2009 Trainings

Now that the final training of 2009 is completed, I can rest! I must say, this has been a lot of fun for me. Although I have worked hard on writing/preparing, the positive feedback from the classes/trainings were very inspiring and motivating.

In 2009, I providing three professional trainings on Sexual Addiction: August 7th, September 25th, and November 13, 2009. Although the trainings were oriented for mental health practitioners seeking continuing education credits (CEU's), they were also designed to be informative for the general public. Topics included: signs and symptoms, behavior types, levels of addictions, demographics, gender differences, cross addictions, co-sex addiction, assessment, and treatment of individuals with compulsive sexual behaviors and/or sexual addictions.

The August 7, AATP, training was on "Compulsive Sexual Behavior and Sexual Addiction. It was at Christ Hospital in Oak Lawn IL was a great success. I received favorable feedback and plan to continue with the message: this is a very important topic to understand as well as an under-served and under-recognized population that needs help. AATP is a not-for-profit training academy established to provide professional continuing education for mental health practitioners. To contact AATP (click on this link or go to http://www.aatpofillinois.com/.

On September 25 Arbor Counseling Center hosted a similar training, but only for three hours (3 CEU's). The training was at Indian Trails Public Library, 355 Schoenbeck Rd., Wheeling IL.

On November 13, Alexian Brothers Behavioral Center for Professional Education hosted 2 hour (2 CEU) training on Sexual Addictions: An Introduction. The training was posted on their websit: http://www.alexianbrothershealth.org/services/abbhh/professionaleducation/professional-education-programs.aspx

I am anticipating further trainings in 2010. Some of the topics I am considering include: ADHD, Codpendency/Co-Addictions, and/or Treatment and Assessment of Sexual Addiction.

Signs of Sexual Addiction

Signs of Sexual Addiction (Based upon Patrick Carnes work)

1. Loss of Control
• Out of control sexual behavior predominates
• The addicts cannot control the extent, duration and regularity of his/her sexual behavior
• Behavior excesses continue despite clear signs of danger (consequences)
-- Compulsive masturbation
-- Compulsive pornography use
-- Chronic affairs
-- Exhibitionism: intrusive "flaunting/showing"
-- Dangerous sexual practices, i.e., asphyxiation
-- Prostitution
-- Anonymous sex (at porn shops, bars, etc.)
-- Voyeurism: intrusive "watching"

2. Continuation Despite Consequences
• Social Consequences
-- Loss of marriage/primary relationship, friendships and social networks
-- Problematic relationships with spouse, family and/or significant others
• Emotional Consequences
-- Depression, anxiety, fear, etc.
-- Suicidal thoughts, plans and/or attempts (70% have thought about it)
• Physical Consequences
-- Injury due to frequency and type of behaviors
-- Sexually-transmitted diseases
-- Unwanted pregnancies or abortions
-- Sleep disturbances
• Legal Consequences
-- Arrests for sexual crimes (voyeurism, lewd conduct, etc.),
-- Loss of job, licensure, and/or professional status
-- Sexual harassment charges
-- Fines, legal fees, probation, or incarceration
-- Being on the Sexual Offender Database
• Financial Consequences
-- Costs of pornography, prostitutes, and phone sex can cause financial hardships
-- Loss of productivity, creativity and/or employment
-- Loss of career opportunities
-- Bankruptcy

3. Efforts to Stop
• Repeated specific attempts to the behavior, which fail
• Even after multiple life changing consequences, the sex addict cannot stop -- Leads to further frustration, anger, shame and depression
-- Frustration fuels further episodes of addictive behavior)

4. Loss of Time
• Significant amounts of time lost doing and/or recovering from the behavior

5. Inability to Fulfill Obligations
• The behavior interferes with work, school, family, and friends
• High-risk behavior is continued despite responsibilities and expectations
• A pattern of broken promises and failures

6. Ongoing Desire or Effort to Limit Sexual Behavior
• Repeated but futile attempts to change, limit or stop addictive behavior
• Breaking promises to change, limit or stop behavior
• Cross Addictions: substituting or transferring another addiction to aid in stopping or controlling sexual cravings
-- Workaholism
-- Overeating
-- Alcohol abuse
-- Illegal and prescribed drug abuse
-- Compulsive gambling
-- Religious Addiction
-- Romance addiction

7. Preoccupation (Obsession about or because of behavior)
• Sexual obsession and fantasy as a primary coping strategy
• Elevated levels of arousal are used to cover up feelings
• Sex becomes a primary drug to numb, "medicate" and/or regulate emotions
• Sex is used to block out painful and unpleasant memories
• Euphoric Recall or "Sex in the head" maintains the fix whenever needed
-- Secretive mental images of past sexual acting out, which is used to sexually act out again
-- Its like having a personal collection of pornography to be used at any time

8. Escalation
• Amounts of behavior increase because the current levels no longer satiate cravings
-- Higher "dosages" are needed to get the same feeling/excitement.
-- Can cause self injury
• Masturbation to the point of injury
• Asphyxiation
-- Increased levels create victims

9. Severe mood changes around sexual activity
• Depression, anxiety, anger, and other mood/affective states can result from repeated failures to stop or control the
addictive behavior
• 70% described chronic feelings of depression
-- Other chronic mood or affective states include:
• Anxiety
• Guilt and shame
• Anger at self and others
• Hopelessness and despair (monitor suicidal ideations)
-- Mood changes may be "medicated" (hidden) through the use of other drugs or medications

10. Compulsive Behavior
• Sexual behavior that you want to stop but you can't
• A pattern of out of control behavior over time
• Sex becomes the organizing principal of daily life
• Everything revolves around it
-- On sexual obsessions and fantasizing
-- On planning next event
-- On sexual acting out (some spend 8 hours a night on the internet)
-- On covering up or making up for lost time
-- Addressing consequences of sexual behavior

11. Losses
• Losing, limiting, or sacrificing valued parts of life
-- Hobbies, family relationships, and work
-- Loss of important personal, social, occupational or recreational activities
-- Loss of friends and family (loss of relationships)
-- Loss of long-term relationships
-- Loss of talents, goals, and personal and professional aspirations

12. Withdrawal
• Stopping behavior causes considerable distress, anxiety, irritability, or physical discomfort.
• Usually lasts for about 14 days, but can be as long as 10 weeks
-- Insomnia
-- Headaches and/or body aches
-- High or low sexual arousal and/or genital sensitivity
-- Increased appetite for food
-- Chills, sweats, shakes and/or nausea
-- Rapid heartbeat and/or shortness of breath
-- Intrusive dreams
-- High level of anxiety and irritability
-- Emotional lability (roller coaster feelings)
• Some sex addicts with a chemical dependency report that withdrawals are worse for sex addiction than for drug/alcohol addictions

Online Articles

I have decided to get some of my written work published online. So far I am have my written work published on Enzinearticles.com , Articlesbase.com, and SelfGrowth.com

I hope to get the word out about my passions to a broader audience.

Heaven (A Spiritual Poem)

Seven years ago I was asked by a friend if I was "religious and if I believed in God?" As a (formerly) practicing agnostic I quickly answered:"no." However, I defended myself by explaining that I lived my life according to universal principals of "right and wrong" (as I understood them). Because I believed that our deeds create a lasting effect on the world, I felt confident in my everlasting future. In other words, I wasn't worried about there being a heaven or not. I told my friend that when I die, I am banking on knowing that my impact on the world will be ever lasting. My "heaven" will ultimately be the creation of the the sum total of all my actions.

I will never forget my friend's response: he looked at me with glassy eyes, and told me how deeply spiritual I was. I didn't see it. It took five more years to see what he meant. Such was the inspiration of the following poem I wrote.

Heaven
The pebble is worn smooth
Made small over time
A product of a cataclysmic force of nature
A fragment of mountainous sheets of rock
An accidental offspring of a boulder
But just a very small stone.

The pebble's place in our world
Is neither understood nor appreciated
But when thrown into a glassy calm pond
Its insignificance is transformed
Its meaning and purpose is unleashed.

The instant the pebble kisses the pond
Its signature of concentric ripples
Spiral outwards
Moving far beyond itself.
Gently affecting everything in its wake
Forever altering the smooth placid surface.
 
The pebble creates its worth and meaning
By unleashing its unimagined power 
Into a dueling force of action and reaction
Creating karmic energy
Producing lasting and fluid impressions.

Aren't we all pebbles?
Feeling small and insignificant
But ultimately recognizing
That who we are meant to be
Can never be measured in isolation
on a path into ourselves.

It is true then:
Our everlasting future
Is created by the indiscriminate tossing of pebbles
Into the pond of life
Creating ripples
that leave unique mark on our world
Not because of thoughts
not because of well meaning plans
But because of actions.

Our life's prayers our answered
Because even the smallest pebble
No matter how seemingly insignificant
Changes the course of the lives
Of those we touch. 

And when the icy winds of death
beckon our lasting attention
We will gently leave this life
With the knowledge that
because of that one pebble
The world will never be the same.

And then we have heaven …

Ross Rosenberg
8/18/03

"My Name is Roger (Ebert), and I'm an Alcoholic"

Seldom have I been so impressed with an article about someone's experience with alcoholism (addiction) as I was when I read Roger Ebert's article on his own struggles. Mr Ebert writes beautifully, masterfully, and with incredible insight about the disease of alcoholism. As an addiction specialist I have a vested interest in "getting the word out" about the insidious and destructive nature of addictions (chemical and process addictions). Mr. Ebert has always been a favorite movie reviewer of mine because I always sensed he understood the human condition, spoke fairly and sensitively about issues, and reserved judgment about movies from a place of sensitivity, openness, and kindness. When a man with Mr. Ebert's personal and professional qualifications speaks out, then I listen. Unfortunately, not enough people actually have access to this article. So here it is. I hope you appreciate it and are inspired by it as I much as me.

I welcome anyone's reactions or comments. Feel free to comment on my blog or email me at Rossr61@comcast.net.

My Name is Roger, and I am an Alcoholic (click on title for the article)

Transformations (Victories of the Heart)

Once in a while, during a moment of apparent moment of personal insight and enlightenment, I am compelled to write a poem. These poems seem to have a life of their own; they almost write themselves. Until the poem is finished, the emotion I am feeling or the insight I have reached, won't subside. And when the poem is is completed, I then reach deep feelings of satisfaction--a moment of catharsis.

Five years ago, during a life changing Victories of the Heart (http://victoriesoftheheart.net/) retreat, I had one of those peak moment, which compelled me to write the following poem. It speaks to the part in me who decided to start a journey of healing and growth. Even though personal transformation take their toll on us, we know in our hearts and our minds that we really have no choice. Here is my "jewel" of a poem:

Transformations

I am a coarse stone.
Yearning to be touched
Dreaming of being smooth
rounded and glassy.

I am a colorless piece of rubble.
Wanting to be held and caressed.
Desiring to become
a cherished part
of a beloved rock collection.

I am a sharp edged rock.
Isolated and alone.
Needing to no longer be a tool
Used to cut and divide
a person from his own heart.

Today is the day
I allow myself to toss,
turn and tumble.
To be kicked around.
Stomped into the earth.
And dug up again.

The endless cycle of seasons take its toll
Autumn’s blustery winds
Winter’s freezing blizzards
Spring’s drenching rains
And Summer’s blanching sun
transform my surface
Forever alter what I look like.


After what seems like a lifetime
I find myself resting in a dry river bed.
To eventually be carefully chosen
by a boastful youth,
Who sublimely skips me
across the river’s tranquil
but rippled surface.

Because of honest youthful enthusiasm
I am reconnected to my destiny.
Plunging back back down
into the river's cold and dark waters,
I am carried further down-river.
Carried quickly
with a sense of urgency
Toward a tumultuous
raging white water river.


Violently crashing
grinding
into unforgiving boulders.
I begin to lose necessary parts of myself.

Pushed lower and lower
Submerged deep
at the bottom of the river,
I remain dormant
for years that stretch
toward no apparent endpoint.

With a torrential downpour
And hurricane-like winds,
I am moved from my murky
muddy and silted home,
to be wildly churned in stormy waters

With a tremendous gust of wind
and a resulting wave,
I am cast shoreward
To be perfectly placed on a path
where a wandering dreamy child
is exploring the river bank
seeking his perfect jewel of a stone.

And during this magnificent
bright summer day,
the shining rays of the afternoon sun
strike me so perfectly
that my surface explodes with
eye-catching glimmering sparkles.

Capturing the attention
Of this adventurous
and seeking child.
Who stops, notices, stares,
and picks me up.

With the excitement of a discovery,
The boy carefully examines
my glassy translucent surface,
Marvels at my rainbow colors,
Caresses my smooth contours.
And with a burst of pride
places me in his shirt pocket
to be forever close to his heart.

Ross Rosenberg
4/23/06

ADHD: An Overview

ADHD is neither a “new” mental health problem nor is it a disorder created for the purpose of personal gain or financial profit by pharmaceutical companies, the mental health field, or by the media. It is a very real behavioral and medical disorder that affects millions of people nationwide. According to the National Institute of Mental Health (NIMH), ADHD is one of the most common mental disorders in children and adolescents. According to research sponsored by NIMH, estimated the number of children with ADHD to be between 3% - 5% of the population. NIMH also estimates that 4.1 percent of adults have ADHD.

Although it has taken quite some time for our society to accept ADHD as a bonafide mental health and/or medical disorder, in actuality it is a problem that has been noted in modern literature for at least 200 years. As early as 1798, ADHD was first described in the medical literature by Dr. Alexander Crichton, who referred to it as “Mental Restlessness.” A fairy tale of an apparent ADHD youth, “The Story of Fidgety Philip," was written in 1845 by Dr. Heinrich Hoffman. In 1922, ADHD was recognized as Post Encephalitic Behavior Disorder. In 1937 it was discovered that stimulants helped control hyperactivity in children. In 1957 methylphenidate (Ritalin), became commercially available to treat hyperactive children.

The formal and accepted mental health/behavioral diagnosis of ADHD is relatively recent. In the early 1960s, ADHD was referred to as “Minimal Brain Dysfunction.” In 1968, the disorder became known as “Hyperkinetic Reaction of Childhood.” At this point, emphasis was placed more on the hyperactivity than inattention symptoms. In 1980, the diagnosis was changed to “ADD--Attention Deficit Disorder, with or without Hyperactivity,” which placed equal emphasis on hyperactivity and inattention. By 1987, the disorder was renamed Attention Deficit Hyperactivity Disorder (ADHD) and was subdivided into four categories (see below). Since then, ADHD has been considered a medical disorder that results in behavioral problems.

Currently, ADHD is defined by the DSM IV-TR (the accepted diagnostic manual) as one disorder which is subdivided into four categories:

1. Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type--previously known as ADD--is marked by impaired attention and concentration.

2. Attention-Deficit/Hyperactivity Disorder, Predominantly Hyperactive, Impulsive
Type--formerly known as ADHD--is marked by hyperactivity without inattentiveness.

3. Attention-Deficit/Hyperactivity Disorder, Combined Type--the most common type--
involves all the symptoms: inattention, hyperactivity, and impulsivity.

4. Attention-Deficit/Hyperactivity Disorder Not Otherwise Specified. This category
is for the ADHD disorders that include prominent symptoms of inattention or
hyperactivity-impulsivity, but do not meet the DSM IV-TR criteria for a
diagnosis.

To further understand ADHD and its four subcategories, it may be helpful to illustrate hyperactivity, impulsivity, and/or inattention through examples.

Typical hyperactive symptoms in youth include:
• Often "on the go" or acting as if "driven by a motor"
• Feeling restless
• Moving hands and feet nervously or squirming
• Getting up frequently to walk or run around
• Running or climbing excessively when it's inappropriate
• Having difficulty playing quietly or engaging in quiet leisure activities
• Talking excessively or too fast
• Often leaving seat when staying seated is expected
• Often can't be involved in social activities quietly

Typical symptoms of impulsivity in youth include:
• Acting rashly or suddenly without thinking first
• Blurting out answers before questions are fully asked
• Having a difficult time awaiting a turn
• Often interrupting others' conversations or activities
• Poor judgment or decisions in social situations, which result in the child not being accepted by his/her own peer group.

Typical symptoms of inattention in youth include:
• Not paying attention to details or makes careless mistakes
• Having trouble staying focused and being easily distracted
• Appearing not to listen when spoken to
• Often forgetful in daily activities
• Having trouble staying organized, planning ahead, and finishing projects
• Losing or misplacing homework, books, toys, or other items
• Not seeming to listen when directly spoken to
• Not following instructions and failing to finish activities, schoolwork,
chores or duties in the workplace
• Avoiding or disliking tasks that require ongoing mental effort or
concentration

Of the four ADHD subcategories, Hyperactive-Impulsive Type is the most distinguishable, recognizable, and the easiest to diagnose. The hyperactive and impulsive symptoms are behaviorally manifested in the various environments in which a child interacts: i.e., at home, with friends, at school, and/or during extracurricular or athletic activities. Because of the hyperactive and impulsive traits of this subcategory, these children naturally arouse the attention (often negative) of those around them. Compared to children without ADHD, they are more difficult to instruct, teach, coach, and with whom to communicate. Additionally, they are prone to be disruptive, seemingly oppositional, reckless, accident prone, and are socially underdeveloped.

Parents of ADHD youth often report frustration, anger, and emotional depletion because of their child’s inattention, impulsivity, and hyperactivity. By the time they receive professional services many parents of ADHD children describe complex feelings of anger, fear, desperation, and guilt. Their multiple “failures” at trying to get their children to focus, pay attention, and to follow through with directions, responsibilities, and assignments have resulted in feelings of hopelessness and desperation. These parents often report feeling guilty over their resentment, loss of patience, and reactive discipline style. Both psychotherapists and psychiatrists have worked with parents of ADHD youth who "joke" by saying "if someone doesn't help my child, give me some medication!"

The following statistics (Dr. Russel Barkley and Dr. Tim Willens) illustrate the far reaching implications of ADHD in youth.
• ADHD has a childhood rate of occurrence of 6-8%, with the illness continuing
into adolescence for 75% of the patients, and with 50% of cases persisting into
adulthood.
• Boys are diagnosed with ADHD 3 times more often than girls.
• Emotional development in children with ADHD is 30% slower than in their non-ADHD peers.
• 65% of children with ADHD exhibit problems in defiance or problems with authority figures. This can include verbal hostility and temper tantrums.
• Teenagers with ADHD have almost four times as many traffic citations as non ADD/ADHD drivers. They have four times as many car accidents and are seven times more likely to have a second accident.
• 21% of teens with ADHD skip school on a regular basis, and 35% drop out of school before finishing high school.
• 45% of children with ADHD have been suspended from school at least once.
• 30% of children with ADHD have repeated a year of school.
• Youth treated with medication have a six fold less chance of developing a substance abuse disorder through adolescence.
• The juvenile justice system is composed of 75% of kids with undiagnosed learning disabilities, including ADHD.

ADHD is a genetically transmitted disorder. Research funded by the National Institute of Medical Health (NIMH) and the U.S. Public Health Service (PHS) have shown clear evidence that ADHD runs in families. According to recent research, over 25% of first-degree relatives of the families of ADHD children also have ADHD. Other research indicates that 80% of adults with ADHD have at least one child with ADHD and 52% have two or more children with ADHD. The hereditary link of ADHD has important treatment implications because other children in a family may also have ADHD. Moreover, there is a distinct possibility that the parents also may have ADHD. Of course, matters get complicated when parents with undiagnosed ADHD have problems with their ADHD child. Therefore, it is crucial to evaluate a family occurrence of ADHD, when assessing an ADHD in youth.

Diagnosing Attention Deficit Disorder Inattentive Type in youth is no easy task. More harm than good is done when a person is incorrectly diagnosed. A wrong diagnosis may lead to unnecessary treatment, i.e., a prescription for ADHD medication and/or unnecessary psychological, behavioral and/or educational services. Unnecessary treatment like ADHD medication may be emotionally and physically harmful. Conversely, when an individual is correctly diagnosed and subsequently treated for ADHD, the potential for dramatic life changes are limitless.

Psychologists, Clinical Social Workers, Licensed Clinical Professional Counselors, Neurologists, Psychiatrists, and Pediatricians/Family Physicians can diagnose ADHD. Only physicians (M.D. or D.O.), nurse practitioners, and physician assistants (P.A.) under the supervision of a physician can prescribe medication. However, psychiatrists, because of their training and expertise in mental health disorders, are the best qualified to prescribe ADHD medication.

While the ADHD Hyperactive Type youth are easily noticed, those with ADHD Inattentive Type are prone to be misdiagnosed or, worse, do not even get noticed. Moreover, ADHD Inattentive Type youth are often mislabeled, misunderstood, and even blamed for a disorder over which they have no control. Because ADHD Inattentive Type manifests more internally and less behaviorally, these youth are not as frequently flagged by potential treatment providers. Therefore, these youth often do not receive potentially life-enhancing treatment, i.e., psychotherapy, school counseling/coaching, educational services, and/or medical/psychiatric services. Unfortunately, many “fall between the cracks” of the social service, mental health, juvenile justice, and educational systems.

Youth with unrecognized and untreated ADHD may develop into adults with poor self concepts low self esteem, associated emotional, educational, and employment problems. According to reliable statistics, adults with unrecognized and/or untreated ADHD are more prone to develop alcohol and drug problems. It is common for adolescents and adults with ADHD to attempt to soothe or “self medicate” themselves by using addictive substances such as alcohol, marijuana, narcotics, tranquilizers, nicotine, cocaine and illegally prescribed or street amphetamines (stimulants).

There is no "cure" for ADHD. Children with the disorder seldom outgrow it.
Approximately 60% of people who had ADHD symptoms as a child continue to have symptoms as adults. And only 1 in 4 of adults with ADHD was diagnosed in childhood—and even fewer are treated. Thanks to increased public awareness and the pharmaceutical corporations’ marketing of their medications, more adults are now seeking help for ADHD. However, many of these adults who were not treated as children, carry emotional, educational, personal, and occupational “scars.” As children, these individuals, did not feel “as smart, successful and/or likable” as their non ADHD counterparts. With no one to explain why they struggled at home, with friends, and in school, they naturally turned inward to explain their deficiencies. Eventually they internalize the negative messages about themselves, thereby creating fewer opportunities for success as adults.

Similarly to youths, adults with ADHD have serious problems with concentration or paying attention, or are overactive (hyperactive) in one or more areas of living. Some of the most common problems include:
• Problems with jobs or careers; losing or quitting jobs frequently
• Problems doing as well as you should at work or in school
• Problems with day-to-day tasks such as doing household chores, paying bills, and organizing things
• Problems with relationships because you forget important things, can't finish tasks, or get upset over little things
• Ongoing stress and worry because you don't meet goals and responsibilities
• Ongoing, strong feelings of frustration, guilt, or blame

According to Adult ADHD research:
• ADHD may affect 30% of people who had ADHD in childhood.
• ADHD does not develop in adulthood. Only those who have had the disorder since early childhood really suffer from ADHD.
• A key criterion of ADHD in adults is "disinhibition"--the inability to stop acting on impulse. Hyperactivity is much less likely to be a symptom of the disorder in adulthood.
• Adults with ADHD tend to forget appointments and are frequently socially
inappropriate--making rude or insulting remarks--and are disorganized.
• They find prioritizing difficult.
• Adults with ADHD find it difficult to form lasting relationships.
• Adults with ADHD have problems with short-term memory.
• Almost all people with ADHD suffer other psychological problems-particularly depression and substance abuse.

While there is not a consensus as to the cause of ADHD, there is a general agreement within the medical and mental health communities that it is biological in nature. Some common explanations for ADHD include: chemical imbalance in the brain, nutritional deficiencies, early head trauma/brain injury, or impediments to normal brain development (i.e. the use of cigarettes and alcohol during pregnancy). ADHD may also be caused by brain dysfunction or neurological impairment. Dysfunction in the areas in the frontal lobes, basal ganglia, and cerebellum may negatively impact regulation of behavior, inhibition, short-term memory, planning, self-monitoring, verbal regulation, motor control, and emotional regulation.

Because successful treatment of this disorder can have profound positive emotional, social, and family outcomes, an accurate diagnosis is tremendously important. Requirements to diagnose ADHD include: professional education (graduate and post graduate), ongoing training, supervision, experience, and licensure. Even with the essential professional qualifications, collaboration and input from current or former psychotherapists, parents, teachers, school staff, medical practitioners and/or psychiatrists creates more reliable and accurate diagnoses. The value of collaboration cannot be understated.

Sound ethical practice compels clinicians to provide the least restrictive and least risky form of therapy/treatment to youth with ADHD. Medication or intensive psycho-therapeutic services should only be provided when the client would not favorably respond to less invasive treatment approaches. Therefore, it is crucial to determine whether “functional impairment” is or is not present. Clients who are functionally impaired will fail to be successful in their environment without specialized assistance, services, and/or psycho-therapeutic or medical treatment. Once functional impairment is established, then it is the job of the treatment team to collaborate on the most effective method of treatment.

All too often, a person is mistakenly diagnosed with ADHD, not due to attention deficit issues, but rather because of their unique personality, learning style, emotional make-up, energy and activity levels, and other psycho-social factors that better explain their problematic behaviors. A misdiagnosis could also be related to other mental or emotional conditions (discussed next), a life circumstance including a parent’s unemployment, divorce, family dysfunction, or medical conditions. In a small but significant number of cases, this diagnosis of ADHD better represents an adult’s need to manage a challenging, willful and oppositional child, who even with these problems may not have ADHD.

It is critical that before an ADHD diagnosis is reached (especially before medication is prescribed), that a clinician consider if other coexisting mental or medical disorders may be responsible for the hyperactive, impulsive, and/or inattentive symptoms. Because other disorders share similar symptoms with ADHD, it is necessary to consider the probability of one mental/psychological disorder over that of another that could possibly account for a client’s symptoms. For example, Generalized Anxiety Disorder and Major Depression share the symptoms of disorganization, lack of concentration, and work completion issues. A trained and qualified ADHD specialist will consider differential diagnoses in order to arrive at the most logical and clinically sound diagnosis. Typical disorders to be ruled out include: Generalized Anxiety, Major Depression, Post Traumatic Stress Disorder, and Substance Abuse Disorders. Additionally, medical explanations should be similarly sought: sleep disorders, nutritional deficiencies, hearing impairment, and others.

When a non-medical practitioner formally diagnoses a client with ADHD, i.e. a licensed psychotherapist, it is recommended that a second opinion (or confirmation of the diagnosis) be sought from a psychiatrist. Psychiatrists are medical practitioners who specialize in the medical side of mental disorders. Psychiatrists are able to prescribe medicine that may be necessary to treat ADHD. In collaboration, the parents, school personnel, the referring psychotherapist, and the psychiatrist, will monitor the effectiveness of the medical component of the ADHD treatment.

In summary, ADHD is a mental health and medical disorder that has become increasingly more accepted and consequently treated more effectively. To achieve high professional assessment, diagnostic, educational, and treatment standards, it is important that trained and qualified practitioners understands the multidimensional aspects of ADHD: history, diagnosis, statistics, etiology, and treatment. Training, experience, a keen interest for details, a solid foundation of information, and a system of collaboration creates the potential for positive outcomes in the treatment of ADHD.


References
1. Genetic factors, not necessarily sex of child, influence ADHD by Jim Dryden
http://record.wustl.edu/archive/1999/04-15-99/articles/ADHD.html
2. What are the risk factors and causes of Attention Deficit Hyperactivity
Disorder
http://www.adhdissues.com/ms/guides/adhd_risk_factors/main.html
3. What Causes ADHD?
http://add.about.com/od/adhdthebasics/a/causes.htm
4. History of ADHD by Keith Londrie
http://EzineArticles.com/?expert=Keith_Londrie
5. Taking Charge of ADHD, Dr. Russell Barkley
http://www.healthcentral.com/adhd/c/1443/13716/addadhd-statistics/
6. ADHD Facts by Dr. B, Murray, Ph.D.
http://www.upliftprogram.com/bob_murray.html
7. Cause ADHD
http://www.myadhd.com/causesofadhd.html
8. ADHD.org.nz (New Zealand ADHD Support GroupP
http://www.adhd.org.nz/cause1.html
9. Understanding the Causes of ADHD Keath Low, About.com
http://add.about.com/od/adhdthebasics/a/causes.htm
10. Interventions for ADHD: Treatment in Developmental Context By Phyllis Anne Teeter 1988
11. Diagnosis of AD/HD in Adults
National Resource Center on AD/HD Children and Adults with Attention-Deficit/Hyperactivity Disorder
http://www.help4adhd.org/en/treatment/guides/WWK9S
12. Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 2005 Jun;62(6):617-27.
13. The Numbers Count: Mental Disorders in America
The National Institute of Mental Health Website
http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america/index.shtml#KesslerPrevalence
14. Historical Development of ADHD Margaret Austin, Ph.D., Natalie Staats Reiss, Ph.D., and Laura Burgdorf, Ph.D.
http://resources.atcmhmr.com/poc/view_doc.php?type=doc&id=13848
15. ADHD, Alcoholism and Other Addictions by Wendy Richardson, M.A., LMFCC
Soquel, CA—1998
http://www.addresources.org/article_adhd_addictions_richardson.php
15. National Institutes of Neurological Disorders and Stroke
NINDS Attention Deficit-Hyperactivity Disorder Information Page
http://www.ninds.nih.gov/disorders/adhd/adhd.htm