Pronoun Power

by James C. Wiley, MD, FAAP

@adddoc

ADHD brains get corrected, blamed, and shamed so often that they find ways to push back. One favorite strategy is blaming everything and everyone else. You’ve heard it…”The dog ate my homework.”

During a follow up visit one of my bright teenage patients explained that he rarely needed his ADHD medication anymore and mainly took it when he had a big test or project due. His response to why his grades had tumbled from honor roll to toilet bowl was that he had several teachers that didn’t like him.  More than that, a couple of them “didn’t really teach”. In addition, one teacher “messed me up because she only posts assignments online so I have to remember to login to the website to even know what we are supposed to do–the work sneaks up on me!”.  When I asked if he had looked into the summer program he told me about at our last visit, he explained that “so much has been going on that there really hadn’t been time to do that and the application deadline passed.”

At that moment something fired from my ADHD brain and shot straight out of my mouth like a bullet.  “You need to change your pronouns.”  I didn’t even realize what I was saying but like a lot of us with ADHD, that didn’t stop me from continuing.

“You see, as long as they don’t like you, they don’t teach, she messes you up, it sneaks up on you, it has kept you from meeting a deadline, YOU are powerless.  You can’t change them or it. You can only change you.”

What if you changed your story to this?  I need to be more respectful, get my work done and participate in class more. I need to come up with a system to overcome my tendency to forget online assignments.  I need to work on my time management so that I don’t miss important deadlines.’

He sat there blinking for a moment before saying, “so I would be in charge.”

Then something fired from his ADHD brain and shot straight out of his mouth.  “Wow, Dr. Wiley, you should write that down”.  So, I did.

5 Helpful Tips to Pass Midterms

Focus MD ADHD Tips to passing midtrems

It’s that time of year again, the most dreaded part of the semester for most college students, midterms. If you have ADHD, midterms can be even more stressful because lets face it, procrastination always finds its way into your study sessions. Before you start calculating how well you have to do on your exams, let us help take the stress out of midterms. Here are 5 helpful tips to help you study smarter and be successful on your exams.

Get plenty of sleep

Getting sleep is key to passing test
We have all pulled an all-nighter expecting to become an overnight expert in the subject; however, the truth is those last minute cram sessions are not good for your health or grades. When you don’t get the rest you need, you are unable to concentrate, stay productive or retain information. While all-nighters are an ode to college life, try to avoid them. It’s overstated, but nonetheless true; get plenty of sleep!

Get creative

Tips for studying, take good notes
No one said studying was fun, but you can make it more interesting. Boredom is the doorway to procrastination; so instead of forcing information into your head, try making what you’re studying memorable. What do we mean? When you’re highlighting use different colors for importance, make notes in the margins, doodle in your notes, read aloud or create funny ways to remember facts. Use your ADHD to your advantage.

Schedule study time

Schedule time to study will help you pass midterms
Many students with ADHD are quite intelligent; their downfall is poor time-management skills. The best way to stay on track is to think of college as a job. Plan to spend about 40 hours a week, this accounts for both class and studying. By scheduling time to study either in between or after your classes can better help you retain what you’re leaning.

Make a plan and stick to it

Make a plan to study for each class and you'll have no problems passing midterms
A skill college students with ADHD need to learn is how to assess and prioritize. Learning this concept will help you be less reactive and more proactive. Every week make a plan of what needs to be done. When you can assess what needs to be done versus what you could do, you’ll be able to prioritize what needs to be done first and take care of it.

Reward yourself

you study hard, now play hard!
When you have accomplished what you set out to achieve, you should reward yourself with something you enjoy. For example read for 2 hours then take a break and go get a cup of coffee with friends or catch a school baseball game. Whatever you choose, your reward should not be open ended; it should have a beginning, middle and an end.

Now get out there tiger, you’ve got midterms to conquer.

If you would like more information on ADHD and resources please visit focus-md.com or click here.

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Featured Doc Blog: 12 Things Every Parent Should Do for Their College-Bound Kids (Part 2)

In part one of this blog, Dr. Mark Thomas with our Focus-MD Tuscaloosa office shared some tips that would help college students help manage their academics and daily life on campus. Below, he discusses ways to help them manage their healthcare and resources.

6. Teach them about navigating the health care system

  • Making and remembering appointments
  • Calling the MD office rather than sitting on a problem
  • When is appropriate time to seek medical care
  • Does this problem need to go to the ER?
  • How, when and where to fill prescriptions (Anecdote: In treating college freshmen in a student health center, I have been asked by the student “What do I do with this prescription?” or “What is this?” (after handing them the prescription) or “How am I going to get my medicine now?”

7.  Let them know about how to use health insurance

  • Ensure they have their own copy of their health insurance card
  • Educate them about co-pays and deductibles
  • Let them know about in-network versus out-of-network coverage
  • Explain to them what pharmacy benefits they have and give them a copy of the pharmacy benefits card if there is a separate one
  • If you have a Health Savings Account, give them a copy of the card and teach them when it should be used

8.  Set up strategy to continue their ADHD medication while away.

  • The worst times for a younger person to try managing ADHD without medication is while making a transition to new level! Starting college may be the absolute worst!!!
  • Discuss with the doctor who manages the ADHD medication at home about her or his policies about continuing to prescribe ADHD medications to students attending a school at a significant distance from home.
  • If the provider at home will continue to oversee the prescription of ADHD medications, they will need to see the student at regular intervals, optimally at least once every 3 months.
  • Ask if the provider would be available to discuss problems or questions about treatment via phone, video calling, or through a secure portal that arise will student is away.
  • It would be best to have a follow-up within the first couple of months after leaving for college to ensure the usual regimen at home works well on new schedule.

9. Usually, it is better to help them find a physician near the school to take over their care. Some of the reasons to consider this include the following:

  • If it is not feasible to return home frequently to be seen by their ADHD provider
  • A provider close to college campus is usually more familiar with the needs of college aged patients.
  • Being able to schedule more frequent visit with the prescribing doctor when medication adjustments are needed is easier  with a doctor close to campus
  • In some states controlled substance prescriptions written by out of state providers cannot be filled.
  • Check with the college or university about the availability of on-campus student health services
    • Some schools will have physicians on staff who can provide care for students with ADHD and other chronic conditions
    • Other schools may have a go-to list of medical providers in the community
    • Help them determine which providers are in-network (If there are no local providers in-network, call the insurance carrier to discuss arrangements for care to be provided while away.)

10. Consider engaging an ADHD Coach

  • ADHD coaches take a very practical approach to helping students overcome executive functioning deficits,
  • Coaches may instruct in skills such as organization, time management, wise use of electronic resources, study skills, interpersonal skills, test taking strategies
  • Coach can provide encouragement, support, and accountability without seeming to nag.

11. Register with the disabilities services office on campus to ensure they receiving accommodations – the earlier the better

  • The documentation requirements from each school may differ. Sometimes additional testing will be needed. The usual requirement is for full psychological and educational testing performed within the past three years.
  • Accommodations found helpful by most students with ADHD include
    • Note-taking services (Even if student can take notes successfully, they often miss important opportunity for the auditory learning experience if they concentrate too hard on getting down what the professor is saying.)
    • Extended-time on tests (Even if students do not typically run out of time on examinations, knowing they have extra time availability may prevent them from rushing through exams and making careless errors.)
    • Test taking with reduced distractions (Large lecture halls with numerous other students taking the same test provide numerous potential distractions such as other students coughing, fidgeting, and finishing their tests early.)
    • Priority in registration (It can be very important to plan class schedules that maximize class time when medication is strongest but avoid too many back to back to back classes in which students will struggle to maintain focus even more than usual. Having a choice of professors can be crucial in finding those who teaching style best fits the student’s learning style. )

12. Maintain the right amount of support.

  • Make your expectations clear about how often the student should check in with family. (Remember how Bear Bryant emphasized to his players the importance for them to regularly “call mama.”)
  • Check in often enough to know when he or she is struggling before things spiral out of control
  • Help them find a support network on campus through meeting professors or student services staff members in advance. Encourage them to becoming involved with the organizations on campus that are right for them individually.
  • Not every student is best suited to pledge the same fraternity or sorority as Mom or Dad. Most students with ADHD would do better waiting until after they have adjusted to campus life for a full semester or year before joining a Greek organization that will place huge demands on their schedule.
  • Students need to be reassured of your UNCONDITIONAL LOVE and support, Provide a sympathetic listening ear whenever they call. DO NOT NAG or SHAME students when they are struggling. They do not need to dread calling you or answering the phone when you call. Keeping open and accepting channels of community is crucial to their success!

Hopefully, both students and parents will find these tips helpful as they embark on their college careers.  At Focus-MD, our mission is to support the whole patient and his or her family as they go from frustration to focus.

Featured Doc Blog: 12 Things Every Parent Should Do for Their College-Bound Kids (Part 1)

As you can imagine, Dr. Mark Thomas in our Focus-MD Tuscaloosa office has a lot of experience helping college students. In this two-part blog, he discusses things that parents can do to make the transition to college easier. 

I have been treating college-aged young persons with ADHD for over twenty years. In that time, I have witnessed numerous students struggle with getting away from the support structure in place for them at home and adjusting to the new demands of college life and independence. Many of the things that I have observed providing them difficulties could be greatly helped when parents know what things are most beneficial for them to do and what things they should avoid.

Things parents should know and do for their college-bound daughters and sons –

  1. Know that each student is individual in their needs and level of development of executive functioning skills
    1. Some students will need more assistance from home than others.
    2. Parents need to balance between becoming a “helicopter parent” versus having a student who suffers without the support system to which they are accustomed.
    3. Almost all students with ADHD will have some Executive Functioning Deficits that will pose challenges for them when entering college life. Some of these executive functioning areas that are difficult for these younger persons include:
      • schedule planning and time management
      • keeping up with needed personal items
      • physical organizational skills
      • prioritizing use of time and money, and connecting the dots between their personal choices and consequences
      • keeping a long-term view and making decisions that are best for their future
      • monitoring their own performance and making needed corrections in personal habits
      • avoiding impulsive choices and emotional over-reaction
  2. Discuss with them setting up a weekly schedule using either a paper or electronic planner
    1. Many students are so accustomed to close support of parents and teachers that they do not have experience in organizing time for themselves.
    2. Stress the importance of not skipping classes, even when attendance is not required.
    3. Instruct them to set aside adequate time in the schedule for regular studying (not just before a test is imminent.)
    4. Break big projects and assignments in smaller steps to avoid becoming overwhelmed.
  3. Teach them how to manage money wisely through planning and budgeting
    1. Have them get accustomed to paying for their own expenses on a weekly or monthly allowance before they go away
    2. If they have the maturity to manage a credit card, teach them to use it wisely. Make it clear what expenses you expect them to pay with the card
    3. Consider a low-limit credit card in their name with a parent as co-signer that they are responsible for paying. (This will not only give them experience but also help build their credit score.
  4. Give guidance about meal planning and nutrition
    1. Discuss with them the importance of proper nutrition for best performance cognitively, emotionally, and physically. (Protein in the morning is a must!)
    2. Develop habits of not skipping meals, especially breakfast! Eating a hearty breakfast helps to reduce any side effects of stimulants medication such as diminished appetite and upset stomach.
    3. If they have difficulty remembering to eat, have them set an alarm on phone or wearable electronic device to remind themselves.
    4. Often freshmen will live on-campus and rely upon the cafeteria for most meals, but will still need to know about planning and preparing their own meals
    5. Teach them how to shop for groceries wisely
    6. Give them experience in fixing meals at home with simple recipes low in time and ingredients needed.
  5. Make sure students have safe transportation
    1. Bad News: Untreated ADHD increases risk of young adult driver becoming involved in a motor vehicle collision by 300-400%.
    2. Good News: Studies have shown that optimized medical treatment may reduce this risk by up to 50%
    3. If the student will have a car, make sure they know to drive only when medication is in effect.
    4. Discuss who is safe for them to ride with and when they should use alternate means of transportation
    5. Do not assume they know better than to drive after drinking (even a little) or to ride with someone who has had any alcohol or other substances that could impair driving!
    6. In urban environments, students need to be familiar with accessing public transportation.

In the second part of this series, Dr. Thomas will share insight on how to help manage the student’s healthcare while he or she is away at college. 

 

Featured Doc Blog: How to Help a Child with ADHD Adjust to a New School Year

Dr. Joanna Ghegan in our Mount Pleasant, SC office recently contributed to an article in Lowcountry Parent Magazine.  This article describes 5 ways you can make sure your child has a great start to a better school year. Parents of children with ADHD understand the difficulties that come along with new routines (or getting back in a routine!), new teachers, and more advanced coursework.  You can find the original article here, or read below.

“For parents of children with attention deficit hyperactivity disorder (ADHD), facing those first few months of a new school year can be a challenge. Routines have changed, teachers are different and academic struggles may be more pronounced as coursework becomes more advanced.

But helping your children get comfortable in a new school year doesn’t have to feel like an uphill battle. Here are 5 ways to help your child with ADHD have better school year.

1. Confirm the ADHD diagnosis.

Usually a pediatrician or family doctor makes a diagnosis based on subjective questionnaires from parents and teachers, and that information may be conflicting.

“While those questionnaires are very important and part of the diagnostic process, it’s not enough information,” says Dr. Joanna Ghegan, a physician with Focus-MD in Mount Pleasant . In fact, that’s part of the reason she switched from a general pediatric practice to Focus-MD, which uses a FDA-cleared objective test to improve accuracy in ADHD diagnosis.

This computerized test objectively measures activity, attention and impulse control and compares each patient’s results with other kids of the same age and gender. “Including an objective measure of the patients symptoms helps prevent over-diagnosis of ADHD, which is a real comfort to parents,” according to Dr. Ghegan.

2. Adjust medications as needed.

Like all medications, ADHD medications can have side effects, but these can be avoided almost entirely by working closely with your child’s doctor to find the optimal medication and dose.

Teacher and parent input is critical and it’s important to listen to children and teens about their experiences with medication, both positive and negative, to get to the right balance.

“Having our objective testing to assess the effect of medication helps prevent over-medication and allows us to find the optimal dose more quickly that waiting for grades or subjective assessments”, says Ghegan. At Focus-MD physicians follow patients closely to monitor improvement in symptoms, academic and social progress and minimize side effects.

3. Go to bed early.

Many parents don’t always realize just how much sleep children need. While adults need 8 hours of sleep, children – especially ages 4 to 7 – require 11 or 12 hours of sleep.

With earlier school start times, after-school activities and both parents working, many children are sleep deprived. A child with ADHD will benefit greatly from getting enough rest since sleep is proven to help with attention, focus and hyperactivity.

4. Cut down on screen time.

We could all probably benefit from less time spent in front of the TV or computer, but this is especially true for children with ADHD. Remove televisions and computers from your child’s bedroom to eliminate distractions during both sleep time and study time.

5. Stay organized.

For children struggling to stay focused, getting organized will help greatly. Have the child keep an assignment book for school, makes lists and use a calendar. This not only helps the child stay on track but will cut down on stress at home.

Gheghan also stresses the importance a good diet and exercise, which releases endorphins that aid in concentration and focus.

“It’s not just about handing out medicine,” she says. “We take a holistic approach to the patient and talk about lifestyle as well.”

Focus-MD is a medical practice in Mount Pleasant for children with ADHD and related problems. At Focus-MD, ADHD is treated like a medical problem, not a psychological one. Their team of qualified and experienced medical doctors is committed to providing the high-quality, individualized care.

Call (843) 593-9332 for additional information or to schedule an appointment.”

Meet the 2017 Focus-MD $1,000 Scholarship Winner

We are very pleased to introduce the winner of the 2017 Focus on Your Future Scholarship Essay contest.  Isabel is a student at the College of Charleston in Charleston, SC.  Like many patients with ADHD, she was diagnosed in grade school, but it wasn’t until high school when she started to really struggle with the academic demands.

In high school she was frustrated that many of her peers were performing better and grasped the concepts much easier than she. After falling behind in most of her classes, she took charge of both her educational and medical well-being. She obtained a 504 education plan  to help her manage some of her barriers to learning. She also started treating her ADHD with medication and using organizational techniques that in her words, “enabled me to utilize the knowledge I possessed all along, but up until that point, struggled to organize and apply.”  She even improved her diet and sleep habits and began to exercise more regularly.

Once she was able to focus on her classes, Isabel says, “It was not a matter of not being smart enough, but instead, a matter of unscrambling the jumbled thoughts in my head.”  Now that she had that focus she also realized her love for mathematics and even made the Varsity Math Team her senior year, which moved on to win the State Championships!  That same year Isabel also started volunteering as a teacher’s assistant for students with learning disabilities. With over 150 volunteer hours serving the youth in Charleston, it’s no surprise that she is now pursuing a career in education, with a focus on STEM (Science, Technology, Engineering, and Math).

Now on her way earn her bachelor’s degree in Mathematics with minors in Computer Science and Women and Gender Studies at the College of Charleston, she is a member of the Bonner Leader Program, which is a four year civic leadership and development program for student advocates for social justice and change. She is also a volunteer with Girls Rock Charleston, a grassroots nonprofit that uses music as a vehicle for social change and builds power among girls in Charleston, South Carolina.  After finishing her bachelor’s degree she plans on attending graduate school for a Master’s Degree in Education.

Focus-MD is honored to award Isabel $1,000 towards her tuition to help her reach her dreams of becoming a Math Teacher. Her desire to help other students that face similar learning struggles is a testament to her character and hard work.  It is clear that her focus is not only on her future, but the future of her community.

 

Focus in Practice Opens at Crossway Medical Clinic in Oklahoma City

Focus-MD is thrilled to partner with Dr. Stuart Schrader and Dr. Susan Redwine of Crossway Medical Clinic to bring premium ADHD care to patients in the Oklahoma City area. With 15 providers, the clinic serves patients of all ages with over 60 years combined experience in pediatrics, internal medicine, and osteopathic medicine.

Crossway Medical Clinic maximizes the latest medical technology to offer services like advanced cardiac testing, on-site radiology, and personalized pharmacogenetics. Just as they have utilized this technology to provide the very best care for their patients, their decision to partner with Focus-MD to offer the best standard of ADHD care to their practice is further testament of their dedication to serve the whole patient and their families.

Dr. Schrader, Dr. Redwine, and Christy Greenly, APRN-CNP recently traveled to Mobile, AL to train with Dr. James Wiley and other providers and learn about the most effective strategies for diagnosing and treating ADHD within the AAP guidelines.  This guideline-driven training is what sets Focus-MD providers apart from many pediatricians who may have a difficult time with ADHD and attention disorders due to a lack of understanding or time.

For more information about Crossway Medical Clinic and their providers or to schedule an appointment, please visit their website at www.crosswaymedical.com

 

 

 

Featured Doc Blog: Spring is Just Around the Corner!

by Dr. Andrew Burstiner, Focus-MD Red Bank

March and April mark the halfway point for kid’s ages when determining what grade a child should be in.  Here in New Jersey, most school districts use October 1 as the cutoff date for determining a child’s grade eligibility.  So, kid’s born in the March/April period have classmates up to half a year older or younger.

As a Pediatrician, I know that this age variability can mean a world of difference in the physical, mental and social development of children.  This phenomenon has been well researched over many years, is clear to most professionals caring for and/or working with children, and has been well portrayed about 10 years ago in the Malcolm Gladwell book, Outliers.

Older children in a grade year often have a competitive advantage over their younger peers, and this advantage often continues into adolescence and adulthood.  At times, the physical and mental immaturity of younger children in a class or group/team activity may lead observers to consider developmental disorders like ADHD, learning disorders or other concerns.

We at Focus-MD help families try to differentiate between an age based or maturity concern versus a potential neurodevelopment disorder like ADHD.  QbTest, the FDA-cleared neuropsychiatric computer performance test, we have available in our office helps to serve this purpose.  QbTest is validated from age 6, and measures core ADHD behavioral parameters for individuals in relation to validated age-matched controls and norms. In studies using QbTest in Sweden and the United Kingdom to help assess for ADHD, it was noted that almost 40% of the tested children were in the youngest children by month in the school grade.  Thus, objective validated testing can help make more accurate assessments in these situations.  Accuracy in assessment and diagnosis are key concerns in the Focus-MD model of care.

Please link on to the direct information regarding this issue from Qbtech, the developers of QbTest, and let us know how we can help you.

http://adhdnews.qbtech.com/objective-data-confirms-birthdate-bias-in-childhood-adhd

All the best,

Dr. B

https://focusmdredbanknj.wordpress.com/blog/ 

www.adhdredbank.com

The Independence Curve

focusmdindependencecurve

ADHD is a neurodevelopment disorder.  That means that it delays the way the brain develops the connections leading to normal function in certain areas.  Well connected brains can sustain attention, regulate emotions, resist impulses and regulate motor activity.  Less well connected brains, well, you know…Until those connections catch up, parents are filling the void on organization, completing tasks and providing time management.  Parents are reminding, giving the same instructions over and over while they go in one ear and out of the other over and over. Inescapably this leads to frustration and resentment.  Parents try punishment and kids get angrier and angrier. Parents just want their kids with ADHD to be responsible and kids with ADHD just want to stop getting yelled at.  So, if reminders, yelling and restricting privileges don’t work, what will?   How about regularly treating the problem that is leading to the symptoms of inattention, impulsivity and hyperactivity?  Most parents try everything before they try the one thing that has been consistently shown to be safe and effective for more than thirty years, stimulant medication.   ‘Pills don’t build skills’ is the common mantra.  Maybe so, but kids with ADHD aren’t likely to build skills until their underlying problems with chemical brain connections are corrected any more that continuing to yell in a cell phone with poor reception is likely to help the person at the opposite end understand you. Stimulant medication corrects those connections on day one for many kids.  At that point they can begin paying attention to good discipline and parenting strategies.  Over time this is their best chance to catch up on their executive function skills.  Medication helps kids make the connections that level the road to maturity and independence.   focusmdindependencecurve

At age 6 parents are still doing almost everything for kids but by age 8 they should manage their own book bag.  By age 12 they must manage a locker and by 16 we expect them to manage an automobile.  How are they going to be ready for independence at 18 if we don’t use medication regularly to manage their connection issues so that they can pay attention to parenting and educational strategies? Growing up is hard enough. Isn’t it time to level the road to independence for your child?

Focus-MD Introduces “Focus in Practice”

Focus-MD, the world’s largest network of medical clinics devoted to the care of ADHD and related disorders, announces the launch of FOCUS in Practice at next week’s American Academy of Pediatrics National Exhibition and Conference. CEO Todd Martin says that the additional approach arose out of feedback from pediatric practices and health care systems at previous AAP meetings. “They loved our concept of operationalizing the AAP Guideline for ADHD and wanted a process that would allow larger practices and systems to rapidly and efficiently improve the quality of their care around ADHD and its co-occurring conditions. Although we have opened individual practices in eight states and continue to offer primary care doctors the option of opening a standalone practice, we want to be able to offer a model of a Focus-MD clinic within an existing pediatric clinic. Our first FOCUS in Practice clinic will start seeing patients two days before the AAP NCE.”

James Wiley, MD, FAAP Founder and CMO of Focus-MD says the new model is exciting because it provides so many resources to existing pediatric practices. “The Institute of Medicine is on record that it takes seventeen years for guidelines to be implemented at the practice level. Kids with ADHD can’t keep waiting for us to catch up with the science and deliver the highest quality care. The Focus in Practice system can fully operationalize the AAP Guideline on ADHD in a practice in less than six months,” says Wiley. “Perhaps most importantly, we individualize that care for every patient.”

The system has been forged using quality improvement principles over more than eight years. “Because we are a collaborative network with the same ideal of practicing quality evidence-based medicine with compassion, we have been able to grow and accelerate improvement to the benefit of our patients.” Providers previously frustrated by everything that makes it hard to pay attention to ADHD have found the system comprehensive and efficient, allowing general pediatricians to develop a level of expertise and confidence to function as experts. “The most gratifying thing about the model is that the kids get better,” says Dr. Wiley. “But the second most gratifying thing for us is the quality of the pediatricians attracted to our model.”

The system also addresses the complicated practice management challenges faced by primary care physicians trying to address the needs of these patients. “We have understood from the beginning that there had to be a business case for this change,” says CEO Martin. “We have worked together to ensure that our providers can have the time and clinical resources to take great care of patients and at the same time generate enough revenue to make the practice financially successful.”