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Back To School. Back To An ADHD Routine.

Focus-MD | Back To School. Back To An ADHD Routine.

By James Wiley, MD, FAAP

 

It’s back to school time, and that means it’s time to get back into a routine. One of the most important routines to focus on is bedtime and awakening time. Summer tends to shift bedtime later, and it definitely shifts awakening time later for most kids, especially teenagers. So, in order to adjust the sleep cycle, we recommend beginning to wake a little earlier each day and going to bed a little earlier each night.

One of the things that you have to do in order to accomplish this is to restrict those electronics your child or teenager takes to bed with them. That sometimes meets resistance. Whether you have ADHD or not, a good night’s sleep is essential for attention — but it is especially important for ADHD patients. The ADHD brain is very hard to slow down and it takes time to adjust. So, begin now to shift that sleep cycle back to the school year pattern. You’ll be glad you did.

 

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5 Quick Low-Tech Tips to Help Start Your School Year Off Right

Focus-MD | 5 Quick Low-Tech Tips to Help Start Your School Year Off Right

By James Wiley, MD, FAAP

It’s back to school time, and we at Focus-MD do more than just prescribe medicine to treat ADHD — we also like to provide tips and tricks on how to manage life with ADHD. So, to help you and your child start the school year off right, here are five quick low-tech tips:

1. Have extra pencils, erasers, pens, and paper.
These are all inexpensive tools. Make sure you have plenty on-hand so that you don’t hear, “I can’t find my pencil” or “I can’t get started because I don’t have a pencil.”

2. Have these tools in multiple colors.
ADHD brains love color, and a great system to begin to teach your child now is to highlight the important points. This way, when it’s time to go back and study, they’re ready to go.

3. Use a simple index card.
Boys resist using planners, and it frustrates teachers and parents to no end. Boys really do have trouble with planners a lot of times. But, what they will use is a simple index card. Some school uniforms have a pocket, so the index card fits in there nicely. Have them go ahead and write the four or five subjects they’re going to have homework in on that card. And, yes — I know moms are going to accidentally wash some of them, but it’s still good to teach them that technique!

4. Use Post-It notes.
Have your child write themselves notes. Remember that if you write the note, you’re doing the executive function in the reminding. But if the child writes something on the Post-It note, then they can remember without you nagging.

5. And finally, gather the things they’re going to need for school onto a “launch pad.”
Have them create it. Remember, kids don’t play as often in a playhouse that dad builds by himself — they’re going to want to be involved in the creative process. So, if you want your kid to get organized, have them design their own system. One great way is to find a piece of paper or poster board and have them create a space in which they gather the things they’re going to need for that day (AKA a “launch pad”). Whether that be their phone, their shoes — whatever it may be — they begin to learn to put those things together in one place. It works for NASA, and it’ll make your school year go much better.

 

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5 Things Teachers Should Know About ADHD in the Classroom

Focus-Md | 5 Things Teachers Should Know About ADHD in the Classroom

By James Wiley, MD, FAAP

It’s back-to-school time, and as the father and brother of teachers, I get to hear firsthand the joys and struggles educators face in the classroom. One challenge is managing hyperactive and impulsive behavior in the 10% of students that have ADHD. Here are 5 tips that will help you keep your sanity and make your students with ADHD (and their parents) eternally grateful.

1. Let them move
Research is in! Kids with ADHD perform better and learn more if they can wiggle while they work. Help them find less disruptive ways to do just that! A fidget pal — like an eraser or a small stress ball — can be helpful, but some kids will need more. Allowing students to sit on exercise balls has been helpful for some. Consider allowing students to stand at desks in the back of the room or have a walking and listening track if you find you have a kid that has to move. Incorporate stand up and stretch breaks into instruction.

2. Encourage PE and recess
Kids who get recess do better on standardized tests than those who don’t. If you restrict these high-movement times, then be prepared to face the repercussions. The need for the ADHD brain to move is cumulative — that is, it builds over the day. PE and recess allow a pop-off valve for that energy. Restriction from these activities due to behavioral issues or unfinished work is counter-productive.

3. Preferential seating
Some kids with ADHD get distracted visually and need to be in the front. For the ones more distracted by sound, consider letting them sit in the back of the class — these are the kids that are always looking behind them when you place them in the front closer to you so that they can listen better! Separating a child from his/her peers in a chair away from the action can lead to stigmatization and give a subconscious green light for bullying that child. Any changes in seating should be done privately and never in front of the other students or out of frustration. One thought is to move everyone around — that way no one is singled out, and the wiggle worm just happens to land in the seat you want him/her in! Don’t hesitate to rearrange if it doesn’t help.

4. Catch them being good and be specific on the negative behaviors
Kids with ADHD hear a lot of negative messages. When they have success controlling their behavior or completing their work, make sure to notice, and be easy on the frowny faces! Equal is not always fair. Most of God’s children, including the grown-up kind, will work more for encouragement and praise than for correction and discipline. When there are behavioral problems that need to be addressed, BE SPECIFIC. “He was blurting out answers and out of his seat a great deal today” is much more helpful than “Terrible day!” Consider identifying three problem behaviors and giving a daily grade of 1-5, with 1-2 being problematic, 3 being average and 4-5 being great! Parents can then see how their child is doing in the classroom and reinforce or discipline as indicated.

5. Never mention medication in the classroom
Asking a child about medication in the classroom or in front of a peer is a serious violation of privacy. Most teachers reading this will certainly agree! But from what kids say, it happens all too frequently, and it is devastating for them and often leads to problems with medication non-compliance. It’s much better to say, “You seem distracted today” or “You’re active today” than to ask about medication. If there needs to be a conversation about medication, remember to do it in private. Finally, please share concerns about medication side effects or lack of effectiveness of medication with the parent (or physician with parental approval). You are with the child eight hours a day, five days a week for nine months (as you no doubt know!), and your professional opinion counts!

Watch the late Rita Pearson’s Ted Talks video Every Kid Needs a Champion. She says it best.

 

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Stop Being Creative

Focus-MD | Stop Being Creative

By James Wiley, MD, FAAP

Those of us who have ADHD often hear about the gifts that come with it. It’s true — we aren’t normal; we’re gifted. Creativity is one of the most awesome gifts. I’m often astounded by the creations of my patients using a box of random Legos. Art, comedy, music, tech, drama, writing, entrepreneurship, problem-solving ADHD brains are at home here! How bland would the neuro-typical world be without us? Very, I think.

My grandmother, Madge, had a favorite saying that rolled slowly off her elegantly southern tongue. ‘Suga, (Sugar) there’re two sides to everything, even a piece of toilet paypa (paper).”

And so it is with ADHD-inspired creativity. We always have another idea, so it’s hard to know when to stop imagining/thinking and actually start to do something. Since we can think of so many ways to solve a math problem, we don’t show our work, or we get lost along the way. And since no problem or decision has only a normal, single answer, deciding where to go to dinner can take 20 minutes, and that’s just to decide between Mexican or Chinese — not which restaurant. “Oh, wait we haven’t tried that new burger place…”

I have been challenging myself lately. Stop being creative. At least long enough to do the laundry.

 

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“ADHD: Not Always a Good Thing!” by Dr. Farid Sabet: Blog Review by Dr. James Wiley

Saber Blog Review By Dr. James Wiley

Dr. Farid Sabet’s blog ADHD: Not Always a Good Thing! was refreshing to read, and I recommend it to anyone with an interest in understanding ADHD. Celebrating ADHD as a gift, while ignoring its liabilities, may make us feel better for a moment but it won’t help us cope with the challenges over the long run.

Embracing our ADHD shouldn’t keep us from acknowledging the medical facts of increased risks for significant negatives: relationship problems including divorce, underperformance, accidents, depression, anxiety, addiction, incarceration and suicide. As Dr. Sabet said, “Facing and overcoming challenges through patient, persistent education and training are the keys to success. A balanced approach must be maintained that emphasizes hard work and persistence in overcoming challenges, while minimizing shame and destructive criticism.”
I look at ADHD not as a gift, but as a disorder. However, I don’t know anyone who has it that isn’t an exceptional, gifted person. At Focus-MD, we believe that treating ADHD shouldn’t diminish those gifts; it should enhance them.

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Dr. James Wiley Published on ImpactADHD.com

FocusMD Dr. James Wiley Published ImpactADHD

Dr. James Wiley has been featured as this week’s ImpactADHD Guest Expert of the Week. Impact ADHD is an organization dedicated to “Helping Parents Help Kids” who are diagnosed or suspected to have ADHD. A pediatrician who specializes in working with ADHD children, Dr. Wiley advocates for learning the difference between “being” ADHD and “having” ADHD and how to diagnose the disease.

Dr. Wiley rebutted the idea that there are certain Psychoeducational or Neuropsychological tests that classify someone as having ADHD. In reality, there are a number of criteria that a child must meet in order to be diagnosed with ADHD, as determined by a clinical psychologist, educator, or physician who has gotten to know the child well. To find out more about these criteria and how to determine if your child has ADHD, read Dr. Wiley’s article,

To find out more about these criteria and how to determine if your child has ADHD, read Dr. Wiley’s ImpactADHD article here: There is no Test for ADHD: Diagnosis Starts Here.

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Can ADHD Kill Me?

FocusMD-ADHD-killme-Wiley-blog

By James Wiley, MD ~ @ADDdoc

I often compare the diagnosis and treatment of ADHD to diabetes. When I do, sometimes people remark, “Yeah, but you can die of diabetes.” Diabetes does increase the risk of premature death. ADHD actually does too—especially when it’s diagnosed later in life. In fact, people with ADHD have more than double the risk of premature death. The most common cause of those deaths is accidents.

Researchers at Aarhus University in Denmark recently completed a study in which they analyzed approximately two million people in the Danish National Health Service Register over the course of 32 years. They found that the patients with ADHD faced at least a doubled risk of dying prematurely. They also discovered that the risk was higher for women than men and that later diagnosis was associated with a greater increase in risk as well. In fact, the patients diagnosed with ADHD as adults had four times the risk. Younger patients had only double the risk.

While this news is certainly alarming, it’s no reason to panic. The study offered reassuring information as well. Researchers noted that the relative risk of premature death does not mean that there are a large number of ADHD patients actually dying prematurely. It’s important to keep in mind that the doubled relative risk of premature death only results in a small absolute risk of premature death.

Gaining knowledge from studies like this – about how ADHD affects our health and safety -is critical. It helps us develop awareness that motivates and prepares us to take better care of ourselves. And, yet again, this study reminds us that early diagnosis and medical treatment are the best ways to improve an ADHD patient’s overall health, lifestyle, and well-being. At Focus MD, we think it’s time we all start paying more attention to ADHD.

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Resources:

http://bss.au.dk/currently/news/news-item/artikel/people-with-adhd-are-twice-as-likely-to-die-prematurely/

Treat Your ADHD Brain Like a Race Car and Get on the Road to Better Focus.

FocusMD-ADHD-racecar-Wiley-blog1

By James Wiley, MD, FAAP

ADHD brains are like race cars. I don’t know who coined the metaphor, but I use it frequently with my patients. ADHD brains are fast; they are powerful. Some of the most creative and successful people on the planet drive one. But here’s the flip side: the steering is difficult and the brakes are lousy.

Like any car, a race car requires maintenance. Things like oil, gas, a clean windshield and air in the tires are all essential regardless of the type of car—whether it’s a Ferrari or a Yugo from back in the day. It’s the same situation with the brain. Good nutrition, exercise, adequate sleep, fresh air and sunshine are all important for any brain to function well, and these are even more important for ADHD brains. But like any high performance vehicle,  an ADHD brain requires much more than typical maintenance.

Here are some strategies to tune up your ADHD care, race car style:

Medication. A race car can go nowhere without the motor being fueled effectively. An ADHD brain lacks the right chemistry for attention, motor and impulse control, so it usually needs medication to enhance those chemical connections. Think of medication as a necessary fuel additive that helps the brain run smoothly. Most of us need medication to operate more efficiently and without it, some of us won’t even make it out of the garage.

Skills. It takes skill to drive a high performance vehicle. Getting medication optimized to the just right dose of the just right medication is often the first part of acquiring the skills needed. Another key is being in the right academic or work setting. With the medication and environment tuned, some ADHD brains are able to flourish and develop the needed executive function to be less frustrated. But for others, more help is needed.

A team. No race car gets to the finish line without a pit crew. And ADHD patients often benefit from a pit crew of their own—supportive people who understand ADHD mentality and play specific roles in the patient’s life. Putting together that pit crew—whether it’s adding an ADHD coach, a nutritionist, a behavior therapist or someone to help with organization skills— and getting them to work in harmony can be difficult for families.

At Focus-MD we don’t pretend to offer the pit crew, but we work every day to be the best in the world at providing a careful diagnosis and evidence-based medical treatment for our patients. We help patients go from frustration to focus by getting diagnosis and medication right, then connect the individual to additional trusted resources for building social skills, academic skills, and organization skills according to his or her needs. Our goal for our patients is a healthy, well-maintained and more attentive brain to help them navigate their lives.

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5 Simple Things to Help Behavior & Attention Issues

Focus-Wiley-ADHD-5things_header

ADHD is common and it is also over diagnosed. In our frantic modern world we can forget some of the basics that contribute to healthy attention and behavior. At Focus-MD we don’t believe that there are a lot of parents rushing to medicate their kids. Most patients come to us having tried other interventions first. Here are some suggestions that are likely to help with behavior and attention problems regardless of their cause.

Focus-Wiley-ADHD-bettersleep-Help

Better Sleep

None of God’s children no matter how small or how tall pay attention and behave well if they haven’t had adequate sleep. Intrusion of screen time in the bedroom has gone from TV watching to constant contact with texting, social media, video streaming and gaming. Eliminate media from the bedroom at least 30 minutes before bedtime; a good book is still ok. Animals and other household distractions affect sleep too. Get the cat and the dog out of the bedroom and consider white noise to drown out things that go bump in the night. Most people need eight quality hours of sleep.

Focus-Wiley-ADHD-Screen-Help

Limit Daytime Screen Time

With all of the options above we are all online a lot, probably too much. No don’t close your browser; you need to read this! The American Academy of Pediatrics recommends no more than 2 hours of screen time a day for school aged kids. No one is more interesting to kids than their favorite game or show so parents with a chore list in hand take note—make the screen black first, then get their attention.

Focus-Wiley-ADHD-Natural-sunshine

More Fresh Air and Sunshine

Kids need unstructured out door playtime, time to be a kid. This doesn’t include activities like ball practice. This means outdoor play like bike riding and playing chase or building a fort or playhouse. Imaginations soar when kids get into the natural world and get their hands dirty. Schools can help here by realizing that PE is not recess. Kids do better on standardized testing when they have free play at recess—it’s a fact!

Focus-Wiley-ADHD-Natural-exercise2

Exercise

With some schools cutting back PE it is important that kids get some physical activity. This may go hand in hand with their dose of fresh air and sunshine but it may be separate. Recent studies have shown that sitting down is making us fat and killing us early and what are our kids supposed to do in school all day? Sit still.  Let’s rethink that! Standing up to do work allows the ADHD brain to function better and is better for overall health. Throw in a bike ride or a game of Red Rover and we improve attention and decrease the obesity problem!

Focus-Wiley-ADHD-eathealthy-Help

Nutrition 

ADHD is not a nutrition problem. But every parent and teacher knows that nutrition is important for attention and behavior. They even made a protein candy bar commercial about how we behave when we haven’t eaten! Making sure that kids wake up to a breakfast with good sources of protein and following that up with a nutritious lunch will go far in helping our kids stay on task, concentrate and avoiding sugar crashes from doughnut hangover. Adding omega 3 supplements and a multivitamin until we can improve nutrition from food sources is a good start. While we’re at it why not try eating a little closer to the earth by decreasing the processed foods our families eat and concentrate on getting in a few more fruits and vegetables.

At Focus-MD we concentrate on ADHD but we care about you as a person first and foremost. These tips will help your family live a healthier lifestyle whether you have a diagnosis or not!

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ADHD and OCD in Childhood – The Chicken, the Egg or Both

ADHD and OCD in Childhood, James Wiley MD, Focus MD

Article by: James Wiley, MD ~ FocusMD

Obsessive Compulsive Disorder is not rare in childhood and it is more common in children with ADHD. Few parents come to Focus-MD clinics concerned that their child has OCD. They are more worried about social skills issues and disruptive behavior at school and meltdowns and tantrums at home. Often a teacher or some other professional will have suggested that the child has ADHD, ODD-Oppositional Defiant Disorder or ASD, Autism Spectrum Disorder or Asperger’s Disorder (no longer diagnosed). These observations are a great place to start. When we listen to the voices of people who know the child well and then take the time to look carefully at the presenting symptoms, we are more likely to get the diagnosis right. Remember that sometimes OCD occurs with ADHD and sometimes OCD diagnosis alone best explains the patient’s symptoms. In other words, the diagnosis can be either or both. To make matters more confusing some patients have other conditions tagging along. Mood disorders, anxiety and tics are all more common in these kids. At Focus-MD we find that when we look at the whole child, including their struggles and their strengths, we are better able to arrive at a correct diagnosis or combination of diagnoses that make sense to parents. Helping you put the pieces of the behavior puzzle together is what we strive to do every day. 

How to spot OCD

Just because your child’s room is a mess doesn’t mean that he/she doesn’t have OCD. Remember both neat freaks and hoarders have OCD. The neat are obsessed with cleanliness and order while hoarders are obsessed that they may need that half used ketchup packet tomorrow.  One compulsively cleans, the other compulsively holds on to trash. Look for these common symptoms

Symptoms of OCD

  1. Counting
  2. Lining things up
  3. Sorting
  4. Making things symmetrical
  5. Checking behavior—asking the same question over and over even when the answer  is known or verifying that the door is locked a certain number of times. This is also called Need to Know.
  6. Need to Tell—will start stories all over from the  beginning if narrative gets out-of-order or they forget a detail.  Will need you to listen to the detail that is in their mind no matter if it doesn’t matter.
  7. Persistent thoughts
  8. Rituals – having to do things in a certain order.
  9. Food aversion due to texture or one food touching another or having to eat foods in a certain order.
  10. Sensory issues — loud noises, tags in clothes, the way under wear or socks fit or feel, texture of clothes or other fabrics.
  11. Picking at fingers, biting nails, twirling or pulling out hair, eye lashes or eyebrows.

In reading below you will see that OCD impairments can look a like with ADHD problems.

Functional Impairment in OCD compared to ADHD

Functional Impairment in OCD compared to ADHD = FocusMD

OCD compared to ODD

  • OCD kids are often defiant but they don’t tend to be vindictive or spiteful like ODD kids.
  • Once they have their way, they’re happy again though they’ll remember a grudge!
  • In OCD it’s ‘my way or the highway’.
  • In ODD it’s ‘anyway but your way’.

OCD compared to ASD

  • OCD kids have more reciprocal interaction than ASD kids.
  • Their social skills issues are not a lack of interpersonal connection but rather that things have to be a certain way on certain things.
  • They will talk about or engage other things but on certain topics/procedures but they are very inflexible.
  • ASD kids are happier with parallel interaction if any at all.

If you would like more information concerning ADHD. ADHD treatment, diagnosis, and resources, please visit focus-md.com

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