10/23/2019 ADHD, Anxiety and Depression A Perfect Storm CADDAC - - PDF document

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10/23/2019 1

ADHD, Anxiety and Depression A Perfect Storm

CADDAC 2019 Conference Toronto, ON Jennifer Tiviluk, MA,CCC,RP transitions@start.ca 4165760690

This Photo by Unknown Author is licensed under CC BY-SA This Photo by Unknown Author is licensed under CC BY-NC

Contents

Conditions for the “Storm”

• The Neurological Climate
• The Environmental Climate

Eye of the “Storm”

• The Daily Storm from Executive Functioning Weakness

Damage from the “Storm”

• Negative Effects on Self-Esteem from Executive

Functioning Weaknesses

• The Start of the Damage
• Damage Control/Unhelpful Rules and Assumptions
• Negative Core Beliefs
• Development of Depression and Anxiety

The Calm After the Storm

• Treating your Function Executive Weaknesses
• Conditions for the

Storm

The lights went out. The trees were torn. The sky was gray. The night was born. The lightning crashed. The thunder roared The Eye Of The Storm Kim Robin Edwards

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Neurological Conditions for the Storm

ADHD affects the frontal lobes of the brain’s high level information processing including the Executive Functions. Some parts of the ADHD brain are 3-5% smaller with less blood flow in the right frontal region of the brain. Neurotransmitters (dopamine and norepinephrine) explain inconsistency of performance in ADHD (blinkey hard-drive). Neurotypical Executive Functions finish developing around 25. ADHD brains development finishes around the age of 30.

Environmental Climate

General Risk Factor

• Family history of mental illness
• Chronic physical or mental health

disorder

ADHD Life Outcomes

• ADHD families tend to be at risk for

SUD, depression, anxiety and have a parent or parents with ADHD.

• ADHD folks at higher risk for learning

disabilities, SUD, insomnia, obesity, more accidents and traumas, early pregnancy etc..

Environmental Climate

General Risk Factor

• Major life changes and stress
• Little or no social support

ADHD Life Outcomes

• ADHD folks have an increased

incidence of divorce, occupational changes, money issues, social issues, academic stress and accidents.

• Higher rates of divorce and challenges

with social interpersonal relationships.

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Environmental Climate

General Risk Factor

• Female
• Trauma

ADHD Life Outcomes

• Women with ADHD usually report to

physicians with depression and anxiety symptoms.

• Children with ADHD may be at

increased risk for Adverse Childhood Experiences which contribute to experiencing trauma triggers as an adult

Environmental Climate

General Risk Factor

• Low self-esteem
• Years of school before the age of 21

ADHD Life Outcome

• ADHD folks vulnerable to low-self

esteem because of perceived “failures” in the past. Many ADHD folks co- morbid learning disorders as well.

• ADHD teens more likely to drop out
• f school, have been suspended at

school and have failed or had to repeat a year of school.

The Eye of the Storm

We were caught in the eye of the hurricane. We were caught in the eye of the storm. We were caught by the lights that lit the sky. We were caught in the eye of the storm. The Eye Of The Storm Kim Robin Edwards

This Photo by Unknown Author is licensed under CC BY-NC

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Daily Weather Patterns Executive Functioning Weaknesses

Low-self esteem is a high-risk factor for depression and anxiety. “Low self-esteem is having a generally negative

• verall opinion of oneself, judging or evaluating
• neself negatively, and placing a general negative

value on oneself as a person.” (Centre for Clinical Interventions)

Daily Weather Patterns Executive Functioning Weaknesses

Executive function weaknesses explain the daily struggles of folks with ADHD and why “neurotypical” strategies don’t work well for people. Executive function weaknesses explain why certain approaches work better for folks living with ADHD. (Ari Tuckman, Understand Your Brain Get More Done)

Executive Functions

Response Inhibition Working Memory Emotional Control Sustained Attention Task Initiation Planning/Prioritization Organization Time Management Goal Directed Persistence Flexibility Metacognition

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The Damage From the Storm

The rain came down. The thunder roared. The rain came down. The trees were torn.. The rain came down. It crashed to the ground. The Eye Of The Storm Kim Robin Edwards

This Photo by Unknown Author is licensed under CC BY-NC-ND

Self-esteem Damage From Executive Function Weaknesses

Repetitive inconsistent outcomes from weak executive functions lead to negative self appraisals and low self esteem.

Low Self Esteem Task Use weak EF for Task EF not Consistently working Try harder/not differently/use willpower Still don’t have success Develop negative appraisal of self

The Start of the Damage

• Disruptive home life
• Bullying, bullied or lack of social support
• Academic challenges in school
• Negative environmental feedback from

parents, teachers and friends.

• Impulsive decisions and impulsive behaviour.

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Damage Control Unhelpful Rules and Assumptions Develop

I need to try harder to pay attention, have self-control, be productive, be on time etc.. I need to make sure I please other people. I can’t please people I always fail so why try? I must avoid or leave things to the last minute in order to reduce my distress about not being able to deliver. I must be “perfect” to avoid negative feedback. I need to blame others or cover-up for my weaknesses to protect myself.

Negative Core Beliefs Formed From Repeated EF Challenges

I can’t trust/ believe in myself. I am unworthy I am unlikeable I am dumb I am hopeless I am out of control I am alone I am helpless I am undeserving I am an imposter

Negative Core Beliefs Leads to Sub- Optimal Decisions and Choices

If new strategies aren’t incorporated

• More “failures” at home, school, friends, work, money,

relationships, substance abuse, job changes etc…

• Relationships between core beliefs, negative assumptions

and “bad” decisions and behaviour strengthen the rules and assumptions.

• The cycle gets strengthened.
• Low self esteem is solidified.
• More psychology around ADHD develops such as

depression and anxiety.

• Unhelpful or maladaptive coping mechanisms are used as

individuals feel out of control to change situation: substance abuse, avoidance, procrastination, perfectionism, blaming and “lying”.

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Collateral Damage Causes Regrets over Past Past Challenges and Worries over Future

Anxiety disorders are focussed on future risks whereas depressive disorders reflect on past “failures” or mistakes. The self-esteem hit from fallout from executive functioning weaknesses causes the ADHD person to mourn their past failures and have regrets over what might have been. Which can lead to depression symptoms and

• ften the person “checking
• ut” or “numbing”.

If the ADHD person has not checked out psychologically, they may develop anxiety

• ver future “failures” or

fears of underperforming in the affected areas of their life. Many ADHD folks develop procrastination and perfectionism as ways to moderate their anxiety about future performances. .

Cycle of Failure My Own Experience

Kindergarten

• “She is not able to persist too long in a task as yet, becoming easily tired and frustrated”
• Grade 1
• “Jennifer is a nice little girl in class but so “scatty”. She is so active and enthusiastic which often leads

to careless work habits”

• Grade 2
• “Jennifer is sometimes a little too talkative in class and consequently her work suffers”
• Grade 4
• “Jenny’s….; however, talking, thereby distracting herself and others has kept her from achieving

excellent marks, but she’s trying hard and improving”

• Grade 9
• “her work has slipped a little not enough attention to class work”
• “Very irregular and careless”
• “Talkative, inconsistent, poor attitude toward the subject”
• “Have noted a little drop in Jenny’s work. A little more active attention in class will help.”

The Calm After the Storm

Or Getting Support for Your Executive Functioning Weaknesses As we watched the storm pass. We watched the winds blow. As we watched the storm pass. We watched the storm grow. The Eye Of The Storm Kim Robin Edwards

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A Solid Foundation for Hope

• Education is the first step about what ADHD is

and what it isn’t (I Am Not Lazy, Crazy or Stupid)

• Accept that ADHD is a particular set of struggles.
• Make an informed choice about medication.
• Get some good Executive Functioning strategies

with the assistance of a coach or a support person.

• Go to therapy to deal with your underlying self-

concept which may be affecting self-esteem and contributing to anxiety and depression symptoms.

• Maintaining a resilient mindset and understand

that there will be trial and error and that it is a process not a destination.

• Questions?

References

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