’ll each be touched in different ways — gathering lessons and meanings that are relevant for us. Here are some life-affirming directions that occur to me as I deal with my own grief and sadness around this loss.

1. Be honest with ourselves.

Saying “yes” to life means noticing and allowing whatever we’re experiencing right now. Being honest with ourselves means affirming ourselves as we are rather than fashioning a self that we think will be attractive to others. Instead of striving to be someone we’re not or comparing ourselves to others (including those who we think might be happier than us or more successful), can we accept and value ourselves as we are? This includes recognizing our dark side and despairing moments — embracing the full range of our humanity (our joys and sorrows) without feeling shame around whatever we happen to be experiencing.

Being and affirming our true self allows us to grow more and more into who we really are. As Rabbi Zusya exclaimed shortly before his death: “In the coming world, they will not ask me: ‘Why were you not Moses?’ They will ask me: ‘Why were you not Zusya?’”

2. Accept and love ourselves as we are.

Sometimes what we experience is so difficult or painful that we try to push it away. We just want the pain to stop and don’t know where to turn. We may judge ourselves harshly for being in such unspeakable pain. Giving ourselves permission to courageously acknowledge feelings such as sadness, fear, or shame, we connect with ourselves. We begin to find peace by no longer fighting ourselves.

Replacing self-judgment with self-love isn’t easy, but it’s something we can practice. Sometimes it’s easier to be kinder toward others than toward ourselves. Practicing loving-kindness toward ourselves doesn’t mean we’re being selfish; it means that we value and cherish this precious life we’ve been given.

3. Reveal our true self to others.

We cannot know for sure what kinds of conversations Robin Williams had with others and to what extent he revealed his true feelings and struggles. But many people who take their own lives feel isolated in their suffering. It’s so important to have at least one person (hopefully more) with whom we can share with openly and authentically, such as our partner, our friends, a clergy person, or a therapist. And it’s important to listen kindly when people take the risk to open up to us.

Finding the courage to share what’s real for us with selected people allows us to not carry things inside us so tightly. Feeling safe enough to risk opening our authentic heart connects us with people. We feel less isolated and alone, which may help break the cycle of depression.

4. Reach out for contact — and let in the love!

It’s one thing to share our feelings and quite another to actually receive the gift of listening and caring. Oftentimes we have blocks to receiving, especially if we were frequently shamed and criticized growing up. Concluding that we’ve had enough pain, we may now protect a tender and vulnerable place within ourselves.

People may be eager to comfort us and love us if they know we’re hurting, but their caring doesn’t do much good if we don’t allow it to seep into the tender place that needs it. Psychotherapy with someone who’s a good fit for us is often helpful in healing old hurts and traumas that make it hard to let people in.

5. Creating a society where we take care of each other.

The sudden death of a well-loved person awakens us to what’s meaningful in life. We see with fresh eyes how important they’ve been to us. We’re reminded of how precious life is.

Affirming life means creating a society where we safeguard our own and each other’s health — and work cooperatively toward resolving issues that threaten our collective safety and well-being. It means looking out for people who might be isolating and in despair.

People often do a good job of concealing their suffering. Sadly, our pain-avoidant society encourages us to hide our anguish in favor of a happy face. We get the message that something is wrong with us if we’re in pain. We need to create a society where everyone feels safe to have and show their true feelings. Education for emotional intelligence needs to begin in our school systems.

Psychological struggles and planetary ill health are treated more effectively when done in a timely manner. This means facing difficult issues with courage, gentleness, and authenticity. On a larger level, caring for each other means devoting resources to mental health care and treatment options for individuals and our struggling planet.

Perhaps the death of Mr. Williams — and others to come — can remind us about what’s important in life. Just as he served us through sparkling entertainment and philanthropic work, we can honor him by valuing our own precious lives, cherishing our loved ones, and co-creating a society that protects and serves our community and world.

Wikimedia Commons Image of Plato by Marie-Lan Nguyen

By MARGARITA TARTAKOVSKY, M.S.

When ADHD and Anxiety Occur TogetherIt’s not uncommon for individuals with attention deficit hyperactivity disorder (ADHD) to struggle with anxiety, whether it’s several symptoms or a full-blown disorder.

In fact, about 30 to 40 percent of people with ADHD have an anxiety disorder, which includes “obsessive-compulsive disorder, generalized anxiety disorder, phobias, social anxiety and panic disorder,” according to Roberto Olivardia, Ph.D, a clinical psychologist and clinical instructor at Harvard Medical School. The Anxiety Disorders Association of America even estimates the figure to be almost 50 percent.

Here’s why ADHD and anxiety co-occur (occur together), how this affects treatment and several strategies for coping with anxiety.

Why ADHD & Anxiety Co-occur
ADHD symptoms can be very intrusive and make life a lot more stressful. For instance, you might miss a critical deadline at work and get fired, forget about your math final and fail the exam or act impulsively and put yourself in danger. Even the fear that you might forget something can keep people continuously worried and anxious.

In other words, “People with ADHD, especially when untreated, are more likely to feel overwhelmed and to have more things fall through the cracks which evokes more frequent negative situations—others are angry with them, they feel disappointed in themselves,” said Ari Tuckman, PsyD, a clinical psychologist and author of More Attention, Less Deficit: Successful Strategies for Adults with ADHD.

People with ADHD tend to be sensitive, which can leave them especially “vulnerable to feeling things more deeply and being more affected by situations and emotions,” Olivardia said.

Genetics also may explain why ADHD and anxiety co-occur. According to Olivardia, there’s good evidence to show that ADHD and OCD have genetic underpinnings. (Here’s one study.) Studies from Massachusetts General Hospital suggest that 30 percent of people with OCD have ADHD.

How Anxiety Affects Treatment
“Anxiety adds another element to ADHD treatment, because you are both developing strategies for the ADHD symptoms and working with the resulting anxiety simultaneously,” Olivardia said.

It also potentially complicates treatment because anxiety can paralyze and leave people stuck in their old ways. As Tuckman said, “People who are anxious are less likely to try new things for fear of them not working out—this includes new strategies to help them get on top of their ADHD.”

Anxiety has another side effect. “We don’t think as clearly when we feel anxious or preoccupied which can add to the ADHD-based distractibility and forgetfulness,” Tuckman said. This can happen particularly with more complex problems, he added.

Anxiety & Stimulants
Stimulant medications are highly effective in treating ADHD. But stimulants “can sometimes exacerbate anxiety symptoms,” Olivardia said. Still, symptoms should subside after several days or weeks, Tuckman said.

Also, these symptoms actually might be responses to the medication. According to Tuckman, “the physical sensations of faster heartbeat, dry mouth, etc. are just normal reactions to the medication, just as we would expect that our heart rate would increase after running up a flight of stairs.”

If people can’t tolerate stimulants, psychiatrists may prescribe a non-stimulant along with a selective serotonin reuptake inhibitor (SSRI), which has anxiety-reducing effects. (Tuckman noted that non-stimulants may be less effective than stimulants.)

However, if a person doesn’t want to take several medications, they might decide to medicate one of the disorders and cope with the other behaviorally, Olivardia said.

Also, therapy is very effective for anxiety, said Tuckman, who typically “prefer[s] to address the ADHD first and then see how much of the anxiety shakes out on its own…”

Anxiety-Alleviating Strategies
Understand how your anxiety and ADHD work. Determining how your anxiety functions will help to “inform your treatment,” Olivardia said. “For example, if you found that most of your anxiety was coming from consequences of your ADHD, then the focus of treatment should be the ADHD. If you find they are independent of each other, although are affecting each other, then you want to make sure you are adequately giving each the clinical attention it deserves,” he said.
Minimize worry. Anxious people worry excessively, and these negative thoughts can run your life if you let them. Instead, “Try to come up with alternate explanations or predictions,” Tuckman said. Let’s say your boss was short with you. Instead of thinking that you did something wrong, consider that she’s stressed because of personal reasons, he said. Unless you have a specific reason or actual proof, worrying is needless (and only makes things worse).
Don’t believe everything you think. Again, worry thoughts energize anxiety. But you don’t have to listen to them. “Notice your anxious thoughts without believing everything your imagination comes up with nor feeling compelled to act on it,” Tuckman said.
He explained that anxiety acts as an alarm that “warns us of danger.” For some people, this alarm is super sensitive. He compared it to a “fire alarm that goes off every time someone burns the toast. It’s bothersome to listen to that alarm go off, but we don’t go running from the building. We check out the situation, see there is nothing to worry about, then go about our business.”

Engage in healthy habits and good self-care. Poor nutrition, lack of sleep and little exercise also fuel anxiety, and ensure you have a shorter fuse when it comes to stress. It’s tremendously helpful to eat nutritious foods, participate in enjoyable physical activities and get enough sleep.
Minimize stress. Olivardia suggested that readers “lower [the] stress in their lives and introduc[e] activities that they enjoy and feel soothed by.”
Surround yourself with supportive people. Negative people only add to your stress. Instead, fill your life with “positive, affirming people,” Olivardia said.
Practice relaxation techniques. “Engaging in relaxation training and deep breathing can help [alleviate anxiety],” according to Olivardia. Learn more about relaxation and meditation methods and deep breathing.
Both anxiety and ADHD are very treatable with medication and psychotherapy, and there are many effective strategies to manage symptoms and lead a more enjoyable life.

By KARLEIA STEINER
High-functioning alcoholics might be one of the most dangerous types. They often are in denial about their alcoholism. They don’t realize how hard their drinking is on family members and friends, and since they seem to function normally, they don’t see a problem with it.

High-functioning alcoholics do not fit the “drunk” stereotype. They might reason that because they go to work and school, interact with their family, manage a household, and fulfill their everyday responsibilities, they can’t possibly have an alcohol problem.

Unfortunately, it’s not only the alcoholic who is in danger of denial. Family and friends often fail to see the danger signs. They refuse to believe that their loved one has a problem, and even congratulate him or her on his or her ability to function under the influence. The first step to helping a high-functioning alcoholic is to stop denying that they need help.

Recognizing a high-functioning alcoholic isn’t difficult if you know what to watch for. No matter how well they might function, drug or alcohol use affects everyone in some way. Here are some signs to watch for:

They start skipping social events uncharacteristically.
They have a sudden lack of focus or change in attitude.
They suffer from typical signs of alcoholism such as insomnia, paranoia, or shakiness.
They miss deadlines at work or call in sick often.
Once you have determined that your loved one needs help, understand that they don’t think they need it. Realize that to them, these signs are not symptoms of a problem, but something they can handle and don’t need to worry about. It will be difficult to convince them otherwise, so be prepared for a challenge.

When you approach a high-functioning alcoholic, make sure that he or she is sober first. Talking to a loved one when he or she is under the influence will be a useless exercise. The best time to open a serious conversation about getting addiction help is when they are hungover or feeling remorse or guilt, but before they need legal help for a DUI charge.

Do not go on the offensive. Explain to them how their drinking is affecting you and your family, and be careful to express your own personal feelings so that they don’t get defensive. Telling them how difficult it is for you to watch them when they are drunk or drinking might help them see that their addiction does not just affect them.

Alcoholism isn’t a simple problem to have, and it isn’t easy to cure. It will be particularly difficult to break through your loved one’s barriers since they can’t even admit that they have a problem. Ultimately, however, alcoholism is a choice and can be overcome.

The most important thing to remember is to approach the alcoholic with compassion. However, do not let your love for them cloud your judgment. You must be willing to walk away when their chosen lifestyle becomes too much for your emotional health. You have a responsibility to yourself too, and running yourself ragged will not do either of you any good.

Like anyone with an addiction, high-functioning alcoholics will have plenty of excuses for their behavior. Do not accept them. There is no excuse for alcoholism, and if you let them justify their addiction, they will never have a reason to change.

Excuses cannot shield them from the consequences of their alcoholism. High-functioning alcoholics might believe that their lives are unaffected by their drinking, but there will always be negative consequences, both in their own life and the lives of those they love. Alcoholism takes an emotional, spiritual, and physical toll on family and friends. It also results in emotional distress, lack of self-esteem, hangovers, drunk driving, and health risks for the alcoholic.

Recovering from alcoholism is not easy, but approach your loved one with patience, firmness and honesty. The ultimate decision to quit drinking is theirs, but your attitude and support might make all the difference.

This page is provided as a public service by Metanoia, and is dedicated with gratitude to David Conroy, Ph.D. whose work inspired it. Metanoia cannot provide counseling to suicidal persons. If you need help please use the resources outlined above.

To read the original article ith all the links go to: http://www.metanoia.org/suicide/original.htm

if you are thinking about
suicide… read this first
If you are feeling suicidal now, please stop long enough to read this. It will only take about five minutes. I do not want to talk you out of your bad feelings. I am not a therapist or other mental health professional – only someone who knows what it is like to be in pain.

I don’t know who you are, or why you are reading this page. I only know that for the moment, you’re reading it, and that is good. I can assume that you are here because you are troubled and considering ending your life. If it were possible, I would prefer to be there with you at this moment, to sit with you and talk, face to face and heart to heart. But since that is not possible, we will have to make do with this.

I have known a lot of people who have wanted to kill themselves, so I have some small idea of what you might be feeling. I know that you might not be up to reading a long book, so I am going to keep this short. While we are together here for the next five minutes, I have five simple, practical things I would like to share with you. I won’t argue with you about whether you should kill yourself. But I assume that if you are thinking about it, you feel pretty bad.

Well, you’re still reading, and that’s very good. I’d like to ask you to stay with me for the rest of this page. I hope it means that you’re at least a tiny bit unsure, somewhere deep inside, about whether or not you really will end your life. Often people feel that, even in the deepest darkness of despair. Being unsure about dying is okay and normal. The fact that you are still alive at this minute means you are still a little bit unsure. It means that even while you want to die, at the same time some part of you still wants to live. So let’s hang on to that, and keep going for a few more minutes.

Start by considering this statement:

“Suicide is not chosen; it happens
when pain exceeds
resources for coping with pain.”

That’s all it’s about. You are not a bad person, or crazy, or weak, or flawed, because you feel suicidal. It doesn’t even mean that you really want to die – it only means that you have more pain than you can cope with right now. If I start piling weights on your shoulders, you will eventually collapse if I add enough weights… no matter how much you want to remain standing. Willpower has nothing to do with it. Of course you would cheer yourself up, if you could.

Don’t accept it if someone tells you, “that’s not enough to be suicidal about.” There are many kinds of pain that may lead to suicide. Whether or not the pain is bearable may differ from person to person. What might be bearable to someone else, may not be bearable to you. The point at which the pain becomes unbearable depends on what kinds of coping resources you have. Individuals vary greatly in their capacity to withstand pain.

When pain exceeds pain-coping resources, suicidal feelings are the result. Suicide is neither wrong nor right; it is not a defect of character; it is morally neutral. It is simply an imbalance of pain versus coping resources.

You can survive suicidal feelings if you do either of two things: (1) find a way to reduce your pain, or (2) find a way to increase your coping resources. Both are possible.

Now I want to tell you five things to think about.

1
You need to hear that people do get through this — even people who feel as badly as you are feeling now. Statistically, there is a very good chance that you are going to live. I hope that this information gives you some sense of hope.

2
Give yourself some distance. Say to yourself, “I will wait 24 hours before I do anything.” Or a week. Remember that feelings and actions are two different things – just because you feel like killing yourself, doesn’t mean that you have to actually do it right this minute. Put some distance between your suicidal feelings and suicidal action. Even if it’s just 24 hours. You have already done it for 5 minutes, just by reading this page. You can do it for another 5 minutes by continuing to read this page. Keep going, and realize that while you still feel suicidal, you are not, at this moment, acting on it. That is very encouraging to me, and I hope it is to you.

3
People often turn to suicide because they are seeking relief from pain. Remember that relief is a feeling. And you have to be alive to feel it. You will not feel the relief you so desperately seek, if you are dead.

4
Some people will react badly to your suicidal feelings, either because they are frightened, or angry; they may actually increase your pain instead of helping you, despite their intentions, by saying or doing thoughtless things. You have to understand that their bad reactions are about their fears, not about you.

But there are people out there who can be with you in this horrible time, and will not judge you, or argue with you, or send you to a hospital, or try to talk you out of how badly you feel. They will simply care for you. Find one of them. Now. Use your 24 hours, or your week, and tell someone what’s going on with you. It is okay to ask for help. Try:

Send an anonymous e-mail to The Samaritans
Call 1-800-SUICIDE in the U.S.
Teenagers, call Covenant House NineLine, 1-800-999-9999
Look in the front of your phone book for a crisis line
Call a psychotherapist
Carefully choose a friend or a minister or rabbi, someone who is likely to listen
But don’t give yourself the additional burden of trying to deal with this alone. Just talking about how you got to where you are, releases an awful lot of the pressure, and it might be just the additional coping resource you need to regain your balance.

5
Suicidal feelings are, in and of themselves, traumatic. After they subside, you need to continue caring for yourself. Therapy is a really good idea. So are the various self-help groups available both in your community and on the Internet.

This resource is hosted by mental health information at Psych Central.
Well, it’s been a few minutes and you’re still with me. I’m really glad.

Since you have made it this far, you deserve a reward. I think you should reward yourself by giving yourself a gift. The gift you will give yourself is a coping resource. Remember, back up near the top of the page, I said that the idea is to make sure you have more coping resources than you have pain. So lets give you another coping resource, or two, or ten…! until they outnumber your sources of pain.

Now, while this page may have given you some small relief, the best coping resource we can give you is another human being to talk with. If you find someone who wants to listen, and tell them how you are feeling and how you got to this point, you will have increased your coping resources by one. Hopefully the first person you choose won’t be the last. There are a lot of people out there who really want to hear from you. It’s time to start looking around for one of them.

Now: I’d like you to call someone.

And while you’re at it, you can still stay with me for a bit. Check out these sources of online help.

Additional things to read at this site:

How serious is our condition? …”he only took 15 pills, he wasn’t really serious…” if others are making you feel like you’re just trying to get attention… read this.

Why is it so hard for us to recover from being suicidal? …while most suicidal people recover and go on, others struggle with suicidal thoughts and feelings for months or even years. Suicide and post-traumatic stress disorder (PTSD).

Recovery from grief and loss …has anyone significant in your life recently died? You would be in good company… many suicidal people have recently suffered a loss.

The stigma of suicide that prevents suicidal people from recovering: we are not only fighting our own pain, but the pain that others inflict on us… and that we ourselves add to. Stigma is a huge complicating factor in suicidal feelings.

Resources about depression …if you are suicidal, you are most likely experiencing some form of depression. This is good news, because depression can be treated, helping you feel better.

Do you know someone who is suicidal… or would you like to be able to help, if the situation arises? Learn what to do, so that you can make the situation better, not worse.

Handling a call from a suicidal person …a very helpful ten-point list that you can print out and keep near your phone or computer.

What can I do to help someone who may be suicidal? …a helpful guide, includes Suicide Warning Signs.

Other online sources of help:
The Samaritans – trained volunteers are available 24 hours a day to listen and provide emotional support. You can call a volunteer on the phone, or e-mail them. Confidential and non-judgmental. Short of writing to a psychotherapist, the best source of online help.

Talk to a therapist online – Read this page to find out how.

Depression support group online: Psych Central Depression Support Group – Please note: this is a very big group, but amidst all the chatter, it is possible to find someone who will hear you and offer support.

Psych Central has a good listing of online resources for suicide and other mental health needs.

Still feel bad? These jokes might relieve the pressure for a minute or two.

If you want help finding a human being to talk with in person, who can help you live through this, try reading this article about how to Choose a Competent Counselor.

Sometimes people need additional private help before they are ready to talk with someone in person. Here are a few books you could read on your own in private. I know from personal experience that each one has helped someone like you.

Suicide: The Forever Decision by Paul G. Quinnett, PhD (Continuum, ISBN 0-8264-0391-3). Frank and helpful conversation with a therapist who cares.

Choosing to Live: how to defeat suicide through cognitive therapy by Thomas E. Ellis PsyD and Cory F. Newman PhD (New Harbinger Publications, ISBN 1-57224-056-3). Another conversational book with practical help for suicidal persons.

How I Stayed Alive When My Brain Was Trying to Kill Me: One Person’s Guide to Suicide Prevention by Susan Rose Blauner (William Morrow, ISBN 0066211212). A very practical survival guide by an actual survivor.

Out of the Nightmare: Recovery From Depression And Suicidal Pain, by David L. Conroy, PhD (Authors Choice Press, ISBN 0595414974). As if suicidal persons weren’t feeling bad enough already, our thoughtless attitudes can cause them to feel guilt and shame, and keep them from getting help in time. Dr. Conroy blasts apart the myths of suicide, and looks at suicidal feelings from the inside, in a down to earth, non-judgmental way. This is a book that will save lives by washing away the stigma of suicide and opening the door to a real way out of the nightmare.

Suicide: The Forever Decision, Paul G. Quinnett, PhD Choosing to Live, Thomas E. Ellis PsyD How I Stayed Alive When My Brain Was Trying to Kill Me Out of the Nightmare, David L. Conroy, PhD
I make no money whatsoever on recommending these books… they are simply recommendations.

Would you like to print out this page? Here is a plain black-on-white version that should print more easily.

Want to share your suicide story?
Please visit the Suicide Project and leave your story

This resource is hosted by mental health information at Psych Central.
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This page is provided as a public service by Metanoia, and is dedicated with gratitude to David Conroy, Ph.D. whose work inspired it. Metanoia cannot provide counseling to suicidal persons. If you need help please use the resources outlined above.

© Copyright 1995-2009 Martha Ainsworth. All rights reserved. Reprints: Please feel free to link to this page. Please do not reproduce this page on the Internet; you may link to it instead. You may reproduce this page in print media for non-commercial, non-profit use only, if you meet the following three conditions: (1) you must use the full text without alteration up to and including the words “Now: I’d like you to call someone.”; (2) please consider making a donation to The Samaritans (see above); and (3) you must print the following notice verbatim: “Reprinted with permission. Suicide: Read This First (http://www.metanoia.org/suicide) was written by Martha Ainsworth based on work by David Conroy, Ph.D. To talk with a caring listener about your suicidal feelings, in the U.S. call 1-800-SUICIDE any time, day or night. Online, send an anonymous e-mail to jo@samaritans.org for confidential and non-judgmental help, or visit http://www.samaritans.org.”

Hosted as a community service by Mental Health Information at Psych Central
Mental Health Support Groups – Psychology Blogs

By HELEN NIEVES

UnknownNarcissistic Personality Disorder (NPD) is when a person is excessively preoccupied with power, vanity, prestige, and are unable to see the damage they may be causing themselves or others. People with NPD have an exaggerated feeling of self importance, sense of entitlement, and lack empathy. Those who have NPD believe they are superior and have little regard for other peoples’ feelings. It is rare and to affects more men than women. It often begins in early adulthood. So how can you identify NPD? Below, you will find symptoms, causes, and treatment.

What are the symptoms of Narcissistic Personality Disorder?

Fantasizing about power
Believing you are special
Being easily hurt
Fantasizing about success
Believing others are jealous of you
Being jealous of others
Taking advantage of others
Setting unrealistic goals
Failing to recognize other people’s emotions
Fragile self-esteem
Some features of NPD may seem like you have a strong self-esteem or confidence, but it is not the same. People with NPD put themselves on a pedestal and think highly of themselves. In contrast, people with self esteem do not value themselves more than they value others. When you have NPD, you monopolize conversations and belittle people you see as inferior or less than you. When a person with NPD does not receive the treatment they are looking for, they become angry.

Underneath this behavior however often lies a fragile self- esteem. You have trouble handling criticism and in order to feel better you react in anger and start to belittle others.

What are the Causes of Narcissistic Personality Disorder?

As with other mental disorders, the causes are unknown. It could be linked to a dysfunctional childhood, abuse, excessively pampered, neglect, or genetics.

Children may be brought up with lack of affection and praise, may have unpredictable caregiving, or learn manipulative behaviors from parents. Children may lose to empathize with others when they learn from their parents that vulnerability is unacceptable. Children may also mask their feelings and needs with grandiose and egotistical behaviors.

What is the Treatment?

There are no medications used to treat NPD. Treatment is usually centered around therapy. Cognitive behavior therapy, group therapy, or family therapy can be helpful. Therapy can help you learn to relate with others and better help you to understand your emotions. It can also help you to reshape your personality so you can change patterns of thinking and create a realistic self image.

By TRACI PEDERSEN Associate News Editor

Overactive Immune System May Be Linked to Mental Illness Risk
The immune system may play a vital role in the development of mental illness, according to new research published in the journal JAMA Psychiatry.

The study shows that children with regularly high levels of a protein released in the blood during an infection are at greater risk of developing depression and psychosis as adults.

“Our immune system acts like a thermostat, turned down low most of the time, but cranked up when we have an infection. In some people, the thermostat is always set slightly higher, behaving as if they have a persistent low level infection — these people appear to be at a higher risk of developing depression and psychosis,” said study leader Dr. Golam Khandaker of the Department of Psychiatry at the University of Cambridge.

“It’s too early to say whether this association is causal, and we are carrying out additional studies to examine this association further.”

For the study, scientists led by the University of Cambridge analyzed a sample of 4,500 individuals from the Avon Longitudinal Study of Parents and Children. They took blood samples from the participants at age nine and then followed up at age 18 to see if they had experienced any episodes of depression or psychosis.

The researchers divided the participants into three groups, depending on whether their everyday levels of the protein interleukin-6 (IL-6) were low, medium or high. They found that children in the “high” group were nearly twice as likely to have experienced depression or psychosis than those in the “low” group.

“Inflammation may be a common mechanism that influences both our physical and mental health. It is possible that early life adversity and stress lead to persistent increase in levels of IL-6 and other inflammatory markers in our body, which, in turn, increase the risk of a number of chronic physical and mental illness,” said senior author Dr. Peter Jones, head of the Department of Psychiatry.

People with depression and schizophrenia are known to have a much higher risk of developing heart disease and diabetes, and elevated levels of IL-6 have previously been shown to increase the risk of heart disease and type II diabetes.

Furthermore, low birth weight, a marker of abnormal fetal development, is connected to increased everyday levels of inflammatory markers as well as greater risks of heart disease, diabetes, depression, and schizophrenia in adults.

The findings could help explain why physical exercise and diet — classic ways of reducing risk of heart disease — are also found to enhance mood and lower depression. The researchers are now planning further studies to confirm whether inflammation is a common link between chronic physical and mental illness.

The research also hints at the possibility of treating mental illness with anti-inflammatory drugs. Previous research has suggested that anti-inflammatory drugs, such as aspirin, used in conjunction with antipsychotic drugs may be more effective than just the antipsychotics alone.

Source: University of Cambridge

By JOHN M. GROHOL, PSY.D.
Depression is the common cold of mental disorders — most people will be affected by depression in their lives either directly or indirectly, through a friend or family member. Confusion is commonplace about depression, for example, about what depression exactly is and what makes it different from just feeling down. There is also confusion surrounding the many types of depression (e.g., unipolar depression, biological depression, manic depression, seasonal affective disorder, dysthymia, etc.) that people may experience. There have been so many terms used to describe this set of feelings we’ve all felt at one time or another in our lives, to one degree or another, that it is time to set the record straight.

Depression is characterized by a number of common symptoms. These include a persistent sad, anxious, or “empty” mood, and feelings of hopelessness or pessimism. A person who is depressed also often has feelings of guilt, worthlessness, and helplessness. They no longer take interest or pleasure in hobbies and activities that were once enjoyed; this may include things like going out with friends or even sex. Insomnia, early-morning awakening, and oversleeping are all common.

Appetite and/or weight loss or overeating and weight gain may be symptoms of depression in some people. Many others experience decreased energy, fatigue, and a constant feeling of being “slowed down.” Thoughts of death or suicide are not uncommon in those suffering from severe depression. Restlessness and irritability among those who have depression is common. A person who is depressed also has difficulty concentrating, remembering, and trouble making decisions. And sometimes, persistent physical symptoms that do not respond to traditional treatments — such as headaches, digestive disorders, and chronic pain — may be signs of a depressive illness.

Do I Have Just The Blues… Or Something More?
Feeling down or feeling like you’ve got the blues is pretty common in today’s fast-paced society. People are more stressed than ever, working longer hours than ever, for less pay than ever. It is therefore natural to not feel 100% some days. That’s completely normal.

Depression can be a gradual withdrawal from your active life.

What differentiates occasionally feeling down for a few days from depression is the severity of the symptoms listed above, and how long you’ve had the symptoms. Typically, for most depressive disorders, you need to have felt some of those symptoms for longer than two weeks. They also need to cause you a fair amount of distress in your life, and interfere with your ability to carry on your normal daily routine.

Depression is a severe disorder, and one that can often go undetected in some people’s lives because it can creep up on you. Depression doesn’t need to strike all at once; it can be a gradual and nearly unnoticeable withdrawal from your active life and enjoyment of living. Or it can be caused by a clear event, such as the breakup of a long-term relationship, a divorce, family problems, etc. Finding and understanding the causes of depression isn’t nearly as important as getting appropriate and effective treatment for it.

Grief after the death or loss of a loved one is common and not considered depression in the usual sense. Teenagers going through the usual mood swings common to that age usually don’t experience clinical depression either. Depression usually strikes adults, and twice as many women as men. It is theorized that men express their depressive feelings in more external ways that often don’t get diagnosed as depression. For example, men may spend more time or energy focused on an activity to the exclusion of all other activities, or may have difficult controlling outbursts of rage or anger. These types of reactions can be symptoms of depression.

PETER UBEL, MD JULY 23, 2014

It all comes down to willpower, right? Strength of purpose. Muster the resolve to skip dessert, and you have a shot at losing that spare tire hanging off your belly. Succumb to your temptations, however, and you are simply being weak.

But is it just weakness that causes us to overeat?

A study in Psychological Science suggests that our inability to resist that mouthwatering looking chocolate cake doesn’t arise simply because our willpower is weak but also because, after exhausting our willpower, the cake looks even more mouthwatering to us than it did before. Our ability to overcome temptation is reduced at the same time that the power of the temptation increases.

In this study, participants first underwent an exercise meant to exhaust their willpower. They watched a seven minute documentary on Canadian bighorn mountain sheep. Believe it or not, that documentary on its own doesn’t delete people’s willpower significantly. Instead, it was distracting words scrolling across the screen that exhausted people’s willpower. You see, half the participants were told to watch the documentary and read the words if they wanted to, as they scrolled in front of their field of vision. No willpower needed there. If you are curious what the word looks like, you look at it. If not, you don’t.

But the other half of the participants were told specifically not to read the words — they were told to maintain their focus on the sheep. Nothing but the sheep. Seven minutes of ignoring words while watching sheep? Exhausting just to think about it!

And willpower exhaustion was an important part of the study, because previous research has shown that willpower is depletable. Exert willpower for seven minutes and you have less willpower to draw upon in the near future.

Which leads us to part two of the study. The researchers placed these participants in an fMRI machine (a brain imager) and flashed pictures of deliciously unhealthy foods. They wanted to see which parts of people’s brains lit up in front of these tempting delicacies. I should tell you that the participants in this study were all trying to lose weight, and had all fasted before the study (which, by the way, probably means their willpower was already beginning to be depleted before they began the research).

Here is what happened. The fMRI images revealed differences across the two groups of participants in their ability to resist temptation. They found neurologic evidence of depleted willpower among the people who spent seven minutes not reading those pesky words. But that is not all that the researchers found. Those people whose willpower had been relatively depleted also showed increased activity in regions of the brain associated with “Q reactivity” — something to do with the OFC portion of their brains. (Sorry, neuroscience is above my pay grade.) Basically, the activity in these brain regions revealed that the food pictures looked tastier to depleted participants than it did to non-depleted ones.

Think of it this way. You’re on a diet. You have a tough day at work, and an awful commute back home (where it took all your remaining willpower not to flip off that @$&hole who cut in front of you on the highway) and now you open up your fridge to have a healthy salad. But you see a tempting container of macaroni and cheese. Not only are you too exhausted to resist the temptation, but the macaroni and cheese actually strikes you as something that would be so delicious to eat!

By JONICE WEBB

Take the ENQ

During twenty years of practicing psychology, I started to see an invisible force from childhood which weighs upon people as adults. It’s a “non-event” which is unnoticeable and unmemorable, and yet leaves a profound mark upon the child which endures throughout adulthood. It’s Childhood Emotional Neglect (CEN).

CEN is a parent’s failure to respond enough to a child’s emotional needs.

This failure to respond can masquerade as loving parent behavior. It can happen in families which are seemingly healthy and fine. And it can be overshadowed by more obvious child mistreatment or abuse. In any case, it goes unseen and unnoticed while it does its silent damage to people’s lives.

Many people have found answers to problems that have baffled them throughout their lives, by recognizing that CEN is the cause. But because CEN is so difficult to see or remember, it can be very hard to identify whether you are living your adult life in its grip. I’ve devised the Emotional Neglect Questionnaire to help you discover whether you may have grown up this way.

I have found it very useful, but have not yet been able to establish reliability or normative data through research. So please know that, at this point, the ENQ is based upon clinical experience, not science.

Emotional Neglect Questionnaire

Circle the items that apply to you.

DO YOU:

ž Often feel disappointed with, or angry at, yourself
ž Sometimes feel like you don’t belong when with your family or friends
ž Pride yourself on not relying upon others
ž Have difficulty asking for help
ž Have friends or family who complain that you are aloof or distant
ž Feel you have not met your potential in life
ž Often just want to be left alone
ž Secretly feel that you may be a fraud
ž Tend to feel uncomfortable in social situations
ž Judge yourself more harshly than you judge others
ž Compare yourself to others and often find yourself sadly lacking
ž Find it easier to love animals than people
ž Often feel irritable or unhappy for no apparent reason
ž Have trouble knowing what you’re feeling
ž Have trouble identifying your strengths and weaknesses
ž Sometimes feel like you’re on the outside looking in
ž Believe you’re one of those people who could easily live as a hermit
ž Have trouble calming yourself
ž Feel there’s something holding you back from being present in the moment
ž At times feel empty inside
ž Secretly feel there’s something wrong with you
ž Struggle with self-discipline
If you circled six or more, this indicates, in my experience, that you may have grown up with significant CEN.

By PAUL C. MILFORD, MSW, RCSWI

How Warren Buffett Found the Key to HappinessMoney will not change how healthy you are or how many people love you. — Warren Buffett

So let’s start off with a tough reality: it’s unlikely that any of us will be as rich as Warren Buffett. In fact, he’s so rich that one-thousandth of a percent of his wealth is still about $6.5 million.

Before I get into why Buffett is winning at life, let me answer the question that’s probably roaming in the back of your mind: How could I possibly relate to someone so wealthy?

The answer is simple. Buffett was not always the mega-billionaire he is today. In fact, he had a rather humble upbringing. Yet he always had a clear vision of his future. In his high school yearbook, Buffett described himself as a “future stockbroker.” Either the man was highly driven to accomplish his goals, or he was clairvoyant.

What many do not know is that, despite his current wealth of billions, Buffett still lives in the home he purchased for $31,500 in 1958. (That would be about $250,000 in today’s market.) While the home has reportedly undergone renovations over the years, it is still not the mega-mansion most would expect America’s second-richest person to call home. So why does someone with more money than the entire economy of Uruguay choose to live in such a modest dwelling?

When asked this very question at a recent shareholder meeting, Buffett responded, “I don’t think standard of living equates with cost of living beyond a certain point. Good housing, good health, good food, good transport. There’s a point you start getting inverse correlation between wealth and quality of life. My life couldn’t be happier. In fact, it’d be worse if I had six or eight houses. So, I have everything I need to have, and I don’t need any more because it doesn’t make a difference after a point.”

What Buffett revealed in his response to the question was much more than a guide to financial responsibility. He shared his personal philosophy about happiness, and it’s very clear it doesn’t depend on overflowing bank accounts. Instead, Buffett says the two are inversely related; more wealth actually reduces quality of life.

In Buffett’s eyes, quality of life hinges upon having good health, housing, food, and transportation. These are fairly basic needs in life, ones that most of us likely already have. But, yet, we still search for more to make us happy. Bigger houses, flashier cars, more lavish meals. We derive happiness from the ever-fleeting joys of having more. But the problem is that no matter how new and shiny and expensive our iPhone is, we still run to line up every time a new one comes out.

How do we translate Buffett’s life insights into practical steps for ourselves? Well don’t worry, I already did that for you.

Take an inventory of your life. This is probably the most important thing we can learn from Buffett. Despite having enough money to buy whatever he wants, Buffett views objects as merely hindrances to the true joys in life. “The asset I most value, aside from health, is interesting, diverse, and long-standing friends,” he said. The absolute first step to helping bring your important life assets into perspective is to acknowledge they exist. These are the things you cannot replace by going to the store: Your family, your significant other, your friends. This also includes your inherent assets, such as your personality, humor, strength, education, and so on. Write these down on a piece of paper and hold it sacred. They are the most important assets you’ll ever own.
Embrace the simple pleasures of life. Buffett once said that a perfect day for him would be to have a whole day of peace and quiet just to read, without interruption. Figure out the simple pleasures in your life and find every opportunity to embrace them. Maybe it’s listening to your favorite radio station in the car, watching the news with a cup of hot tea, or literally stopping to smell the roses. Whatever these moments are, cherish them. Allow yourself to be fully present in the moments as they occur.
Stay true to your core principles and values. Buffett invests in companies in which he believes, rather than in ones that can return the most profit. Buffett has been quoted as saying “It’s far better to buy a wonderful company at a fair price than a fair company at a wonderful price.” The essence of this statement is that standing behind principle far outweighs the alternative. Now go back to the list you wrote of your assets. What does this list reveal about your values? What principles helped you achieve some of these assets in the first place? Take the time to answer these questions for yourself. You can write them down if you wish. Once you uncover these values and principles, you’ll reveal an important part of your own identity.
By sticking to these steps, I believe we can unlock the key to a much more gratifying life. These steps may not grant us the same financial achievements as Warren Buffett, but they just may help us better appreciate our most valuable assets.

By THERESE J. BORCHARD

If a person went to his primary care physician and complained of symptoms of fatigue, guilt, worthlessness, irritability, insomnia, decreased appetite, loss of interest in regular activities, persistent sadness, anxiety, and thoughts of suicide, I am pretty sure he would leave that office with a diagnosis of Major Depressive Disorder (MDD) and a prescription for Zoloft, Prozac, or another popular selective serotonin reuptake inhibitor (SSRI). After all, the guy has just cataloged the classic symptoms of clinical depression.

However, those same symptoms belong to a variety of other conditions that require treatments other than antidepressants and psychotherapy, the two pillars of conventional psychiatric recovery today. They may certainly look and feel like clinical depression to the outsider, but they may require just a small tweak in diet or hormones. Here are six conditions that fall under that category.

1. Vitamin D deficiency

A good doctor will order bloodwork to see if a patient is low on vitamin D before sending him off with a prescription for Prozac because so many of us are lacking adequate amounts of this critical vitamin. In fact, according to a 2009 study publishing in the Archives of Internal Medicine, as many as three-quarters of U.S. teens and adults are deficient.

Last year Canadian researchers performed a systematic review and analysis of 14 studies that revealed a close association between vitamin D levels and depression. Researchers found that low levels of vitamin D corresponded to depression and increased risk of depression.

The best source of vitamin D is sunshine, but for those of us with family histories of skin cancer, we have to get it in small pieces because sunscreens prohibit the body from making vitamin D. Supplements are easy to find, but make sure they are third-party tested. Good brands are Prothera, Pure Encapsulations, Douglas Labs, and Vital Nutrients. I take drops of liquid vitamin D because it is absorbed more easily that way.

2. Hypothyroidism.

Hypothyroidism also is easily mistaken for clinical depression. You feel exhausted, worthless, irritable, and incapable of making a decision. Getting through each day without naps is a major accomplishment.

This one is especially tricky because you can get your thyroid levels checked by an endocrinologist or primary care physician, as I have done for eight years, and walk away believing your thyroid is just fine. Dena Trentini writes a brilliant blog about this on her site, Hypothyroid Mom.

One of the problems, she explains, is that mainstream medicine relies on only one blood test, TSH, to diagnose thyroid dysfunction and that can’t provide an accurate picture. Both she and I were told our thyroids were fine by conventional doctors, which is probably why the Thyroid Federal International estimates there are up to 300 million people worldwide suffering from thyroid dysfunction, but only half are aware of their condition. Dena writes, “Hypothyroidism, an underactive thyroid, is one of the most undiagnosed, misdiagnosed, and unrecognized health problems in the world.”

3. Low blood sugar.

The best marriage advice I ever received was this: When you are about to say something unkind to your spouse, first check to see if you’re hungry. Naturopathic doctor Peter Bongiorno explains the mood-blood sugar connection in his informative blog post, “Is There a Sugar Monster Lurking Within You?“

Hunger, he says, is a primitive signal known to set off the stress response in us. For people who are predisposed to anxiety and depression, that stress manifests itself as mood changes.

“Triggered by drops and fluctuations in blood sugar,” writes Bongiorno, “anxiety and depression can manifest in people who are very sensitive and can become chronic if food intake isn’t consistent. Humans are built like all the other animals — and animals get very unhappy when blood sugar is low.” Folks who experience yo-yo blood sugar levels on a daily basis are usually insulin-resistant, a precursor to Type 2 diabetes.

The Journal of Orthomolecular Medicine shows 82 studies that link insulin resistance with depression. One study of 1,054 Finnish military male conscripts found that moderate to severe depressive symptoms increased the risk for insulin resistance by almost three times. The good news is that with some simple diet modifications — eating low-carb, high-protein foods every few hours — symptoms abate.

4. Dehydration.

I forgot about this one until my son exhibited some bizarre behavior last night and my husband and I realized he was dehydrated. We go through this every summer. The problem with him (and with most human beings) is that he waits until he is thirsty to drink. By then dehydration has already set in.

According to a two studies conducted at the University of Connecticut’s Human Performance Laboratory, even mild dehydration can alter a person’s mood. “Our thirst sensation doesn’t really appear until we are 1 [percent] or 2 percent dehydrated. By then dehydration is already setting in and starting to impact how our mind and body perform,” explained Lawrence E. Armstrong, one of the study’s lead scientists and an international expert on hydration. Apparently it didn’t matter if a person had just walked for 40 minutes on a treadmill or was sitting at rest, the cognitive effects from mild dehydration were the same.

5. Food intolerances.

Like most people, I used to think that food intolerance caused unpleasant reactions like diarrhea, hives or swelling. I would never have associated a turkey sandwich with my suicidal thoughts. However, now I catalog the questionable items that I eat or drink (those containing traces of gluten or dairy) in my mood journal in case I have a reaction.

After reading best-selling books “Grain Brain” by David Perlmutter, M.D. and “The Ultramind Solution” by Mark Hyman, M.D., I realized that certain foods can trigger inflammation in our bodies just like toxins from the environment. And while some people like my husband break out in hives, other folks like me get sad and anxious and start making plans to exit this earth. According to Hyman, these delayed reactions to food or hidden allergens lead to “brain allergies,” allergic reactions in the body that cause inflammation in the brain.

6. Caffeine withdrawal.

I’ll always remember my sister’s advice last summer when I showed up to her Michigan farm shaking, crying, and unable to focus on a conversation. I was in the midst of a severe depressive episode.

One morning was especially bad. I tried to bring my coffee cup to my lips, but my hands were quivering so much even that was difficult. “The first thing I’d do is stop drinking that,” my sister said, matter-of-factly, pointing to my coffee. “Even one cup is enough to give me a panic attack,” she said. Since she was my twin, with biogenetic similarities, I paid attention.

Then I read “Caffeine Blues” by Stephen Cherniske, M.S., who has certainly done his homework on the matter and offers a compelling case for quitting “America’s number one drug” for good. It’s basic physics, really. What goes up must come down. So that high you get after a shot of espresso isn’t without its consequences.

You just don’t associate the anxiety and depression you feel three hours later because you’re on to other things. However, your body going through withdrawal, and for those of us like my sister and me who are chemically sensitive to all amphetamine-like substances that raise dopamine levels, that withdrawal translates to tears, shaking, panic attacks, and other forms of suffering.

Originally published on Sanity Break at Everyday Health.

By RICK NAUERT PHD Senior News Editor
New research from the UK finds that while weight loss was associated with improved health, the mental benefits, if any, were fleeting.

Researchers followed 1,979 overweight and obese adults in the UK and found that people who lost five percent or more of their initial body weight over four years showed significant changes in markers of physical health.

However, individuals were more likely to report depressed mood than those who stayed within five percent of their original weight.

Historically, clinical trials of weight loss have been shown to improve participants’ mood, but this could be a result of the supportive environment rather than the weight loss itself. Investigators now believe these effects are seen very early on in treatment and are not related to the extent of weight loss over time.

It’s important to note this new result does not mean that weight loss necessarily causes depression directly, as depression and weight loss may share a common cause.

However, it shows that weight loss outside the clinical trial setting cannot be assumed to improve mood and raises questions about the psychological impact of weight loss.

Investigators reviewed data from the English Longitudinal Study of Ageing, a UK study of adults aged 50 or older — excluding participants with a diagnosis of clinical depression or a debilitating illness.

Depressed mood and overall well-being were assessed using standard questionnaires and weight was measured by trained nurses.

Of the 1,979 overweight and obese participants, 278 (14 percent) lost at least five percent of their initial body weight with a mean weight loss of 6.8 kg per person.

Before adjusting for serious health issues and major life events such as bereavement, which can cause both weight loss and depressed mood, the people who lost weight were 78 percent more likely to report depressed mood.

After controlling for these, the increased odds of depressed mood remained significant at 52 percent.

“We do not want to discourage anyone from trying to lose weight, which has tremendous physical benefits, but people should not expect weight loss to instantly improve all aspects of life,” said lead author Sarah Jackson, M.D.

“Aspirational advertising by diet brands may give people unrealistic expectations about weight loss. They often promise instant life improvements, which may not be borne out in reality for many people.”

In other words, people should understand that weight loss may not be a panacea for all mental and physical woes, rather, people should be realistic about weight loss and be prepared for the challenges.

“Resisting the ever-present temptations of unhealthy food in modern society takes a mental toll, as it requires considerable willpower and may involve missing out on some enjoyable activities,” said Jackson.

This work can affect well-being as anyone who has ever been on a diet would understand.

“However, mood may improve once target weight is reached and the focus is on weight maintenance. Our data only covered a four year period so it would be interesting to see how mood changes once people settle into their lower weight.”

In summary, researchers believe health care professionals should monitor patients’ mental as well as physical health when recommending or responding to weight loss, and offer support where necessary.

Moreover, people who are trying to lose weight should be aware of the challenges and not be afraid to seek support, whether from friends, family, or healthcare professionals.

Senior author Professor Jane Wardle, director of the Cancer Research UK Health Behavior Centre at University College of London, said, “A recent UK survey found that 60 percent of overweight and obese adults in the UK are trying to lose weight. There are clear benefits in terms of physical health, which our study confirmed.

“People who lost weight achieved a reduction in blood pressure and serum triglycerides; significantly reducing the risk of heart disease. However, patients and doctors alike should be aware that there is no immediate psychological benefit and there may be an increased risk of depression.”

Source: University College London

I recently diagnosed eight-year-old Aidan with attention deficit disorder (ADD ADHD). When I met with his parents to explain the disorder, each time I described a symptom, his mother exclaimed, “That’s me!” or “I’ve been like that all my life, too.” At the end of the appointment, she asked me if she should be evaluated, as well.

As an adult, Aidan’s mother had jumped from job to job, and had difficulty meeting household demands. As a child, she had struggled through school, often getting into trouble and getting poor grades. After a thorough evaluation of her chronic and pervasive history of hyperactivity, distractibility, and other symptoms of ADHD, she was diagnosed by a psychiatrist who works with adults.

Aidan and his mother both started on ADHD medication. Aidan’s grades and behavior improved. His mom reported being more relaxed and efficient at work and at home. On a follow-up visit, she remarked, “If only I had been on medication as a child. I could have finished college, I could….” Then she paused: “Oh, my gosh, does this mean that Aidan will take medication for the rest of his life?”

Good question. The best answer I could give was, “Possibly.” Why can’t I be more specific? Didn’t she deserve a clearer answer? Until the early 1990s, the medical community considered ADHD a “childhood disorder.” Believing that children “outgrew” the condition, physicians routinely took them off medication before high school. In many cases, however, the teens struggled socially and academically, making it clear that ADHD symptoms had not gone away. And, as greater efforts were made to educate parents about ADHD, more and more of them, like Aidan’s mother, began to recognize their own ADHD symptoms.

Clinically, we have seen that some individuals do show enough improvement after puberty that they no longer need medication. But the American Academy of Family Physicians reports that two-thirds of children with ADHD continue to grapple with the condition throughout adulthood.

How do I determine whether a particular child still needs medication? I advise taking children and adolescents off medication once a year. If the symptoms of hyperactivity, inattention, and/or impulsivity are no longer noticeable, they stay off. Should these behaviors return, medication should be restarted. This process teaches adolescents about the challenges ADHD presents in their lives, and how to determine themselves whether medication is needed in school, at home, with friends, and so on. Medication should be used whenever symptoms interfere with the demands and expectations of a specific task or activity. It is not necessarily needed all day, every day.

For example, a college student may learn that she benefits from an eight-hour capsule to cover morning and afternoon classes, but can be off medication while she relaxes, exercises, or socializes later in the day. On evenings when she needs to study, she can take a four-hour tablet at about 6 p.m. An adult may find that he needs medication at work but not at home, or for some social functions, but not others.

Will your child need medication for the rest of his life? Possibly. You can find out one year at a time. And, if medication is needed, you can teach him to use it for specific times and situations. In the future, I hope that fewer adults will tell me, “If only I had been on medication as a child….”