Addressing ADHD 8 More Goals and Strategies

Welcome back to Addressing adhd. This is part three where we're talking about more goals and strategies. I'm your host, Dr. Donnellice Snipes. In this segment we'll identify more symptoms and issues for people with ADHD and possible interventions. Remember, if you want more in depth knowledge about ADHD, I have videos on the YouTube channel that include diagnosis of ADHD with the DSM 5 trigger, ADHD treatment strategies, evidence based practices. These are more general than what we're talking about today. Addressing ADHD Part one Motivating the person with ADHD and addressing ADHD Part two Goals and Strategies. So the next goal we're going to talk about is addressing rejection sensitivity. And a lot of what we're going to talk about in this part has to do with relationships with others as well as with yourself. People with ADHD have often experienced a lot of rejection because they have needs that they weren't able to express as young children. So those needs didn't get met. And they received criticism for not fitting in with people who were not adhd, which remember children think egocentrically and dichotomously. So it was I am a bad person and I am all bad. So they received a lot of messages that whether they were intended to be or not, they received the message or inter internalized the notion that they were unlovable and they were broken and they were not good enough. As a result, people's inner child, if you will, now holds on to this notion that they're not good enough, they're not lovable and they are going to be rejected. They make mistakes and people are going to reject them as a result. Since none of us likes being rejected, they're hyper vigilant to signs of rejection, to hints of rejection, which has been coined rejection sensitivity. And it's very common in people with adhd. So the goal or a goal is to improve feelings of confidence and esteem around others from a one to a four or better, five or more days a week. Now what, what we're talking about here is helping the person recognize for one that they are valuable as an individual so they're not as dependent on other others for validation. Now it's likely that they will have some work to do, working through insecure attachment issues and rejection trauma from childhood when it comes to dealing with rejection from other people. So it's going to be kind of a multiforked process here, but it's going to be important to help people start developing that esteem, start reprogramming or, or adjusting that schema that says you're not good enough. To one that says, you know what? You are good enough. You are lovable. Even when you make mistakes, you are lovable. And I'm sorry you didn't get your needs met when you were a child. I'm sorry nobody noticed that you needed help. So when I say from a one to a four or better five days a week, I I like using this scale because it's very quantifiable. 1, 10% or less. So 10% of the time or less the person feels confident and good about themselves. So 90% of the time or more they are fearing rejection. A2 is 11 to 25%. So 11 to 25% of the time they feel confident. And the other 75 to 90% of the time they are fearing rejection. You see where I'm going with that? So that helps people identify kind of where they are on the scale. Interventions we want to help people recognize rejection sensitivity as a re reaction to past attachment trauma. If they received a lot of what we call insensitive responses from their caregivers, their caregivers were not aware of and sensitive to their needs, so they were insensitive in their responding. It often creates an environment where the child feels unsafe and the child doesn't feel like the caregivers are meeting their needs, which leads to insecure attachment. So there is work to be done here. It's important for the person to start developing a secure attachment with themselves. Since they likely didn't have one with their caregivers, they probably don't have one with themselves. So learning how to be consistently aware of their needs, to respond appropriately, to validate their perception of things, to provide themselves encouragement and unconditional love, saying, you know what? You can try. If you fail, all right, you failed. You're still lovable. That's going to be really important. And I do have videos on developing secure attachment with yourself on the YouTube channel if you want more information on that. It's going to be important to practice separating rejection of a behavior from rejection of the person. So in your relationships, you may make mistakes, you may forget something, you may be tardy, and the other person may get angry. The person is likely not rejecting you. They are angry about or rejecting. They don't like that behavior. And it's going to be important to separate the two. You are a person worthy of love. Your behaviors may not be and you can choose to address your behaviors, but as a person, you're acceptable. Reflect on a character strength each day. People with rejection sensitivity have been primed to notice their mistakes, to notice their foibles and to ignore all of their strengths because it's more dangerous to step on the viper than it is to step on a bunny rabbit. Please don't step on either one. So the person with ADHD is noticing their character flaws. We need to help them balance that out. To see their character strengths and help them learn or help start to learn to reframe mistakes through journaling. You made them this mistake. Okay, everybody makes mistakes. How? What happened? What led to the mistake? How can you learn from it so it doesn't happen again? Improve self esteem. When you are developing that secure attachment with yourself, you're going to be developing a sense that you are lovable and you are worthy as a person. Again, your behaviors, some of them may need to be addressed, but you as a human being are lovable. Think about children, children. You see children on the playground. Some of the things they do not so lovable. But the child themself is worthy of love, is worthy of care. So the goals are to reduce unhelpful self critical thoughts to less than three times per week. Now this is a huge ask for people with adhd. We may want to reduce start out by reducing it to less than three times a day and then less than once a day and then you know, build from there to make sure that you have successes in achieving this goal. But it's important to examine and become aware of those self critical thoughts because every time you tell yourself something that's self critical, you're triggering that HbA axis, you're triggering that rejection response and actually increasing the likelihood of attention deficit and hyper vigilance and hyperactivity and other things. Another goal could be to feel quote pretty good about yourself seven days a week. Now I know I didn't quantify that one but if somebody can say yeah, every single day I felt pretty good about myself, I'm happy with that. And developing confidence in being able to accomplish goals 90% of the time. I try not to put anything at a hundred percent of the time because Nobody's perfect. So 90% of the time is really good and that is important. This is another thing that you may have to build up to. If the person has very little self confidence than having confidence in being able to accomplish their goals 50% of the time when they can regularly do that, then 60% of the time and build up from there. So how do we do this? Well one strategy or two strategies develop self compassion and problem solving. When you make a mistake, acknowledge you made the mistake but acknowledge that you're lovable and everybody makes mistakes. So have compassion for yourself like you would for your best friend, like you would for your child. And then problem solve, okay, I made a mistake, or I'm not perfect, or there's this thing that I want to work on about myself. All right, nobody's perfect, so how can I solve the problem? Once you have that compassion, instead of being angry about the fact that you're not the person you want to be, you're not doing things the way you want to. Once you get out of that anger, fight or flight place and you have compassion, then you can get into your wise mind and more effectively problem solve, explore and address rejection related schema and I know we've talked about this on multiple different things slides, but it's important to remember that these rejection messages that you got growing up with ADHD are underscoring a lot of what's going on now. And rejection may not have been overt saying you're bad or you suck at this or you never do KN do things right. It could have been even when you were young, you know, an, in an infant or a toddler, and you had needs and your parents didn't meet those needs. That is perceived by children, by infants, as rejection because the caregiver is not meeting their needs. So the, the child internalizes the world as an unsafe place and a rejecting place. It's important to identify strengths and synergies to really focus on, all right, what do I have, what do I contribute and how can I synergize? Nobody can do everything all the time. It's just not, not realistic, not possible. Synergies mean what strengths do I bring to this situation and what strengths do I need to recruit from others in this situation? In other videos, I've talked about writing grants and I am a broad strokes person. I love writing grants. I love coming up with ideas, but I am not detail oriented. I know this about myself. That's part of my temperament. I synergize with people because I will write. I. I know I have friends who are great with details, but coming up with the ideas is overwhelming to them. So we work well together. I do the broad strokes and get everything, you know, laid out and then I have them either help me with the details or, or proof it to make sure I didn't miss any details because I know again, I'm prone to doing that. But that's part of synergizing. I recognize my weaknesses and then I work with people who have complimentary strengths. There's Nothing wrong with that. And maintain a journal of your progress on whatever changes you're trying to make, whatever you're trying, you're trying to do better, whatever goals you're trying to achieve, whether it's changing behaviors or goals at work or whatever. Maintain a journal of your progress. Note when you've made positive steps forward. Great. Keep doing that. Note when you have had a hiccup somewhere and when you have Figure out why, learn from it. Figure out how to prevent it from happening again and then move on. That way you can see that you're learning from your mistakes and you're moving forward. Learning is a process. Life is a process. A lot of people with ADHD struggle in relationships not only because of rejection sensitivity, but because of some of the other symptoms associated with adhd. One of the tasks can be to reduce arguments to less than two per week, and another one may be to increase social in invitations to one per week. If you are getting along better with people, they're going to want to spend more time with you. Therefore, if your invitations are going up, it means what you're doing is working. So identify the five most common causes of arguments and ways to address them. And in general, working with people with adhd, I found the five most com common causes are tardiness, forgetfulness, carelessness blurting or interrupting, and rejection sensitivity. Now the first four the other person may get angry because you're tardy or forgetful or careless, or you interrupt the last one, Rejection sensitivity. The person with adhd. You may get angry with somebody because you notice a micro expression and you assume that they're rejecting of you. So the anger can go both ways. Either way it ends up causing conflict or friction or arguments. So identifying the common causes of these different things, starting to address these things, and noticing how it impacts your relationships. Identify and address your vulnerabilities for argumentativeness. When you are sleepy, in pain, overwhelmed, you know we went through those vulnerabilities earlier. You may be more likely to be argumentative because you're feeling defensive, you're feeling unsafe. So you may start to be more irritable and argumentative. Know what your vulnerabilities are and figure out what can I do to avoid getting in arguments. Maybe if you know that you are not feeling so hot today and that makes you more argumentative. When you start feeling the desire to respond with an argumentative response, you take a breath or you may avoid as much social interaction. Those days you know that you're going to have a hard time saying something nice you just avoid saying anything at all and educate your significant others about ADHD and how they can help you make your changes. A lot of people don't understand all of the nuances of adhd, so if you let them know when I'm tired, it's harder for me to focus or I tend to be more argumentative. Okay, that can help them understand what's going on, or it can help them understand if they notice, hey, you know, you look like you're really tired today. They know probably not the best day to discuss a high, highly emotional topic with you. Interrupting and blurting is also another problem. So improving communication to less than three interrupting or blurting instances per day and potentially the ability to sit still for 30 minutes. Interventions explore and address how blurting is related to rejection sensitivity. Now, you may be scratching your head on this one. Sometimes people with ADHD feel like they need to get their opinions in. They feel like they need to interrupt in order to get heard or, or people will not hear them. They'll not remember what they're saying. So it's important to examine in what ways do, do I blurt? Because I feel like if I don't blurt, then I'm not going to get heard. Educate significant others regarding helpful communication. For people with adhd, it can, especially when they're vulnerable, it can be helpful to talk about one thing at a time. Instead of talking about some big complex issue and going on this long diatribe, saying a few things and then giving them a chance to respond and then saying a few things and giving them a chance to respond so they don't feel like, oh my gosh, I've got to remember, I want to say this and this and this and this and this. Oh my gosh, I've got to get it out. The same thing when giving instructions, give simple instructions. One at a time can be really helpful for younger people. But again, when communicating, every time you make a point, give them a chance to respond. Instead of making this complex argument and then saying, okay, you can have the floor for 15 minutes for people with ADHD. If you notice that you start feeling like, oh, I want to respond to that and I want to respond to that, and I can't forget to respond to that, okay, it can be helpful to write it down. And that's one of the beauties of having mobile devices as like another appendage these days. You can have a notepad open and if you have to do it, you can type a little note to yourself. So then when it is your Turn to talk. You can go over those notes. Other interventions for blurting before you answer somebody, inhale slowly, hold for four. Exhale slowly, hold for four. While you're doing this, put on a thoughtful expression and say to to yourself, let me think about that for a second. The inhaling and exhaling is a way of triggering your vagus nerve and triggering that relaxation response. So you're getting out of fight or flight into relaxation, into your wise mind where you can think more clearly. So it's a combination, but you're saying to yourself, okay, let me think about what you're saying. You can put a finger over your mouth for a few seconds as if you're considering what you're going to say. And some of us do that by default. You may do that or put a finger up to your mouth. Whatever you do, you may not feel as comfortable being quite that demonstrative. So you can imagine locking your mouth with the key to prevent yourself from speaking. Or imagine in the. In the day of technology, before you speak, you've actually got to unmute yourself. So when the person finishes talking, then you've got to reach up, if you will. Imagine, imagine reaching up and unmuting yourself. So until you do that, then you're muted and you're not talking. It's also helpful to use active listening. In American culture, ADHD or not, a lot of people have difficulty with listening and with interrupting. Listening until the person is finished speaking is important. Wait until they have a natural break and then paraphrase what they said. For example, so you're trying to plan a party for Sally's birthday, or you're asking me to do this, or you want me to go to the store for you this afternoon. So you're paraphrasing what they said to make sure that you heard them correctly. And then they can adjust. They can correct you if you're wrong. But that also ensures that you listen to hear the entire message before you start formulating your response. Other interventions include developing social skills. Address which social skills that you lack. When children are growing up in healthy environments where they're developing secure attachments, they learn emotional intelligence, they learn mindfulness, they learn emotion identification, they learn how to moderate their emotions, they learn problem solving, they learn communication, assertiveness, boundaries, all this stuff. If you didn't have a secure attachment, if you didn't have someone helping you learn these things, and you may not have developed these skills. So assess which social skills you may need to work on and then develop a plan to address each deficit. Another Thing that I mentioned multiple times, and I'm going to mention again, is trauma processing. A lot of children, infants, toddlers, experienced early rejection because they had needs that were different than their caregivers or than their siblings and they weren't able to articulate those needs, so those needs didn't get met. They also may have had lower frustration tolerance or been more fussy. They may have had more emotional dysregulation as children, which may have also contributed to early rejection from caregivers, caregivers getting frustrated and not being appropriately responsive. Children with ADHD may also have experienced sensory trauma and I talked about that in one of the other videos that infants that are born with ADHD actually show that they do not habituate to stimuli. So a dog barking may really startle them once. The next time the dog barks. Instead of getting used to having a dog around that's barking and making noise, they respond with the same intensity of startle. So every time they are stimulated, it's with the same intensity. Nothing ever kind of drowns out into the background and that is really exhausting. And as I mentioned in, in the first video, a lot of people with ADHD have sensory sensitivities to light, to sound, to smell. And caregivers may not have recognized that. A lot of people may not have ever recognized it. They may be, you know, older children, adolescents or even adults and they're just now figuring out that, hey, I have sensitivities to smells or to really bright lights or something and, and not really have made the connection yet that that may be partly due to the ADHD and that those sensitivities may be keeping their stress response amped up. When you're being bombarded by unpleasant or overly powerful stimuli, it triggers that HPA axis, the thing that we're trying to help relax right now get adequate quality sleep. It's important to identify for yourself why it's important to recovery and how it'll help you achieve your goals. Audit your sleep hygiene and develop a plan to improve it. I do have videos on sleep hygiene, multiple videos, so you can explore that. But we do know that disrupted circadian rhythms and poor quality sleep contribute to worsening of ADHD symptoms in both children and adults. Proper nutrition. They found a connection between vitamin D, magnesium, zinc, copper, iron deficits as well as other things, including omegas, can be associated with a worsening of ADHD symptoms. It's important not to just go willy nilly and start supplementing because some things it's. For example, if you take a Extra zinc, for example. It may inhibit the absorption of a different, different vitamin or mineral that's necessary. So you want to make sure that it's in the right balance and that you actually need it. But there are multiple studies that indicate that many people with ADHD have some nutritional deficits. Additionally, some people, not all, but some people with ADHD, have food sensitivities that contribute to a worsening of their symptoms. Mindfulness oriented meditation is another technique that's been found to be helpful in general with people with adhd. And what mindfulness oriented meditation is is exactly what it sounds like just taking time each day, preferably frequently, to focus your attention on the present moment and be mindful of it. Just notice what's going on. Instead of having your thoughts all over the place. Focus on what's going on right in front of me right now. Prioritize and purpose identifying what is the most important thing that I need to do right now to move toward a rich and meaningful life? Identify like the top 10 things and tackle one at a time. Create that vision board defining your rich and meaningful life. What people things, experiences are important and what do you need to do to move towards those things and then identify one and start working towards it. You can't do everything in a day. You can't do everything in a week. One thing at a time. Every positive change you make is going to positively affect every other area and plan ahead. Create a plan for handling each time of frequent each type of frequent situations that cause you problems. Whether you have difficulties in meetings at work or when you get angry or sitting still during movies or whatever it is. If there are types of situations that are problematic for you, plan ahead of time so you have a strategy in place and you feel prepared and confident and confident that you can handle that situation. ADD and ADHD can negatively impact relationships, work and mental health if not addressed. It's more important to identify and address symptoms rather than worry about fitting particular diagnoses. It's important to identify for yourself, for the person which symptom is most problematic and address that one first. Remember that many people with ADHD also have a history of trauma and insecure attachment, which may contribute to anxiety, irritability, impulsivity and distractibility. It's going to be important to rule out any concurrent, complex post traumatic stress disorder.