Edge Foundation Blog

This month we are pleased to interview Carolyn Dukarm, M.D. Dr. Dukarm  is founder and director of the Center for Eating Disorders, which is an outpatient treatment center that specializes in the overlap between disordered eating symptoms and attention problems.

Edge: It’s surprising to find out that people with  ADHD are prone to obesity.  Why do you think that’s true?

Dr. Dukarm: Both ADHD and eating disorders tend to cause individuals to be disconnected from their internal cues.  Those with ADD are easily distracted and may miss a meal; then, they feel ravenous and are at risk for binge eating.  Hunger and satiety cues are often misinterpreted.   Restricting eating when hungry, and binge eating beyond fullness, temporarily destroy the communication between the stomach and the brain. Scheduling meals can help with this, but for people with ADHD the task of scheduling meals  can be challenging.

Edge:  Can you speak to the reasons for how impulsive eating by girls and women with ADHD turns into an eating disorder?

Dr. Dukarm: Several key characteristics of ADHD can contribute to the development of an eating disorder. Individuals with ADHD exhibit impulsivity (which can result in impulsive binge eating), distractibility (and, therefore, a tendency to often be distracted by thoughts of food and body image), and poor attention and organizational skills (leading to difficulty following a meal plan.) Impulsivity can cause binge eating, poor food choices, use of food as a reward, out of control eating and self-medication with food (specifically carbohydrates.) Distractibility can lead to binge eating because of difficulty following a meal plan, trouble estimating portion size, a persistent internal “running conversation” regarding food and weight and stimulation-seeking behavior through food. In addition, poor attention and concentration can decrease awareness of internal cues including hunger/ satiety and contribute to unstructured eating.

Edge: What do you mean when you say some people self-medicating ADHD symptoms with food?

Dr. Dukarm: Sugar and high glycemic carbohydrates can temporarily increase the neurotransmitter, serotonin, and therefore can create a temporary feeling of calmness or a decrease in anxiety. However, due to the effects of low-glycemic carbohydrates on blood sugar, these feelings are only temporary and soon result in a paradoxical reaction of increased restlessness and irritability when blood sugar levels decrease.  In addition, this paradoxical reaction can cause an increased craving for sugar, contributing to the cyclic pattern of binge eating.

Edge:  What are some healthy eating habits that may be obvious to everyone else that ADHD women and girls have to learn the hard way?

Dr. Dukarm: Meal planning does not come naturally to most people, especially those with ADHD and some people with eating disorders.  However, without some amount of pre-planning meals for the day, the risk of binge eating increases.  Therefore, temporarily eating in a more “mechanical” fashion (by your watch, not your stomach) while becoming more in tune to internal cues can re-establish this feedback loop and break the starvation/binge eating cycle.

Having the right foods, in the right place, at the right time decreases impulsive eating.  Structuring eating is essential for people with ADHD and eating disorders, providing a framework for feeling safe at meals.  Structuring and planning meals actually decreases the amount of time spent thinking about food.  It is important to be realistic and make sure your meal plan can actually be carried out given your schedule on a specific day.

The following suggestions may help to develop a beneficial plan:

• Eat every 3 to 4 hours. Eating every three to four hours stabilizes blood sugar and prevents hypoglycemia (low blood sugar).  Hypoglycemia is a common trigger to binge eating, because low blood sugar can result in a paradoxical reaction of carbohydrate craving.  In addition, eating small, frequent “mini-meals” throughout the day stimulates your metabolism and digestion.
• Set specific times to eat. Pre-determining times to eat, i.e. every four hours, can actually decrease the potential of feeling overly hungry and thereby reduce the risk of binge eating.
• Set specific amounts to eat. Pre-determining how much to eat and when to eat it can prevent the pattern of hoarding food until late in the day, a common trigger for binge eating.  Pre-determining portions often serves as a way to maintain a sufficient intake until hunger and satiety cues are reestablished.
• Enhance the quality of your nutritional intake. Balancing adequate quantity of protein, carbohydrates and fat at every meal and snack will significantly affect appetite, cravings, binge eating, mood and attention.  In addition, choosing high quality proteins, low-glycemic carbohydrates and quality fats will lead to further improvement in appetite and attention.

Edge:  Can you point us in the direction of any research studies or books on this topic for parents or professionals to learn more about this important issue?

Dr. Dukarm: In my book Pieces of a Puzzle: The Link between Eating Disorders and ADD, I include sections for individuals, as well as specific information for professionals who treat eating disorders or ADHD.  Several peer-reviewed journals, including the Journal of Women’s Health and the Journal of Abnormal Psychology have published articles on the overlap of these disorders.

Do you ever hold back about sharing that you have ADHD?  You aren’t alone.  Some people’s parents tell them not to disclose it for fear their child will be discriminated against.  Some people hold back because they are ashamed of the impact ADHD has on their lives.  Still others can’t face another conversation explaining how ADHD is a real condition – not symptom of bad parenting, media hype or poor diet.  It can feel risky to reveal you have ADHD.

Sharing that you have ADHD with your friends, families and teachers is a very private and personal decision.  With ADHD Awareness Week just around the corner (September 13 – 17, 2010), we’d like to offer a few thoughts about the positive side of disclosing your ADHD and using it as an opportunity to educate others.

1. Secrecy breeds shame: Keeping a secret that is never discussed has a dark side – it can leave you feeling like there is something wrong with you that you have to hide.
2. Secrecy build barriers: When you decide to hold back about your ADHD, you build a little wall between you and that person.  The longer the wall is in place, the harder it will be to disclose the truth.  While the other person is oblivious, you can end up spending a lot of energy worrying about being discovered.
3. Secrecy keeps YOU in the dark: You can’t educate yourself about ADHD very easily if you aren’t open about having it.  Asking questions of an expert, sharing experiences with other people who have ADHD and learning strategies to work with your strengths and weakness – all require that you are open about having ADHD.
4. Secrecy can hurt you: If the people around you don’t understand that you have ADHD, they don’t have the same kind of compassion for your mistakes as they might otherwise have if you’d give them the opportunity.  Moreover, you need to be able to disclose your ADHD status if you want to receive accommodations in school.

Being Open About ADHD

We hope we’ve shown you some of the positive side of  “coming out” with your ADHD with your family and friends.  If you do, may we recommend you don’t just blurt it out there?  But that you take a three step, thoughtful approach to disclosing your ADHD status:

1. Take the time to do it right. Tell people when you have time to talk about it and they can ask you questions.  There are a lot of misperceptions about ADHD out there and people often don’t have any idea what it means to have ADHD.
2. Educate yourself. Be ready with information about what ADHD is and how it affects people. ADHD affects everyone differently and so understanding your own symptoms and need for support will empower you to advocate for yourself much more effectively. There are tons of resources on the web.  A particularly good one that addresses common concerns people may raise was written by ADHD Coach, Pete Quily http://www.addcoach4u.com/doesaddreallyexist.html.
3. Ask for help. When you talk about your ADHD, don’t be afraid to ask people to help you out.  That can mean being understanding when you slip up by being late, interrupting or running in three different directions.  Married couples should definitely spend time working out the give and take of an ADHD relationship in managing home life.

Finally, if you do share, be sure to pat yourself on the back.  By being open, educating others and asking for help, you pave the way for other people with ADHD to share and learn – or even discover for the first time that they aren’t stupid, lazy or inconsiderate – they just have ADHD!

Do you disclose your ADHD or keep it to yourself?  Have you ever had a bad experience in sharing?  Tell us your story in the comments.

Dear Edge,

I see you have another training class for coaches running.  Why shouldn’t I just sign up for that instead of hiring a coach for my son?

Sincerely,  Sandy L.

Dear Sandy,

We’ve heard that some parents believe that they should sign up for ADHD coach training instead of hiring an ADHD coach because it’s so much less expensive.  We of course disagree.

Yes, understanding how coaching works can be helpful to you, but it doesn’t replace the value of getting coaching in real life for your student.  Why?

• High school and college students do not want to hear anything from their parents about anything – it’s their job to break away and be independent
• The student, not the parent, sets the ADHD coaching agenda – it can be difficult to detach from your personal agenda as a parent and critical for your student to be empowered to direct her own life path.
• Just because you’ve taken the class doesn’t mean you have the experience our coaches bring to the table.  Sure you know your child, but we know dozens – and that gives us perspective on many different approaches that work, or don’t work, for different people.
• Edge coaches have received previous life coaching training and have at least two years of experience.  ADHD coaching is an advanced coaching skill that takes practice.  That’s why our coaches receive mentoring after they complete the class.  They also have access to the expertise and wisdom of the Edge coaching bench – when they find a problem they haven’t encountered for, they can bounce ideas and strategies off the team for input.

If you want to learn more about the coaching process, Edge Foundation coach trainer, Jodi Sleeper-Triplet has a great book at the printers on the topic that you can preorder here:   Empowering Youth with ADHD: Your Guide to Coaching Adolescents and Young Adults for Coaches, Parents, and Professionals

What’s your opinion, do you think the outside perspective of a coach can accomplish more than a parent’s influence?  Sound off in the comments, or join the conversation on Facebook.

Last week we featured the first installment of an important article on ADHD medication abuse written by Edge Foundation Executive Director, Robert Tudisco and first publishedin Attention Magazine.  Our second part gets into the nitty gritty:  What’s it mean to you.

Key Facts:

• 34 percent of students polled admitted to taking stimulant medications without a prescription; in juniors and seniors, the percentage can be as high as 80 percent.
• Possessing stimulant medications without a prescription is essentially the same as possessing any other controlled substance
• Students who face challenges based upon the symptoms of their ADHD do not take medications to gain an advantage, but do so in order to have the ability to function in a school setting

What do parents and students need to keep in mind about ADHD medication?

Students: Be smart with your medications

• Remember that your ADHD medications are a controlled substance.  Possession of these medications without a prescription is illegal.
• Safeguard your medication from theft on campus.  It is an important tool to management of your ADHD symptoms and it should be there when you need it.
• A gift is a sale.  In the eyes of the law, giving a controlled substance to someone who does not have the legal or medical authority to possess it is the same as selling it.
• Don’t share your medication with others.  Giving controlled substances to your friends is not only illegal, but can cause them harm if they are not being supervised by a doctor.
• Follow your medication plan.  Changing your plan without consulting your doctor can have medical consequences and can create a surplus of pills that can lead to trouble. If you don’t feel that you need to take your meds on the schedule prescribed, tell your doctor and modify the plan with his or her guidance.
• Have local resources.  If you are away at school, have your prescribingdoctor coordinate with a doctor located near your school to address any issues that may come up or emergencies.

Parents:  Protect your child—prevent diversion

• Get the facts and avoid the myths associated with ADHD medication from your doctor.
• Educate your child about his or her medication, the laws that govern its use, and how it can interact with other substances.
• Speak with your child about respecting the purpose of the medication and using it only for its prescribed and intended purpose.
• Stress the importance of reporting any side effects to you and your treating physician.
• Consult with your child’s doctor and develop a solid medication plan that will work at home and school. Revisit that plan if and when your child goes away to college.
• Make sure your child understands that he or she is taking what is considered a controlled substance that is illegal to all others.
• Make sure that the school is aware of the medication that your child is taking, even if it is not dispensed by school medical personnel.  This is especially important if your child is away at college.
• Make sure your child understands the need to keep medication safeguarded inside its prescription container at all times.
• Provide your prescribing physician’s contact information to the school along with the prescription information itself in the event that any emergencies arise.

Other articles you might find of interest about ADHD medication:

Is ADHD Over Medicated?

Is Ritalin Good for You?

Do you protect you ADHD medications from theft?  Have you ever had any stolen?  Let us know your experience in the comments.

Edge Foundation Executive Director, Robert Tudisco, published this article in the June issue of Attention Magazine.  Attention is published by CHADD [link] and is available online for paid subscribers.We are pleased to be able to bring this important information to our readers.

Key findings:

• As many as 60 percent and as high as 80 percent of juniors and seniors admitted to taking stimulant medications without a prescription.
• Possessing stimulant medications without a prescription is essentially the same as possessing any other controlled substance.
• Money does not need to change hands in order for a gift or other exchange of a controlled substance to be considered a “sale.”
• Students who face challenges based upon the symptoms of their ADHD do not take medications to gain an advantage, but do so in order to have the ability to function in a school setting
• Extra care should be taken to ensure that young adults act responsibly to follow their medication plans and safeguard their medication from unauthorized use.

Recent media reports raised an alert on the availability of stimulant medications used to treat students with ADHD and the alarming percentage of students with no diagnosis or prescription who are using ADHD medications.  Medication diversion has also been popularized in movies and television programs.  In Juno, the main character offers one of her meds to a classmate who needs to get a report done on time.  Characters in Desperate Housewives openly discuss taking their children’s stimulant meds to help them lose weight or get through the day.  Campus news sources report students not diagnosed with ADHD taking stimulants for recreational use or to gain an academic advantage.  What do the statistics really show, and what are the facts?

I’ve written and often read about the pitfalls many students with ADHD face as they struggle with transitions.  This concept is not only important to bear in mind academically but behaviorally, as the students adapt to a medication plan at a particularly vulnerable time in their development.  The diversion of ADHD medication to undiagnosed individuals who take it recreationally and without proper supervision is a dangerous problem that can have disastrous medical and legal consequences.  Unauthorized use of ADHD medication can fuel the social stigmas we in the disability community have fought so hard against.

Controlled substances

Traditionally, the most effective and widely used medications to manage ADHD symptoms are stimulant medications, such as methylphenidate and amphetamine.  Pursuant to the Controlled Substances Act, both of these drugs are classified by the Drug Enforcement Administration (DEA) and the Food and Drug Administration (FDA) as Schedule II Controlled Substances.  This classification puts stringent restrictions upon how these drugs are prescribed.  While these medications have no “intoxicating “effects, they are unfortunately used recreationally for weight loss or to simulate the effects of other stimulants.  In the eyes of the law, the possession of a controlled substance without an authorized prescription is a crime.  It is important to recognize and to alert students and their parents that possessing stimulant medications without a prescription is essentially the same as possessing any other controlled substance.  In fact, in some states (such as New York) it is illegal—though not a criminal offense—to possess Schedule II controlled substance medication unless it is inside the prescription bottle issued by the pharmacy.  ADHD medication, like any medication, is safe only when prescribed and used under the supervision of a physician or other authorized prescribing professional.  Unauthorized use or abuse of ADHD medication, or any other medication, can have serious medical consequences, depending upon how much is taken, how often it is taken, an individual’s chemistry, and with what other substances or medications it is taken.

Social stigma

It is also important to understand that far too many people in our culture stigmatize the diagnosis of ADHD and the medications that can effectively manage its symptoms.  The myths about ADHD—as an excuse for poor behavior, bad parenting, and laziness—still hold back many bright students with ADHD from realizing their full potentials.  One of the most debilitating myths is that medication is a bad thing.  Medication is a personal choice that should be made between the patient, their parents, and a qualified physician.  It is also important to note that medication does not cure ADHD but, when taken under the supervision of a doctor, can effectively manage many of its symptoms.  Medication should be considered as a part of a multimodal approach along with other behavioral management interventions and techniques, such as exercise, behavioral modification, and coaching.  Many students who take stimulant medication without a prescription claim that they do so to gain a competitive edge over other students.  They claim the stimulant medications help them to complete their work and to raise their test scores.  It is important to understand that students who face challenges based upon the symptoms of their ADHD do not take medications to gain an advantage, but do so in order to have the ability to function in a school setting.  While stimulant medication may enhance the performance of individuals with or without ADHD, in many cases, the ones actually diagnosed cannot function effectively without it.  Thus, unauthorized diversion of ADHD medication not only has legal and medical consequences, as listed above, but it fuels the very social stigmas that the disability community has worked so hard to overcome.

Keeping perspective

Much of the concern over the increased use of ADHD medication is clouded by the rising numbers of diagnoses and prescriptions over the last ten to twenty years.  As our understanding of the nature and nuances of the disorder improved, diagnosis and treatment of ADHD increased.  For instance, traditionally, ADHD was thought to present only in hyperactive boys.  We now know that the disorder spans gender and does not always present with symptoms of hyperactivity.  Inattentive-type ADHD carries many of the same challenges and isomer frequently missed because of the lack of outward symptoms associated with hyperactivity.  Additionally, it was once thought that people grew out of ADHD, largely because hyperactive symptoms decline after puberty in many cases.  It is now widely accepted that other symptoms—inattention, impulsivity, time perception, and disorganization—continue through the lifespan in many cases.  According to the National Institute on Drug Abuse and the Centers for Disease Control and Prevention, ADHD is diagnosed in an estimated 8 percent of children ages four through seventeen and in 2.9-4.4 percent of adults. The increase in diagnoses and prescriptions for ADHD medication is a separate issue from the unauthorized diversion of stimulant medication which is then taken recreationally by individuals who have not been diagnosed with the disorder and who are using the drug outside of the supervision of a physician. Nonmedical use typically refers to students who consume stolen, borrowed or stimulant medication purchased without a diagnosis, or a prescription from a treating physician.  Each year, the University of Michigan conducts a “Monitoring the Future” survey, which is funded by the National Institute on Drug Abuse.  Data from the MTF surveys since 2001 shows that nonmedical use of stimulant medication has been falling between 25-42 percent at each grade level surveyed.

Katie Couric’s recent 60 Minutes report discussed a study conducted at the University of Kentucky. The study showed that 34 percent of students polled admitted to taking stimulant medications without a prescription; in juniors and seniors, the percentage can be as high as 60 percent and as high as 80 percent among juniors and seniors in fraternities and sororities. Yet the study also showed that only 4 percent of the students using the drugs were doing so with a diagnosis and a prescription.

Preventing diversion

As alarming as these numbers are, they beg the question: Where are all of these no prescribed stimulants coming from?  According to the University of Kentucky study, the typical student who is prescribed stimulant medication does not take it as prescribed on a regular basis.  This leaves a surplus of medication at the end of the month.  This “surplus”—which is then either stolen, sold, or given to fellow students—is what makes the drugs readily available on campus.  Students must be made aware of the very serious potential medical consequences of unauthorized use of stimulant medications.  They also need to understand that in the eyes of the law, money does not need to change hands in order for a gift or other exchange of a controlled substance to be considered a “sale.” While the criminal penalties for possessing controlled substances can be high, they are much higher for the sale of a controlled substance.  While some data suggest that the phenomenon may be declining, any unauthorized diversion of medication can have legal, medical, and social consequences.  It is important that parents discuss ADHD medication with their children and impress upon them the strict requirements for their use imposed by law.  Parents must also emphasize the dangers and consequences of sharing medication with friends or using it recreationally.  This is especially important when students leave home to attend college.  They often do not have instant access to the support and guidance of their parents and are also removed from their prescribing physicians.  Extra care should be taken to ensure that these young adults act responsibly to follow their medication plans and safeguard their medication from unauthorized use.

Next time:  What do you need to do?

If you are attending college, you probably don’t realize that just a few short years ago gambling was not part of everyday American life.  Today gambling is as common as alcohol in college life.  There are gambling opportunities everywhere:   Vegas vacations targeting the spring break crowd, state-run lottery tickets at every corner store, Native-run casinos just up the road, slot games can be joined from every computer, and dorm room card games are a Friday night ritual.

Gambling isn’t that big a deal, right?

Wrong!  Most people don’t think of gambling as being that much of a problem, so it gets little attention.  But did you know that nearly 10% of college students qualify as problem gamblers?  That’s a higher number than for adults!

Think you don’t know anyone with a gambling problem, think again.  Statistics show that at least 1 person sitting around the 10 person table at your seminar has a gambling problem or 30 people in that lecture hall are spending too much money on gaming.

ADHD and Gambling:  a bad combination

Students with ADHD are especially at risk for developing a gambling addiction. In fact ADHD students have an even higher rate of problem gambling than other college students – as many as 19% (nearly 1 in 5) college students with ADHD have a problem with gambling.

Researchers are still teasing out why this is the case.  But if you have lived with ADHD it’s pretty easy to make the connection between problem gambling and ADHD.  Impulse control is a hallmark of ADHD, and impulse control is a hallmark of addiction.  Gambling is also exciting and can feed the ADHD brain’s craving for stimulus and excitement.

Researchers have found that there are strong associations between ADHD and addictive behavior, including substance abuse, alcoholism, and nicotine dependence.

Do you have a gambling problem?

The National Council on Problem Gambling offers this checklist:

10  Questions About Gambling Behavior

1. You have often gambled longer than you had planned.
2. You have often gambled until your last dollar was gone.
3. Thoughts of gambling have caused you to lose sleep.
4. You have used your income or savings to gamble while letting bills go unpaid.
5. You have made repeated, unsuccessful attempts to stop gambling.
6. You have broken the law or considered breaking the law to finance your gambling.
7. You have borrowed money to finance your gambling.
8. You have felt depressed or suicidal because of your gambling losses.
9. You have been remorseful after gambling.
10. You have gambled to get money to meet your financial obligations.

If you or someone you know answers “Yes” to any of these questions, consider seeking assistance from a professional regarding this gambling behavior by calling the National Problem Gambling HelpLine Network (800.522.4700) toll free and confidential throughout the U.S.

Facts sited in this post are primarily drawn from these two excellent research reports on ADHD and college gambling:

http://www.camh.net/egambling/issue2/clinic/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775442/

Last August, Edge interviewed Dr. Patricia Quinn regarding her work with girls and ADHD.  Dr. Quinn, an Edge Foundation board member, has published four books about the special ADHD challenges that women and girls face that are different men and boys.  Some of those challenges include:

• Under diagnosis due to symptoms that don’t echo the male standard for ADHD
• Hyperactivity presenting as talkativeness and emotional behavior instead of the classic “propelled by a motor.”
• Greater disorganization, depression and anxiety than boys.

This fall Dr. Quinn will publish a new book, 100 Questions and Answers about ADHD in Women and Girls.  We thought this would be a good time to ask her a few questions of our own.

Edge: Is there anything about the challenges ADHD girls and women face that has emerged for you since our last interview?

Dr. Quinn: I think we have seen more in the way of confirming the development of eating disorders in girls with ADHD.

Edge: What, if anything, is unique about diagnosing ADHD girls with eating disorders than is different from other girls?

Dr. Quinn: Well first, the symptom of impulsivity seems to be a significant factor in the development of eating disorders in girls with ADHD. Poor self-esteem may also play a role, but one does not see the impaired body image seen in girls with eating disorders in general.  Girls with ADHD may binge and develop bulimia, but not because of a desire for thinness, but rather because of mindless or impulsive eating. Women with ADHD often report that they eat to feel better or for stimulation.

Edge: What should parents do when they suspect their daughter with ADHD has an eating disorder?

Dr. Quinn: Parents of these girls should pursue a complete assessment with an eating disorder specialist trained to realize that ADHD may be part of the picture. Girls will need to be treated for their ADHD symptoms (inattention and impulsivity) in order to be able to follow a program to address their disordered eating. Stimulants not only treat the symptoms of ADHD, but, according to some experts, may actually decrease the urge to binge.

Edge: Is there anything else you want people to know about girls and ADHD?

Dr. Quinn: Girls tend to suffer silently for many years, and as a result develop poor self-esteem early on. In addition, many develop anxiety because of their untreated ADHD symptoms. Their symptoms seem to sneak up and ambush them and they worry that this will happen again. So, they get anxious or develop compensatory strategies. They may worry and begin checking to see if they have a test they have forgotten about, or a book they forgot to bring home from school.

They can even develop obsessive compulsive personality disorders where they try to control one aspect of their life to the exclusion of others.  I have seen girls with ADHD become perfectionists to compensate for their symptoms. They spend a great amount of time and energy trying to compensate until it all gets too much for them and they get depressed or just give up.  It is, therefore, important to treat ADHD in girls even if they seem to be doing well academically and holding it all together because they may be doing so at a great cost.

I also want to send the overall message that the disorder does not remit but continues to cause significant problems and functional impairments particularly in girls with the inattentive type ADD.

Edge: What would you say, then to parents who are hoping their daughter will just “outgrow it?”

Dr. Quinn: ADHD is a chronic, life-long disorder. Symptoms may be less impairing as we learn to live with them and develop strategies and a life style to better cope. However, girls who demonstrate the most success are those that have adopted a multi-pronged approach to treating the disorder including, medication, therapy and appropriate treatment goals early on. ADHD coaching, like the Edge Foundation offers, can be an important component in learning compensatory strategies and behaviors.  Girls who as adolescents continue to have significant functional impairments are those who are usually not taking medication even though they have briefly made use of other services in and outside of school. These, however, may not be enough.

Edge: What are some of the most common questions you are asked about women and girls who have ADHD?

DR. Quinn: I am constantly asked why girls and women aren’t diagnosed as early as boys. I think this is because girls are not identified by teachers or others. Often teachers are comparing girls’ behaviors to those of boys rather than the performance of other girls. Mothers may be more likely to compare their daughter’s behavior to that of other girls thus may be more reliable at referring their daughters for an evaluation.  Girls are less disruptive and don’t call attention to themselves, so they don’t get referred. In addition girls and women work hard to compensate for their symptoms and to not let others know the problems that they are having.

Edge: Do women’s hormones have any impact on how medication levels need to be prescribed over time? For instance, does going through puberty or menopause mean medication levels need to be adjusted during those periods?

Dr. Quinn: When hormone levels decrease in menopause many women report that their ADHD symptoms increase and that their medications don’t seem to be as effective as previously.  It is often necessary to increase the dose of medications at this time. In addition, I find that during puberty symptoms often worsen in girls with ADHD. A medication dose that worked previously may no longer be effective during this time.

Edge: You’ve been a long-standing champion for women and girls who have ADHD, do you see the rest of the medical profession catching up in awareness or is there still a lot of ground to cover until females with ADHD receive equal medical treatment?

Dr. Quinn: I think that overall the medical profession is doing a better job at recognizing and treating girls with ADHD.  The problem seems to be with educating teachers and school systems about the disorder in females.

Readers:  Do you have a question about ADHD in girls?  Let us know in the comments and we’ll do our best to get you an answer.

Dear Coach:

I know that my son would really benefit from a coach. (He certainly doesn’t want to hear me carping at him anymore!) Yet when I bring up the subject, he completely shuts down. How can I get him to agree to working with a coach?

Sincerely,  Denise W.

Dear Denise,

As you are well aware, parenting teens and young adults is a tough balancing act between providing support and letting your child succeed (or fail) on their own. We strongly encourage the student to be involved with all conversations with our coaches from the beginning. The more you, as parent, speak with the coach without the student involved, the less your child will want to talk to the coach. That’s why most coaches require that parents and their kids meet together with the coach during the first conference call so the student doesn’t feel railroaded into the idea of coaching.

It’s also helpful for the student (and you) to understand what an ADHD coach does. Often students think an ADHD coach is just one more person that will nag them about school, their room, etc. This is far from the case. A coach address whatever the student (not you) thinks is important. This could mean making friends or getting on a sports team are priorities for your son, where your priority is getting his grade up. In this example, we’d be working on helping him with his priorities: friends and sports. And, of course, as a student builds trust with his coach, other life issues – like grades – will inevitably come up and be addressed.

And, of course, everything that a coach talks about with your child will be confidential. It can be hard to let go as a parent, but it can really help your son relax about getting coaching to know that he sets the agenda and sessions are private.

Of course, there are always kids that just don’t want any help. In those situations you will need to determine what influence you have over your child’s behavior. Are they still living at home? Are you paying for their education? If you believe coaching is the best course of action for your child, you can set a clear expectation that he needs to participate. AND outline clear consequences if he doesn’t. Dr. Phil may not be everyone’s cup of tea, but his article on Parenting with Purpose may give you a good starting place for thinking about setting expectations for your child.

You can always set up a no-obligation introductory conversation between Edge and your son. Just fill out the contact form using the link below and we’ll get right back to you. Good luck!

Yes! Send me more information about working with an Edge ADHD coach!

Do you have a question for the Edge coach? Leave it in the comments or send it in an email to info@edgefoundation.org.

Editor’s Note: As you most likely know, Edge Foundation coaches have all completed Edge’s rigorous training for coaches working with students and young adults with ADHD.  We are very proud that Jodi Sleeper-Triplett, adolescent coaching expert, has been instrumental in developing our coach training and mentoring program.  She’s publishing a new book in June, Empowering Youth with ADHD:  Your Guide to Coaching Adolescents and Young Adults for Coaches, Parents and Professionals, and we chatted with her a bit about what you can expect to find inside.

Edge:  You’ve been instrumental at Edge Foundation in designing our ADHD youth coaching training program.  How did training and mentoring the Edge coaches shape your point of view as an author?

Sleeper-Triplett:  My work with the Edge Foundation gave me a fresh perspective on my work and insight into the questions that coaches, clients and parents have about ADHD, the coaching process, and strategies for success.  Each time I was asked a question during my work with Edge, I took notes and used those queries to formulate the information shared in the book.

Edge:  High school and college is a time that most children draw away from their parents or even outright rebel.  How will parents benefit from reading this book?

Sleeper-Triplett:  Parents will learn how a coach can be a great partner for high school and college-aged children.  Coaching allows parents to step back from the day-to-day routine and nagging and allows the young person to be more independent.

Edge:  Over the years were there common questions you’ve fielded from parents about coaching?

Sleeper-Triplett:  Parents need a deeper understanding the coaching process.  They need better insight into what their role is in the coaching process.  They want to explore how boundaries are established within the coaching relationship.  And they want to understand what makes a coach qualified to work with young people with ADHD.

Edge: And how do you respond to parents who are skeptical that coaching won’t make a difference for their students?

Sleeper-Triplett: It’s important for parents to understand that coaching is different from other services, especially therapy.  Many parents have struggled with their ADHD adolescent over time management, organization, and self-advocacy and social skills.  These are all areas addressed in coaching in a non-judgmental manner, allowing young people to feel more confident and ready to stretch themselves to a new level of success.  Not everyone is cut out to benefit from coaching.  So the book also includes a information about how prescreening is used by coaches to ensure a person is ready for coaching before they sign up and invest in the process.

Edge: Writing a book is a huge undertaking of time and energy.  What inspired you?

Sleeper-Triplett:  My clients and coach trainees are my inspiration.  Watching the positive changes that coaching can have on young people and helping coaches to learn new skills is really motivating to me.  I have been encouraged and supported by coaches, therapists, educators and friends to put my work on the page.  Once I committed to doing it there was no turning back for me.

Note:  Empowering Youth with ADHD:  Your Guide to Coaching Adolescents and Young Adults for Coaches, Parents and Professionals will be available in September, however, preordering is now available at Amazon.com.

Click here for more books on ADHD.

The end of the school year is right around the corner. This is a time of year that many student’s IEP or 504 meetings are scheduled. Before you head into your meeting, take a few minutes to plan out your meeting time so you can use your time wisely.

Outcome: Be clear with yourself what you are hoping the meeting will accomplish. Understand your child’s needs and develop a plan to see that they are met. The clearer you can be with yourself, the more likely you are to be able to communicate your objectives effectively.

Participants: Ask who will be attending the meeting. You have the right to ask for your child’s special education, homeroom or other teacher who knows your child well to participate in the meeting. At many schools the principal also attends these meetings.

Assessments: Ask , in writing, to see your child’s recent assessments ahead of the meeting — especially if the meeting is the three-year service review. If you don’t understand what the scores mean, be sure to schedule time to discuss them with the school, or if you have had your own evaluation, discuss them with your evaluator.

Agenda: While the special educator is under pressure to get your signature at the end of the meeting, you don’t have to give into that pressure. If you need more time to discuss things, don’t let a 15 minute meeting cut off valuable discussion time. Be sure to request a long enough meeting time if you know you will have concerns coming into the meeting.

Support: You have the right to bring other people to a meeting with you such as an advocate, psychologist or evaluator. But be advised, bringing a lawyer to the meeting can set up a hostile dynamic and can be counterproductive to achieving a good outcome. That being said, you still may want to consider bringing (or consulting with in advance) any outside experts (such as psychologists, speech language/PT/OT therapists, etc) to support you and give you perspective, or have them available by phone if necessary.

Follow-up: Always follow up the meeting with a detailed letter summarizing what was said and by whom. Indicate what you agree with and what you disagree with and why. Be thorough and assertive, but also diplomatic. It is important to preserve your position by creating a paper trail. You may always request additional meetings at any point in the year. Some families find that quarterly meetings are a good way to stay on top of issues before time passes.