For adults with ADHD, career choices may be based not only on skills but how a job fits with our ADHD symptoms. Here are some things to consider.

For Good Career Choices: Ask 20 Questions

Planning a career is serious business. Money, time, effort and self-esteem go into the process of finding that right career match. How can we maximize the probability of success and minimize the possibility of failure? It isn't by an instant, simple fix of stereotypic generalizations. We need to start with a complete collection of data, and in so doing, ask the following 20 questions:

1. What are my passions...those interests that really "light me up?"
2. What have been my accomplishments thus far?
3. What personality factors contribute to my ease of handling life?
4. What are the specifics that feel as natural and automatic as writing with my dominant hand?
5. What are my priority values that must be considered to feel good about myself?
6. What are my aptitude levels that maximize success?
7. What is my energy pattern throughout the day, week, month?
8. What are my dreams and how do they relate to the real world of work?
9. What are the pieces of jobs that always attracted me and how can those pieces be threaded together?
10. How realistic are my related options in terms of today's job market needs?
11. How much do I really know about the related options?
12. How can the options be tested out, rather than tried out, with the possibility of failure?
13. What special challenges do I have?
14. How do my challenges impact me?
15. How might my challenges impact on the work options?
16. How could the challenges be overcome by appropriate strategies and interventions?
17. How great is the degree of match between the option & the real me?
18. Can we test out the degree of match before pursuing the field?
19. How could I enter and sustain the work environment chosen?
20. What supports can be put in place to ensure long-term success?

Let's examine each of the questions, to see how the information they provide is valuable:

1. Interests:
   As we get older our interests broaden. We become exposed to more of life's experiences and select those that create a spark for us. Yet, most adolescents are asked at 17 to make a decision about what interests them enough to formulate a career! A career counselor can administer an interest inventory that will throw out dozens of options, but the secret to its helpfulness is in the interpretation of the results. There are clues to be gotten from an interest inventory...tiny clues that added to other clues, will weave a trend, an answer, a direction. Just handing someone a list of correlated jobs often "falls flat" in terms of helpfulness.
2. Accomplishments:
   We learn from our successes and from our failures. Accomplishments should be charted to see if there is a pattern that can lend support for a particular career route. Early accomplishments might be simple, yet still demonstrate a quality or talent that has grown with the individual.
3. Personality factors:
   When we are comfortable within our own skin, we do a better job at whatever we attempt. It's helpful to identify how personality factors impact on our day-to-day comfort, in an attempt to move toward those environments that nurture our comfort zones-and away from those that constantly threaten.
4. Natural & Automatic:
   Most people have a dominant hand preference. If we break our dominant hand, we can adjust--but it requires more focus and more energy. Most of us want a certain degree of challenge in our life's work. We want to feel as though we are growing. However, if 95% of our day-to-day tasks felt as unnatural as writing with our non-dominant hand, or if we had to focus with everything we have at every moment, we would likely feel threatened and burn out quickly. If we can feel natural and automatic with the majority of our job tasks, (even 51%) and still interject areas of challenge, then we have found a balance that could cultivate freshness, creativity and growth.
5. Priority Values:
   We want to feel proud when we speak of our life's work. It's important to consider those parts of life that have the greatest meaning and identify them to be incorporated into a career. While we can't always work at our greatest "heart's desire," we also wouldn't want a career that goes against our deepest convictions, values and beliefs.
6. Aptitude Levels:
   As in the discussion of personality factors, comfort is essential in a good career match. If we are working at a job that requires too high or too low an aptitude level for us, the match won't work out in the long run. Aptitude levels can be tested, or assumptions can be made using school achievement scores, aptitude levels and/or past performance in various subjects.

1. Energy Pattern:
   Charting an Energy Pattern is an enormously useful tool in assuring a good career match. While everyone tends to have times when they are more "tuned in" than others (i.e., "I'm a morning person," or "I do my best work in the wee small hours...") charting an Energy Patterns goes far beyond that. It includes charting one's degree of energy (rating on a scale of 1-10) 3 times a day for at least a month. The results can be surprisingly helpful to learning to harness energy when it's there--and plan more "automatic" tasks for when it is not there. Particularly with adults with ADD, gaining predictability is an essential part of the career development process.
2. Dreams:
   Our dreams need not be taken literally. If I dream of being a fireman, I may or may not find that a good career match. But, there are clues from our dreams that add to the process. If adventure and physical activity are both things I value and strive for, then I will keep that in mind as I continue to gather my facts.
3. Threading pieces:
   Rarely do we love or hate all aspects of a job. It's more often the case that there are pieces of jobs that we enjoy or wish to avoid. A very helpful process is going through previous jobs and identifying those pieces and then threading them together to see what type of bigger picture they indicate.
4. Realistic vs. Fantasy:
   If I truly want to be trained to be a circus clown, do I know if there currently is a market for them? If my talents lie in watercolor painting, am I aware of whether or not I can support myself doing that kind of work? I know for sure that I would want to go into something with my eyes open, and not with a fantasy shroud covering reality!
5. Knowing about options:
   Today, it is easy to access valuable labor-market information that can cut down on mistakes in career decision-making. It is estimated that a career can be read about in the library in about 12 minutes. An easy investment in one's future!
6. Testing out options:
   Once we've done the reading and still feel interested in a particular field, it's equally essential to do some testing of the option. We need to place ourselves, physically within the boundaries of where the work is being done. By observing, discussing, volunteering, interning, etc., we are gathering clues that would otherwise never be collected. This step separates the trial-and-error career seekers from those who wish to have more logic behind their final choice.
7. Special Challenges:
   Often in the testing of options, we discover that, while there may be many areas of match, there might also be areas of mismatch. It's important then to identify the mismatch, the degree of mismatch and what might be done to offset it! If it's a disability that results in the mismatch, we'll need to zero in on the extent to which extra support and/or modifications would be necessary. As in previous discussion, if the degree of mismatch is greater than the degree of match, the option is probably not going to prove to be a good one in the long run. Strategies and accommodations are available for consideration, providing the match is otherwise a good one, and the outcome can result in a marketable employee.
8. Individual Challenges:
   One person with ADHD may find that his/her symptoms manifest totally differently from another person with ADHD. Therefore, the next step would be to access the specific "gotcha" areas of the job that runs up against the individual challenge. Since we are all different, the strategy should match the specific person, and not be a stereotyping of someone else.
9. Challenges Vs. Career Options:
   By observing, volunteering, interning, etc., we can often get a good idea of the degree of challenge a disability might provide within a given career option. It might be this step that separates a really exciting career option from one that has the potential to be a constant source of frustration.
10. Strategies and interventions:
    There are dozens of wonderful books that highlight strategies and interventions used by others with similar challenges. These should be tried out in "safe" environments, long before the career match has been chosen, to see if they can provide enough offset power to eliminate the challenge as a barrier to the career option.
11. Degree of match:
    Once there are one or several career options before us, we want to do more than make a pro and con list, for good decision-making. We also want to decide on the degree of match for each option. If there are 23 essential tasks associated with a particular job, and 2 of them don't match with what we are all about, it becomes extremely important to assess the degree of mismatch. It can often be the case that if 23 tasks line up well, but only 1 doesn't...that the one that doesn't is so great a degree of mismatch that the career should not be considered. This step must be dealt with carefully and skillfully.
12. Test out:
    To begin with we stated that we want to minimize the possibility of failure and maximize the probability of success. This "test out" step cannot be skipped for that reason. Testing out can simply mean working as a volunteer in a place LIKE the one you'd like to work...just to see if it works. If all the other steps have already been done, the number of times that this step produces a surprise negative is very small...compared to not using a structured method of career decision-making.
13. Enter & sustain:
    If we have tested out the career option, we have also already made some contacts into the field. Therefore, entering the field becomes much easier than one who tries to "knock on doors from the outside." To help sustain employment, all areas of perceived mismatch should be identified, along with strategies, accommodations and modifications, if necessary. Remember to be sure that the majority of the job is a comfortable, non-threatening environment.
14. Supports:
    Today, more than ever before, career counselors, therapists, coaches and other professionals lend support for the career seeker to continue to grow within the field. There is no shame in seeking support. If talented basketball players require coaches to help them achieve their best, why not career-seekers? Such supportive interventions can be behind the scenes and no one else need know of it. It's the wise career person who identifies his/her needs and seeks them!

Planning a career is serious business. But it isn't a difficult business. It requires that we agree to as much effort put into it as we do in what we choose to wear! It requires that we find a process that works for us. It requires that we gather as much data about what makes "us tick" as we can gather in order to make the best decisions possible! Put the time in. You're worth it! For really good career choices, ask 20 questions.

Adapted from the book by Wilma Fellman. (2000). Finding A Career That Works For You. Specialty Press

next: Majority of Business Owners Exhibit ADHD Characteristics
~ adhd library articles
~ all add/adhd articles

Thorough discussion of treating depression in women, the different types of treatments, and treatment of depression during pregnancy and postpartum.

Although having depression has become more acceptable, many women still feel stigmatized by the disorder and do not seek treatment. Others don't recognize the symptoms of depression in themselves.

Symptoms of Depression in Women

• No interest or pleasure in things you used to enjoy
• Feeling sad or empty
• Crying easily or crying for no reason
• Feeling slowed down or feeling restless and unable to sit still
• Feeling worthless or guilty
• Weight gain or loss
• Thoughts of death or suicide
• Trouble thinking, recalling things, or focusing on what you're doing
• Trouble making everyday decisions
• Problems sleeping, especially in the early morning, or wanting to sleep all of the time
• Feeling tired all the time
• Feeling numb emotionally, perhaps even to the point of not being able to cry
• Persistent headaches, digestive disorders, chronic pain, or other physical symptoms

When seeing your doctor or mental health therapist for a diagnosis of depression, it is important for the specialist to try and identify any relationship between depression and menstruation, pregnancy, the postpartum period or the perimenopausal period. A possible relationship between depression and medications such as birth control pills or agents used in hormone replacement therapy must also be explored. If there is a link to any treatable cause of depression, it should be addressed first. If your depression does not respond to this intervention, further treatment is required.

Treating Depression in Women

If you are depressed, it is important to seek treatment from your doctor other other mental health professional. There are many effective treatments for depression. The goals of the treatment of depression include treating the symptoms as well as addressing the psychological, social, and physical issues that may have contributed to its development.

The two most common approaches to treating depression are psychological treatments and antidepressant medications. If your depression is mild, psychological treatment alone may improve symptoms. However, in most cases a combination of therapy and antidepressant medication is recommended. Exercise and relaxation therapies, for example, yoga, Tai chi, and meditation will be also helpful in recovering from depression.

Psychological Therapy for Depression

There are various types of psychological treatments that your healthcare professional can discuss with you. The treatments will involve seeing a trained therapist for several sessions over a period of time. Some people may feel uncomfortable about this form of treatment as it involves revealing personal details to a healthcare professional and it carries a certain social stigma in our society. However, psychological treatments have been proven very beneficial in treating depression and reducing the risk of relapse.

The two most common types of psychological treatment for depression are:

Cognitive-behavioral therapy

Cognitive behavioral therapy involves seeing a therapist to understand how your thoughts and behaviors are linked. In cognitive behavioral therapy, techniques such as goal setting, problem solving, and keeping a diary of thoughts and emotions are used. Such techniques help you learn about your thought processes and how to change them as well as your response to them.

Interpersonal psychotherapy

This type of therapy involves seeing a trained psychotherapist in order to gain an increased understanding of your relationships and how they affect your life.

Antidepressant Medications

Medications to relieve symptoms of depression are called antidepressants. They work by altering levels of certain neurotransmitters such as serotonin, norepinephrine, and dopamine in the brain. A neurotransmitter is a brain chemical that enables messages to pass from nerve cell to nerve cell in the central nervous system. Many people with depression have low levels of one or more of these neurotransmitters and antidepressant medications help to boost levels.

Selective serotonin reuptake inhibitors are the most commonly prescribed medication in the U.S. for depression, because their side effects are more tolerable and they are safe if taken accidentally in excessive quantities. SSRIs include Prozac, Lexapro, , and Celexa.

Antidepressants sometimes cause mild side effects, some of which may be transient. Common antidepressants side effects include diarrhea, nausea, insomnia, headache, and feeling jittery. Often these side effects are temporary and will resolve within a few days of commencing treatment. One troublesome side effect is sexual problems, whereby people can experience a reduced libido. Bupropion (Wellbutrin XL/XR), which belongs to another class of antidepressants, has common side effects that include headache and an appetite-suppressing effect caused by a stimulant ingredient. It is much less likely to cause sexual dysfunction that selective serotonin reuptake inhibitors. Bupropion is not to be used in people with anorexia nervosa or bulimia.

See your healthcare professional to discuss any side effects you may experience or that interfere with your normal functioning, because stopping your antidepressant medication abruptly will worsen side effects.

Self-Help and Lifestyle Changes for Treatment of Depression

Taking care of yourself and making some lifestyle changes may be effective in reducing your symptoms of depression and helping you recover. Some suggested lifestyle and self-care approaches include:

• Eating a healthful balanced diet
• Exercising daily
• Meditation
• Breathing exercises to reduce stress
• Avoiding smoking, drugs and excessive alcohol
• Surrounding yourself with a supportive friends and family
• Making sure you get enough sleep
• Planning pleasant events into your day

Treatment for Depression During Pregnancy and Postpartum Depression

As with nonpregnant women, mild depression in pregnancy and postpartum can be treated with psychological therapies.

If antidepressant medication is required and a woman is pregnant, she should discuss this with her healthcare provider, as some medications carry a risk of affecting the fetus. In rare cases, some antidepressants have been associated with breathing and heart problems in newborns, as well as jitteriness after delivery. However, mothers who stop medications can be at increased risk for a relapse of their depression. This risk needs to be weighed against the risk of the mother's depression symptoms being untreated or getting worse.

Postpartum depression is usually treated with a mixed approach including psychological treatment, antidepresssant medication, and addressing specific issues in the postpartum period, such as sleep deprivation and family stressors. Psychological treatment can be given in group settings as well as individually. Education on looking after the newborn is useful, too.

When deciding on an antidepressant medication, it is important to remember that some medications can be secreted into breast milk and, therefore, may not be the first choice for a breastfeeding woman. However, a number of research studies indicate that certain antidepressants, such as some of the selective serotonin reuptake inhibitors (SSRIs), a class of antidepressants for treating depression and anxiety disorders that includes medications such as Prozac, Celexa, and , have been used relatively safely during breast-feeding. You should discuss with your healthcare provider whether breast-feeding is an option or whether you should plan to feed your baby formula. Although breast-feeding has some advantages for your baby, most importantly, as a mother, you need to stay healthy so you can take care of your baby.

Dealing with Chronic Symptoms of Depression and Relapse

There are various factors that will influence how well a person with depression is treated will respond to treatment and what his or her chances of relapse. Generally, after one episode of depression there is a 50% chance of relapse.

The following factors are important in predicting how well someone will respond to antidepressant treatment.

• Ongoing life stressors as an adult such as relationship or marital difficulties will place an increased burden on the recovery process and will need to be addressed with psychological therapy.
• Major childhood stressors, such as experiences of child abuse, need to be addressed with psychological therapy at the same time as depression is treated with medication to help improve a child's coping abilities and recovery.
• Alcohol abuse and/or drug abuse may need to be treated separately from the symptoms of depression. This can be achieved by seeking specialized drug and alcohol counseling and treatment programs. Alcohol and/or drug abuse is a common comorbidity with depression and the prognosis of depression with this comorbidity is not good.
• Psychiatric comorbidities may be treated in addition to the symptoms of depression itself. Common comorbidities to depression are anxiety disorders, eating disorders, sleep disorders, personality disorders and substance abuse.

In closing, the most important thing for women with depression is to see your doctor for a thorough evaluation and diagnosis, which is then followed by treatment.

next: On Campus: The Doctors Are 'In'
~ depression library articles
~ all articles on depression

• Increase your assertiveness:
  Online Assertiveness Training
• For you Seligman fans:
  Martin Seligman's Research Alliance
• Become tougher than you have ever been:
  Resiliency In Action
• A wealth of self-help material:
  Self-Help and Psychology Magazine
• Bookstore for success material:
  Success Shop
• Resources for lowering stress:
  Stress Less
• Dedicated to your success:
  American Success Institute
• Inspirational stories and quotations
  CyberQuotations
• 12 Online Bookstores
  Twelve online bookstores now carry Adam Khan's new book, Self-Help Stuff That Works, including:
• BarnesandNoble.com
• Borders.com
• Amazon.com
• Alternative Therapies by the American Cancer Society
• Positive Press covers good news
• The Academy of Achievement
• Measuring and dealing with stress
• Philosophy and Self-Help
• How defective is your brain? Fun site.
• Beck Institute for Cognitive Therapy
• The American Psychological Association's online journal
• Self-Improvement-Related Websites
• Self-Help Tools from the CyberPsychologist
• Optimist International - Friend of Youth
• Center for Cognitive Therapy
• Willingness Works

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• ABCs of Personal Growth
• Deep Fun
• LifeScope: Bright Ideas for Better Living
• Mind Tools
• Motivating Moments
• Developing Attitudes that Help You Cope
• Personal growth stories, support, and advice
• InteliHealth: John Hopkin's health information
• The Power of Why Not
• The Simple Living Network
• The Positive Futures Network (economics as if LIFE matters)
• The Center for the New American Dream (and responsible, earth-friendly consumerism)
• CyberStory: Stories of kindness and making a difference
• The Forgiveness Institute
• Motivational Mecca
• The Napoleon Hill Foundation
• Get a free download of an interactive personal-development software program

next: Media Appearances

Interview with Tracy Cochran

Tracy Cochran is a writer and contributing editor of Tricycle: the Buddhist Review where she has a column. She also writes for New Age Journal and Publisher's Weekly. She is the co-author of the wonderful book, "Transformations: Awakening To the Sacred in Ourselves."

Tammie: What led you to write, "Transformations: Awakening to the Sacred In Ourselves"?

Tracy: I came to feel very strongly that a spiritual life can't really be granted to us or borrowed from others or from books. That extraordinary experience that I had while being mugged was evidence to me that spiritual awakening is an organic potential, a birthright that each one us can realize as we journey through our various life lessons.

Tammie: In your book, you mention that at some point you realized that you had lost over the years your sense of "the scale of my possibilities and of the value of my own experience." I believe that so many people can relate to your observation, and I was hoping that you might share how your journey helped to put you in touch with the vast mine of possibilities that existed within yourself.

Tracy: I slowly lost a sense of the miraculous. It dawned on me at a certain point that every spiritual experience I've ever had has occurred because I was receptive, because my body, heart, and mind were literally made to be a kind of laboratory for transformation...if I wanted it.

Tammie: You also mention that cultivating attention is a critical aspect of all spiritual disciplines. How does one best cultivate attention from your perspective?

Tracy: I think learning a meditation technique is an invaluable help. There are many different forms, as I know you know. But I think some kind of mindfulness practice taught by someone who has been well trained is an invaluable daily touchstone--then we can learn to observe ourselves in our daily lives. If we're in touch with ourselves, our whole life can be a kind of spiritual food.

Tammie: How do you see the personal and the cosmic as connected?

Tracy: At the heart of the most profound spiritual experiences I've had is the realization that the personal and the cosmic are truly related. What was most astonishing to me in the midst of that extraordinary experience I had while being mugged was the feeling of being under a gaze of a higher being that cared about me personally, small and flawed as I was. That night, I experienced a light behind everything that wasn't a kind of impersonal void, but a loving intelligence that was profoundly attuned to us. This experience leads me to believe that there is an aspect to us that is cosmic, that vibrates at the same frequency, although we're unaware of it most of the time.

Tammie: I found that as I wrote BirthQuake, it began to write me in some very remarkable ways. I don't feel that I was quite the same person when I finished it. I'm wondering how the writing of Transformations effected you?

Tracy: Writing Transformations was a wonderfully empowering experience. It was also arduous because we were asked to write it very quickly, though I don't suppose it could have been done any other way. I came away from the project yearning to try to get even closer to the truth. I felt liberated but I also felt like I had just begun, just had the first taste of what it was like to try to express myself.

Tammie: What's your definition of wholeness?

Tracy: To be aware and alive in my feelings, body, intellect, and to live a life in which what is inside me gets expressed outside, to dissolve the difference between the inside me and the outside or social me. To feel free to be what I truly am.

Tammie: When you look at our troubled but still beautiful world, what concerns you the most? What gives you the most hope?

Tracy: Like everybody else, I worry about the destruction of the planet and our collective inability to stop destroying the planet. What gives me hope is the ever present of possibility of awakening.

Tammie:: What particular "quake" (difficulty, challenge) has been the most influential in your personal and spiritual growth?

Tracy: I think my moments of insight and creativity have almost always been preceded by a shock of some kind. Here are two that come to mind: Four or five years ago, while I was writing Transformations, I suddenly lost a friend who meant the world to me. It was baffling and utterly devastating, as if I had lost my twin. It turned out to be an incredible gift, however, as it galvanized me to really explore who I was and how I related to people. I had to reach down deep inside myself and learn to claim and hold disowned childhood feelings. As a therapist I know you know the value of this. So, it seemed like the end of the world but it was a doorway to transformation or rebirth. I encountered Tracy in a brand new way. All kinds of people have commented on how much I have changed in the past few years, that I'm much more open and self-accepting and available. It all came from what seemed to be an end.

Now, we're in the midst of a new BirthQuake because our building is being sold and we're searching for a new home, probably outside of the city. Again, all my childhood fears of rejection are being stirred up--as if I'm in a game of musical chairs and the music has stopped and I'm standing there stunned without a chair. In the midst of these feelings, however, there will be moments of a really wonderful vibrancy and awareness. I feel awake and alive and in God's hands for lack of a better expression. As if this move and this period of insecurity were given to me to push me where I need to go. I never feel more aware of the love in the universe than when I am in the midst of personal suffering.

Tammie: Where has your journey led since the writing of Transformations?

Tracy: I'm writing a new book full of stories about how being a mother has been a string of "quakes," a wonderful, surprising trip towards authentic being. We'll see where it goes.

Note: I've decided to share a synchronictic experience here. One night, I had a dream where I learned that I would be loosing my home and was anxiously searching for a new one. Throughout the dream, there was a gentle voice that kept saying, "you're already home, don't be afraid." When I awoke, I wondered what the dream represented since I wasn't planning on going anywhere or making any significant changes in the near future. The next morning, I received a letter from Tracy informing me that her building had been sold and that she'd need to find a new home.

next: Interviews: Anthony Spina: On 'Voluntary Simplicity' and 'Intentional Conscious Living'

Self-Therapy For People Who ENJOY Learning About Themselves

THREE STYLES OF RELATIONSHIPS

People generally tend to relate to each other in one of three ways: Dependently, Independently, or Interdependently.

People in dependent relationships spend much of their time fighting about who has to take care of whom.

People in independent relationships are often lonely. They spend much of their time out of each other's sight. People in interdependent relationships do whatever is best for both partners. They make sincere, reliable agreements with each other,

based on their separate wants and needs, and they stick to them. We can be happy in all three relationships. But we can only feel genuinely secure in interdependence.

DEGREES OF DEPENDENCE, THEN AND NOW

These three types of relationships correspond to stages of personal maturity. Infants are born dependent and remain primarily dependent until at least age 15 or so. Healthy teenagers become independent and remain that way until at least age 20.

Healthy adults can become interdependent after age 20 and for the rest of their lives. (The ages given above are only statements of an ideal. They hardly relate to the real world at all!) If you ever get to the point of having a truly interdependent relationship - in which there is never any bickering about who has to take care of whom and in which there is almost never any unnecessary loneliness - consider you and your partner mature and very, very lucky!

Dependent people think of independent people as "detached" or even "self-centered." Independent people think of interdependent people as "stodgy" or "boring." Interdependent people think of both other groups as "immature" and "too predictable."

OUR STAGE OF PERSONAL MATURITY IS PARAMOUNT.

We can't even IMAGINE being in a different stage than the one we are in! We form relationships with others who are at the same stage of personal maturity as we are.

YOU ARE MORE IMPORTANT THAN YOUR RELATIONSHIP

You only change your level of personal maturity when you get what you need! It does no good at all to try to be in a different stage. It does do a whole lot of good to get what you need!

Dependent people must get enough love, attention, and protection from others before they can become independent. Independent people must learn that they can survive on their own before they can become interdependent. You are more important than your relationship. Get what you need and you will "advance" in terms of personal maturity. And if you and your partner are even minimally close, you will automatically bring your partner along with you!

CAN WE "SKIP" THE INDEPENDENT STAGE?

No, we can't. It's a necessity. But some people who have remained dependent long into adulthood are happy with a very brief independent period.

ABOUT CHOICE

No one chooses to remain dependent all their lives. Everyone wants to get enough love, attention, and protection to outgrow dependency. Some people do choose to remain independent all their lives and, supposedly, they can be happy that way without feeling a need to become interdependent. (Note the word "supposedly". I was taught this by people I respect, but I've never really met anyone who was independent and happy about it past the age of 35.) Nobody reverts to an earlier stage of maturity unless they have to. If you know what you need and choose people who can give it to you, the rest is automatic.

next: Loneliness

Choosing the right ADHD treatment for your child is very important. Here's what parents should consider when selecting an ADHD medication.

You have many options in types of medications, doses and treatment strategies.

If your child has been diagnosed with attention deficit disorder, you may be facing decisions about ADHD medications. Fortunately, you have many options, not only for types of medications, but also for doses and treatment strategies.

First, it's important to know a few things about ADHD treatment in general. In the largest study ever of ADHD treatments, researchers funded by the National Institute of Mental Health found in 1999 that the most effective treatment for ADHD was a combination of behavioral therapy and ADHD medications. In March 2005, researchers from the from the University at Buffalo SUNY found that behavioral modification therapy allowed doctors to significantly lower the doses of ADHD medications that children need to take.

So, while ADHD medications can clearly help many children manage symptoms, the drugs may be most effective -- with the fewest side effects -- when used in combination with behavioral therapy.

How do you know which ADHD medication is right for your child?

Most experts advise parents to work closely with their child's doctor, and understand that finding the best dose and ADHD medication may be a gradual process.

"Treating ADHD is more an art than a science," says Richard Sogn, MD, a clinical specialist in ADD/ADHD. After all, every child is unique, and every child's ADHD symptoms are slightly different. Finding the medication that works best -- or the combination of drugs -- is a process.

With all ADHD medications, the goal is to make your child's day go more smoothly, more productively. Until recent years, this was done by giving a child two or three doses of the stimulant Ritalin, which is considered a short-acting medication -- it wears off after three or four hours. Many newer medications are longer-lasting -- meaning they slowly release for up to six, eight, 10, or 12 hours. Yet the short-acting drugs still have their place in managing symptoms.

While stimulants are still the mainstay of ADHD treatment, in recent years, doctors have found success in trying other drugs as well. In recent years the FDA has approved Strattera, a nonstimulant ADHD medication. Some doctors also prescribe antidepressants, although these have not yet been approved by the FDA to treat ADHD. All the drugs are generally considered safe for kids. But all can also cause side effects.

As you try to find the best ADHD medication for your child, it's important to chart any changes you notice, advises Sogn. Look for positive changes -- better focus or calmness -- as well as negative changes that could be side effects, such as lack of appetite or difficulty sleeping.

"You can expect your child to have side effects," says Sogn. "But generally those related to stimulants are easily managed. Most side effects are mild and transient."

Here is information to help you sort through your options.

Stimulant ADHD Medications

Stimulant ADHD medications work by increasing the levels of brain chemicals, like epinephrine and norepinephrine, which help transmit signals between nerves. With these medications, children are better able to focus and ignore distraction, which can help them control their own behavior. In the classroom, they may be less fidgety, less emotional, and better able to concentrate. Their relationships may also improve. They may get along better at school and at home.

There are two classes of stimulants:

• Methylphenidate-based drugs such as Ritalin, Concerta and Metadate
  Over 200 studies have shown that methylphenidate is effective for the majority of ADHD children.
• Amphetamine-based drugs such as Adderall and Dexedrine
  These AHDH medications provide an option for kids who don't benefit from methylphenidate, or who are looking for an alternative for other reasons. The trade names include Dexedrine, Adderall, and Adderall XR.

Both types of stimulant drugs work equally well in improving ADHD symptoms, according to the American Academy of Pediatrics (AAP). Individual children, however, may respond to one better than another.

"There's no inherent advantage of one medication over another," says Steven Parker, MD, director of behavioral and developmental pediatrics at Boston Medical Center. "Most doctors start with the drug they are most comfortable with, and if it's ineffective or if there are side effects, then we try a different one." The goal is to find the drug or combination of drugs that works best for each specific child.

These stimulants are generally considered safe medications with few side effects, the AAP states in its guidelines. The side effects occur early in treatment and tend to be mild and short-lived. The most common are: decreased appetite, stomachache or headache, difficulty falling asleep, jitteriness, or social withdrawal. Most of these symptoms can be successfully reduced by adjusting the dosage or the time of day the child takes medication. From 15% to 30% of children develop tics while taking stimulants. This is a short-term side effect that goes away when the child stops taking stimulants.

Perhaps the biggest advance in ADHD stimulants is that newer versions are available in long-acting form. Here, briefly, are the pros and cons of various forms of stimulants:

Long-Acting Stimulants for ADHD

Because the effects of some of these drugs can last up to 10 or 12 hours, a child can take one pill in the morning, and not worry about taking another at school. Longer-acting stimulants may also help children get through after-school activities. Some children, however, may need a second dose or a shorter-acting form of a different drug if afternoons and evenings are challenging.

Short-Acting Stimulants for ADHD:

These are usually taken at three- to four-hour intervals -- usually about 30 minutes before the earlier dose wears off. This means that children have to take the pills at school, either at lunchtime or another time during the day. At some schools, this is not always easy to coordinate. Often there is not a school nurse on site to give the medication, and children are not allowed to keep their own pills.

But short-acting drugs do help control many children's ADHD symptoms. Often, children might take a short-acting stimulant in the afternoon -- after the longer-acting stimulant wears off - so they can participate in after-school activities or have quieter evenings at home.

Side Effects of Stimulant ADHD Medications

Loss of appetite and weight loss are common side effects of stimulant ADHD medications. Concern for growth delay has been raised, but studies have found little or no significant delay. Children usually catch up later on. Most doctors believe in "drug holidays" during summers, although no studies have looked at this.

Stimulants are not considered to be habit forming when used to treat ADHD in children and adolescents. Also, there is no evidence that their use leads to drug abuse. However, there is a potential for abuse and addiction with any stimulant medication -- especially if that person has a history of substance abuse.

In February 2007, the U.S. Food and Drug Administration ordered drug manufacturers to add warning labels to all ADHD stimulant medications addressing cardiac and psychiatric risks associated with ADHD drugs.

Nonstimulant ADHD Medication

Individual children respond to drugs differently; a child may benefit from one drug but not another. Because some children don't benefit from stimulant drugs, doctors have turned to other medications to treat ADHD.

Strattera (Atomoxetine)

Sold under the trade name Strattera, this is the first nonstimulant ADHD medication approved by the FDA. Like the stimulants, Strattera works on the norepinephrine brain chemicals. And also like stimulant drugs, Strattera is effective in treating and controlling ADHD symptoms. However, this medication is not a controlled substance and children are less likely to abuse the drug or become dependant on it.

Strattera is given in a single dose either in the morning or afternoon. Effects last until the next dose. It may be taken with or without food. However, some evidence shows that taking it with food will decrease any stomach upsets.

Side Effects of Strattera

Overall, Strattera is well tolerated with minimal side effects, according to the AAP. It doesn't cause many of the potential side effects linked to stimulants, such as sleeplessness. The most common side effects: upset stomach, decreased appetite, nausea, dizziness, fatigue, and mood swings. Generally these side effects are not severe, and only a very small percentage of children in clinical trials testing Strattera stopped this ADHD medication due to side effects.

There have been reports of slightly decreased growth in children and teens taking Strattera. It is recommended that children and adolescents be observed, measured, and weighed periodically while on this ADHD medication. Allergic reactions are rare but do occur, usually as swelling or hives. The doctor or other health care professional should be advised immediately if anyone taking Strattera develops a skin rash, swelling, hives, or other allergic symptoms.

In 2004, Strattera began carrying a warning label that the drug should be stopped if patients showed signs of jaundice -- yellowing of the skin or whites of the eyes, a sign of liver damage. If blood tests show evidence of liver damage, the drug should also be stopped.

Antidepressants as ADHD Medications

Various types of antidepressant medications have all been shown to help children and adults with ADHD, says the AAP. These include Pamelor , Aventyl, Tofranil, Norpramin, Pertofrane, Effexor, Nardil, and Parnate. Some are better tolerated than others. Some have side effects that can be a problem.

However, antidepressants are not approved by the FDA to treat ADHD. And antidepressants are generally not as effective as stimulants or Straterra at improving attention span and concentration. Also, in 2004 the FDA determined that antidepressant medications increase the risk of suicidal thinking and behavior in children with depression and other psychiatric disorders.

Sources:

• Clinical Practice Guideline: Treatment of the School-Aged Child With Attention-Deficit/Hyperactivity Disorder, American Academy of Pediatrics, PEDIATRICS Vol. 108 No. 4 October 2001, pp. 1033-1044.
• FDA warning on ADHD medications, Feb. 2007.
• Efron, D. "Side Effects Of Methylphenidate And Dexamphetamine In Children With Attention Deficit Hyperactivity Disorder; A Double-blind, Crossover Trial," Pediatrics 100 (1997).
• Strattera website, strattera.com

next: Where Does Strattera Fit into the Treatment of ADHD?
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I have noticed over the years that eating disorders are becoming more pervasive and more serious, especially in the past two years. I cannot explain in words the pressure I experience as a therapist working with the people suffering from these disorders. These are life-threatening disorders and on a weekly basis I am faced with making decisions whether to send a client to the Emergency Room to check for electrolyte imbalances and possible dehydration. Additionally, I find myself requesting medical doctors to evaluate for procedures such as endoscopy searching for possible complications in the esophagus or stomach, as well as the need for the insertion of feeding tubes, and checking bone density. All of this has to be done on an out-patient basis because the patients often don't meet the criteria set forward by many insurance companies for admission into the hospital psychiatrically or otherwise. Excellent colleagues of mine, specialists in eating disorders, are backing away because insurance companies won't allow for appropriate treatment.

More frequently that I want to think I am in the position of attempting to get a client admitted into a residential program which can take up to two months. The delays are not due to waiting lists of the various residential programs but are a result of the insurance companies criteria and denial of services. This is tremendously difficult from a therapist's point of view because the client usually needs help immediately.

Not many can afford outright the cost of these eating disorder facilities (averaging around $20,000 a month) and then the real fight begins with many insurance companies. After they deny the client care the next step of their appeal process usually demands large amounts of written information from care-givers proving that lower levels of care have failed. If they do agree to the treatment then I as a care-giver, quietly suggest that the client take their time in getting the help they need because the insurance companies will usually attempt to stop treatment the minute the client has a good day. Many insurance companies hound the facilities almost daily and as soon as they hear that there is progress they refuse further payment disrupting the treatment altogether. As far as I am concerned as a care-giver this serves to set the client up for relapse and often we are back where we started.

While it is encouraging that law suits against insurance companies and letters to state government officials have produced laws in some states (like Missouri Just in March 2002) which demand that insurance companies provide their policy holders some treatment for eating disorders, the public should not be fooled! Within the past month I had a client turned down for treatment in Missouri because the headquarters for the insurance company was located in another state which had no such law.

All to often people have to take out enormous loans to get the treatment they need. This financially straps a family which is already stressed to the max. As the therapist I find myself struggling to keep the client alive while attempting to overcome the tremendous disappointments experienced by the client and their loved ones during this process. Sometimes this process sadly ends with the word "no" causing much anguish for all involved.

next: Eating Disorders: The Road to Recovery
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Self-Therapy For People Who ENJOY Learning About Themselves

In the United States we constantly brag about how free we are... "The Land of the Free" and all that. But therapists know that many people, maybe even most people, are enslaved.

Some of us are slaves to other people, especially spouses and employers. Others are slaves to our own beliefs and desires.

"REGARDLESS OF OTHERS"

Making decisions "regardless" of others means:

1. Knowing we are free to make our own decisions.

2. Knowing we can always choose to do all, some, or none of what others want us to do.

3. Taking responsibility when we do what others want (instead of blaming them for wanting it).

4. Taking responsibility when we don't do what others want (instead of giving excuses to them or ourselves).

CHOOSING TO BE ENSLAVED

Adults actually choose the poisons that rob them of their freedom.

The most popular current poison is success. People decide they will be successful "at all costs" and then even brag that they are driven by it! They sell off most of their time and energy in exchange for money, and the jealousy of others who share their shallow values.

Some other common freedom poisons are: Drugs, alcohol, sex, constantly pleasing a lover or relative, and following someone else's religious or philosophical beliefs instead of developing our own.

THE FREEDOM QUIZ

Each "Yes" indicates freedom. Each "No" shows a lack of it.

AT WORK:
___ Did you think your job would be enjoyable when you accepted it?
___ Do you choose your own assignments, or are you happy about the assignments you get?
___ Do you and your coworkers cooperate about time and energy?
___ Do you usually feel proud and satisfied at the end of a work day?
___ Would you change jobs without much thought if you were dissatisfied?

AT HOME:
___ Did you freely choose whether to be alone or married, whether to have children, etc.
___ Do you choose the chores you do around the house, and do you do them on your own initiative?
___ Do you stay home when you want and leave when you want?

EVERYWHERE:
___ Do you almost always feel safe?
___ Do you usually think you make your own choices about what to do and when to do it?
___ When you are dissatisfied with someone do you tell them?
___ Are you seldom bored (lacking excitement)?
___ Are you seldom exhausted (lacking food or rest)?
___ Do people seldom? say you are "too perfect" (compliant) or "too negative" (rebellious)?
___ Do people seldom refer to you as "rigid" or "righteous" (stuck in your own beliefs)?
___ Are you free of chemical addictions (things you think you need)?
___ Are you free of behavioral addictions (things you think you need to do)?

IT'S YOUR LIFE!

Being alive means having a certain amount of time and energy. Being an adult means taking responsibility for how you use this time and energy. Adults always make all of their own decisions, whether they know it or not.

It has always been YOUR life - even when other people didn't respect it and even when you didn't know it yourself.

Take full responsibility for every decision you make, every decision you keep, and every decision you change.

Enjoy Your Changes!

Everything here is designed to help you do just that!

next: Powerful Ideas #1

Self-Therapy For People Who ENJOY Learning About Themselves

Have you noticed that someone who says they have a problem with perfectionism usually says it with a sheepish smile on their face?

Have you also noticed that their smile is a strangely complicated one which includes both pride and shame?

The pride comes from believing that they are doing what they are supposed to do. (Wrong!)

The shame comes from thinking of themselves as failures. (Wrong again!)

HOW DID I GET THIS WAY?

Perfectionism comes from childhood.

It comes from trying to please a parent who was psychologically unable to be pleased.

It starts to change when we realize that this was their problem, not ours.

FEELING RELIEF

There is this wonderful thing we can feel called relief. It comes to us as soon as we feel "finished" or we know something is "good enough".

(The best example I can give of relief is that feeling of completeness we all feel when we've just finished urinating. Now that's relief!)

RELIEF CONQUERS PERFECTIONISM!

Perfectionists rush right past their own feeling of relief!

They do this because they believe that their own relief doesn't matter, and that they should instead concentrate on whether someone else is happy with what they've done.

Become excellent at identifying this feeling of relief. Notice that it comes way before you are even close to perfection.

When relief comes, stop whatever you are doing and realize that you are finished. And always take plenty of time to enjoy it.

PERFECTION VS. ACCEPTANCE

Perfectionism is caused by adults who teach children that what they do is more important than who they are.

It doesn't help to blame the adults, but it does help to remember where you got the beliefs that caused your problem.

All you wanted as a child was acceptance, not perfection. And you can find lots of acceptance in adult life, but you will never find perfection.

PURSUING THE IMPOSSIBLE

The problem with perfectionism is how much time and energy it takes. While you are trying to be perfect at work your personal life suffers, and vice versa.

And, since perfection is always impossible, the fact that other people are happy with you doesn't really matter because YOU are never satisfied!

ACCEPTING THE POSSIBLE

The solution to perfectionism is to relax.

By accepting that you will never be perfect and stopping when you feel relief, all aspects of your life, work and home, will be "good enough."

And, since acceptance is possible, the fact that other people are happy with you will matter
and you can experience satisfaction!

AM I DOING WELL ENOUGH?

People who are getting over perfectionism always face a dilemma: How can they measure how well they are doing?

I suggest that they weigh the "past voices" (memories from childhood) against the "current voices" (bosses, customers, spouses, children) and realize that only the current voices are based in reality.

After a rather long while, the past voices just fade away. If the current people in your life are not pleased with your work, maybe your work really isn't good enough and you need to make some changes.

But maybe not..... It might also be that your boss or your spouse have the same problem your parent had - that they are unable to be pleased. (Since we tend to pick partners who are like our parents, this happens often.) If this is the case, you'll want to pay far greater attention to the people in your life who CAN be pleased.

SUMMARY

Perfectionism is a real problem, not something to be proud of. It comes from parents who could not be pleased.

You can overcome it by acknowledging relief, by taking the time to relax, by giving up on being perfect, and by absorbing the acceptance you always wanted.

If you doubt your competence after you stop trying to be perfect, believe the people you know who can be pleased.

If you don't know any people like this, you need a new "family of friends."

Enjoy Your Changes!

Everything here is designed to help you do just that!

next: Personal Freedom

When Mary-Kate Olsen entered a treatment facility in 2004 for anorexia, she became the latest celebrity to struggle publicly with what is arguably the most difficult eating disorder to cure.

Her father, Dave Olsen, told Us Weekly that the 18-year-old actress has been wrestling with anorexia for two years.

Eating disorders afflict 8 million to 11 million Americans. Anorexia nervosa, whose victims avoid food and obsess over weight, is responsible for more deaths than any other mental illness.

Yet, despite repeated media warnings every time a celebrity is the victim -- actresses Kate Beckinsale, Christina Ricci and Jamie-Lynn DiScala are among those who have shared their troubles with anorexia -- there is still no gold standard for treatment.

The reasons: resistant patients, depressive effects of starvation that hide an accurate assessment of the mental illness, additional disorders and stigma because the problem is perceived as self-inflicted.

Then there is the common desire among anorexics to be perfect. "We don't really know how to treat the perfectionism," says psychologist Douglas Bunnell, president of the National Eating Disorders Association and director of the Renfrew Center of Connecticut, a women's mental health center. "As long as people hold onto their perfectionism, we don't know how to treat their anorexia."

About 90 percent of people with eating disorders are female, mostly girls or young women. Many are white and upwardly mobile, but experts are quick to add that the disorders also affect males, minorities and the poor.

Anorexia goes beyond the need to be thin -- "that's only the first layer," says Jana Rosenbaum, a clinical social worker in private practice and former director of the eating disorders program at Baylor College of Medicine Psychiatric Clinic. What sufferers seek is a sense of control and identity, she says.

Environmental factors such as societal pressures to be thin and demanding family expectations are not solely to blame, experts say. Research indicates genes might contribute to the problem. The National Institute of Mental Health is funding a five-year international study that is recruiting families with at least two members who have or have had anorexia.

Gaining weight terrifies anorexics. They feel overweight even when dramatically underweight. Their obsession with weight and body shape manifests itself in multiple ways, such as ignoring hunger, refusing certain foods and exercising too much.

Anorexia must be treated on two fronts, mental and physical.

"It's just a real difficult balance," says Rosenbaum, who teams up with physicians and nutritionists. "You have to address the (eating) behaviors because they're so self-destructive, but the more you address the behaviors, the more they hang onto them."

Having a second disorder can add complications.

"Co-morbidity is really the norm rather than the exception," says Cynthia Bulik, a professor of eating disorders at the University of North Carolina at Chapel Hill. She estimates that more than 80 percent of people with eating disorders experience another disorder, the most common being depression or anxiety.

The trick is "treating them together," says Carolyn Cochrane, director of the eating disorders program at Menninger Clinic, a psychiatric facility in Houston.

But most experts agree that if a patient is dangerously below weight, stabilizing physical health is the first priority. Severe cases might call for hospitalization and tube feeding.

The psychological toll that starvation takes can also produce an inaccurate snapshot of the patient's mental state. "People who don't eat often get depressed," says Vivian Hanson Meehan, founder and president of the National Association of Anorexia Nervosa and Associated Disorders.

Medications for eating disorders also may not work at very low weights, Bulik adds.

Experts generally agree on the practice of behavioral therapy and nutrition counseling, yet when and how they're administered can vary. Some hold off on treating patients psychologically until they are close to ideal weight, whereas others start earlier. The type of therapy ranges from art to movement to journaling. The level of family involvement varies.

The Maudsley Method, developed in London and being tested at U.S. universities, is among the latest approaches in this country. The therapy makes the patient's family the primary provider, responsible for monitoring food intake and enforcing rules.

Bouncing back from anorexia can take four to seven years, but "if it's caught early, there's a better chance for speedier recovery," says Lynn Grefe, CEO of the National Eating Disorders Association.

"Recovery is never a straight line," Meehan says. "It's an up-and-down thing, with people sliding back into their eating disorder behavior whenever stressful situations appear in their life."

UPDATE WARNING SIGNS

Someone with anorexia nervosa may:

• Lose a lot of weight and fear gaining any.
• Be underweight, but believe himself or herself to be overweight.
• Consistently talk about food and weight.
• Follow a strict diet, weigh food and count calories.
• Ignore or deny hunger, not eat.
• Exercise excessively, abuse diet pills or diuretics.
• Be moody, depressed, irritable, unsociable.

Source: The National Women's Health Information Center, www.4woman.gov.

next: Eating Disorders: Dealing with Insurance Companies
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