SAP Newsletter

Neurodiversity means that all of our nervous systems (brain, spinal cord and nerves) are naturally wired differently than each other, or that we all have different neurotypes. Neurodivergence or being "neurodivergent" means that someone has a nervous system that is different than most of their peers. ADHD, or Attention Deficit Hyperactive Disorder, is one of these neurotypes.

"ADHD" is widely used in research literature, self-help, and diagnostic materials (DSM-V). Some people with ADHD feel strongly about ADHD being labeled as a "disorder", as there is no perfectly "ordered" or "normal" brain. To some, ADHD is inseparable from their sense of intersectional identity (race, class, gender identity, other disabilities, ethnicity, nationality, etc.). Intersectionality was coined by Kimberle Crenshaw, a Black woman who is a civil rights advocate, scholar of critical race theory, and professor at the ULCA School of Law. She provides the following brief explanation of intersectionality:

“Intersectionality is a metaphor for understanding the ways that multiple forms of inequality or disadvantage sometimes compound themselves and create obstacles that often are not understood among conventional ways of thinking.”

The purpose of this article is to highlight and embrace key differences in how people with ADHD exist in the world and encourage allies to advocate for changes that support people with ADHD.

While not all folks with ADHD consider it be a disability, ADHD is protected under the Americans with Disabilities Act (ADA). ADHD is also usually considered to be neurodevelopmental, or it manifests before adulthood and can affect language, physical ability, behavior, and learning processes.

While there is no "normal" brain, ADHD is a different experience from person to person due to difference in brain development. The biggest commonalities in people with ADHD are executive functioning, emotional regulation, sensory regulation, working memory, and movement differences. Executive functioning is a set of abilities controlled by the frontal lobe, or front third, of the brain. Other parts of the brain, including the basal ganglia, temporal lobe, and cerebellum may also develop more slowly compared to neurotypical/non-ADHD brains.

ADHD, similar to autism, exists on a spectrum with differing abilities from person to person, and day to day. Below is a visual example of the ADHD spectrum.

ADD, or Attention Deficit Disorder, is an outdated term. ADHD is now divided into 3 subtypes in the Diagnostic Manual of Statistics (DSM) 5th Version. The subtypes of ADHD are inattentive, hyperactive, and combined type. A venn diagram below explains key differences between the 3 subtypes of ADHD. Deficit language can be reframed to be more neutral or objective. For example, "talks excessively" can be reframed to "talks a lot" or "extensive verbal communication".

There are more than a few common myths and misconceptions about ADHD. The following are just a few.

ADHD IS/DOES/CAN NOT:

• Be prevented from developing
• Be cured
• A disorder (despite its current name), illness or tragedy
• A complete lack of attention
• A result of parenting methods
• Develop after childhood or disappear with age/"outgrown"
• Always dangerous or disruptive
• Always the only reason someone is struggling
• Always require medication to manage, though consideration is normal

ADHD IS/CAN BE....

• A set of strengths and disabling traits
• Managed with the right combination of methods for each person
• Self-managed
• A struggle with attentional regulation, not the "amount" of attention
• Influenced by environmental and genetic factors

Additional strategies to manage time blindness include:

• Visual timers and schedules (Google Maps, Calendars, other apps)
• Use goblin.tools to break down tasks and estimate the time needed to complete tasks
• Creating a schedule: TIME how long each task takes, BE FLEXIBLE where possible, ALLOW time for transitions, use ONE calendar, REFLECT on what worked/didn't work
• Scheduled "needs breaks": after a regular time block, check if you need water, food, rest, movement, etc.

RSD can be managed, but please remember it is normal to have emotions! The goal of emotional regulation is to bring yourself as close to baseline/"regulation" as possible, and everyone has rough days. Some other ways to regulate your emotions could include:

• Movement (running, walking, dancing, etc.)
• Talking it out with someone
• Turn. It. Off. (take a break from electronics, uninstall the app, block the person if that is the source of dysregulation)
• Distraction (non-harmful and safe)

It is good practice to have a toolbox (i.e. "options") of emotional regulation, which can take more time, intentionality, and help from others for people with ADHD to develop.

Info-dumping is a communication difference that involves sharing a lot of information in a stream-like format, usually about a topic they're interested in and excited about.

ADHD folks, just like anyone else, appreciate when people are able to engage with their interests. Cooperative overlap, or "interrupting" someone to contribute to the conversation, is a typical neurodivergent behavior.

Shared stories, or story swapping, is sharing about a time similar to what someone else is going through in order to connect and demonstrate empathy.

Discuss communication differences between yourself and your loved ones without judgement. It is ok if you do not have the capacity to listen and/or respond sometimes, as we all have different needs that should be respected. Kindly drawing a boundary could look like, "I had a really rough day at work, and I need some time to myself. I still care about your interests, and I love you. Let's talk about this later tonight, when I can really listen and respond."

ADHD has a lot of stigma (negative attitudes and beliefs) around it, which makes it more difficult for ADHD folks to talk about their experiences and ask for accommodations. Coupling the stigma with a justified fear of rejection and discrimination can lead to ADHD folks internalizing those negative beliefs.

Many factors, including internalization of negative beliefs, systemic and interpersonal discrimination, genetics, and environmental influences can lead to ADHD folks developing additional diagnosable conditions. The CDC provided a chart summarizing data from a 2022 parent survey about ADHD.

CHADD (Children and Adults with Attention Deficit/Hyperactivity Disorder) recognizes that suicidality (thoughts, behaviors such as self-harm, and attempts) is a lifelong concern for people with ADHD, as...

• Adults with ADHD: higher risk compared to other adults, with increasing risks due to depression and conduct disorder co-morbidities (more than one diagnosis)
• Early adolescents (11–14 years old): greater risk than older adolescents
• Men with ADHD: greater risk of death by suicide

If you notice a loved one with ADHD struggling, please reach out for mental health services. Bucks County has an array of services that will be included at the end of this article.

ADHD brains are naturally deficient in dopamine and norepinephrine, neurotransmitters involved in the motivation and reward brain circuits. The usual reason behind developing a substance use disorder (SUD) is self-medicating, or using non-prescription substances as a way to provide adequate "stimulating" or "depressing" effects to manage ADHD in everyday life.

A few more facts about ADHD and substance use are below:

• ADHD youth are two to three times more likely than their neurotypical/non-ADHD peers to abuse substances in their lifetime.
• ADHD folks can experience more intense reactions to substances due to lower dopamine and norepinephrine levels, impulsivity, and a need for immediate gratification.
• Most ADHD teens using substances are mostly using marijuana, with nicotine and alcohol trailing close behind.
• ADHD teens abuse alcohol at a higher rate than other substances.
  
• Co-occurring conditions increase the risk of youth with ADHD abusing substances.
• Environmental factors, such as less social and educational supports, increase the risk of ADHD youth choosing friends who regularly engage in risky behaviors.
• ADHD medications do not increase the risk of developing a substance use disorder (SUD). In fact, youth who regularly took prescribed ADHD medications were 7.3% less likely to develop a SUD than ADHD youth not taking any medications.

ADHD is considered neurodevelopmental, meaning it influences how the brain functions and neurologically develops resulting in notable differences in social, cognitive, and emotional functioning. As stated in the "myths" section, ADHD cannot be cured or prevented from developing. "Treatment" is referring to any methods to help people with ADHD manage themselves, including environmental supports, and thrive.

Families should first seek out school accommodations, such as IEP/504 evaluations and plans, skills/psychoeducational groups, and emotional supports. Discuss your concerns with your child's counselor.

Other common options for ADHD treatment or accommodations include:

• Lifestyle Changes: more movement, dietary changes, sleep, stress management, outside time, social/creative time
• Medication: stimulants (e.g. Vyvanse, Adderall, Ritalin, Concerta), antidepressants (e.g. Wellbutrin, Lexapro, Prozac), non-stimulants (e.g. Strattera, Intuniv)
• Sensory Regulation: fidget toys, break/movement times, removal of environmental distractions, acupressure mat, etc.
• Occupational Therapy: person-centered, goal-oriented therapy that positively contributes to quality of life
• ADHD Coaching: education about ADHD, building on individual strengths and providing resources, and developing new strategies and system to manage ADHD in daily life
• Talk Therapy (family, individual, couples): working with individuals, families, or couples to improve understanding, communication, conflict- resolution, and emotional regulation skills
• Community Resources: organizations focused on ADHD diagnosis and management, like BuxMont CHADD, Bucks County Behavioral Health/Developmental Programs

Medication Take Back Day is Saturday, October 26, 2024 from 10 am - 2 pm! 46 public collection sites are available throughout the county. Simply walk or drive up and drop in any unused, unneeded or expired medications for safe disposal. Law enforcement officers will be collecting prescription medications, over the counter and pet medications, vitamins, vaping products and more.

More information is available here: Medication Take Back Day Information

• What is SAP? In Pennsylvania, every school must have a Student Assistance Program (SAP). A SAP team, made up of school and community agency staff, is here to help you access school and community services.

• How can SAP support ADHD students and families? SAP offers psychoeducational groups, including but not limited to coping skills, affinity groups, and socio-emotional supports. SAP also provides short-term, 1 on 1 problem-solving sessions tailored to your child's needs. Other options available through SAP are behavioral health screenings and biopsychosocial assessments. SAP is unable to provide an ADHD diagnosis or be part of an IEP/504 accommodations plan.

• Who to contact: You can reach out to your child's guidance counselor or look at their school website for SAP information.

The video below contains information about the SAP program in Pennsylvania K-12 schools.

Email: Mgroden@councilsepa.org
Website: councilsepa.org
Location: 4459 West Swamp Road, Doylestown, PA, USA
Phone: 2153456644

Education and Supports

• Pennsylvania Parent Guide to Special Education for School-Age Children (pattan.net)
• Insights of a Neurodivergent Clinician
• Empowering Individuals with ADHD to Thrive | The Mini ADHD Coach
• OT4ADHD - The Full Scope of Evidenced Based Support for ADHD, also has Facebook Group
• What It's Like to be ADHD and Black
• How to ADHD
• Gender Identity and ADHD: Supporting Diverse Children and Teens (additudemag.com)
• ADHD Youth Substance Use: Facts and Suggestions
• Data and Statistics on ADHD | Attention-Deficit / Hyperactivity Disorder (ADHD) | CDC
• ADHD, Self-Harm, and Suicide - CHADD
• ADHD Lifestyle Changes to Consider -- ADDitude Magazine

• Laziness Does Not Exist - Devon Price

• We Have ADHD - Facebook Group

Local and State Community Resources

• BuxMont CHADD | Bucks & Montgomery County ADHD: Local ADHD professionals and additional ADHD educational/support resources.
• Behavioral Health/Developmental Programs | Bucks County, PA: Early Intervention, Intellectual Disability/Autism Services, Mental Health Services, and Managed Care.
• Bucks County LIFE: Various supports available, including case management, peer support, and family support.
• Big Brothers Big Sisters: Opportunities for youth to be matched with a role model/mentor and receive peer support.
• Ability Programs | YMCA of Bucks and Hunterdon Counties (ymcabhc.org): Various recreational opportunities for disabled youth and adults.
  
• Find Therapists and Psychologists in Pennsylvania - Psychology Today: General website with multiple filters, including insurance, to find an individual therapist.
  
• St. Luke's Penn Foundation: Case management, Counseling, Family-Based Services, Adolescent Behavioral Health Unit, Early Intervention
• Lenape Valley Foundation: Intensive Behavioral Health Services (IBHS, formerly "wraparound services), mobile crisis response, walk-in crisis response centers, Blended Case Management, and Early Intervention.
• Medicaid | Department of Human Services | Commonwealth of Pennsylvania: Youth with mental health and/or disability diagnoses can be eligible for Medicaid/Medical Assistance.