ODD & Oppositional Rising

Small Blessings

Fortunately, most of us with ADD do NOT have full-blown, comorbid, diagnositic ODD – Oppositional Defiant Disorder – a protracted “terrible twos,” on steroids!  

Almost ALL of us, howeverADD or not, have a small – perfectly “normal” – part of our personalities that balks unless the task is totally appealing in the moment we are “supposed” to take it on.

Part of developmental maturity is learning how to “postpone gratification” and work with what some therapists and self-help gurus call “the self-saboteur.”  (I prefer to think of it as “learning how to bribe our Inner Three-Year olds.”)  

In any case, and for whatever reason, those of us who qualify for an ADD diagnosis, even those who aren’t particularly impulsive otherwise, seem to struggle with “postponing gratification” more than the neurotypical population: sort of like having “ODD Rising.”

ABOUT ODD Rising

“ODD Rising” and “Oppositional Rising” are my terms for what I refer to as “a high oppositional piece” in an ADD symptom profile.  ODD rising is significantly below the diagnostic threshhold for ODD, yet severe enough to make us feel a little crazy as we wonder what it is, exactly, that is stopping us from achievement commensurate with our level of intelligence or education.

I keep up with the ODD field, as I keep a keen eye on all of the ADD Comorbid diagnoses, but ODD itself is not my speciality. 

My focus is applying what I learn from related disorders to help those with Attentional Spectrum Disorders work with whatever it is that is going on with them: learning to drive their very own brains.

AFTER I offer a brief introduction to diagnostic ODD, the remainder of this article will introduce the “oppositional piece” concept. I will revisit ODD in future articles exploring ADD comorbidities — conditions that frequently accompany an ADD diagnosis, to a statistically significant degree more often than in the neurotypical population.

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ABOUT ADD Comorbidities

Link dense – links become obvious on mouse-over

Cormorbid or Co-occuring?

Wait!  Doesn’t comorbid mean
co-occuring?

Not exactly. Comorbidity refers to a specific KIND of “co-occurance.”

A comorbid disorder refers to additional conditions or syndromes or disorders frequently found in a specific diagnostic population.

In other words, we’re talking about accompanying conditions that are not part of the diagnostic criteria for the “main” condition, but are frequently seen in that particular population of individuals.

From a behavioral standpoint, these additional conditions occur sometimes with similar or overlapping symptoms, and sometimes they show up with additional symptoms – those not necessarily seen in those with the original or “base” diagnosis.

The overlap may reflect a causal relationship between the two diagnoses, and they may relect an underlying vulnerability in common, but the important concept is that they co-occur more frequently in our “target population” than in population norms otherwise, and to a statistically significant degree.

So, even if an entire hotel full of ADDers happens to be diabetic as well, we still would not say their diagnosis was ADD with comorbid diabetes, because the two conditions haven’t been proven to occur in tandem any more frequently than the incidence of diabetes in the general (non-ADD or “vanilla”) population.

So, in this example, the two conditions are co-occuring, NOT comorbid, even though it may not look that way to anyone staying in this particular hotel!

Muddying the waters further, the statistics change depending on which end of the diagnostic telescope you look through. For example, up to 60% percent of children with tic disorders also have ADD, but nowhere near 60% of ADDers have tic disorders.

The high possibility of comorbidities is yet another good reason to make sure you get an excellent differential diagnosis – but the articles in the Comorbidities Series are going to look at some of the diagnoses that frequenly hitch-hike along with ADD through another lens: SUCCESS!

Developing person-specific work-arounds and interventions to help you achieve that blessed state of Optimal Functioning that I believe is our birthright comes through the identifying, understanding, and learning to work with and work around ALL of the “mix-ins” in your particular flavor of ADD.

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Alphabet Soup

EFD, ADD, ADHD, HRT, MBD – WTF?

Hold onto your hats everybody, there is discussion afoot toward yet another renaming of ADD – and the front-runner seems to be (at the moment, at least), EFD.

I wouldn’t block consensus on EFD.

However, as illuminated in an earlier article on this site [ADD - What's in a Name?], I don’t have a problem with the acronym “ADD” – as long as we focus on the disorder of THE ATTENDING MECHANISM and the Dynamics of Attending.

In other words, the essential point, for me, is that, for whatever reason, ADD is an impairment in the extent of one’s ability to pay attention, STOP paying attention, and/or to get back on track after an interruption or distraction.

  1. Focusing on the intended object;
  2. Sustaining the focus;
  3. Shifting focus AT WILL

Underlying each of the Dynamics is the same impaired element of cognition common to all of the Executive Functioning Disorders: VOLITION.

That’s INTENTIONALITY, boys and girls – being able to drive your own brain and run your own life, rather than being at the effect of chronic oopses and mishaps.

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Are you OUT of your MIND?

Reframing to Rewire (First in a series)

Most of us take that “Are you out of your mind?” question to mean that we’ve just said or done something NUTS.  I want to stand that idea on its ear.

A bowl of spaghetti looks twisted and tangled,...

Image via Wikipedia

I think it would be FAR more powerful to use that phrase as a reminder to do exactly that: to GET out of our minds.

To “get out of our reactionary mind” so that we can align our actions with our intentions is more what I had in my mind, so let’s explore how we might begin to DO that.

For those of us with Executive Functioning Dysregulation, following one idea to completion is frequently an exercise in frustration and failure.

Metaphorically, our brains are rather like a tangle of string-like dendritic connections resembling a plate of cooked spaghetti.  

About the only way we can locate both ends of a single strand of spaghetti on a dinner plate is to lift it up out of the plate and away from the rest of the tangle.

After twenty plus years of investigating ADD and working with ADDers, I’ve come to believe that “getting it up and out of the plate for closer observation” is the most successful way to locate both “ends” of a single train of thought as well.

When that single-thought strand is left tangled with the other strands, ADDers in particular can become like Alice in Wonderland clones, looping around relatively aimlessly and getting ourselves into all sorts of odd predicaments

Lifting that strand of spaghetti away from its tangle successfully is where the mere presence of another person makes all the difference in the world: an ADD-literate mentor, coach, or non-judgmental friend who can reframe our challenges simply by virtue of the fact that, from their vantage point, things don’t look so convoluted.

(More to come about that concept in a later post in this series)

Movin’ ON to the Rewiring

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The ADD-ADHD Coachablity Index™

ADD Coachability

In early 1994, to better suit the needs and reflect the brain-based realities of individuals with Attention Deficit Disorder, Madelyn Griffith-Haynie requested and received permission from Thomas J. Leonard to adapt the Coachability Index© that he developed for Coach-U.

The language of The ADD Coachability Index™ reflects the impact of the challenges of Executive Functioning Disorders on learning and accomplishment: brain-based struggles with short-term memory deficits, focus & decision-making, planning & follow-through, sequencing & prioritizing; activation & motivation, mood lability, time-sense & transition-facility chief among them.

©Adaptions and/or duplication must credit both parties

How Coachable are YOU?

Although the magic of ADD Coaching is a product of the
coaching relationship and it’s ability to compensate for
unreliable executive functioning, it only works if and when
clients are ready, willing and able.

Are you READY and WILLING:

  • to take the actions that will be necessary?
  • to make the changes that will be necessary?
  • to step,  with power and ownership, into the life you were destined to live?

Heck yea!  Seriously, who says no to that?
Certainly not an ADDer! We’re always ready (for that last one, anyway)

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Brain-based Coaching Paradigms

Underlying Assumptions Keeping us Stuck

Each Professional Coach has an way of looking at life and at coaching that shapes his or her particular approach and determines the way they coach.

I personally believe that it is impossible
to make lasting changes
that are nothing more than reactions to shame
.

Shame is a lousy “motivator” that we’ve somehow come to believe will keep the “lawless” on the straight and narrow.

MAYBE – if “on the straight and narrow” means “behind the eight ball!”

Shame’s Genesis

After 20 years of coaching ADDers, I have observed that shame is actually the internalization of  repeated “evidence of failure” after years of struggling to incorporate the implications of ADD with the well-meaning “support” of people who didn’t really understand the pragmatics of Executive Functioning dysregulation: what moves things forward and what makes things worse.

Whatever the rationale behind saying them, variations of comments like the ones below not only make it more difficult to live up to expectations, they encourage a black and white belief that we are fundamentally inadequate and always will be.

  • You HAVE to get organized — why don’t you write things down!?
  • Anyone with your intelligence should be doing better! 
  • You could if you wanted to badly enough and put the effort in.
  • You don’t listen! You aren’t really trying. 
  • You MUST take responsibility for your own life!

Our “helpers” need to understand that attempts to MOTIVATE us to make better choices in any fashion will never work – because 90% of our chronic oopses are not the result of a “failure of WILL.”  They aren’t even “choices” at all, unless you want to use the term “choice” to hold us accountable for unconscious assumptions underlying our actions.

We don’t need to be motivated to make better choices, we need to be coached and mentored to learn how to MAKE and ACTUATE choices at all.  And that absolutely must begin with an examination of The User’s Manual for the ADD Brain!

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Got Memory? – Part I

Memory, Aging and ADD
See also: Senior Moments? – The Heartbreak of CRS

My sleep disorder has me out of phase with the rest of America again.  Bummer!

Since, of late, I seem to be asleep when the rest of America is up and at’em, awake when it seems that all the world’s aslumber, there’s not much to distract me from reading and research – so I’ve been reading a lot lately!

One of the few good things about Living with JetLag™ is that there are periods of time when I can do little else but dive into books I have been too busy to read while I scrambled to catch up with everything missed “off-phase” during those precious times when I am “on-phase” with the rest of you earthlings.

A number of books have come out in the past few years exploring what happens to our brains as we age. Several are exploring “normal” changes, others are looking at brain disorders that seem to strike at middle-age, most notably Alzheimers.

Other than mentioning the link between aging and sleep struggles, which I will explore in another series of posts, the primary focus of most of the books I’m currently ingesting concerns the processes of memory: what happens when they work as expected, and what happens when they don’t.

Two I just finished are:

  • Barbara Strauch’s The Secret Life of the Grown-up Brain
  • Cathryn Jakobson Ramin’s Carved in Sand
    - when attention fails and memory fades in midlife
The timing seems suddenly right for a series of articles on memory and ADD, but before I get into the details, I need to get something off my chest.

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ABOUT Activation

Activation – Inertia’s Handmaiden


Activation struggles
are a common occurance in the ADD population.


What’s going on when we wait until the last minute to begin something we’ve know about for months?  

What is it about the last minute rush that busts a desperate case of  “I just can’t make myself” w-i-d-e open, uncovering a secret activator that we couldn’t, for the life of us, locate the day before?

Closely related both to motivation deficit, and  under-arousal, insufficient activation  is usually misidentified, mislabeled, and totally misunderstood.

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Differential Diagnosis – Part 2

Archery target with arrow in center of bullseye

Differential DiagnosisWhat is it?

– and why would I care?

To answer the first part of the question, click on “What is it” (above) and read the first part of this article.

Click the link at the end of THAT article to come back here to read why you really need to care.

The answer to the second part?

In a nutshell: as with everything else in life,
“The Name of the Game™ determines the rules!”

If you don’t have the correct diagnosis, there is NO WAY you will be addressing your problems in a manner that will be successful.

Pretend you are a former college marathon runner in his late 30′s.  Lately you’re having problems completing your morning run.  You can barely breathe after about ten minutes of what used to be an easy warm-up.

Obviously, you’d be headed for trouble if you were treated with asthma medication and the source of your shortness of breath turned out to be a problem with your heart.

Since you aren’t sure what’s going on, you’d want to feel confident that your doctor knows enough about “shortness of breath” conditions to make a referral to the correct specialist, even if your particular doctor specializes in sports medicine, right?

When you’re dealing with a differential diagnosis that has few quantifiable measures to identify it, it becomes all the more important to work with a doctor who has the depth of knowledge it may take to distinguish between a daunting number of possibilities with similar presentations — yet very different treatments.

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Symptoms of Attentional Struggles

Part 4 in the Intentional Attending series of posts – As I said in Part 3 (The Dynamics of Attending), one of the goals of ADD Coaching is to identify areas where our clients can improve on the intentional direction of attentive awareness.
—————————————————————————————————————————————— 

A man n a white lab coat stands behind a counter staring at beakers of various colored liquids, a bit dazed andperplexed

Dynamic Difficulties

Problems with any or all phases of The Dynamics of Attending are at the very heart of the ADD characteristics.

That is why many ADDers struggle to have much of a life beyond the all-too-familiar “mess it up, clean it up” cycle.

ADDers typically have impairments in at least one of the Dynamics, often all three in combination, which dominoes into problems with the  registrationlinking and retrieval stages of the memory process.

However, every single person living
has problems with each of the Dynamics of Attending
in some situations at some times –
which means they struggle with:
#1  - Focusing on the Intended Object 
and/or
#2  - 
Sustaining the Focus, and/or
#3  - Shifting Focus at Will

A few of the ways those occasional “mind blips” show up in our behavior provide very funny stories - afterwards. Unfortunately, some of them (or too many of them) lead others to conclude that we are not reliable and can’t be trusted — and to lead us to doubt our own talents and abilities as well.

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The Dynamics of Attending

Part 3 in the Intentional Attending Series of Posts – As I said in Part 2, Brain Waves, Scans and ATTENTION –  One of the goals of ADD Coaching is to identify areas where our clients can improve on the intentional direction of attentive awareness.

The ADDCoach.com™ Favorite Model of Attention

A small man in the foreground watches fearfully while a larger one in the background juggles planets, both in the clouds, surrounded by worlds.Problems Juggling the Elements of our Worlds

Similar to Sylwester’s three-part model of attention (described in the prior article of the Intentional Intending Series of posts), I, too, favor a three-part portioning of the attentional pie.

I have found it more useful from an ADD Coaching perspective to focus my own study and observation of attention on the tasks involved in three “sub-domains” of a particular area of  the Sohlberg/Mateer model: selective attention.

I refer to these three domains or sub-divisions, collectively, as

The Dynamics of Attending:

    1. Focusing on the Intended Object
    2. Sustaining the Focus
    3. Shifting Focus at will

Underlying each of the Dynamics is the same impaired element of cognition common to all of the Executive Functioning Disorders: VOLITION.

Read more of this post

Brain Waves, Scans and ATTENTION

Part 2 in the Intentional Attending Series of Posts –
As I said in Part 1, The Link Between Attention and ACTION, before I can explain what you need to DO to be intentional with attention, I need to explain a little more about the relationship between memory and attention – and before I can do THAT, we need to come to an agreement about the meaning of this “Attention” term! 

Brain Waves and Vibrational Frequencies

Drawing of a screen of medical monitor showing the up-down lines that indicate the functioning of what they are monitoring

ALL changes in attention and focus produce a variety of specific patterns in the brain.  These patterns can be recorded using technologies developed and refined since the 1990s, the ten year period that was declared The Decade of The Brain

Whenever our state of awareness and concentration changes,
brain waves change vibrational frequenc
y

A neurofeedback practitioner, for example, can tell by looking at an EEG read-out whether a person hooked up to a special computer is asleep or awake, strongly focused or daydreaming.

The REST of this article will help you understand how measuring brain waves relates to attention and what’s involved in becoming INTENTIONAL with your ATTENDING.

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TYPES of Attentional Deficits

Drawing of a brown-skinned man in a hat, walking through a shallow body of water, cat-tails growing in the background. He is about to be surprised by a crocodile because 100% of his attention is on a book in front of his face: Safety Tips.Attentional Deficits: Three Biggies

While ALL attentional deficits are, strictly speaking, neurological events – meaning that they are marked by changes in the pattern of brain waves and the location of area doing the work – it is useful to think about them in three separate categories:

  1. Physical
  2. Neurological
  3. Situational

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What ARE Executive Functions?

Part 2 in a Series (click HERE for Part 1graphic image of lady in formal dress and long gloves

What the heck ARE Executive Functions ANYWAY?

Well, that all depends on who you ask!

While there is certainly a consensus that executive systems are involved in handling situations outside the domains of most of the processes of the body (whether ‘automatic’ or something under our conscious control) – and while there is very little disagreement that executive processes are not controlled by the same processes that produce our emotional reactions –
the exact nature of executive control is difficult to pin down and articulate.

Until science discovers more about the neuro-chemical, bio-electric  processes underlying brain function, all anybody can really do is attempt to describe them based on how and where they work - or don’t!

Try to describe the elements that combine to allow an orchestra to create beautiful music . . .

Orchestra on stage to illustrate Executive Functioning concept . . . see the problem?

You can’t really say much about it until you know what kind of music the orchestra is trying to make beautiful.

AND . . .

as challenging as it would be to come up with a list of ALL of the kinds of music any orchestra might play . . . it’s not a whole lot easier to agree even upon a set of categories into which all the factors could be be sorted.

So it is with the executive functions . . . which will never stop science from TRYING to categorize! 

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ABOUT Executive Functions

graphic image of lady in formal dress and long glovesExecutive Functions

Sorry, no trophy wife gets a new gown for these functions.  Execs, you’re off the hook too; no need to get the tux cleaned.

We’re referring to cognitive abilities that most adults take for granted as products of intelligence, education and maturity – like planning, problem solving, concentration, mental flexibility, and controlling short-term behavior to achieve long-term goals.

If that list of mental abilities looks a tad familiar, it’s because it is incredibly similar to a list of traits with which those of us with Attentional Spectrum Disorders experience big-time problems!

Sound like your experience with ADD?  Oh yeah! ADD is a front-runner in the Executive Functioning Disorders relay race. Read more of this post

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