What are the Real-Life Consequences of ADHD?

In my last blog, I  reviewed what ADHD (Attention Deficit Hyperactivity Disorder) actually is. I provided descriptions of executive functioning impairments and how they may show up. In this blog, I will focus on the very real academic, professional, social and relational consequences that can arise for people with undiagnosed and/or unmanaged ADHD. Although I only treat adults and do not see children in therapy, I think it’s very important for adults to understand how their experiences with ADHD during their childhood may have impacted them in various ways. 

Most school curriculums are not sufficient for building and supporting the executive functioning skills of someone with ADHD. Because impairments in executive functioning disrupt learning, this often leads to academic underachievement or failure.Children are often labeled as not “living up to potential”. They may not be advanced to the next grade in school and may drop out of high school or college.

Because information about ADHD is still new, and many parents and teachers don’t understand executive functioning impairments, they may offer suggestions that aren’t helpful, such as “just try harder” or assuming that a child is “lazy” or badly behaved.

This external shaming from parents and teachers often leads to internal feelings of shame about themselves that develops into a harsh inner critic. The combination of insufficient support around educational needs and internal shame can have a powerful psychological impact. Many of the adults who I see in therapy who have ADHD have long-held beliefs that they are lazy and unintelligent and often tie their self-worth to their level of productivity. This negative feedback from adults may be intensified for people of color, since words such as “lazy” and “stupid” have been used frequently as weapons of racism.

There are many documented psychosocial impacts of ADHD, including decreased earning potential, chronic unemployment or underemployment, increased divorce rate and increased likelihood of criminal justice involvement. Researchers found that high school graduates with ADHD earn about 17% less than their peers and that adults in general with ADHD may reach retirement with up to 75% lower net worth than adults without ADHD.Research finds that 30% of people with ADHD are likely to have chronic unemployment issues and 24% of people collecting long-term disability meet the criteria for ADHD. The divorce rate is nearly twice as high for people with ADHD and people with ADHD are two to three times more likely to be arrested, convicted and put into prison than people without ADHD. 

All of this may sound very discouraging. It’s important to remember that there are several forms of treatment for ADHD that can have a significant impact on management of symptoms, including medication and behavioral approaches supported by therapy or ADHD coaching. Appropriate diagnosis and intervention is critical. An important takeaway from this information is that ADHD is a set of symptoms, not a personality trait. WIthout treatment and appropriate support, it’s understandable that many do not thrive. 

If these experiences sound familiar to you, therapy can help. Schedule an appointment with me today to talk about next steps and receive the support you need. 

Written by: Kate Loewenstein, LCSW

Sources: 

Niederman, J. Providing Effective Therapy for Adult ADHD. Simple Practice Learning. https://learning.simplepractice.com/learn/course/providing-effective-therapy-for-adult-adhd/course/course-slides

Demystifying ADHD: What does it really mean?

You have probably heard the term ADHD (short for Attention Deficit Hyperactivity Disorder), but do you  understand what it actually means? Many of us may have heard the term used flippantly in casual conversation, i.e. “Oh, I totally have ADHD” when talking about getting distracted. However, ADHD is a real disorder that can have serious academic, professional, emotional and relational consequences.

In my experience as a therapist, I have worked with many clients who have ADHD. Some were diagnosed as a child and prescribed medication and some learned about their diagnosis as an adult after years of struggling with work and school. In my experience, few have received support identifying behavioral strategies to boost up and compensate for impairments in their executive functioning. 

So what is executive functioning, exactly?

At its core, ADHD is caused by impairments in our executive functioning.

Executive functions are a group of brain processes that allow individuals to regulate the way they interact with their environment. They are not the same as intelligence. Intelligence is the ability to understand concepts and how different concepts are related to one another. 

The neuroscience related to ADHD is complex and research is constantly developing. Because ADHD research is still in early stages, there is not yet an official list of executive functions that are agreed upon, but a list of 6 to 12 that scientists have identified.

Executive functions distinguish humans from other animals. In the presence of stimulus, our executive functions stop our automatic reactions and allow us to think about our next step. For example:

In the animal world: stimulus > response

Example: Food > eat

With executive functioning: Food > I will save this for later when I’m ready for a snack

Some examples of executive functions include (not an official or complete list):

1. Sustained attention- the ability to focus on an intended task, in spite of distractions, internal or external, for an effective duration of time

2. Working memory- the ability to hold information in awareness even while performing complex tasks

3. Response Inhibition- Also referred to as impulse control, self-control and delay of gratification. A response to a stimulus, where the response is inhibited. For example, the ability to think before you speak or act

4. Planning- Developing a well-thought-out strategy before starting a task.

5. Organization- Developing and maintaining a system to keep track of materials and plans

6. Task initiation- Being able to independently start tasks, i.e. sit down to begin studying

7. Time management- Being able to use time efficiently to complete tasks

8. Metacognition- Having self-awareness about our own thinking, knowing what we know and what we don’t know

9. Flexibility- Being able to adapt to change. That includes going with the flow when something doesn’t go our way and problem-solving to figure out a different strategy when plan A doesn’t work out.

10. Perseverance- The ability to keep working until the completion of a goal.

If you struggle with some of the  executive functions on this list, you may have ADHD. The first step to find out if this is an appropriate diagnosis for you is to set up an appointment for neuropsychological testing. If you are diagnosed with ADHD, there are many helpful interventions that may make your life easier, including medication, therapy and ADHD coaching. 

In my next blog, we will dive into the real life consequences of untreated and misunderstood ADHD and the many impacts that this can have on our academic and career achievement, self-concept, mental health and  relationships. 

If you are someone struggling with managing life with ADHD, I can help. Contact me today to schedule an appointment. 

Written by: Kate Loewenstein, LCSW

Sources:

Scully, K. 10 Executive Functioning Skills: The Ultimate Guide. Pathway 2 Success..https://www.thepathway2success.com/10-executive-functioning-skills-the-ultimate-guide/

Niederman, J. Providing Effective Therapy for Adult ADHD. Simple Practice Learning. https://learning.simplepractice.com/learn/course/providing-effective-therapy-for-adult-adhd/course/course-slides

Disorganized Attachment Style: What Does it Look Like?

In our last blog post, we introduced the disorganized attachment style and reviewed the causes. In this post, we will explore what disorganized attachment may look like and how it shows up in our behavior, according to Diane Poole Heller in her book The Power of Attachment. 

If you or someone you love has a disorganized attachment style, it’s likely that you may find your own behavior, or theirs, to be very confusing. Heller identifies these six presentations that may show up and offers helpful insight into what may be happening beneath the surface. 

1. Threat orientation- As a result of lack of safety and consistency in childhood, many people with a disorganized attachment style live in a constant state of hypervigilance, in which they are in high alert, bracing themselves for danger, either real or imagined. “Physiologically, when the parts of our brain that are associated with survival are activated in this way, we lose access to other parts of the brain that have to do with connecting with other people,” writes Heller. This may prevent development of strong interpersonal skills and make it difficult to develop healthy relationships with others. 

2. Self-absorption and controlling behaviors- Managing internal chaos and pain can require a lot of internal focus, often causing those with a disorganized attachment style to be self-absorbed. Many of us with this attachment style may also become very rigid in our own lives and controlling of others. This is an adaptation to regain control if something bad has happened to us when we were not in control, but it can be very problematic in relationships, as it threatens the autonomy of others. 

3. Lack of impulse control- Alternatively, people with a disorganized attachment style may often feel that they have very little control in life, particularly in terms of their emotions. Limited control over our emotions can lead to acting out, and occasionally may cause someone to be “overly aggressive, prone to violent outbursts, or chronically angry,” notes Heller. 

4. Ongoing sense of failure- When caregivers routinely use confusing communication and children do not have the tools and support that they need, they often develop a lack of self-worth and a belief that they are a failure. As a result, people with a disorganized attachment style are often reluctant to try new things, as they assume that they will fail.  This belief is further reinforced because when we are flooded with fear much of the time, concentration and problem-solving abilities are often impacted. 

5. Internal conflict and confusion- With disorganized attachment, two major biological drives are in constant conflict- we are driven to connect with others, but we are also programmed to avoid danger. Those with this type of attachment style find themselves in constant conflict, and this can often be very difficult for both themselves and  those close to them to understand. They may appear open to intimacy one moment, and then become triggered by fear and appear avoidant in the next. Much of the time, they may not have a conscious awareness of why this is occurring, and will not be able to provide an explanation. 

6. Overwhelm and the freeze response- When someone with a disorganized attachment style becomes overwhelmed with fear, they may have a freeze response. People who are in a state of freeze often experience high levels of fear, dissociation and immobility, and may even temporarily lose their ability to speak or hear. A person in this state may appear calm, but they are experiencing a high level of emotional arousal. Going into a freeze response is not a conscious decision, but an unconscious reaction to feeling threatened. 

Those with a disorganized attachment style are likely to have endured a childhood of neglect and abuse. These experiences cause deep wounds, but repair is possible. To learn more about your own attachment style and begin the process of healing, check out The Power of Attachment and make an appointment today.

Written by: Kate Loewenstein, LCSW

Understanding the Disorganized Attachment Style

Throughout this blog series, we have been exploring the various attachment styles identified by Diane Poole Heller in her book The Power of Attachment. Until now, the 3 styles of attachment that we have outlined- secure, ambivalent and avoidant- have been characterized by fairly predictable behavior patterns and perhaps may be somewhat clear to identify in ourselves and others. This next attachment style is much more complex. 

Disorganized attachment is just that- disorganized. It can be unpredictable, sometimes presenting as either ambivalent or avoidant attachment, or a combination of both. Disorganized attachment is developed as a result of having caregivers who were too scary too much of the time, often as a result of their own trauma history or abusive behavior. Children who are raised in this type of environment do not learn how to self-soothe or manage their own distress, often causing them to act out their emotions in ways that can be viewed as disruptive. 

When parents are a source of danger, children have nowhere to turn. It’s horribly sad, and it’s also very confusing on a physiological level. “In disorganized attachment, we have two biological instincts at odds with each other: We’re oriented toward survival, but we also need our caregivers to help us with that. The attachment system is trying to connect with the parents, but then the survival instinct that fears the parent kicks in and shuts it all down. This sets up an impossible situation for infants because they’re completely dependent on their parents for interactive regulation, not to mention their basic safety,” writes Heller. 

Heller notes that when parents are chronically distressed, children end up spending much of their time in either the energy-expending hyperarousal state of fight or flight, or the energy-saving shut down state that may appear like chronic disengagement. Not surprisingly, these children do not learn how to manage their own difficult emotions, and often struggle socially. They may experience low motivation, poor impulse control that can often look like acting out, social disconnection, low comprehension and under performance in school. As adults, those with a disorganized attachment style may find it to be very difficult to create and sustain stable intimate relationships in which we feel safe, due to chronic emotional dysregulation. 

Ambivalent and avoidant attachment are developed as a result of insufficient caregiving. For people with a disorganized attachment style, their experiences with caregivers went beyond insufficient, often falling into the categories of abuse and/or neglect. To learn more about your own attachment style and work towards becoming more securely attached, check out The Power of Attachment and make an appointment with a therapist today. 

Written by: Kate Loewenstein, LCSW

17 Characteristics of an Avoidant Attachment Style

In her book The Power of Attachment, Diane Poole Heller offers a deep dive into the variety of attachment styles, what contributes to them and how they show up in our behavior and relationships. In our last blog, we reviewed what an avoidant attachment style can look like in others. 

Below is a list of 17 questions that Heller has identified to help assess whether you may have an avoidant attachment style:

1. Are close relationships difficult for you?

2. Does closeness cause you to create distance afterward?

3. Do you find it difficult to relax with your partner in your intimate relationship?

4. Do you feel inexplicably stressed when people approach you physically?

5. Is it difficult for you to reach out and ask for help?

6. Do you have trouble knowing or asking for what you need?

7. Do you struggle to maintain eye contact?

8. Do you prefer to work alone instead of with others?

9. Would you rather be with others or engage in solo activities?

10. Do you often judge others for not being more self-sufficient?

11. Do you find emotional and dramatic people annoying?

12. Which is easier to do: to think about issues that are important to you or to express how you feel about these topics to others?

13. When you have lost an important relationship in the past, did you feel an initial wave of relief or happiness? Was that relief eventually followed by polar opposite feelings like depression or despair?

14. Do you prefer relationships with animals or objects over relationships with people?

15. How important is your career and work life in comparison to your personal relationships?

16. Do you feel more available and connected to your exes after you break up, when the pressure is off?

17. Do you feel there’s a perfect someone out there who you haven’t met yet and that it is easier to search for that fantasy bond than enjoy and commit to the person you’re actually with?

If you answered “yes” to many of these questions, you may have developed an avoidant attachment style. Remember that this is not a personal weakness, but an adaptation that you made at a young age to protect yourself from hurtful interactions and feelings of rejection. This style of attachment may be problematic in relationships, but it may also rob you of the opportunity to experience meaningful connection with others in a way that feels safe to you.

The good news is that we are all capable of shifting our attachment style and becoming more securely connected. To learn more about how to challenge an avoidant attachment style and become more securely attached, review the suggested exercises outlined in The Power of Attachment and make an appointment with a therapist today. 

Written by: Kate Loewenstein, LCSW

What Does Avoidant Attachment Look Like?

In our last blog post in this attachment series, we outlined the factors that may contribute to development of an avoidant attachment style. But how does this show up in real life?

Below are 8 examples of how avoidant attachment may look in relationships, outlined by Diane Poole Heller in her book The Power of Attachment.

1. Relational discomfort and isolated sense of self- As Heller notes, the attachment system is under activated for people with avoidant attachment style. Because they learned as infants that attachment is negative or painful, they naturally learn to devalue interpersonal relationships. People with this style of attachment do not reach out to others because they don’t expect them to be there for them. They may have many friendships, but none that involve true emotional intimacy. Sexual intimacy and commitment may be difficult within romantic relationships. Those with this style of attachment are less likely to miss people that they are close to when they are gone, or even feel a sense of relief when they are separated. 

   2. Dissociation- From their early experiences with isolation and neglect, people with this style of attachment have learned to deactivate their attachment system by withdrawing or isolating. They may have learned to “leave” their bodies through disconnection. People who experience this often distract themselves with activities that promote disconnection from others, such as scrolling the internet, playing video games or watching TV. 

   3. Difficulty with eye contact

   4. Self- regulation and the importance of transitions- People with avoidant attachment style are accustomed to being alone and are often very immersed in their internal experience. For this reason, they may be more likely to respond tersely when they are interrupted, as this can feel abrupt. They may need a moment to take a breath and make a mental transition away from their internal world towards a more relational interaction. 

   5. Difficulty recognizing personal needs- It’s common for people with avoidant attachment style not to recognize or reflect on the emotional neglect of their childhood. They are likely to be future-focused and to downplay their experiences of neglect. They are also likely to engage in very limited self-reflection and often do not recognize when a need is not being met as an adult, or know how to meet it. They may be more likely to decline help and support from others. As a result of years of self-repression, they may struggle to recognize and empathize with the emotional needs of others, perceiving them as overly dependent. 

   6. Left brain orientation- Children who grow up with limited support or emotional awareness often become left-brain oriented, meaning that they are naturally very analytical and logical. Their right brain may remain underdeveloped, resulting in a lack of warmth or depth. They may struggle to remember relational memories from their childhood and may be more likely to recall only factual information, such as where they lived or what their neighbor’s name was, without recalling how it felt to live there. 

   7. Bias toward action- People with avoidant attachment are likely to be very focused on their work and may work best independently, finding teamwork to be frustrating. They may provide limited detail when talking about their childhoods and it may feel like you are pulling the information out of them. This is not because they are intentionally withholding, but that they didn’t learn the value of emotional communication at a young age and have therefore adapted to speaking in more factual terms. 

   8. Gesture inhibition- People who did not receive nurturing physical connection as young children will often learn to be inhibited in their use of body language that others may use to connect, such as reaching for a hug or leaning in to a conversation. It may feel awkward to greet or approach them, as their body language may not appear inviting. 

If you have a partner, family member or friend with an avoidant attachment style, you may often feel disconnected and shut out. It may feel that they can be cold or disinterested in communicating in a meaningful way. The more you try to connect, the more they may withdraw. This can be very hurtful and can make it difficult to establish real emotional intimacy. Remember that this is not personal. Limiting intimate connection is a strategy that people with avoidant attachment learned at a young age to protect themselves from painful feelings of rejection.

To learn more about your own attachment style and the impact on your relationships, make an appointment today. 

Written by: Kate Loewenstein, LCSW

8 Parenting Behaviors that May Lead to Avoidant Attachment in Children

As babies, we are extremely vulnerable. We rely on our caregivers to meet every need. If we are not fortunate enough to have parents who are able to attune to our emotional needs, we will adapt for survival. This may mean that we learn to avoid emotional intimacy or connection, causing us to develop an avoidant attachment style. 

In her book The Power of Attachment, Diane Poole Heller outlines these 8 parenting behaviors that may lead to avoidant attachment in children:

1. Isolation- Children may be left alone too much, or may not get adequate face-to-face contact with their caregivers. 

2. Lack of presence- Caregivers may be physically present, but may be emotionally removed, causing the child to feel alone.

3. Task-based presence- Parents may be present with their children only when they are trying to teach them something. Children may translate this message that they are only valuable if they are practical or functional. 

4. Absence of touch- Children need comforting physical touch in order to be soothed and attune to their caregivers. Those who are not held and rocked as infants may struggle to connect with others later in life. 

5. Emotional neglect- Caregivers who do not meet their children’s emotional needs with a timely and adequate response, who aren’t sensitive to their children’s emotional needs, may prevent overall emotional nourishment. 

6. Expressive dissonance- Parents whose facial expressions, body language and tone of voice consistently do not match their emotional state may cause children to struggle with self-expression. Children may have trouble understanding, interpreting or sending appropriate social cues. 

7. Disrupted Engagement- If either a parent or child is sick or incapacitated in some way, they may not be able to stimulate secure attachment responses in one another. 

8. Rejection- Some children experience outright rejection from their parents, which may have a significant impact on a child’s ability to securely connect with others, particularly if the rejection takes place regularly. 

We all learn to adapt to our caregivers, causing some of us to develop an avoidant attachment style. This is done out of self-protection. If we are repeatedly rejected or ignored, it makes sense that we would decrease our attempts to connect with others. Connecting with others can feel too vulnerable. 

To learn more about your own attachment style and the impact on your relationships, make an appointment today.

Written by: Kate Loewenstein, LCSW

15 Signs of a Secure Attachment Style

In my last few blog posts, we have reviewed secure attachment- how it’s developed and how to foster it in ourselves. 

In her book The Power of Attachment, Diane Poole Heller offers this list of 15 questions to assess for secure attachment:

1. Do you want to be close to others, find it easy to connect, and expect relationships to go well?

2. Do you feel relaxed most of the time with people who are close to you?

3. Do you transition between alone time and time together fluidly and without much difficulty?

4. Do you and your partner apologize easily and work for win-win solutions to any conflicts that arise?

5. Do you believe that people are basically good at heart?

6. Is it important to you to meet the needs of people who are close to you?

7. Do you easily and clearly ask to have your own needs met?

8. Are you present with your loved ones and free yourself from distractions when connecting?

9. Do you work to maintain safety in your relationships, and do you protect those with whom you feel close?

10. Do you look forward to spending time with your partner and friends?

11. Are you affectionate with those with whom you feel close?

12. Do you respect others’ needs for privacy?

13. How important are healthy boundaries to you?

14. Do you leave when things are too off in a relationship, knowing there are other great options for fulfilling relationships?

15. Do you make time to play regularly?

Regardless of how you responded to these questions, I invite you to refer to my previous blog post outlining strategies to foster secure attachment. Practice them.  We all have the capacity to attach securely with others. 

To learn more about your own attachment style and strengthen your attachment skills, make an appointment today.

Written by: Kate Loewenstein, LCSW

11 Strategies for Fostering Secure Attachment

In my last blog post, I reviewed parenting approaches that can support secure attachment in children. In part 3 of this multi-part blog series, I’ll introduce you to strategies to develop secure attachment with others. These approaches can be used to build relationships with your partner, children, family members or friends. 

In her book The Power of Attachment, Diane Poole Heller identifies these 11 strategies for building secure attachment with others:

1. Listen deeply- Listen, reflect back to the other person and ask questions meant to promote and convey understanding. Give space before explaining your perspective. 

2. Practice presence- Heller describes presence as “showing up, paying attention, and letting the other person know that we’re there for them with whatever’s going on. It means we do our best to put aside our own worries and concerns and be with them in an undistracted way.” 

3. Attune- Attunement requires listening, presence and compassion. It requires us to understand someone else’s perspective on the world, and also resonate with their feelings. Attunement is empathic concern, reinforcing to others that we are there for them and that they aren’t alone. 

4. Engage in joint attention- Regardless of what you are doing, do it together. Whether it’s watching a movie, working on a project or going on a walk- make eye contact, laugh together, have a conversation about what you are doing. 

5. Maintain contact- Consistent responsiveness is key to secure attachment. This involves maintaining regular connection with the other person, whether through eye contact, touch, texts or spending meaningful time together. 

6. Be mindful of comings and goings- Heller notes that “our attachment systems are sensitive to when people approach us, when they leave and what happens in our relationships as a result of those transitions.” Be intentional about greeting and departing with others, consider creating a ritual in which you hug or tell each other good night or good morning each time you come and go.

7. Use your eyes- Humans are neurologically designed to communicate face- to- face. Texting, emailing and using social media all have their place, but they don’t foster the type of connection necessary for secure attachment. 

8. Play- It doesn’t matter what it is that you choose to do, but setting aside time to have fun with one another helps to build a strong attachment bond.

9. Un-automate- Novelty creates attraction in the brain, meaning that the more that we allow for novelty and complexity, the more possibilities we encourage to arise in our relationship, which keeps us interested. Don’t assume that you know everything there is to know about another person. 

10. Repair, repair, repair- Learning to repair conflict within a timely manner is crucial to promoting secure attachment. Apologizing is hard for many people. When someone else approaches you with a gesture of reconciliation, do your best to accept it, rather than focusing on how it felt short. 

11. Attend to the good- Simply put, pay attention to and acknowledge what’s going right. 

We aren’t all fortunate enough to have developed secure attachment naturally as children, but we all have the opportunity to develop a stronger attachment style if we are willing to put in the work. 

For support developing secure attachments in your relationships, make an appointment with me today. 

Written by: Kate Loewenstein, LCSW

6 Parenting Approaches that Support Secure Attachment

In my last blog post, I introduced the concept of Attachment Theory. Researchers have identified four different styles of attachment; secure, avoidant, ambivalent and disorganized. In this post, we’ll start unpacking secure attachment. 

Secure attachment is the ideal. Secure attachment supports healthy, trusting relationships. In her book The Power of Attachment, Diane Poole Heller identifies six factors that can support secure attachment in children:

1. Protection- We feel taken care of and watched over by our parents. Heller explains “we learn to take care of ourself by receiving appropriate protection early on”. 

2. Presence and support- We have compassionate parents who are on our side. They are present in our lives and they have our backs, we feel that we can depend on them. “Securely attached people naturally seek out support when they need it, in addition to freely offering support to others”, notes Heller. 

3. Autonomy and Interdependence- We develop autonomy when our parents are protective and supportive, but not overbearing, allowing some independence. Heller explains that with this type of parenting, we gain “interdependence- where we can give and receive support and love as well as have our needs expressed and met with true mutuality”.

4. Relaxation- We are able to let our guard down and be ourselves. Play and laughter are encouraged, while boundaries and appropriate consequences and limitations are also enforced. 

5. Trust- Through our life experiences and parenting, we are taught to believe that the world is an inherently good place and that people are good and well-meaning. 

6. Resilience- Trust in the world as a safe place is essential to developing resilience. When we are resilient, we are better able to ask for and access support, as well as find solutions. 

If you didn’t receive this type of parenting and support, you aren’t alone. The good news is that our attachment style is not fixed. Anyone can work towards building a secure attachment. In my next blog post, I will review strategies to build your attachment muscle.

To learn more about your own attachment style and work towards becoming more securely attached in your relationships, make an appointment today. 

Written by: Kate Loewenstein, LCSW