ADHD's Emotional Distress Syndrome

I'd thought I'd share an article that my sister's therapist shared wrote. It really hit a spot with me when I read it. It really enlightened a lot of things for me. Read and enjoy on a out look of ADD/ADHD.

Coping with ADHD’s “Emotional Distress Syndrome”© by James Ochoa, LPC Director, The Life Empowerment Center Austin, TX

Written for Counseling Today magazine

The driving force behind my mission to mentor, coach and counsel individuals with Attention Deficit Hyperactivity Disorder (ADHD) began in 1989 when I had the opportunity to work with bright, vibrant ADHD children. The caveat, however, was my realization that these children, living within their own chaotic ADHD world, were at risk of losing something very precious; a connection to their unique passions, interests and talents. This insight launched my journey as a counselor to empower those with ADHD to recognize and reach their greatest potential. Helping my clients overcome the risk of what I call the “emotional distress syndrome” is an important first step and key therapeutic component to their success. I use this term to describe the cumulative effect of neurological processing differences and behavioral challenges that can break down a person’s emotional tolerance, stamina, and ability to maintain a strong sense of spiritual well-being and emotional health. This remains a factor even after one has been diagnosed, engaged in sound treatment options, and learned effective strategies to compensate for their ADHD. As counselors, if we hope to lay out a plan to manage this long-term risk, I believe it is vital for us to be cognizant of the ways in which ADHD creates a higher risk of distress for our clients’ emotional and spiritual lives. Most adults are capable of handling a significant amount of daily stress, yet because the neurological differences and behavioral characteristics of ADHD are chronic and life-long, one’s emotional distress tends to increase to such a level that it becomes a syndrome, or symptomatic of the chronic emotional distress akin to Post Traumatic Stress Disorder (PTSD.) For individuals who have been living under chronic low-grade emotional distress their entire lives as a result of ADHD, that stress level can negatively impact their ability to reach their potential, feel good about themselves, and create the resilience and stamina necessary to thrive in today’s world. ADHD and PTSD has been researched along the lines of comorbidity, Cuffe, S. P., McCullough, E. L., and Pumariega, A. J. (1994), Fischer et al., 2007, Sarkis et al.( 2005), yet none of the research directly addresses the theory that the disruption of ADHD creates an emotional distress syndrome. This emotional distress is also an exponential factor that multiplies throughout an adult’s life as similar stressful events are linked together, creating a long-term erosion of a person’s ability to cope emotionally, mentally, spiritually and physically. Scenarios such as these can lead to an emotional distress syndrome that potentially develops into a covert form of PTSD; covert because there is no specific trauma that can be clinically cited as precipitating the syndrome, unless one wants to characterize ADHD as the precipitating event. The rate of this decline in functioning depends upon variables such as the severity of the individual’s ADHD, the environment in which they were raised, pre-existing conditions, and an array of other factors. For adults diagnosed with ADHD later in life, being unaware of the true nature of their problems for so many years is often a major factor contributing to the emotional distress syndrome. The mystery of not understanding why they couldn’t focus, finish projects, or remember simple things, is a constant source of frustration. This slowly erodes their confidence and courage along with putting significant stress on their character development along the lines of their self esteem and identity. After many years of untreated ADHD, the anxiety and life disruption a person experiences becomes chronic, and the emotional distress syndrome takes on a life of its own, often evolving into as big of a challenge as the ADHD itself. For many of my adult clients, this syndrome is the single most destructive factor in their lives. I often believe that if I could somehow magically eliminate this distress, many of my clients would live happier, more productive lives. The Educational/Directive Action Approach One of my goals as a therapist is to address the emotional distress syndrome by taking clients beyond a diagnostic understanding of ADHD and educating them on how it affects their lives and by helping personalize life-long strategies to cope with their challenges. This education and strategy development allows the client to better understand the basis of their emotional distress and dramatically lessens their anxiety. Rote strategies routinely given to those diagnosed with ADHD have a tendency to become mere exercises in futility. Without a personalized approach, it is very likely that clients will disconnect from these techniques and risk adding to their emotional distress. This personalization factor is vital in helping clients to create their own unique strategies, structures and routines. Personalized strategies can be as small as choosing a roller ball pen because of the feel of the ink flow, or as large as hiring an executive assistant to help manage the underactive neurology of a client’s prefrontal cortex, the part of the brain necessary in planning, prioritizing and evaluating. Routines, such as listening to certain types of music while studying different subjects, or while engaging in monotonous tasks, is often an effective strategy. One client relied on heavy metal music to keep his mind “geared up” when reviewing detailed schematics, yet another chose to listen to jazz because it gave him a sense of “rhythm and flow” to stay connected while reading historical documents. Our sensory pathways allow natural strategies to develop. A client’s attraction to visual, auditory, or kinesthetic environments often creates connections to effectively discover techniques if we help them recognize and develop these areas. When a client’s interest is sparked you’ll know you’re guiding them in the right direction. ADHD and Character Development In addition to education and personalized strategies, character development is potentially the most critical long-term issue for clients to address. Character development is defined as the two pillars of self-esteem and self-identity, where clients metaphorically stand, to have the courage, confidence and risk-taking ability needed to reach their potential long- term. Helping a client further develop their self-esteem and self-identity is necessary in strengthening their character. There is no doubt that the unconditional love received growing up allows for development of self-esteem, and that unconditional positive regard develops self-identity. In order to strengthen character, it is vital to deal with the emotional distress that adults with ADHD experience because it is a direct stressor on these pillars. If your client has been seen as impulsive and unreliable, or one who comes up with wild ideas and never finishes tasks, they have likely received negative feedback from others, putting them at a much greater risk of having an interrupted sense of esteem and identity. Your client may have grown up not loving or believing in themselves and not seeing their value in the world. If this feeling state carries into adulthood, they will tend to lack the confidence, courage and ability to take the necessary risks to reach their potential. What evolves out of “being different,” more times than not, is ADHD’s emotional distress syndrome. One technique I have found effective in clinically addressing the emotional distress of ADHD is with Eye Movement Desensitization and Reprocessing (EMDR,) developed in the early 1990s by Francine Shapiro, PhD, to treat PTSD. I use this process to desensitize the emotional distress of ADHD and also to help clients strengthen their self- esteem and self-identity and assist them in developing a strong vision of themselves reaching future success. Renee, a 46-year old client in my practice is an excellent example of how EMDR successfully helps adults struggling with the emotional distress of ADHD. Diagnosed with ADHD in 2001, Renee participated in an ADHD educational group and a long-term process group which I facilitated. Renee recently reconnected with me for counseling when her state-agency job finally took its toll, both emotionally and physically, and she was once again at a career crossroads. Her passion since childhood had always been theatre and she aspired to be a professional actor, so our work became centered on taking steps toward building her acting career. She enrolled in an acting class and was asked to name her three greatest fears about becoming an actor, a task that would cause some level of anxiety for many of us. However, Renee’s anxiety peaked because her fears about acting were so closely connected to her ADHD and past career struggles. The emotional distress caused by her ADHD had always created problems, such as memorizing lines (due her distractibility,) being on time (based on her skewed time-orientation,) and being caught up in the stress of the moment (becoming frozen or defensive in over-personalizing feedback.) EMDR helped Renee cope with the heightened emotional distress she experienced whenever she made strides towards becoming an actor and was key in helping to desensitize her past life experiences, her fear of failure, and her inability to memorize her lines. Renee focused on the distress in the acting class, and through the EMDR desensitizing process, was able to considerably lower her distress levels. Prior to this, Renee knew on a certain level that all actors experienced some degree of fear, but because of her low self-esteem and self-identity, coupled with the distress of ADHD, she was convinced that feeling that fear meant she was not truly an actor. Renee’s fears did not entirely dissipate, but her anxiety did become more manageable and she completed the acting class. The diagnostic process of adult ADHD is only the tip of the iceberg. An educational, directive approach to assist clients with developing personalized strategies, coupled with EMDR, will allow them to reach their potential. As clients begin to restructure their lives and understand their neurology, a transformational shift will begin to occur as they gain insight into who they can become in the next five to ten years. This growth will inevitably create some periods of disruption, so be cognizant of the level of nurturing and encouragement your clients will require. This support needs to be deeply rooted in unconditional love and unconditional positive regard. The vital key is to empower clients to create a stronger connection to themselves that will continue to naturally develop. Once empowered more effectively, a diagnosis of ADHD is no longer a sign of dysfunction. Instead, this empowerment allows the client to understand how to live fully and reach incredible potential within the beautiful chaos and intensity of their lives.

Follow Your Gut

When it comes to making decisions I like hearing people opinions, but in the end you have to follow your gut feeling. Cause when it comes down it, it's your decision to follow through with your decision. What am I talking about exactly? Well, here is the basis of what I'm talking about. Every year or so I get an itch to move or do something drastically different that most people think I'm insane for donig. At the moment it's an itch to move out of California to Portland or Seattle. What? Are you crazy? It's always raining there! Yup I know. I like the cold and love the rain. But unlike my itch to move, I'm not going to get up and go right away. Nope. I'm not crazy. Believe it or not I'm pretty responsible. Before going anywhere I will make sure that I have a job that can support me. With having a car payment, this is very important. So why the interest in the Pacific Northwest? Well, about 6 years or so ago, my sister had lived in Portland and the few other times I've visited I've fallen in love with the place. In fact one of my novels takes place just outside of Seattle. I love all the green, water, and bridges. Plus my all time favorite book store is there. This past weekend I did a drive north to watch two of my sisters skate and it was just cemented that I have to start doing some research in to potentially moving up there. Even my good friend that went with me fell in love with the state and is even looking to make a move as well. So, I'm fallowing my gut that this would be a great move. Especially if I'm able to get a job in a field that I love, ie publishing or film. These are two of my greatest passions and have had the hardest of times finding work in them. Hence me being stuck in accounting. Weither it comes to what you are writing or if you want to make a major life change, follow your gut. More times than not it will lead you in the right direction. Now that I've had my little rant on the fact that I want to make a move in my life out of the Bay Area, I have to get back to reality...at least for while I'm at my day job. Gotta pay my bills. :) Good luck in your writing all! I sure know we could all use a little more luck in our lives.