Giving Thanks

by Chris KelaherRKelaher

As the fourth Thursday in November approaches, thoughts in the United States inevitably turn to Thanksgiving. (Canada beats us to the punch by marking Thanksgiving on the second Monday of October.) This national day of gratitude, whose roots trace back to a post-harvest feast shared by Pilgrims and Native Americans in 1621, was first pronounced a national holiday by Abraham Lincoln during the Civil War and has long been a staple of American cultural life. The holiday conjures up images of turkey and stuffing, parades and pie, airport delays, Black Friday shopping, and endless football. But the real star of the feast is thankfulness, or gratitude. So, what exactly is gratitude, and what does in mean in a psychology context?  cornucopia2

Here is the definition presented in The APA Dictionary of Psychology (American Psychological Association, 2013):

Gratitude n. a sense of thankfulness and happiness in response to receiving a gift, either a tangible benefit (e.g., a present or favor) given by someone or a fortunate happenstance (e.g. a beautiful day).

It is only in relatively recent years that the concept gratitude has received much attention by psychology researchers, but it is now an area of growing attention, due at least in part to its prominent role in positive psychology. It also is an area of interest within subfields such as personality, religion and spirituality, and happiness studies, among others.

Using the search term “gratitude” in APA’s PsycNET database brings up 1,017 results, including 129 books or book chapters. For example, Robert D. Carlisle and Jon-Ann Tsang contributed a chapter on “The Virtues: Gratitude and Forgiveness” to 2013’s APA Handbook of Psychology, Religion, and Spirituality, edited by Kenneth Pargament. (See link below.) Tsang and Carlisle define gratitude in this way: ““a positive emotional reaction to the receipt of a benefit that is perceived to have resulted from the good intentions of another.”

  • Other recent books of interest to those who study gratitude include Philip C. Watkins’ Gratitude and the Good Life: Toward a Psychology of Appreciation (Springer, 2014) and Salman Akhtar’s Good Stuff: Courage, Resilience, Gratitude, Forgiveness, and Sacrifice (Jason Aronson, 2013.)

Several recent psychology books also include individual chapters devoted to the topic of gratitude. A partial sampling:

  • Anthony Ahrens, Courtney Forbes, and Michael Tirade contributed a “Gratitude” chapter to Guilford Press’ Handbook on Positive Emotions (2014).
  • Michael Furlong et al’s Handbook of Positive Psychology in the Schools 2ed includes the chapter “Gratitude in Schools: Benefits of Students and Schools” by Giaconda Bono, Jeffrey J. Froh, and Rafael Forrest.
  • 2014’s Wiley-Blackwell Handbook of Positive Psychology in Interventions (Acacia C. Parks and Stephen M. Schuler, eds.) includes a chapter on “Gratitude Interventions: A Review and Future Agenda,” by Tara Lamas, Jeffrey J. Froh, Robert A. Emmons, Anjali Mishra, and Giaconda Bono.

Thanks to these researchers and others like them, we are developing a much better understanding of gratitude. It has benefits on both ends—for people who receive thanks or appreciation, of course, but also for those expressing thanks. For example, Carlisle and Tsang tell us that “gratitude provides information

about the value, cost, intentionality, and role-independent nature of a benefit from another person.” It promotes pro-social behavior, and researchers have also identified links between gratitude and other positive traits or circumstances, such as life satisfaction, happiness, optimism, empathy, and hope.

 

In the words of Robert Emmons, a leader in the field and editor-in-chief of the Journal of Positive Psychology, “Gratitude works. It has the power to heal, to energize, and to change lives.” So go forth, be grateful, and enjoy your Thanksgiving.

 

You can read more about the benefits of gratitude via the links below.

http://www.apa.org/pubs/books/4311506.aspx

http://www.apa.org/news/press/releases/2015/04/grateful-heart.aspx

http://www.apa.org/science/about/psa/2012/01/research-gratitude.aspx

http://www.apa.org/news/press/releases/2012/08/health-benefits.aspx

 

 

 

 

 

Imants Barušs and Julia Mossbridge: On the Transcendent Mind

This is the latest in a series of interviews with APA Books authors. In this interview, Ron Teeter, Technical Editing and Design Supervisor at APA Books, spoke with Imants Barušs, BSc, MSc, PhD, and Julia Mossbridge, PhD.  Their book, Transcendent Mind: Rethinking the Science of Consciousness was recently released by APA Books.

 

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Imants Barušs is a professor of psychology at King’s University College at Western University where he has been teaching undergraduate courses about consciousness for 29 years. His research has been focused on the fundamental nature of consciousness, with academic papers having been published not only in consciousness journals but also psychology, philosophy, physics, mathematics, anthropology, and other science journals. He is the author of five previous books including Authentic Knowing and Alterations of Consciousness.

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Julia Mossbridge is an experimental psychologist and cognitive neuroscientist at the Institute of Noetic Sciences and a Visiting Scholar in Psychology at Northwestern University. She pursues an understanding of time, especially in terms of the relationships between conscious and non-conscious processing of events. In 2014, she received the Charles Honorton Integrative Contributions award for her work in bringing the phenomenon of presentiment to the mainstream. She is the author of Unfolding: The Science of Your Soul’s Work and the upcoming mystical/philosophical adventure The Garden: An Inside Experiment.

Your new book is titled Transcendent Mind. What does that mean?

IB: By “transcendent mind” we mean that mind cannot be fully explained in physical terms.

JM: We examine data pertaining to the idea that there is a nonlocal mental aspect to us – an extended and shared mind. Another name for this mind is “transcendent” because, to the extent it exists, it seems to transcend our waking experience as well as our physical boundaries.

How do you see this book as fitting in with the field of consciousness studies today?

IB: Consciousness studies has become its own discipline with contributions from psychology, cognitive science, neuroscience, philosophy, medical science, physics, anthropology, religious studies, and other disciplines. This book is timely because we are reflecting the growing recognition in the field of consciousness studies that consciousness is an ontologically primary aspect of reality.

JM: When writing this book, we kept in mind that consciousness studies curricula are cross-disciplinary. Consciousness studies asks, “How can we use physics, biology, sociology, psychology – all the academic tools at our disposal – to answer this one question: How does consciousness work?” The question is difficult enough and complex enough that to even begin to address it requires bringing together multiple disciplines.

Throughout Transcendent Mind, you emphasize that there is a credible case to be made for a paradigm shift in how we study the mind. Can you offer an example or two here? What would you like to see the field move toward?

IB: The paradigmatic cases are those in which a person who has had a near-death experience subsequently makes veridical reports of events that occurred during a time when there was insufficient brain activity of the sort that is usually thought to be required for perception and cognition to occur. There are no adequate conventional explanations of such reports. I would like to see the field of consciousness studies move toward an exploration of alternative theories, along with experiments and field studies to test those theories.

JM: The evidence from carefully controlled telepathy, precognition, and clairvoyance studies indicate that there is some aspect of the mind that is nonlocal. An example will not do this research justice, as frankly for most of us in our everyday consciousness we do not experience these events, and when we think we do, we can easily dismiss them because they arose in situations that were not well controlled. Other explanations can always be found outside the rigor of a controlled experiment, and in many cases, these other explanations are correct. What I would like to see the field move toward is a willingness to examine these results, which have been replicated in some cases more than most other psychology and physiology results, with the seriousness they deserve. In order to get there, we must first acknowledge and remove a great deal of persistent and unscientific knee-jerk bias against these results.

You open your first chapter, “Beyond Materialism,” with the quotation “The idea that consciousness may be fundamental and matter secondary is gaining ground.” How so?

IB: Science, in brief, is the activity of continuously generating empirical data and of discarding theories with poor goodness-of-fit and replacing

them with theories with better goodness-of-fit. With that quotation we are suggesting that there is growing recognition by scientists that the theory that matter is primary and consciousness is secondary is being replaced by the theory that consciousness is primary and matter is secondary.

JM: The idea that matter is fundamental and creates consciousness does not seem to work, so people interested in understanding consciousness are turning to other ideas. In the past decade or so we have seen formalized hints from clinical psychologists, experimental psychologists, and neuroscientists that the idea that consciousness is fundamental is perhaps not beyond the pale. For instance, we refer in the book to a set of papers from clinical psychologists that explore seriously the idea that telepathy may occur in the therapeutic setting. Experimental psychologists have been quietly examining access to extended (non-local) mental abilities such as precognition and clairvoyance. Neuroscientists are now discussing a pantheistic view – that everything has consciousness in it – which is difficult to separate from the idea that consciousness is fundamental.

I’m quoting from your Introduction: “The purpose of this book is to explore what consciousness looks like when we do not automatically assume that consciousness must arise from the workings of matter.” Why do you think that the pursuit of so fundamental a question inspires such resistance among scientists, especially when vast majorities of people profess religious beliefs that paint a similar picture?

IB: That is an empirical question for which psychologists, who study human behavior, have answers. We give some of those answers in Chapter 1 “Beyond Materialism.” In brief, the relevant parameters are a list of the usual suspects, highlighted perhaps by critical thinking being drowned out by compliance with normative behavior.

JM: For decades neuroscientists were taught that our subjective experience is an illusion (discounting the obvious fact that illusions are subjective experiences themselves). To me, the impressively strong dismissal of the only thing that we can actually be sure of – that we have subjective experience – suggests that scientists, and probably others, have to be scared of something. What is that? Well, I think many people have an intuition about how consciousness really works, but it is more unconscious in some people than others. The intuition is that at some basic level we are all connected – there is no clear boundary between some aspects of ourselves. This lack of boundaries suggests a lack of control, which can induce fear in all of us. At the risk of seeming too Freudian, one might imagine that the more unconscious this intuition is, the less likely someone will recognize it as an accurate intuition and the more likely it will only manifest fearful behavior as its telltale signature.

There appears to be a growing recognition in psychology of the importance of spirituality in clients’ worldviews, and certainly APA has published significantly in this area. Do you see the concept of transcendent mind as having reverberations here?

IB: My background is in mathematics and experimental psychology, and Julia’s background is in neuroscience and experimental psychology, so we simply allowed the arguments for transcendent mind to naturally grow out of the science itself without the use of the s-word. The overlap between what we have written and “spirituality” of various sorts can be developed by those who are interested in doing so. In fact, I myself have previously written two books along those lines: Authentic Knowing: The Convergence of Science and Spiritual Aspiration (Purdue University Press, 1996) and Science as a Spiritual Practice (Imprint Academic, 2007).

JM: The “s-word” Imants is referring to is “spirituality” – we use the “science” word a lot, and it is science we are trained to do. But yes, people interested in spirituality tend to be interested in exploring the idea of a transcendent or non-physical mind. As to books about the science of spirituality, I too have written one: Unfolding: The Perpetual Science of Your Soul’s Work (New World Library, 2002).

In one chapter you review near-death experiences, a subject that is often given much attention in the popular media. You state that “the evidence could be read as indicating that, in some exceptional cases, the more the brain is compromised, the greater the clarity of mental activity when it comes to perceiving information that seems normally to be hidden from the realm of our ordinary experiences.” This is one of a number of directions in which you discuss and present evidence for the separation of mind from brain. How close do you think we are – in the scientific community and society – to taking this seriously?

IB: We give some of the survey data to answer that question in the book. In general, I would summarize those data by saying that the idea that the mind could be separate from the brain is taken seriously by a much greater proportion of the scientific community than we are led to believe, because scientists who take that idea seriously stay silent so as to avoid reprisals. One of the purposes of our book is to encourage other scientists who have similar ideas to speak up. In “society,” outside the scientific community and away from formal institutions of various sorts, the notion of a mind separate from the brain is, arguably, the normative view.

JM: However, this societal or non-academic view is rarely made explicit or rigorously tested, even in thought experiments. It is more the folk view that “mind” and “body” are separate, which doesn’t inform us about their relationship. That’s one of the difficulties here; the data support both clear instances in which changes in the brain’s status influence the mind – in both directions! In some cases you have a demonstrable, seemingly causal relationship between brain and mind – and in other cases you have a demonstrable, seemingly causal relationship between mind and brain. So the integration of these data, rather than falling on one side of a philosophical debate or another, is what we are attempting to facilitate.

You’ve probably answered this question, or a variation of it, many times, but have either or both of you had a particular experience, or experiences, that led you to take on the subjects in Transcendent Mind?

IB: I became intellectually interested in the subject matter of Transcendent Mind as a child and have continued to study it ever since. Personal experiences came much later, first, in the form of precognitive dreams, and, years later, as remote viewing and influencing. I have described those experiences in a separate book titled The Impossible Happens (Iff Books, 2013).

JM: For me it was the reverse. As a child I had multiple precognitive dreams that were about mundane occurrences, but were remarkably specific. I kept a dream journal to make sure I wasn’t just confabulating my memories. These experiences continuously reminded me that we do not understand time very well. As an adult I had a near-death experience and a healing experience that were both so remarkable that I had to think about alternatives to materialism.

 

 

November Releases From APA Books!

emotion-focusedEmotion-Focused Therapy, Revised Edition 

by Leslie S. Greenberg

 

In this book, Leslie S. Greenberg presents and explores this versatile and useful approach, its theory, history, therapy process, primary change mechanisms, the empirical basis for its effectiveness, and recent developments that have refined the theory and expanded how it may be practiced. This revised edition describes recent research findings on important constructs such as emotional needs, and new developments in the use of EFT in treating anxiety disorders.

 

 

 

language-acquisitionResearch Methods in Language Acquisition

Principles, Procedures, and Practices

by María Blume and Barbara C. Lust

Copublished with De Gruyter Mouton

 

Synthesizing decades of collective experience into a set of practical guidelines for students and budding researchers, the authors of this book introduce a systematic approach to generating, processing, and interpreting reliable and valid speech data. They review a variety of observational and experimental tasks that allow researchers to collect natural speech, elicit specific types of speech, and assess language comprehension. Guidelines for generating data sets by transcribing and coding raw speech data are also reviewed, as are special considerations for working with infants and multilingual children.

 

long-term-careTransforming Long-Term Care

Expanded Roles for Mental Health Professionals

by Kelly O’Shea Carney and Margaret P. Norris

 

Every long-term care setting has the potential to foster healthier and happier lives for the older adults who reside there. Mental health practitioners are uniquely positioned to serve as critical change agents in these communities. This book shows how mental health practitioners can use their full range of skills to create systems that are more supportive and engaging for residents, while also providing the staff with greater opportunities for professional growth and meaning. To illustrate what is possible, the authors explore an innovative practice model that incorporates consultation, training, and interdisciplinary team leadership, in addition to traditional direct care services, to enhance the wellbeing of older adult residents.  Readers will also find practical information about Medicare and reimbursement for direct mental health services.

 

psych-majorsWhat Psychology Majors Could (and Should) Be Doing

An Informal Guide to Research Experience and Professional Skills

SECOND EDITION

by Paul J. Silvia, Peter F. Delaney, and Stuart Marcovitch

 

More students are majoring in psychology than ever before so competition for grad-school spots and good jobs is fierce. What are you doing to stand out from the other hundreds of thousands of psychology majors? Written in a lighthearted and humorous tone, this book shows both grad-school bound and career-bound students how to seek out and make the most of these opportunities. By getting out of the classroom and actively participating in the real world of psychology, students can build skills that will prepare them for the competitive realms of graduate school and the workforce.

What is Telemental Health?

shh_headshot-smallBy Susan Herman

Telemental health (TMH) is the use of telecommunication technologies to provide behavioral health services such as assessment, education, treatment, counseling and consultation. It refers both to live, real-time interactions as well as data sharing via asynchronous communication.

Over the phone and video teleconferencing systems, clinicians can provide care for most, if not all, the same conditions they treat in the office. Having a distance care option can increase access and decrease costs for consumers. However, telemental health can present certain logistical and safety complications. According to David Luxton, Eve-Lynn Nelson, and Marlene Maheu in their new book A Practitioner’s Guide to Telemental Health, complications can arise in regard to:

  • establishing informed consent
  • adapting intake and assessment protocols for the long-distance environment
  • involving emergency or support services, if necessary, at the client’s location
  • handling emotionally charged conversations when the client can easily power off their device, or when there might be another person in the room out of the clinician’s view

Asynchronous communication in TMH can include messaging technologies such as text or email—say, to ask follow-up questions or to check in on how well a patient is following a prescribed routine.

Software, apps, and peripheral devices for self-care and remote monitoring are also proliferating in the marketplace. These tools are broadly referred to as eHealth, or mHealth when deployed via mobile devices such as cell phones or wearables. They can be useful adjuncts to care, but cannot be used to diagnose mental health problems.

telemental-healthSome eHealth technologies provide alerts to prompt care providers to check in, similar to blood glucose monitoring systems for diabetics. According to the National Institutes of Mental Health (2016), “Such apps might use the device’s built-in sensors to collect information on a user’s typical behavior patterns. If the app detects a change in behavior, it may provide a signal that help is needed before a crisis occurs.”

Apps and wearable devices may include various coaching functions, self-monitoring, journaling, and/or stimuli (music, imagery) for help with:

  • Anxiety and stress management
  • Breathing and heart rate
  • Challenging thoughts
  • Recording moods
  • Activity, sleep, food intake
  • Meditation and mindfulness

Though it can be difficult to keep pace with innovation, providers and consumers alike should evaluate all telemental health tools carefully to make sure their data stays secure, and that actually using the technology doesn’t introduce more complications.

For a complete list of practice and ethical standards and guidelines in telehealth, including information on provider reimbursement for TMH and legal/policy issues, click here.

References

Luxton, D. D., Nelson, E., & Maheu, M. M. (2016). A Practitioner’s Guide to Telemental Health: How to Conduct Legal, Ethical, and Evidence-Based Telepractice. Washington, DC: American Psychological Association.

National Institutes of Mental Health (2016). Technology and the Future of Mental Health Treatment. Retrieved September 30, 2016 from https://www.nimh.nih.gov/health/topics/technology-and-the-future-of-mental-health-treatment/index.shtml

 

A Conversation With Russell A. Barkley, PhD, About Adult ADHD 

 

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Russell A. Barkley, Ph.D., is a Clinical Professor of Psychiatry and Pediatrics at the Medical University of South Carolina.  He holds a Diplomate (board certification) in three specialties: Clinical Psychology, Clinical Child and Adolescent Psychology, and Clinical Neuropsychology.  Dr. Barkley is a clinical scientist, educator, and practitioner whose publications include 22 books, rating scales, and clinical manuals, 7 award-winning DVDs, and more than 260 scientific articles and book chapters related to the nature, assessment, and treatment of ADHD and related disorders.  He is also the founder and Editor of the clinical newsletter, The ADHD Report, now in its 24th year of publication.  Dr. Barkley has presented more than 800 invited addresses internationally and appeared on nationally televised programs such as 60 Minutes, the Today Show, Good Morning America, CBS Sunday Morning, CNN, and many other television and radio programs to disseminate the science about ADHD.  He has received awards from the American Psychological Association, American Academy of Pediatrics, American Board of Professional Psychology, Association for the Advancement of Applied and Preventive Psychology, the Wisconsin Psychological Association, and Children and Adults with ADHD (CHADD) for his career accomplishments, contributions to ADHD research and clinical practice, and for the dissemination of science about ADHD.  His websites are www.russellbarkley.org and ADHDLectures.com. 

shh_headshot-smallBy Susan Herman

Did you know that adults can have ADHD? It’s true—ADHD is not confined to children and teens.

The trademarks of Attention Deficit Hyperactivity Disorder (ADHD) are inattention, combined (for some) with hyperactivity and/or impulsive behaviors. According to the National Institutes of Mental Health, some people with ADHD only have problems with one of the behaviors, while others have both inattention and hyperactivity-impulsivity. It is normal to have some inattention, unfocused motor activity and impulsivity, but for people with ADHD, these behaviors are more severe, occur more often, and interfere with or reduce the quality of how they function socially, at school, or in a job…Children and adults with ADHD need guidance and understanding from their parents, families, and teachers to reach their full potential and to succeed.

Professor, researcher, and clinician Russell A. Barkley recently published a self-help book with APA LifeTools for family members of adults with ADHD, titled When an Adult You Love Has ADHD: Professional Advice for Parents, Partners, and Siblings. You can find more information about the book and purchase it here.

I recently interviewed Dr. Barkley about his work with adults who have ADHD, and how loved ones in their inner circle can support them.

How recently was adult ADHD recognized? 

A German-language textbook published in 1775 has a remarkably accurate description of what we now call ADHD in adults. But, aside from very periodic mentions in the literature—as “minimal brain dysfunction” in the 1950s, and as “hyperkinetic reaction” or “hyperkinetic disorder” in the 1960s—neither the public nor the research community much recognized it. It wasn’t until the 1970s that a series of longitudinal studies was conducted to find out whether ADHD continued beyond childhood. Interest in this picked up throughout the 1980s and 1990s as it was found that half to two-thirds of kids who were diagnosed with ADHD continued to have symptoms into their twenties. This was the first real evidence base that began to show us how ADHD, like mental retardation, dyslexia, and autism, can continue into adulthood.

What would you say has been your greatest contribution to the field of adult ADHD?

In 1991 I started an adult ADHD research clinic at University of Massachusetts Medical School, and the same year my psychiatrist colleague Joe Biederman started one at Massachusetts General Hospital in Boston. We were collecting data on a variety of domains of impairment and symptoms on these adults to see if it was equivalent to the childhood form of the disorder – it clearly was.  Later, Alan Zametkin and colleagues at the NIMH did the first PET scan study showing brain related deficits in functioning in adults with ADHD.  Other studies on never-before-diagnosed adults were done to learn whether they responded to the same types of drugs that children were being given for ADHD.  Results showed that they did so.

In 2008 I published a monograph where I compared results of my own 20-year longitudinal studies on children with ADHD followed to an average age of 27.  Drs. Kevin Murphy and Mariellen Fischer and I compared them with adults diagnosed with ADHD alongside data I’d been collecting in the

clinic from adults who were not diagnosed as ADHD. This was the first time anyone had compared the two groups directly (children with ADHD grown up vs. adults diagnosed with ADHD). The monograph was massive, but I chose that format over journals because with journal articles you have page limitations and you have to peel off tiny bits of your research and present it over multiple, disparate articles. Instead I presented it all at once, and this allowed adult ADHD to really hit the research map. Others followed up my work with various methods of neuroimaging to show differences in brain activity for adults with ADHD.

Why did you decide to focus on parents, siblings, and partners of people with ADHD in your latest book?

Ever since I wrote a self-help book for adults who have ADHD, called Taking Charge of Adult ADHD (in 2010), I’d been wanting to write one for the family members who support them. At the time there was no science-based trade book available for loved ones of people with ADHD. Also, ADHD is in my family. I had been trying to help various of my own family members, get them treatment and offer a safety net, so I knew there were others out there also feeling frustrated after picking up and dusting off their loved one again and again.

I was ready to write the book when my twin brother died. He had ADHD, and I know that it indirectly contributed to his death. He was driving 40 miles per hour on a country road in the Adirondacks. He never wore a seatbelt, and he had a habit of going too fast and drinking while driving. He ran off the road and was killed. I put the book aside while I was grieving him. Not long after my sister, who had physical disabilities, also died. And about three years after that, my deceased brother’s son, who also had ADHD, hanged himself.  So I just “couldn’t go there” for a while due to all this grieving.

Finally, in 2015 the time was right. Several books on how ADHD affects marriage had appeared by that time. Writing about how to love someone with ADHD was cathartic for me. I feared that re-living events would make me feel worse, but actually I felt better.

Thank you for sharing that personal story. I’m glad you decided to include some of it in the book, too. 

adult-adhdLet’s back up a bit and talk about how ADHD can affect adults who have it. Also, how many adults have ADHD—how common is it in the population?

Four to five percent of adults in the USA have ADHD. The percentage is closer to 3-4% worldwide. It’s higher in Western countries because of longer life expectancy and better access to care. In children the ratio of boys to girls with ADHD is three to one; for adults there’s less of a split; it’s closer to 1.4 to 1 male to female. It’s been great seeing more women come out of the woodwork to talk about ADHD. I recently consulted on articles in Elle, Glamour, and Cosmopolitan magazines about adult ADHD.

ADHD is genetic in about two thirds of all cases; in about one third it is acquired either prenatally or after birth because of head trauma or environmental conditions that affect the brain’s frontal lobe development.

Adults who have ADHD typically achieve a lower level of education than they are capable of, and they have problems in the workplace with boring tasks that require sustained attention. Adults with ADHD tend to do well in non-traditional careers, often those that involve performing, music, athletics, police work, and the military. There are people with ADHD in law and medicine, but fewer than you’ll find in the more physically active careers.

Money management is a challenge for many people who have ADHD, as is driving. Adults with ADHD are 2-3 times more likely to be dead by age 46 from accidental injuries, many of which involve driving. About one third of adults with ADHD exhibit antisocial behavior and may even get involved with crime.

New research areas in adult ADHD include risky sexual behavior, along with marriage and parenting problems. ADHD is really one of the most impairing outpatient disorders there is—I would venture to say it’s even more impairing than depression—because it affects so many diverse areas of life. Clinical care and family counseling for adult ADHD exists and is increasingly available but is far from where it needs to be. As of ten years ago, only about one in ten adults with ADHD was diagnosed. The percentage is better now but there is still much progress to be made.

What do family members and partners need to understand about ADHD to best support their loved one who has it?

It’s important to adopt a biologically-based view of ADHD. ADHD is a neuro-genetic disorder. You can’t attribute your loved one’s behaviors to personality quirks, defective morality, laziness, or poor lifestyle choices or say they deserve whatever they get. You can’t be a good support person if you keep thinking, “My loved one could change if they wanted to, but they don’t want to.” People in the inner circle are their loved one’s best safety net and closest influence, but they can’t step up as stakeholders if they don’t adopt a more compassionate outlook about ADHD.

What kinds of support can family members provide to an adult who has ADHD? 

In my clinical work I walk through six steps with adults who have ADHD and their families. Step One is to get a thorough mental health evaluation to document not only ADHD, but any other disorders that the person might also have. Eighty percent of adults with ADHD have an additional disorder, and about half have two additional disorders. These might be anxiety, depression, a learning disability, bipolar, or something else. Detecting secondary disorders affects the course of ADHD treatment. Psychologists, psychiatrists, and behavioral neurologists can diagnose ADHD.

So the support person might offer to set up various appointments for their loved one and help them follow through getting to the specialist’s office.

Yes.

Step Two is to help the patient “own” their ADHD as a part of their identity. It’s easier to accept a diagnosis intellectually than it is to incorporate it as a part of your own view of yourself. Treatment will be superficial if the person doesn’t accept ADHD as a part of their self-view. When the patient starts to grieve their old self-image, that’s when we know we are getting through. Accepting the new you is also a positive thing because it means you’re giving up the old view of yourself as stupid, lazy, or immoral.

Step Three is to read widely and educate yourself about ADHD. I like to say that “truth is an assembled thing.” You can’t just depend on one source for all your information. Jeff Copper’s podcast, Attention Talk Radio, is a great resource, and I offer many more in the book. Think about it: if you’re diabetic, you have to understand how diet plays into your condition, and hygiene [for blood tests and insulin monitoring], and a host of other things. Because ADHD is a chronic disease I sometimes refer to it as the diabetes of psychiatric conditions.

Step Four is to get on medication. Medication is the best treatment for ADHD. And I’m saying this as a psychologist—there is no longer any “us versus them” going on between psychologists [who typically do not prescribe medication] and psychiatrists when it comes to ADHD treatment. Medication is two to three times more effective than behavioral methods alone for treating ADHD. Most adults with ADHD, 80-90%, need medication as part of the treatment package. Family members can help their loved one remember to take their ADHD medication regularly.

Step Five is behavior modification. Cognitive behavioral therapy (CBT) boosts the benefits of ADHD medication for self-control and executive functioning. Outside of formal therapy, there’s a lot family members can do to encourage their loved one to adopt exercise routines and other healthy habits. Often times people with ADHD need to get additional treatment to cut back or eliminate their use of alcohol, tobacco, and marijuana.

Step Six is accommodation. This means altering the environment so the person with ADHD is more likely to succeed. It might mean dedicating one computer for work only and another one for games and social networking. Family members can help their loved one find and download software that blocks distracting content. At home and on the job, adults with ADHD can advocate for themselves by finding support people to keep them accountable for changes they want to make and goals they want to accomplish.

A new type of accommodation that’s becoming more popular is called ADHD coaching. An ADHD coach makes daily contact via text or other channels to help the person stay organized, cope with frustration, and/or work through social problems. The field of ADHD coaching is still developing and is beginning to police itself. Some people are coming to ADHD coaching from financial planning or life coaching and are not currently held to a specific standard of knowledge or experience within psychology or behavior modification. I expect within five years certification requirements and accreditation for ADHD coaching will be in place.