| |
 |
 |
|
|
Dear Dr. Quinn:
I am a 52-year-old female recently diagnosed with ADD. I'm taking Dexadrine (60mg) and Zoloft (100mg). I'm having hot flashes that are getting quite intense and am afraid to start HRT because I don't want to mess up what is working very well for me in regard to medication.
Do you have any advice on this subject? JJ
Dear JJ:
First, no need to worry about "messing up" your stimulants. As a matter of fact, you may find an enhancement of their effect and a decrease in any depression or dysthymia. Peter Schmidt, MD, conducted a study at NIH where he gave estradiol patches to women who were experiencing perimenopausal depression and 80% of them improved with three weeks without an antidepressant. In another study, amphetamines were found to be more effective when given after a period of premedication with estradiol patches.
You should discuss all of this as well as the pros and cons of HRT with your prescribing physician. Despite all of the controversy, osteoporosis, hot flashes and other effects of decreasing estrogen levels respond well to HRT and contribute to the overall well-being of women as they enter menopause.
More information on Hormones and ADHD can be found in our book, Gender Issues and ADHD, which can be purchased at www.addvance.com.
|
 |
|
|
Growing Up is Hard to Do!
(In the following email and response, details and identifying data have been changed to protect the privacy of the family involved. We are sharing this email and response with our readership because it touches on a very common and often difficult problem for mothers raising a daughter with ADD – helping her make a successful transition from school to independent living as a young adult.)
 |
|
|
|
Dear Dr. Nadeau,
I attended your session about
girls who have ADD and clung to every word you said and ordered
your book as soon as I got home. I learned that so many of my daughter's
symptoms can be attributed to ADD. I've had her evaluated many times
and specifically asked about ADD, but they all said "no --
she doesn't have it." I am appalled and discouraged that so
many professionals were wrong. Now -- they finally agree with me!
And the psychological exam she had recently agrees too. I still
cannot find a psychiatrist who has expertise in ADD, especially
in girls.
My daughter, Heather, is about 15 years old developmentally although
23 chronologically -- quite immature. Her IQ is in the low normal
range. She graduated from high school and did pretty well because
I structured her life and forced her to do homework. She also worked
with a tutor. She's living at home and just got fired from her job
for swatting off someone's baseball cap after he made an insulting
remark to her. Vocational Rehabilitation won't work with her any
more since she was fired.
Now, Heather is at home, sleeping late and doing nothing. We've
met with a specialist who helps disabled young adults. She gave
Jill some "assignments" for the week like getting up by
9 a.m. four days and calling her counselor, keeping a journal, drawing
(Heather is pretty creative and has some artistic talent), reading
a book on depression, and exercising 10 minutes a day. We have such
a long, long road to moving out on her own, but I do agree that
these "baby steps" are the way to get started.
I would very much appreciate any suggestions you might have about
other ways to help my daughter.
Sincerely, JB
Dear JB,
The transition from home to independent living is a very difficult
one for many young adults with ADD, and even more so when a young
adult like your daughter also struggles with depression and other
cognitive difficulties. You've clearly done a very good job in working
with her - many students with depression and ADD with above average
IQ's don't successfully graduate from high school with decent grades.
The challenge now is to find or create an environment for your daughter
that will offer her the feeling of success that she needs, while
also providing adequate structure and support.
Getting back out into the world is extremely important for her.
She needs to have the company of her peers and a sense that
she's working toward future goals. Having structured activities
around the house, as the counselor suggests, while better than nothing,
will promote her sense of not belonging and her dependence upon
the family. Finding the company of her peers can be in a low-level
sales job – at the local mall, or better yet, in a vocational
training program.
Do-able Goals are Critical - Are there any certificate programs
associated with your local community college? Many CC's have a number
of vocationally-oriented programs that can work well for someone
at your daughter's academic ability level and could train her for
something in her area of interest. She’ll feel more confident
in her job search if she’s received training in an area of
interest that qualifies her for a specific type of job.
Don’t Set Her Up for Failure –
Like all adolescents, she may not have a good sense of how much
independence she can manage with success. When she gets to the point
of wanting to move out of the house, it’s critical that she
not be expected to handle too much too soon. She may need financial
help now and for many years to come in order to living independently
in her own apartment. Choice of a roommate is critical. You’ve
already seen how her impulsive and emotional reactions to others
can blow up and create big interpersonal problems. As she lives
at home, she needs to gradually take on the responsibilities that
she will have once she moves out – meal preparation, laundry,
maintaining her own personal space.
Finding the Right Job - I've worked with a young woman who
resembles your description of your daughter. She was creative, like
your daughter, happened upon a job in a small family-run printing
company. They almost "adopted" her and taught her many
hands-on things about design and layout of brochures and ads, etc.
Eventually she went on to work at another printing company and has
lots of good self-esteem because of the encouragement she got with
the family-run company.
My experience with Voc Rehab is that they're not so careful about
the psychological fit of a job - they just have too many clients
to serve and not much experience with ADD issues - so you and a
therapist would probably have a better sense of what might work.
Often, young adults like your daughter work best in a small place
in which most of the other employees are older - they are therefore
less likely to tease her or to trigger "immature" responses
that an age-mate might.
Get the Right Level of Support - You might consider engaging
the services of an ADD coach - to help her to develop more functional
daily habits - along the lines that you described. Using a coach
helps your daughter to make the transition from over-dependence
upon you to developing strengths and strategies herself. Frequent
phone sessions with a coach, can get the parent out of the "nag"
role and give the young adult needed structure that isn't provided
by a weekly counseling session.
Helping Young Adults Develop Independent Living Skills - So
often, during high school years, the major focus must be on academics.
You and your daughter had to make many extra efforts for her to
succeed at the level she did during high school. Now, however, it's
critical that she begin to develop practical independent living
skills:
- Managing money - controlling spending, bill paying, balancing checkbooks, filing income tax returns
- Daily self-care - adequate nutrition, sleep, exercise, hygiene, medical check-ups, dental check-ups
- Automobile maintenance, insurance
- Household maintenance - cleaning, laundry, cooking, food shopping
You need to gradually shift responsibility for these
tasks to her, doing them together for a period of time until she
feels comfortable with them.
Independent Living Environments - You may want to explore
the possibility of having your daughter move to an independent living
program. Increasing numbers of these programs are springing up around
the country, serving the needs of young adults with learning disabilities
and emotional challenges. These programs are a good transition point
between home and complete independence. In these programs, young
adults are helped to learn to live with one another in a mature,
cooperative manner - sharing household responsibilities and learning
independent coping skills such as money management, meal planning,
time management, and holding down a job.
Getting Help as a Young Woman with ADD - Unfortunately, your
experience in having people repeatedly tell you that your daughter
does NOT have ADD is all too common. The fact that several professionals
now recognize that she has ADD is a positive sign - professional
recognition and understanding of how ADD presents in females is
slowly developing. If you cannot find an adult ADD specialist who
works with many young women, it may be necessary to serve as your
daughter's advocate - helping to educate the professional who treats
your daughter - presenting copies of our book for professionals
- Gender Issues and AD/HD - to them and giving them information
from our websites - www.addvance.com
and www.ncgiadd.org.
Growing Up is Hard To Do - and even harder when you're a young
adult with ADD and depression - So - don't lose hope - just
keep your perspective and take a long-term view of her maturation.
You described your daughter as 23 going on 15. It's good that you
recognize her immaturity. Her maturation lag is likely to continue
throughout her twenties. At age 30 she may have grown, with your
help and with the supports we recommend, so that she is truly ready
for managing her own life in a productive, responsible way. Often,
the young adults we see who are still floundering at 30 have not
received the structure and support they needed to continue to develop
and mature throughout their twenties. As a result, they've had a
string of failures during their twenties that has greatly damaged
their self-confidence and may have self-medicated with drugs or
alcohol, further stunting their growth and maturation. You've done
a great job in getting your daughter this far. Your task now is
to help her find the resources that she needs and to continue to
provide her support, without allowing her to sink into over-dependence
upon you and the family nest.
Other Resources In our new book, Understanding
Women with AD/HD, there is a chapter on young women with AD/HD that
contains much more detailed information on the challenges and solutions
of making a transition to independent living.
Good luck and please let us know how your daughter is doing.
Kathleen Nadeau, Ph.D.
 |
||
|
|
|
 |
||
 |
|
|
|
||