If you’ve experienced trauma, it can be hard to find your old self again. Intrusive thoughts, flashbacks, hypervigilance, and avoidance of things that trigger the memories can affect every part of your life. Persistent feelings of fear or anger can make it difficult to focus or pay attention, leading to difficulties in school or at work. Relationships can suffer as you try to pull back from the world to maintain some semblance of control. People around you may not understand what’s happening, leading to feelings of isolation or abandonment.

Accelerated Resolution Therapy (ART) is a novel, evidence-based form of psychotherapy that can help. Utilizing the newer understanding of how memory reconsolidation works,[1],[2]ART involves the skilled use of eye movements to process negative memories, images, and sensations to address the symptoms of Post-Traumatic Stress Disorder (PTSD), depression, anxiety, and phobias.

ART is unique from other trauma-focused therapies in that you do not have to discuss or describe your trauma in detail and can share with the therapist as much or as little as feels comfortable. Additionally, throughout the session, focus is consistently brought back to processing and calming any distressing physical sensations or emotions that arise.

The idea of addressing trauma experiences in therapy can be daunting. However, those who have experienced ART sessions frequently report feeling lighter or more relaxed by the end of the session due to ART’s use of positive visualizations and a focus on processing body sensations. Additionally, fewer sessions may be required than in other trauma-focused therapies, as research suggests that ART may significantly reduce PTSD symptoms in as few as five sessions.[3]

*For more information on Accelerated Resolution Therapy, visit ART International’s website at https://artherapyinternational.org.

References:

• Monfils MH, Cowansage KK, Klann E, LeDoux JE. Extinction-reconsolidation boundaries: key to persistent attenuation of fear memories. Science 2009;324:951-955.
• Schiller D, Monfils MH, Raio CM, Johnson DC, LeDoux JE, Phelps EA. Preventing the return of fear in humans using reconsolidation update mechanisms. Nature 2010;363:49-54.
• Kip KE, Rosenzweig L, Hernandez DF, et. al. Randomized controlled trial of Accelerated Resolution Therapy (ART) for symptoms of combat-related post-traumatic stress disorder (PTSD). Military Medicine 2013; 178:1298-1309.

The holiday season is already upon us, which means a break from school, time with family, and gifts. Lots and lots of gifts. If you have that special ADHD person in your life, here are some ideas to help them get more organized (and stay a little more sane) for the New Year.

• According to the American Demographic Society, Americans waste more than 9 million hours each day looking for lost and misplaced articles. My guess is that 7 million of those hours are wasted by those of us with ADHD. The Tile Bluetooth tracking device ($25.00) can help you seriously cut down on that time. This little (1 square inch) doohickey can attach to just about anything you tend to misplace. Download the app for your phone, and you can track it down. I keep one on my keychain and a spare in my car for those “where did I park again?” moments.

• You may lose remote controls, but you’re probably never without your phone. The Blumoo Bluetooth universal remote control ($99.00) puts everything in one place and lets you create your very own remote control the way you like it. Initial setup did take some time, but customer service is fast and very friendly.

• I travel between two offices, and often end up doing a good bit of work at home as well. Flash drives made it much easier to access all my documents from each location, but let’s be honest: you don’t want to give an ADHD person another thing to carry every day. Dropbox online file storage lets you access all of your important digital files no matter where you are. You can also share your Dropbox, so that others can access your photos, shared projects, etc. It offers up to 2 GB free, or you can upgrade to 1 TB for $10 a month (or $99 for a year).

• ADHD types often forget to charge their phone, and that obnoxious “Low Battery Warning” can sound like an air raid siren. The problem is - I lose about 3 of these charging cables every time I go on vacation, and Apple charges $20 for a replacement. Luckily I found this deal on Amazon. I keep two in the car, two in the office, and I’ve hidden the rest from my wife and daughter. ($6.00 each)

• You’re going to need a place to plug all those charging cables. The Anker 36w 4 port USB Wall Charger ($19.99) was reviewed as “the best multiport USB wall charger for most people” by wirecutter.com. It can charge up to four devices quickly, and costs no more than that single port plug you got with your iPhone. Four ports also means that you charge all of your gadgets in the same place, cutting down on that morning search time.

• If you’re like me, you empty your pockets at the end of the day to find crumpled sticky notes filled with ideas and reminders. But if you’re like me when I’m being honest, you actually don’t find these notes until after the washer and dryer have turned them into confetti. Wacom smart notepads and pens ($160) store your notes and sketches as you write/draw, and you can later upload them to your computer for editing and storage.

• I get most of my brilliant ideas when I’m stuck in traffic. In the BC era (Before Cell phones), I kept a pad and pen in my center console so that I could write down the thought or put down a reminder to call someone. Now that I have a cell phone, my time stuck in traffic is some of my most productive. But ADHD drivers don’t need any more distractions, and a phone held to the side of your head uses one of your good hands and might lead to some knee-steering. No bueno. Bluetooth wireless technology has become a standard feature for automobiles over the last several years, allowing drivers to talk on the phone while keeping both hands on the wheel. But some of us happen to enjoy driving our dinosaur cars, thank you very much. This iSimple Bluestream Bluetooth adapter ($60) is plug and play, and turns your pre-2010 dumb car into a smart car.

• Whether or not you need to update your car’s connectivity, you’ll need a place to put your phone while you’re driving. The Spigen magnetic phone mount ($25) attaches to one of the a/c vents on your dashboard, keeping your phone easily in reach.

• Back when we were still dating, my wife would often giggle anytime we were getting ready to leave someplace. I finally asked her what was so funny, and she said, “why do you always do the Macarena before you leave a room?” It took me a while to figure out that she was referring to my unconscious ritual of checking my pockets to make sure I had my keys, wallet, and phone on me. Maybe the Walli smart wallet (pre-order: $89, regular price: $119) would help me feel more secure. It connects to your phone via Bluetooth and alerts you if you’ve left either your wallet or your phone behind. It also monitors each internal card pocket and will alert you if you’re missing a credit card, a boarding pass, or your passport. What happens if you leave both your wallet and your phone behind? Well, that’s when you dance the timeless Macarena.

• Finally, if you’re looking for the perfect gift for your favorite Tarnow Center psychologist who is male and has a colorful bird for a last name, look no further than this street legal Tron light cycle ($55,000). It has a 996cc 4 stroke engine, and 6 speed constant mesh manual transmission. I don’t know what any of that means, but I do know that it lights up. And that it’s awesome. Just don’t tell my wife.

Learning for children with ADHD can seem impossible, even before considering the repercussions from COVID-19. Healthy executive functioning helps children to stay organized, plan ahead, and transition to changing environments smoothly. 2020 has been a year of continued change and transition, ultimately aiming for acceptance. What used to be considered a student’s place for a mental break to play and enjoy activities is now where they must also attend school. This could cause confusion, as the brain isn’t separating work from play. Some might ask, is it work from home, or live at work? Especially while considering an ADHD brain, we must work to help differentiate the two, thus, providing engagement for children in school. While parents are faced with the task of taking place of their child’s teacher, use the below tips to help improve your child’s executive functioning and engage their ADHD brain.

According to ADDitude Magazine, at home learning will become successful when attention is paid to three areas: practicing mindfulness, readying the home environment for distance learning, and encouraging independence and accountability.

The powerhouse of our executive functioning lies in the frontal lobe. When we are attuned to our emotions and can avoid allowing stressors to dominate our thoughts, we are able to better regulate the frontal lobe. What is the most powerful way to do this? Practicing mindfulness. Mindfulness helps to self-regulate while getting emotions in check and understand things we are feeling. When we are stressed we become unregulated, thus, disengaging our frontal lobe. COVID is creating a new reality for children who are unable to educate themselves in ways their brain knows how- deregulating the frontal lobe. In turn, this forces children’s brain to enter flight or fight mode. “We see this in action when children struggle to listen or focus. When it looks like they are ignoring our directions or actively resisting, chances are that they’re actually not in the correct “headspace” to comply. In other words, they are dysregulated and cognitively in fight, flight, or freeze mode” (ADDitude, 2020). Mindfulness trains your body to self-regulate, promote focus, and understand what is going on in the here and now. Mindfulness exercises come in many forms, including: focus on sensations, breathing exercises, mindful eating, meditation, etc. Mindfulness should be practiced when your child is in a regulated state of mind and can comply to the practices.

Children perform well in environments that promote success. If their area of learning is the same physical environment in which they play with their siblings, watch TV after a long day, or play fetch with their dog, they are likely to forego the mental capacity to function educationally. Your child’s physical location will affect their productivity level, especially if sensory needs must be considered. Keep your home organized, leaving space set aside to be your child’s at-home classroom. Still, certain unmet biological or sensory needs can take away from your child’s focus; these include: adequate rest, hydration, exercise, playtime, bonding, and sensory stimulation. Cater to your child’s needs by creating structure and a regular routine. Help to remove distractions by providing pleasing lighting, removing background noise, respecting smell sensitivity, and ensuring comfort in their study space.

In many parents’ attempt to drive their children toward success, they often will tell their children what needs to be done- “But this only keeps their executive functioning skills subdued when they are most needed. To strengthen executive functioning in children, ask them guided questions rather than commanding or directing them” (ADDitude Magazine, 2020). Guided questions will help children to act proactively, and they’ll feel as if they figured it out on their own. Commands are likely to agitate children, shifting their brains to fight-or-flight. Ask guided questions to determine the best morning and night routine, time for homework, the best types of breaks, etc. For example, instead of, “you will not do your school work in your pajamas today,” say “which of these three school outfits would you like to wear?” Instead of, “stop your play time, and get back to your school work”, say, “it is time for one more lesson today, once you finish this last game.”

Though this year’s back to school looks entirely different, it does not have to affect your child’s executive functioning. Use the mentioned approaches to help activate your child’s ADHD brain for a positive learning experience and more comfortable transition.

We will be helping you in doing this in the coming weeks. Please check our website to see resources to create your home the best learning environment!

Refer to the below link to read ADDitude magazine’s tips on activating the ADHD brain!

Link to Article by Elizabeth A Sautter, MA, CCC, Rebecca Branstetter, PhD

 Jay D Tarnow, M.D.

This article is a follow-up from my previous Psychopharmacology Newsletter on the physiological, psychological, and social changes in middle age and beyond. As previously noted, there are a number of changes that occur naturally as we age that can mimic ADHD. The aging process affects us cognitively, some people more than others. ADHD, however, is not associated with any increase of Alzheimers, Dementia, or Parkinson’s Disorders. The normal Mild Cognitive Disorder of older age may have a greater impact because of the difficulty with organizing, working memory, and distractibility of ADHD. The long-term effects of alcohol and drug use can also lead to similar impairments.

Vitamins and nutrition

The use of certain vitamins and nutrients have been shown to improve cognition as we age. Some people seem to need extra “methylated” forms of vitamin B12 and folic acid. A special enzyme is needed to methylate the folic acid and vitamin B12, enabling them to pass over the Blood Brain Barrier into the brain, so that neurotransmitters can be made. Some people do not make enough of the enzyme genetically, or this enzyme may wear out causing the person to lose their cognitive capabilities or becomes depressed.

Omega 3, which is high in fish oils, flax seeds, and nuts, is necessary for normal brain function. It increases the speed of transmission of signals in the brain. Some research has shown that taking these oils will improve cognition, ADHD, and working memory. However, do they reach the brain? The use of a phospholipid serine improves the flow into the brain. I have used Vayacog to improve memory and Vayarin to improve ADHD symptoms. The use of Aricept or Memantadine has had mixed results in Mild Cognitive Impairment, but have not shown to improve ADHD symptoms in this age group. There is minimal evidence that these medicines help Mild Cognitive Impairment.

Medicine for older adult ADHD

The medicines we use for childhood ADHD are still effective in this age group; however, some risks need to be monitored. As you can imagine, telling someone with ADHD to monitor anything can be frustrating, but must be done nevertheless.

While stimulants are still the most effective treatment for symptoms of distractibility, disorganization, and poor detailing, careful monitoring is required in the older population because adults are more susceptible to rising blood pressure and pulse rate. Not surprisingly, members of this age group are starting to have cardiovascular symptoms as these medicines cause vasoconstriction and can worsen hypertension, poor circulation, and chest pain.

Stimulants also can decrease sleep, which is often already a problem in middle to old age. It would not be a good idea to use a benzodiazepine for this problem since it is associated with dementia in later life. Therefore, I suggest a trial of Melatonin. Loss of appetite is another problem for the older generation and can often lead to a vitamin or protein deficiency.

Other interventions

Guanfacine or Clonidine will help with ADHD symptoms and lower blood pressure. These are particularly helpful when anxiety is present. Intuniv is a long-acting guanfacine that can be very helpful since it can be given at night, thus, minimizing daytime sedation. I will use these agents in combination with stimulants to control high blood pressure caused by the stimulants.

There are also antidepressants, which have been shown to have positive effects on ADHD symptoms. They work on a 24-hour basis and need three weeks to build up. Bupropion has been shown to be helpful in ADHD to a minor degree in adults. It is a dopamine reuptake inhibitor and a norepinephrine reuptake inhibitor. I also use Imipramine, Desipramine, or Amitryptilline, all of which can cause sedation. These have multiple effects on neurotransmitters.

Depression and Anxiety Disorders are common conditions in this age period and can mimic the symptoms of ADHD. So antidepressants may have an advantage in this area as well.

In summary, when one reaches middle age, the need for ADHD meds may be greater, but can be more complicated by medical conditions. For further information on this topic, please contact the Tarnow Center.