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Mindfulness

Categories: 2011, June

Mindfulness and Managing ADHD

by Mark Bertin, MD


EDITOR'S NOTE:
Mark Bertin, MD, aims to clarify what the science says about the biology and management of ADHD and to introduce ways the practice of mindfulness can help those facing its challenges. The first section of this feature article is an excerpt from his new book, The Family ADHD Solution (New York: Palgrave Macmillan, 2011). In the second section, Dr. Bertin continues with a discussion exclusive to Attention magazine.

Image"I felt like a complete failure as a parent. I tried sticker charts and time outs and yelling and not yelling. And still Charlie wouldn’t listen. I’d explain all the rules before going to the playground, and I’d turn around and he’d push someone again. It didn’t make any sense. I was sure I was doing something completely wrong."

The myth of perfect

THERE IS NO PERFECT STEP-BY-STEP GUIDE BOOK ON HOW TO RAISE A CHILD, so instead we’re left on our own to sort through the conflicting advice we encounter in the world. When a child has ADHD, the stakes for parents are raised. Where one child might respond to a quick reprimand, a child with ADHD turns around and throws sand again and again. Bumps in the academic road persist and become mountains, exhausting in scale. Instead of a single bad grade or a passing fight with a friend, children with ADHD encounter chronic academic failure, or struggle to maintain friendships.

Unsurprisingly, parents of children with ADHD carry more anxiety and a higher risk of depression. They report feeling burdened by the decisions they face around behavioral, educational, and medical decisions. Their marriages are strained—couples affected by ADHD are more likely to end up divorced.

Extended families and people in the community may often seem judgmental. They might assume a parent could control their child’s behavior if only they tried harder, or made better choices. Stories on television or in magazines raise doubts that biologically driven behavioral problems like ADHD exist. The politics of child development breed uncertainty in parents, leaving them adrift and taxing their sense of control.

Dealing with ADHD, you may wonder why life has to be so complicated. It may be immensely frustrating to observe your child repeating his self-destructive behavior. You know, for sure, that if he could stop standing so close to his peers, or stop knocking over their toys, he would get along better. But the situation is equally frustrating for your child. It’s not like he wandered up to the sand box thinking, “How can I alienate everyone, all at once?” However unskilled his approach may seem, he’s trying to find peace of mind, just like you are.

Reading this, you might think to yourself, “I’ve been doing it wrong.” Or you might find yourself comparing all the advice that follows here to what you have done in the past. When you started your family, you may have had a picture of what everything would be like. You may have expected that your family members would act in a certain way, or that by working hard you and your kids would succeed all the time. Most of us recognize this inner voice that escalates our fear that we’re not parenting “the right way.”

There may be times in life when “perfect” makes sense. Driving somewhere, we want to take the right route, make the right turns, and get there. But despite our best intentions, we will, at some point, get absolutely and completely lost. How do we respond emotionally when we make a wrong turn? How can we separate our emotions from the fact that we messed up?

Most of life is not like driving, it’s like baseball. The best hitters bat .300. Seven out of ten times they are out. They practice and refine, strive to improve—but never get much above .300. How long would a player last who eviscerated himself after each strikeout? Not someone who was angry for a moment, or miserable after striking out with the bases loaded, but who truly assaulted himself? How long would a player last who, overwhelmed, stopped practicing at all? Welcome to parenting—you can expect to bat 1.000, and neither can your children. Perfection is not the goal.

Taking the first step

A broad approach to ADHD starts with a proactive plan to address the most obvious ADHD symptoms, and then continues much further. It helps children build self-esteem and healthy relationships with parents and peers. It helps you manage your own stress because under stress, none of us acts at our best. It helps you examine your actions and cultivate skills that lead you and your children to be adaptable and resilient. You cannot erase your child’s medical condition, but you can make astute choices about what to do next, for your child and for your family.

Building your own strength and resilience as a parent benefits your entire family. When you feel on more solid ground, problem solving becomes more flexible. Destructive habits can be broken, and new options become apparent. Your perspective, and your parenting skills, can fundamentally change. With an all-consuming problem like your child’s ADHD, these life skills become even more important.

Over recent decades mainstream Western culture and health care have embraced the Eastern concept of “mindfulness” as a means of developing these abilities, separating it from spirituality or religion. Mindfulness is often described as living with full awareness of our moment-to-moment experience, without excessive judgment and bias. It comprises a skill set that helps us focus on life as it happens, instead of becoming lost in distracting fantasies of the future, rumination about the past, or emotional reactions that clutter our minds. Practicing mindfulness, we often discover a sense of inner strength and calm in the midst of storms that come and go in our lives.

We train ourselves to focus our attention where we want, away from mental distraction and onto the situation at hand. This skill can be developed through a type of meditation that is about little more than focused attention—our mind becomes lost in thought, and we bring it back. The art of mindfulness is noticing our mind wandering, and guiding it back to real life and to a sense of balance, without giving ourselves a hard time for having wandered off in the first place. We try our best, our thoughts drift off, and we think, of course I got distracted, that happens, and start over again, paying attention.

While our children come first in so many ways, it is important that we take care of ourselves as well. Our physical and mental health benefits them. When stressed, we easily fall into fixed, habitual ways of dealing with stress, limiting ourselves and how we interact with people around us, and perhaps not addressing problems as adeptly as we are capable. So in the face of all the challenges of parenting a child with ADHD, protecting whatever small nurturing moments you find for yourself helps your children.

The long-term goals never change—we all want our children to thrive and be independent and happy. In the short term, the most loving and supportive approach is to take an objective, clear-sighted look at a child’s skills and challenges right now, in this moment. From that starting point, an entirely new way of living with ADHD may begin.

 


The text above is excerpted from The Family ADHD Solution by Mark Bertin, MD. Copyright © 2011 by the author and reprinted by permission of Palgrave Macmillan, a division of Macmillan Publishers Ltd.

 


Mental habits and awareness

Beyond the complex challenges found in managing any chronic medical disorder, ADHD places intense demands on parents. Preconceived images of family life are redrawn. Our style of parenting, based on some combination of life experience and reasoned choice, perhaps hasn’t worked out quite as well as expected. School plans requiring effort and negotiation suddenly need revision—again. A decision for or against medication, inflamed by all the available information and misinformation we encounter, must be handled with as much calm and perspective as possible. Another carefully orchestrated play date ends in tears. Compassionate, effective ADHD care requires of parents a constant ability to adapt, to think flexibly, and to rally loads of patience.

That tall order is amplified further by one common reality: If we pay attention to where our thoughts go throughout the day, we’ll almost always discover that wherever we are, whatever we’re doing, we spend little time engaged in our moment-to-moment lives. Rushing from one place to the next, we barely notice the steps we’re taking in between, packing lunches and saying goodbye, distractedly greeting people as we race through our chores, zipping through our email while we think about dinner. Taking time to slow down, we decide to go for a walk, but then spend most of this ‘quiet time’ fantasizing about our next vacation, or rehashing something that went poorly at work, rather than catching a break. At any particular moment we’re likely to find ourselves lost in fantasies of the future, mulling over our past, or ruminating over problems we perceive in our lives.

Our mental habits affect how we live and how we feel. Adrift in a fog of thinking, planning, or worrying, we miss moments where we might simply relax or just enjoy an easier moment with our kids. Five minutes at the end of lunch could be a peaceful moment with a cup of tea, but instead we dwell over how to juggle the afternoon to-do list. We often react without reflecting, yelling even though in calmer times we’ve vowed to try something different. Or, maybe we fall back on some other ingrained habitual way of dealing with running behind, or children who don’t listen quickly enough, or fears that some crisis looms in the future.

Without effort these habits generally exist outside of our awareness, even though they drive so much of our behavior. When angry, we shut down. When our child doesn’t do her homework, we feel a need to push her harder. Maybe under stress we eat or we drink or feel a compulsion to exercise. We all have tendencies to behave a certain way when exhausted or overwhelmed, or when life feels out of our control. The practice of mindfulness addresses these habits, without asking much more of us than just to pay attention. There isn’t any need to believe in anything in particular, or to seek any religious or spiritual goal. Mindfulness is an effort to see our lives more clearly.

Learning and practicing mindfulness

Living mindfully means paying attention to life, right now, as we live it, while maintaining an open and honest perspective. Through mindfulness, we develop tools that build self-reliance and inner strength. Parents of children with ADHD are often stressed, struggling with decisionmaking. They may feel self-judgment, a belief that they aren’t cutting it as parents. They feel the judgment of those around them, a sense others are commenting on their parenting skills or treatment decisions. Why can’t you just get control of your son? Practicing mindfulness doesn’t ‘fix’ ADHD, but it uniquely supports parents and families under often staggering pressure and stress.

No matter if we practice mindfulness or not, our minds will keep working and making thoughts and running around. That’s what minds do, thankfully, as we negotiate all the choices and problems that arise. Through mindfulness, however, we often discover new possibilities from paying attention and recognizing that not every random idea or anxiety that pops into our mind is real or worth a response. As frustrated as I feel, yelling about her messy room hasn’t changed anything yet, and may not be the best choice right now.

Meditation is often part of programs that teach mindfulness. This style of meditation is accessible to anyone, as there’s no attempt to reach any particular mental or spiritual state of mind. We practice focusing our attention with patience, expecting that we’ll get distracted over and over again. Like training from scratch for a marathon we start with whatever our tendencies are and work from there. On the busiest day, even in the midst of minutes or hours of scattered thinking, pausing and returning to focus on a few breaths is meditation. Meditation is a way of training our ability to focus our attention where we want, away from distracting, anxiety-provoking thoughts, and all the layers we mentally add on to situations that complicate our lives.

We can’t still our minds any more than we can force ourselves to stop blinking. We would set ourselves up for frustration expecting either. Likewise, we shouldn’t aim to completely eliminate stress. Many of us have had the experience of sitting in a car with a driver who has too little concern for safety, too little fear about hurling a couple of tons of metal through city streets. A little stress keeps us safe. But when we let it take over our lives, stress has distinct psychological and medical consequences.

Likewise, we can’t force ourselves to relax any more than we can force ourselves to sleep. All we can do is set up a mental state that makes relaxation more likely to happen. I feel pressured to run around, to keep moving, to buy into the fears I’m feeling without reflection… and instead, I’m getting to pause for a few moments and recharge. Even when life seems overwhelming and pausing doesn’t lead to an instant feeling of relaxation, we practice breaking the mental cycle of always wanting to problem solve or do something every moment. Over time it becomes easier, and less stress follows.

Decades of research have proven that mindfulness augments psychological and physical health. Practicing mindfulness for around half an hour a day for only several weeks (or less in several studies) has been demonstrated to physically change the brain, to lower levels of stress hormones, and to increase our immune response. Positive genetic changes may even occur because of stress reduction.

Mindfulness isn’t a miracle cure, or a magic pill. Stress cannot be eliminated, but it can be managed. Problems will still exist. We’ll find things in life, people, jobs, and various situations that we like, and others we dislike. And still, building our own capacity to maintain a sense of balance, taking care of ourselves so we have the resources to pause and make clear decisions, over and over again, as often as needed, fundamentally changes how we live, and how our families grow.

ADHD is a real medical condition that has countless consequences for individuals and families alike. Mindfulness cannot cure ADHD, but it can build the strength for parents to define a new plan at home and stick to it. To weather storms as they arise, like disappointing report cards or social mishaps with their kids, or maybe another snide remark from a neighbor or relative. Mindfulness fosters clarity while wading through choices about school, about behavioral plans, and about medication. Life still happens, with ups and downs and everything in between, but perhaps with more joy and ease along the way.


 



ImageMINDFULNESS AND ADULT ADHD


Adults with ADHD often ask if mindfulness and mindfulness mediation will work for them.
They might imagine that to benefit they must aim to still their thoughts completely or to sit motionless for hours on end. Neither is true; mindfulness is meant for anyone. The goal isn’t to wrestle a busy mind into submission or to remain perfectly unmoving for half an hour. Rather, the goal is to pay attention to our experience in a way that allows us to see our own habits and tendencies more clearly.

Adults with ADHD may become less reactive and less stressed through the practice of mindfulness, as could anyone. Starting from wherever they are, they can develop an ability to attend to both their external and internal experience. Psychiatrist Lydia Zylowska and others have published research showing benefits for attention and executive function specifically with adult ADHD.

ADHD increases stress, anxiety, and strains relationships. Mindfulness has been shown to decrease stress and anxiety and to promote healthy relationships. Adults with ADHD have as much to gain as anyone through trying it out.



ImageBRING MINDFULNESS INTO YOUR LIFE

Here's a simple place to start bringing mindfulness into your life.

Three times a day for several weeks, pause and pay attention.
  Image  Pick easy times to remember, such as when you are about to leave the house, or when the kids get on the bus, or before each meal. Or, practice taking a brief break when the day starts feeling overwhelming or tense.

Take a minute to focus on several breaths.
  Image  Pay attention to the sensation of breathing, the physical movement of air passing through your nose or mouth, the rising and falling of your chest or belly, or whatever else is most apparent.
  Image  Notice whatever you think and feel at that moment without, for one minute, doing anything more than observing: I am rushed and my feet hurt. I am quiet and at peace now, but worried about tonight.
  Image  Count five or ten breaths, if you like. If you need you can take care of something when you're done; right now, just give your mind a moment to settle. Then, gathering your resources, deliberately choose what you will do next.

 


Mark Bertin, MD, is a pioneering developmental pediatrician in private practice in Pleasantville, New York and assistant professor of pediatrics at New York Medical College. He trains physicians, teachers, and psychologists in ADHD care and leads stress-reduction classes for parents. From 2003 to 2010, he was director of developmental pediatrics at the Westchester Institute for Human Development.
Opening section of this article, as indicated, is excerpted from The Family ADHD Solution by Mark Bertin, MD. Copyright © 2011 by the author and reprinted by permission of Palgrave Macmillan, a division of Macmillan Publishers Ltd.

This article appeared in the June 2011 issue of Attention magazine. Copyright © by CHADD, Children and Adults with Attention Deficit Hyperactivity Disorder. All rights reserved.

PHOTO CREDIT: PARKERDEEN/ISTOCK

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