Sunday, October 28, 2012

Getting ready for Prime Time

Often when speaking with patients i refer to the term 'getting ready for prime time.'
There are several key factors involved in getting oneself ready to do tasks which can be tedious. Tasks that may require lots of focus and attention at home, work or at school. 

Key factors include restfulness, physical activity, nutrition, no distractions and possibly medication. I try to always ask about sleep because the majority of adults with executive functioning challenges often struggle with initiating and maintaining sleep.  Getting enough restorative sleep is now almost a luxury for most Americans and even more so for those with a mind that can be likened to a spinning top. They wake up feeling fatigued and exhausted. I talk to patients about establishing evening routines, having a wind-down period, putting all electronics away, eliminating distractions, listening to white noise and taking a supplement such as melatonin if necessary. 

Physical activity can be extremely beneficial before hunkering down.  Renowned Harvard psychiatrist Dr John Ratey lays out the research done on the transformative
effects of fitness on the brain in his landmark book Spark.  Exercise promotes the release of neurochemicals such as serotonin and dopamine and growth factors. It's like taking a stimulant without actually doing so. There are no negative side effects of exercise (unless of course you overextend yourself).  

Feeling well nourished and hydrated helps as well. A low and steady glycemic index helps maintain mental stability. Protein versus sugar and carbs also helps maintain an even keeled mind set. Keeping well nourished and hydrated is especially important when taking stimulants since they can decrease appetite and cause dry mouth.

Keeping distractions away helps prevent loss of focus and attention. We can easily become distracted by the ringing of a phone, a conversation near by and by a readily available internet connection to our Facebook page, favorite stores and to the news. Pay attention to what can cause loss of attention!

Stimulant medications have been found to be the most effective way of improving executive function when used appropriately. Medications and cognitive behavioral therapy combined is even more effective than medications alone. It's important therefore that you find a health professional who is experienced with these types of medications. It's also important to have a beneficial and on-going relationship with your health care provider. Compliance for many of those with cognitive challenges can be very difficult.

And now, you are ready for 'prime time!' 

Wednesday, April 25, 2012


Now listen up. Yes, relationships are important and not just those with the guys. I mean those between you and the ladies especially between you and THE lady. The one and only who you will have a great time wooing and cooing over when you first get to know her. When your dopamine is being replenished by the excitement of the chase and conquest.

But after the documents are signed and sealed the excitement of it all tends to wear thin, really thin.  Here’s when your not so appreciated ADHD symptoms may creep up and suddenly you become the Hyde in the Jackyll and Hyde. Your dopamine takes a dive and now you’re on the hunt for more novelty and adventure. In the meantime, the lady in your life is wondering why she’s no longer the center of your universe and why you’re suddenly OK with eating microwaved mac and cheese instead of agave-glazed pork belly with grilled pineapple.

In due time, she may well become distracted by bearing and raising your children, mainly on her own and often confusing you for another one of her little ducklings. After years of her feeling like she’s just an asteroid in your universe and you look and act too much like the boy you used to be way back when, she may threaten to throw in the towel. This is when you freak and finally keep the appointment with me that she made several years ago.

Thoughts about being a single dad and having to get the kids out of bed on time for school, make their breakfasts, lunches and dinners, pick them up from school on time, get them to ballet, piano and soccer, make them do homework and finally make them go to bed on time-jump start that part of your brain that’s been distracted from the boring realities of every day home life.  You may have been doing quite well at work. After all, your brilliant ideas and out-of-the box thinking has landed you CEO of your own company. The boring, gory every day details of work have been handled by your various assistants and secretaries who get paid to clean up after you.

So welcome, take a seat. Now the real work begins...