I am a lifelong learner and in a recent class aimed to expand skills and experience as a coach, one of the guiding principles proposed was “first do no harm”. It would never occur to me to purposefully hurt someone, but it made me stop and think about all the people I know with ADHD that have been hurt by thoughtless comments, lack of awareness and misunderstandings about their ADHD.
We seem to be living in a world that gets less kind every day. Being different, visible or not, seems to make someone especially vulnerable. Looking closely at the hurt, pain and loneliness so common with persons with ADHD, it appears there is unawareness of the harm we do, or we ignore the harm we do, or we intentionally do harm because it makes us look better, or sadly in some cases we do harm for our own pleasure and enjoyment. I would like to think it is because we don’t know better.
How do we learn to do no harm?
If we haven’t been taught to do no harm, we see no harm in doing harm. We cause harm and shrug it off. We cause harm and laugh about it. We cause harm and brag about it.
Sadder still, our children bear witness to our actions and never learn to do no harm themselves and the cycle continues. What would be possible if we made a choice to treat each other with greater respect and compassion?
When we become aware of, “Do no harm”, because we can feel pain and suffering, we can imagine the pain and suffering of others, and we can act accordingly to minimize the harm we cause. We can live intentionally doing no harm.
What does “do no harm” mean? Ultimately it means to give thoughtful consideration to our actions. “Do no harm” simply means to consider how our actions may affect the world we all share, to be compassionate in our dealings with others, especially others different than us like those with ADHD, with the creatures of this world, and perhaps even not to thoughtlessly despoil our planet.
Doctors are asked to “first do no harm.” Why not us? Why not now? I am glad that “first do no harm” is being incorporated on a conscious level into the coaching profession.
It sounds like a simple idea because it is a simple idea. Will “do no harm” solve all the problems in our world? Perhaps not, but it might just decrease the suffering in the world and increase the kindness. Wouldn’t that be nice?
Maybe, “do no harm” can become that little voice that guides our actions. And maybe if we do no harm, then someone else will do no harm…and it will keep going and going and going.
Let me know what you think. Do you think a little bit more of “do no harm” could make a difference?
Wishing you a wonderful holiday season and a new year full of kindness and compassion!
Do you hover over your spouse while they’re doing housework or completing other important tasks around the house? Do you take more than your share of responsibility for things in your ADHD relationship? Do you find it is just easier to get things done if you micro-manage your partner’s schedule or better yet, do it yourself? Have you tried nagging, pleading even anger to try and motivate your partner to get things done. If so, you may be a helicopter partner!
Most of the time, a helicopter partner is borne from years of frustration while waiting for job after job or task after task to get completed. Or from a well-founded fear that an important piece of something will be missed in the disorganization, lack of planning or seeming lack of structure typical of your partner. It’s also not uncommon to think we are just “helping” out when our ADHD partner might be struggling to prioritize, follow-through or get back the train of thought they lost.
The problem with being an ADHD helicopter partner, aside from the frustration and imbalance it creates in a relationship, is that it doesn’t allow our partners to learn for themselves. To feel respected. To learn what works for them and what doesn’t. To experience that sense of accomplishment when they are successful, even when getting there is different than how we might have done it. So, if you’re tired of struggling to reform your helicopter partner ways, want to reestablish the balance in your relationship and enjoy the satisfaction when each person is appreciated for their contributions, you can begin by putting the following practices into action:
- Remind them only once. No one likes a nag, and no one likes being a nag. Being nagged makes us feel like a child and being a nag makes us feel like a parent. Not very sexy. So give a single reminder when you must, and then step back and let your ADHD spouse rise to the occasion.
- Leave it. Just because you can fix or do something quicker or easier, doesn’t mean you have to, or even that you should. So the next time you realize your ADHD partner has left for work, but his wallet is on the kitchen table or his briefcase sits by the front door, leave it. They are a grown up and the consequences they’ll face might seem difficult at first, but consequences leave a meaningful impression –– and are more likely to make the impact needed for your partner to create change all on their own.
- Stop taking responsibility for your partner’s actions. You know what I’m talking about –– that subconscious impulse to make an excuse for our spouse’s actions. Like offering the apology when your spouse is late, when they forget an important date, are disorganized, make an impulsive comment or totally dominate a conversation. Adults, including ADHD adults, take responsibility for their own actions, not another’s. Rather than make excuses, make a plan. A plan that your spouse comes up with to take accountability and responsibility for their actions.
- Let them fail. This is a toughie. As a spouse or partner we can feel like our ADHD partners success or performance is somehow (intimately) connected to our own self-worth –– “If they fail, I am a failure.” “If they look bad, I look bad.” But the truth is that we learn best from our own failing, and a whole heck-of-a-lot less when we are rescued! Not to mention the near impossibility of being there all the time to “save” them. An occasional save might be appreciated, but as an everyday occurrence, it becomes a bit enabling.
- Let them learn from their own experiences. As partners, we are…well partners, not parents and our role is not to protect our partners from being uncomfortable. The fact is, when people are uncomfortable, they are more likely to change. A partnership is between two adults who support each other equally with the strengths they have learned from their own experiences.
- Don’t do for your partner what they can do for themselves. This includes calling or texting to remind them of what they are supposed to be doing or where they need to go. Packing for our ADHD partner’s trip, taking time out of our morning to make them breakfast or pack their lunch is not letting them do what they can do for themselves. Often this habit grew out of love for our partners, right? But we have to remember that they’re capable. When we do for someone else what they are capable of doing themselves we rob them of the feeling of enjoying personal success.
- Name the feeling. If your efforts to pull back from being a helicopter partner make you feel a little uncomfortable, you’re probably doing something right. Instead of curing that unsettling feeling by stepping in and doing whatever it is you’re trying to remind yourself not to do, name the feeling. Saying it out loud (“Letting him/her be late for that meeting because I didn’t text to remind them, feels uncomfortable”) or writing it a journal can help you process what you’re feeling without giving in to the temptation to over-partner. Naming it allows you to know it and you can then choose how you want to act.
Finally, remember that this is a process. We’re not going to get it right every time. What counts, though, is that we’re making progress and focusing more on creating a healthy, equal partnership that we can enjoy for years to come.
“I think I have ADHD,” a client told me. “I seem to have all the symptoms! But, is there a test? How can I know for sure?”
Wanting and expecting their to be a physical “test” for ADHD is something that seems to come at a time in our medical history when many of the scientific advancements have made it possible for us to “see” what is happening in our bodies by changes in our blood, urine and even our breath. We live in a time when we can look through our skin to our bones with x-rays and it seems to make sense that we should be able to have a test that shows similar evidence of ADHD. The problem is, we don’t, not really.
The brain is an amazing organ of our body. Science has made it possible to view the structure of the brain with imaging devices allowing us to even have a sense of what parts of the brain do what. However, the brain has an amazing way of protecting itself with what is called the blood brain barrier. This barrier prevents unwanted substances from entering too easily into the brain and is what prevents us from being able to “measure” the exact amount of neurochemicals active in the brain.
Because it is so important to have the correct diagnosis for ADHD, in this article I am going to share with you how the diagnosis of ADHD is made and review some of the pros and cons of new tests that have become available.
To start with, the typical approach to ADHD diagnosis consists of a clinical exam (an office visit to your doctor) and an interview about the history of your symptoms. Often this exam and history is supplemented with paper and pencil assessments. It’s important that your past experience and current symptoms are compared to the diagnostic criteria in the American Psychological Association’s Diagnostic and Statistical Manual of Mental Disorder and also that other possible reasons for your symptoms (such as medical issues) are ruled out before a diagnosis of ADHD can be confirmed. The more experienced a practitioner is in the diagnosis of ADHD, and the more clear cut the individual’s symptoms, the more quickly a diagnosis can be achieved.
Recently a variety of new “tests” for ADHD have been making headlines—in particular, these three:
- NEBA, recently approved by the FDA
- fMRI, used extensively in brain research related to ADHD
- Urine neurotransmitter assay (test)
Understanding what is known about these tests, and what various experts think about them, can help in deciding whether to consider doing these additional “tests” and how to understand their results.
NEBA is short for a lengthy medical term: “Neuropsychiatric EEG-Based Assessment.” It is called this because NEBA is based on electroencephalogram (EEG) technology that examines brain waves. (You have probably heard of EEGs being used to detect seizure activity in the brain.) The NEBA takes only 15- to 20-minutes to complete, involves no shots, or other invasive techniques, and requires only the temporary application of electrodes to the head with small sticky pads.
The FDA approved NEBA as a tool for diagnosing ADHD in July of 2013. This approval was based on the results of a research study of 275 children in which the ratio of two types of brain waves (called theta and beta waves) was found to be to be higher in children and adolescents with ADHD than in children without the condition.
In the study, the brain wave results for the children were compared with clinical (in office) assessments of ADHD by an independent group of experts. According to the FDA, compared with doing the typical clinical assessment alone, the research demonstrated that combining NEBA results with a clinical assessment improved the accuracy of ADHD diagnosis. So, NEBA may be considered helpful in diagnosing ADHD. The FDA did not, however, recommend NEBA as a stand-alone, or the only test for diagnosis of ADHD. They recommended that the NEBA be used along with the regular clinical approach to diagnosis. This distinction is very important.
Some experts feel that use of the NEBA will be valuable because it will help move ADHD diagnosis from the need for a clinical (subjective) assessment toward a more objective standard. However, other experts feel that the NEBA is an unnecessary and expensive test and offers little additional value in the diagnosis of ADHD. Based on how much it will cost to administer the test and the additional benefit that the results of the test will show in comparison to the standard in office assessment, it is possible that not many medical facilities will offer it or that insurance companies will cover the cost.
We all know what x-rays are: x-rays use radiation to create an image that allows us to “see” whether a bone is broken. MRI tests are another type of imaging device, similar to x-rays except that they use magnetic fields (the M in MRI) instead of radiation to help “see” into the body. MRIs of the brain are used to “see” into the structures of the brain. fMRI, the “f” standing for “functional”, is a special type of MRI that can show the patterns of activity in the brain and, as a result, can help us see not only the structure of the brain, but also how the brain is actually functioning. fMRI is particularly useful because it can measure how brain activity changes in relation to various behaviors or in response to various stimuli.
fMRI research on individuals with ADHD has been of increasing interest over the past decade or so. While studies have not always been in agreement about details, there is general consensus on at least several issues:
- Brain functioning in individuals with ADHD is different from that of individuals without ADHD.
- Certain areas of the brain are consistently associated with ADHD, like the frontal lobe of the brain that lies right behind our forehead.
- ADHD medication changes the brain activity, typically changing the brain functioning to be more like that of a person without ADHD.
Like the NEBE, understanding the results of the fMRI is only done when compared to the results of a clinical (in office assessment of someone’s history and current challenges) diagnoses of ADHD.
Some suggest that fMRI might itself be a useful test for diagnosing ADHD. fMRI is neither invasive nor harmful, and it provides a useful picture of the brain’s functioning. However, many factors, including age, gender and other personal characteristics, impact the accuracy of fMRI as a tool to diagnose ADHD. And even though a picture is worth a thousand words, having this additional piece of information about the possibility of an accurate ADHD diagnosis does not clarify what treatment or management options would be the most effective.
In a nutshell, even when an fMRI indicates that a brain functions like an ADHD brain, a clinical (in office assessment) is needed to confirm the diagnosis. Because an fMRI isn’t able to show exactly what amount or type of neurotransmitters are different, treatment options are still done with trial and error. Despite its popularity, further research is necessary before the fMRI can confidently be used as a stand-alone tool for ADHD diagnosis.
Urine Neurotransmitter Assay
Some fluids in our body can tell us a lot about what is going on inside us. Urine is like this. Urine tests are widely known as an effective method of drug screening and as a test for certain disease states – such as how your doctor may test your urine for “sugar” to help in diagnosing diabetes. Because the brain protects itself with its “blood brain” barrier, it is not possible at this time to go directly into the brain and test for certain levels of neurotransmitters. However, researchers studying ADHD have been very interested in the use of urine tests to detect a molecule called a “monoamine.” Urine tests for monoamines are of interest in ADHD research because changes in the brain’s levels of a monoamine molecule called “dopamine” have been found in people with ADHD.
Dopamine is a type of molecule called a “neurotransmitter” which means that it “transmits,” or sends, messages from one nerve cell in the brain to another. When dopamine levels are not normal, certain areas of the brain do not function optimally. This can lead to the symptoms we commonly associate with ADHD.
Recently, urine tests for monoamines, such as dopamine, have become commercially available, and some have suggested their possible usefulness in the diagnosis of ADHD. However, even though the urine tests may be able to detect levels of monoamines (dopamine), there is debate about whether a urine test can effectively indicate what the levels of dopamine or other related molecules are in the brain itself. In other words, being able to test for these monoamines in a urine test, does not tell us how much or how little is functioning in the brain. You see, molecules such as dopamine can be produced in many areas of the body, not only the brain and the indication that there is dopamine in the urine, doesn’t tell us how much, how little or if dopamine has anything to do with brain functioning. Some researchers and clinicians argue that more thorough and comprehensive research is needed before we can say with confidence that urine tests might provide an accurate diagnosis of ADHD.
There is an increasing interest and excitement in the ADHD community of the possibility of having a new, reliable, stand-alone objective test that will diagnose ADHD and help in guiding and monitoring treatment. Some of these new approaches include—NEBA, fMRI and/or a urine test. The good news is that none of the tests are invasive, and none pose any harm. So use of any of these tests is safe and remains an individual choice. That said, these tests are not currently in wide use outside of research studies, because their findings are not fully understood, and they are not generally accepted as definitive approaches to ADHD diagnosis.
On the other hand, if we want the best, most accurate diagnosis of ADHD, there is no doubt that, the common clinical approach to diagnosis – involving a physical exam, symptom history, and possibly paper and pencil tests by an experienced health care provider — remains the current “gold standard” for diagnosing ADHD.
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