7/31/2017. Outline. What is mindfulness? What is complex ADHD? Mindful Awareness and ADHD Care. Complex ADHD & Mindfulness

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1 Outline Complex ADHD & Mindfulness What is mindfulness? What is complex ADHD? Mindful Awareness and ADHD Care Mark Bertin, MD Developmental Pediatrics Author, Mindful Parenting for ADHD What is mindfulness? What is mindfulness? Non-judgmental, moment to moment awareness Getting out of autopilot Responsiveness v reactivity Acceptance v resistance Compassion v judgment Developing wisdom Seeing and accepting life exactly as it is. What is mindfulness? Foundations of Mindfulness Developing compassion We re all doing the best we can to manage the fact that life is inherently changing and uncertain. Awareness matters Benefits of getting out of autopilot. Less acting and thinking habitually Less acting reactivity Pausing encourages changing of habits 1

2 What mindfulness is and is not Foundations of Mindfulness Mindfulness IS a way to more skillfully manage the fact that life is often challenging. Mindfulness isn t specifically stress reduction Mindfulness isn t forced happiness Mindfulness isn t stillness Mindfulness isn t always calm Even a challenging experience is more nuanced than it seems Body Emotion Thought Perception & attitude What are the specific benefits around ADHD to: Outline Seeing life, and ADHD, with clarity and Building an ability to responsively break habits and think flexibly and What is mindfulness? What is complex ADHD? Mindful Awareness and ADHD Care Cultivating compassion for yourself and others? 14 What is ADHD? Activity/Impulsivity Fidgets or squirms 15 ADHD through the lens of Executive Function Inattention Lack of attention to detail Can t sustain attention Poor organization Easily distracted Leaves seat often Runs and climbs excessively Talks excessively Difficulty maintaining play Interrupts others Can t wait for his/her turn Avoids tasks requiring concentration Loses things required for tasks Executive function -brain s ability to monitor itself and organize information EF deficits almost certainly the underlying cause of ADHD A developmental path... 2

3 16 ADHD through the lens of Executive Function 17 ADHD through the lens of Executive Function 1. Attention management Sustaining attention and shifting attention to task 2. Action management Monitoring and selfregulating behaviors 4. Information management (working memory) Utilizing working memory and accessing recall 5. Emotional management handling frustration, modulating emotion 3. Task management Organization, prioritizing, getting started 6. Effort management Self-regulation, sustained effort, processing speed 18 ADHD through the lens of Executive Function 20 What is ADHD? Executive function explains more of ADHD Acts moody / irritable / short tempered Behaves stubbornly / seems self directed Poor time management Motor concerns Difficulty learning from mistakes Complex ADHD and Combobidity Multimodal Treatment of ADHD (MTA) study: Oppositional/defiant disorder: 40% Conduct disorder: 14% Anxiety disorders: 34% Depressive disorders: 4% 23 ADHD and Families ADHD management in a (large) nutshell Understanding executive function from a parent s perspective Increased anxiety and depression (Anastopoulus, 1995) Increased struggle with decision making (Brinkman, 2009) Increased risk of marital strife (Harvey, 2000) Education / occupation Home-based interventions Health routines Medical 3

4 ADHD management in a (large) nutshell ADHD and mindfulness Seeing ADHD and comborbidityaccurately Making difficult choices Sticking to new plans Cognitive flexibility / thinking outside the box Cultivating resilience Managing stress Recognizing the full impact of EF in everyday life, without reactive judgment. Addressing ADHD and co-morbidities with clear-sighted, responsive problem solving. Addressing stress, self-judgment and resilience affected by ADHD. Outline Body Awareness, ADHD and Stress What is mindfulness? What is complex ADHD? Mindful Awareness and ADHD Care ADHD is a stress-producing disorder. Stress undermines how we think and feel. Stress undermines resilience. Stress therefore undermines ADHD care. Body Awareness, ADHD and Stress Body Awareness, ADHD and Stress Lion image ADHD symptoms Restlessness Fidgeting Hyperactivity 4

Body Awareness, ADHD and Stress ADHD, mindfulness and emotion Working with restlessness & discomfort Developing responsiveness (over reactivity) Managing stress Tolerating discomfort (Image) ADHD,

relationships Reactivity often mislabeled oppositional behavior Parent reactivity often fuels the fires ADHD, mindfulness and emotion: Mindful communication Monitor body, thought and emotion Monitor

5 Body Awareness, ADHD and Stress ADHD, mindfulness and emotion Working with restlessness & discomfort Developing responsiveness (over reactivity) Managing stress Tolerating discomfort (Image) ADHD, mindfulness and emotion ADHD, mindfulness and emotion Emotional reactivity is a core component of ADHD for many Causes difficulty all on its own Causes difficulty undermining interventions Strains relationships Reactivity often mislabeled oppositional behavior Parent reactivity often fuels the fires ADHD, mindfulness and emotion: Mindful communication Monitor body, thought and emotion Monitor future and past thinking Listen first whenever appropriate Find a place of agreement Pause often Summarize what you ve heard Allow for communication repair Why does understanding how we think matter? 5

6 Where we pay attention magnifies anxiety and stress. Harvard smart phone study Negativity bias Anxiety & rumination / not letting go of thought ADHD causes anxiety ADHD is mimicked by anxiety Many people have both Comorbidity Defines ADHD Seeing ADHD as it is therefore means Noticing habitual thoughts and assumptions about yourself and about ADHD Seeing the big picture without bias Beginning care may require: Changing thoughts about ADHD Changing thoughts about child development (attention, motivation, behavior ) Changing how parents manage their homes Changing how parents manage their own ADHD Mindful Eating and ADHD How do you habitually think about Attention Motivation Behavior ADHD itself 6

7 The ABCD s of changing habits: Assess your motivation Build stepwise plans Create structure and reminders Debunk perfectionism A model for habitual patterns of thought: Grasping v aversion Overwhelm & exhaustion v restlessness Doubt Perception, attitude and ADHD Perception, attitude and ADHD ADHD and lifestyle I m not the sort of person who Sleeps well. Exercises regularly. Eats that way. Worries about too much time on screen. ADHD, executive function and resilience Sense of personal control, mindset, grit Skills Executive function, Emotion, academic Strengths & successes Relationships Family, social, faith Perception, attitude and ADHD Conclusion ADHD management in a nutshell Education / occupation Home-based interventions Health routines Medical Seeing life and ADHD with precision, responsiveness and compassion What is ADHD? Not anyone s fault. An EF disorder Far more impactful than a school problem 7

8 Conclusion Conclusion Direct training of attention / EF Direct management of stress / anxiety related to ADHD Fear of the future, fear of the past Augmenting overall care Building resilience Sustained habit change Bringing wisdom to ADHD care Seeing things as they are, with more clarity and compassion. Complex ADHD & Mindfulness Mark Bertin, MD Developmental Pediatrics Author, Mindful Parenting for ADHD 8

A Look Inside. Executive Functioning Deficits. Wendy Kelly, M.A., C. Psych. Assoc. Psychological Services, Kawartha Pine Ridge DSB

A Look Inside. Executive Functioning Deficits. Wendy Kelly, M.A., C. Psych. Assoc. Psychological Services, Kawartha Pine Ridge DSB A Look Inside the ADHD Brain: Executive Functioning Deficits Wendy Kelly, M.A., C. Psych. Assoc. Psychological Services, Kawartha Pine Ridge DSB October 19, 2013 Parent Conference Nature of AD/HD Subtypes: